The Role of Close Family Relationships in Predicting Multisystemic Therapy Outcome: An Investigation of Sex Differences ABSTRACT BACKGROUND: Multisystemic.

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The Role of Close Family Relationships in Predicting Multisystemic Therapy Outcome: An Investigation of Sex Differences ABSTRACT BACKGROUND: Multisystemic therapy (MST) is an effective treatment for aggression in youth. A major strength of MST is the emphasis on building and strengthening family relationships. OBJECTIVE: To investigate whether changes in family dynamics over the course of MST leads to different outcomes in boys and girls. METHODS: Interviews were conducted with parents of 66 aggressive adolescent boys and girls before and after MST. Sex differences in the relationship between pre- to post- changes in two predictor variables (family functioning and parental monitoring) and pre- to post- changes in externalizing behaviour were examined. RESULTS: Improvements in family functioning were equally predictive of decreases in aggression for boys and girls. A positive change in parental monitoring was only effective in reducing girls’ aggression. Supplementary analyses revealed that girls’ internalizing problems increased over treatment; boys’ internalizing problems decreased. CONCLUSIONS: A communicative monitoring style indicative of a close emotional relationship may be important for decreasing girls’ aggression. Another implication is that building emotionally close parent-child relationships through treatment may have the iatrogenic effect of increasing depression and anxiety in aggressive girls. Teresa Grimbos and Isabela Granic HYPOTHESES Hypothesis 1. The relationship between an improvement in family functioning and a decrease in externalizing problems will be relatively equal for boys and girls. Hypothesis 2. The relationship between an increase in parental monitoring and a decrease in externalizing behaviour will be stronger for boys than girls. METHOD Participants: Participants in the present study were part of a larger study conducted at The Hospital for Sick Children in Toronto, Ontario. To be included in the study, adolescents must have exhibited physical aggression at home and in school or in the community, been at risk for out-of-home placement and they must have been arrested at least once. Participants included 66 adolescents (46 males and 20 females; mean age = 13.92) and their families receiving MST across 5 agencies in Ontario. Measures: The following instruments were administered via phone interview to parents of aggressive youth at pre-treatment and post-treatment (6 months after pre-treatment) to assess family functioning and parental monitoring:  The Brief Child and Family Phone Interview (BCFPI; Cunningham Pettingill & Boyle, 2000). The six-item family functioning subscale measures problem-solving, communication, support, attachment or general relationships. Example item: “In times of crisis, we turn to each other for support.”  Parent Monitoring Scale (Loeber, Farrington, Stouthamer-Loeber & Van Kammen, 1998). Parents of youth are asked the following 4 questions: “If you or another adult are not at home, does your adolescent leave you a note or call you to let you know where he/she is going?” “Do you know who your adolescent’s companions are when he/she is not at home?” “When you are not at home, does your adolescent know how to get in touch with you?” “When your adolescent is out, do you know what time he/she will be home?” The following instrument was administered via phone interview to each family at pre-treatment and post-treatment to assess externalizing outcome:  The Brief Child and Family Phone Interview (BCFPI; Cunningham et al., 2000). The 18-item externalizing scale is composed of three subscales that measure attention, impulsivity, activity, cooperativeness and conduct. RESULTS CONCLUSIONS  While MST works to reduce boys’ aggression, the effectiveness of MST for girls is limited. First, girls’ externalizing behaviour did not significantly change from pre- to post-treatment. Second, symptoms of anxiety and depression increased over the course of treatment in girls but not boys. So, what works for girls?  Hypothesis 1. Strong family bonds and supportive family relationships is effective in reducing externalizing problems in both boys and girls.  Hypothesis 2. A parental monitoring style that emphasizes communication and openness may indicate a high quality parent-child relationship. This type of monitoring, thus, may be especially effective for girls (a more active approach to monitoring may be more effective for adolescent boys; Patterson & Stouthamer-Loeber, 1984).  Concerning treatment of aggression in girls, clinicians and intervention programs should focus on building and strengthening family relationships.  Clinicians and intervention programs should focus on teaching parents of aggressive girls monitoring strategies that emphasize communication and openness.  Finally, clinicians must also be aware of co-occuring internalizing problems in girls and help them manage these problems rather than exacerbate them. RESULTS For additional information please contact: Teresa Grimbos, PhD candidate Human Development and Applied Psychology Ontario Institute for Studies in Education, University of Toronto Hypothesis 1. Pearson correlation analysis was conducted to evaluate the association between an improvement in family functioning and a decrease in externalizing behaviour in boys and girls. Family functioning was positively and significantly associated with a decrease in BCFPI externalizing behaviour for both boys and girls: r(35) =.49, p <.01 for boys and r(17) =.67, p <.01 for girls. Family Functioning Change Figure 2. Scatterplot of Correlation Between Family Functioning Change and Externalizing Change in Boys and Girls Figure 3.Scatterplot of Correlation Between Parental Monitoring Change and BCFPI Externalizing Change in Boys and Girls Hypothesis 2. Correlation analysis revealed that improvement in parental monitoring was significantly correlated with a decrease in BCFPI externalizing behaviour for girls, r(18) =.62, p <.01, but not for boys, r(36) =.12, ns. The Z-test for two correlation coefficients revealed that the association between a change in parental monitoring and a change in BCFPI externalizing was significantly stronger for girls compared to boys, z = 1.94, p <.05. Externalizing outcome. For boys, pre- to post- comparisons of externalizing behaviour indicated significant treatment effects, F(1,35) = 16.51, p <.01. For girls, pre- to post- comparisons of externalizing behaviour revealed no significant treatment effect. Note that girls failed to make it below the clinical cut-off level (T-score of 70) at post- treatment. Supplementary analyses on BCFPI internalizing outcome. Repeated measures ANOVA was run to investigate the extent to which internalizing behaviour (i.e., anxiety and depression) changed from pre- to post-treatment in boys and girls. There was a marginal gender interaction for pre- to post- differences in internalizing behaviour, F(1,48) = 3.59, p <.10. Internalizing behaviour increased over the course of treatment in girls (compared to improvements in internalizing behaviour found in boys). Figure 4. Insert internalizing graph here. Working on importing file… Note. Change was calculated using raw change scores (pre- scores minus post- scores). Higher change score means greater improvement. Why is this happening? Perhaps girls are experiencing guilt and anxiety as a consequence of reflecting over their past aggressive behaviours towards others?