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ABSTRACT
The course of bipolar disorder in children and adolescents is highly recurrent and impairing. This article describes the adaptation of family-focused treatment (FFT) for children and adolescents with bipolar disorder. FFT is given in 21 sessions over 9 months, and is usually initiated during the recovery period following an acute episode of depression or (hypo)mania. The treatment consists of an engagement phase followed by psychoeducation, communication enhancement training, and problem-solving skills training. Results of randomized trials in adults and adolescents find that patients with bipolar disorder who receive FFT and pharmacotherapy recover from episodes more quickly and have longer periods of sustained remission than patients who receive briefer forms of therapy and pharmacotherapy. The application of FFT to youth who are genetically at risk for bipolar disorder is described. Problems in disseminating empirically supported family interventions in community settings are discussed.
INTRODUCTION
Between 50%-66% of adults with bipolar disorder (BD) report disease onset prior to age 18, and 15%-28% before age 13 (1). BD I and II appear to affect about 2% of youth under age 18, although there is variability across cultures (2). Among offspring of parents with BD I or II, subthreshold or "high-risk" forms of the disorder, which affect between 3%-9% of clinically referred youth, can be detected as much as 10 years prior to the onset of full BD (3-5).
Significant controversies exist about the definition, ascertainment, and boundaries of early-onset BD (4, 6-8). Nonetheless, agreement is substantial that BD spectrum disorders and their high risk antecedents have a significant impact on functionality and quality of life (6, 9). Youth who meet DSM-IV definitions of BD I or II or BD, not otherwise specified (BD-NOS), the latter characterized by brief, recurrent subthreshold (hypo) manic and depressive periods, have high rates of affective morbidity, impairment, suicidal ideation, comorbidity and service use (10, 11).
Without early intervention, the social, intellectual, and emotional development of youth with BD may be seriously compromised. Delays to first treatment of BD spectrum disorders in childhood are associated with greater depressive morbidity and less time euthymie in adulthood (12). Accordingly, well-tolerated interventions early in the course of the illness that reduce affective morbidity, enhance functioning, and teach emotion regulation skills could have a dramatically favorable impact...