Early Family-Focused Treatment for Youth at Risk for Bipolar Disorder

Family-Focused Therapy as Early Treatment for Youth at Risk for Bipolar Disorder

This study will test a family-based therapy aimed at preventing or reducing the symptoms of bipolar disorder in at-risk children.

Study Overview

• Status: Completed
• Conditions: Bipolar Disorder
• Intervention / Treatment: Behavioral: Family-focused therapy; Behavioral: Brief educational treatment

Detailed Description

Early-onset bipolar disorder (BD) is a chronic, recurrent disorder that starts before age 18. In addition to the debilitating effects of BD, which include episodes of lethargic depression and exhausting mania, children and adolescents with BD often have co-occurring disorders, such as attention deficit hyperactivity disorder, conduct disorder, substance abuse disorders, and anxiety disorders. Early interventions may lead to better mental health by preventing BD from ever fully expressing itself. This study will test an early intervention for BD called family-focused treatment (FFT), which targets children and adolescents who are at risk for developing BD. FFT will include education about BD and training in communication strategies and problem-solving skills. It will focus on the family, because family environmental factors are related to the course and recurrence of BD. By reducing risk factors and teaching coping skills, FFT aims to prevent expression of BD, delay the onset or reduce the severity of manic episodes, and ensure that the first treatment received is appropriate.

Participation in this study will last 1 year and include three parts. In the first part, participating children and their families will complete research interviews and questionnaires about the child's mood, behavior, beliefs, and problems. Parent participants will also provide information on the family background of mood or anxiety problems. In the second part, participants will be randomly assigned to receive one of two treatments: FFT or brief educational treatment. Participants receiving FFT will complete 12 therapy sessions in which parents, children, and siblings learn how to cope with mood disorders, new ways to talk to each other, and strategies for solving family problems. FFT sessions will occur weekly for the first 8 weeks and then every other week for the next 8 weeks. Participants receiving brief educational treatment will complete diagnostic assessments and a 1-hour individualized feedback session, and they will be given a workbook about childhood mood disorders. A counselor will be available to all participants, in case of emergencies, for the full study year. All participants will also be provided with standard pharmacotherapy as needed. In the third part of the study, participants will complete follow-up assessments every 4 months for 1 year. Assessments will include interviews and questionnaires similar to those completed in the first part of the study.

• Study Type: Interventional
• Enrollment (Anticipated): 52
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Stanford, California, United States, 94304
      • Stanford University School of Medicine, Lucile Packard Children's Hospital
  • Colorado
    • Boulder, Colorado, United States, 80309-0345
      • University of Colorado, Boulder

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 9 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Has at least one biological parent or stepparent with whom the child or adolescent participant lives and who is willing to participate in family treatment
• Has a DSM-IV diagnosis of at least one of the following within the past 2 years : bipolar disorder not otherwise specified (BD-NOS), major depressive disorder (MDD), or cyclothymia
• If the main diagnosis is MDD, the depressive episode must have occurred within the past 2 years
• Has evidence of current significant affective symptoms, as determined by a score greater than 11 on the Young Mania Rating Scale within the last week or a score greater than 29 on the Child Depression Rating Scale-Revised within the last 2 weeks
• Not currently enrolled in family or marital therapy
• Has at least one biological parent or sibling with a verifiable diagnosis of bipolar disorder I or II
• Speaks English

Exclusion Criteria:

• Fully diagnosable bipolar disorder I or II
• Diagnosis of autism or pervasive developmental disorder
• Evidence of mental retardation, as defined by an intelligence quotient (IQ) less than 70
• Presence of comorbid neurologic diseases such as seizure disorder
• Substance or alcohol abuse or dependence disorders in the 4 months prior to study recruitment
• Evidence of a life-threatening eating disorder or other medical disorder that requires emergency medical treatment
• Has previously been treated with family-focused therapy
• Evidence of current sexual or physical abuse or domestic abuse between the adult partners

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Family-focused therapy; Participants will receive family-focused therapy.	Behavioral: Family-focused therapy; 12 therapy sessions involving the at-risk child or adolescent, parents, and available siblings. Therapy will include psychoeducation about mood disorders, communication enhancement training, and problem-solving skills training. Ongoing medication management from a study psychiatrist will be available.; Other Names: Behavior Therapy; Psychosocial Intervention; Psychoeducation; Family Therapy; FFT; Psychotherapy
Active Comparator: Brief educational treatment; Participants will receive one session of diagnostic feedback, recommendations for continued treatment, and crisis intervention as needed.	Behavioral: Brief educational treatment; Thorough diagnostic assessment by a study evaluator, separate evaluation by a child psychiatrist, feedback session with parents and child, and provision of reading materials pertinent to managing childhood mood disorders. Ongoing medication management and crisis-oriented family sessions will be available as needed.; Other Names: Psychoeducation; Enhanced Care; Diagnostic Evaluation; Crisis Management

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Changes in symptoms and functioning of at-risk children, as defined by depression and mania scores and psychiatric status on the Adolescent Longitudinal Interval Follow-up Evaluation (A-LIFE)	Measured every 4 months for 1 year

Secondary Outcome Measures

Outcome Measure	Time Frame
Delayed onset of first manic, mixed, or hypomanic episode, measured on the A-LIFE	Measured every 4 months for 1 year
Scores on the Child Depression Rating Scale	Measured every 4 months for 1 year
Scores on the Young Mania Rating Scale	Measured every 4 months for 1 year
Parental mood and distress, as measured by the Beck Depression Inventory, Symptom Checklist	Measured every 4 months for 1 year

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: David J. Miklowitz, PhD, University of Colorado, Boulder

Publications and helpful links

General Publications

• Miklowitz DJ, Chang KD. Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations. Dev Psychopathol. 2008 Summer;20(3):881-97. doi: 10.1017/S0954579408000424.
• Chang K, Howe M, Gallelli K, Miklowitz D. Prevention of pediatric bipolar disorder: integration of neurobiological and psychosocial processes. Ann N Y Acad Sci. 2006 Dec;1094:235-47. doi: 10.1196/annals.1376.026.
• Miklowitz DJ, Schneck CD, Singh MK, Taylor DO, George EL, Cosgrove VE, Howe ME, Dickinson LM, Garber J, Chang KD. Early intervention for symptomatic youth at risk for bipolar disorder: a randomized trial of family-focused therapy. J Am Acad Child Adolesc Psychiatry. 2013 Feb;52(2):121-31. doi: 10.1016/j.jaac.2012.10.007. Epub 2013 Jan 2.
• Schneck CD, Chang KD, Singh MK, DelBello MP, Miklowitz DJ. A Pharmacologic Algorithm for Youth Who Are at High Risk for Bipolar Disorder. J Child Adolesc Psychopharmacol. 2017 Nov;27(9):796-805. doi: 10.1089/cap.2017.0035. Epub 2017 Jul 21.

Helpful Links

• UCLA Child and Adolescent Mood Disorders Program

Study record dates

Study Major Dates

• Study Start: April 1, 2007
• Primary Completion (Actual): August 1, 2010
• Study Completion (Actual): August 1, 2011

Study Registration Dates

• First Submitted: July 20, 2009
• First Submitted That Met QC Criteria: July 20, 2009
• First Posted (Estimate): July 21, 2009

Study Record Updates

• Last Update Posted (Estimate): March 26, 2014
• Last Update Submitted That Met QC Criteria: March 24, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Keywords: Childhood; Adolescence; Early Signs of Bipolar Disorder; High Risk Youth
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Bipolar and Related Disorders; Disease; Bipolar Disorder
• Other Study ID Numbers: R34MH077856 (U.S. NIH Grant/Contract); DSIR 84-CTS (Division of Services and Intervention Research); 5R34MH077856 (U.S. NIH Grant/Contract)