As hypothesized, adolescents' social problem solving skills exhibited during problem solving discussions with their primary caregivers were associated with adolescents' enhanced social functioning six months later. In other words, adolescents' abilities to define problems, generate solutions, and move toward resolution when discussing issues that create tension between themselves and their parents were associated with more frequent social engagement with friends six months later. Similarly, adolescents' constructive communication, including displays of affection, efforts to listen to another's point of view, and ability to clarify one's own point of view in a calm manner during problem solving interactions with parents, was associated with improved social functioning with peers. Contrary to hypotheses, however, these skills were not significantly associated with symptom improvement. Adolescent problem solving abilities and constructive communication with parents were associated with improved social functioning with peers, but were unrelated to the progression of youths' positive and negative symptoms.
As hypothesized, youths' conflictual communications during problem solving discussions, such as angry criticism of the other, uncooperativeness, withdrawal, and off-task behavior, were associated with an increase in positive symptoms of psychosis six months later. This brief assessment of UHR and early onset youth behavior in the context of problem solving discussions with parents, a scenario commonly observed by mental health professionals, is informative regarding the possible progression of positive symptoms. Contrary to the study hypotheses, however, youths' conflictual behavior during problem solving discussions was not related to their social functioning with peers, nor with the progression of negative symptoms. Taken together these findings indicate that youths' constructive behavior during problem solving discussions with the family was associated with improved social functioning with peers while youths' conflictual behavior was associated with exacerbation of positive symptoms but not negative symptoms of psychosis. It is possible that efforts to improve youths' problem solving skills and constructive communication at this early stage of illness may have the greatest impact on their social functioning.
In line with the study hypothesis, parents' constructive communication during problem solving discussions was associated with an increase in youths' social functioning. This finding is consistent with prior work that identified an association between caregiver warmth expressed during the CFI and improved social functioning among UHR youth (O'Brien et al., 2006
), and extends the literature by establishing a link between parents' observed behavior during face-to-face problem solving discussions with youth, and youth's future social functioning.
Positive associations were confirmed between parent and adolescent constructive communication, conflictual communication, and problem solving skills. While parents in general demonstrated more skillful communications during the problem solving interactions than did adolescents, as would be expected based on developmental stage, there were strong links between parent and youth approaches to problem solving and communication. Family system theorists (Minuchin, 1977
) as well as research on behavioral reciprocity (Bandura, 1985
) speak to the influence of parents' and adolescents' communications on each other, and indicate that intervention in any one aspect of the family system will have ripple effects throughout the entire system.
Despite the inclusion of psychosocial stress in most etiologic models of schizophrenia, frequently conceptualized as a precipitating factor for psychosis in individuals with a genetic diathesis (Nuechterlein and Dawson, 1984
), little is known about the family's potential at the earliest identifiable stage of illness to effectively buffer stress and to contribute to enhanced functional outcome for youth. Questions regarding the degree and type of family involvement that is needed at various stages of a psychotic disorder (Diamond and Siqueland, 2001
) require research into family protective factors to inform treatment efforts. Taken together, findings from this study provide support for further research into the possibility that specific family interventions, such as problem solving and communication skills training, may improve the functional prognosis of at risk youth, especially in terms of their social functioning. Prior research indicates that multi-family group interventions focused on problem solving and communication skill enhancement are tolerable to UHR youth and their parents and feasible to administer (O'Brien et al., 2007
Surprisingly, parents' behavior during problem solving discussions was not related to youths' symptom progression. While work focused on adults with established illnesses has found a robust relationship between high levels of family conflict (e.g., high expressed emotion) and symptom exacerbation (Hooley, 1985
), prior work focused on UHR youth has not established a connection between CFI critical comments and youth symptom progression (O'Brien et al., 2006
). It is possible that critical attitudes and conflictual behaviors are more predictive once they have become established negative cycles within the family, and that early identification and intervention could eliminate this source of stress.
This study would have benefited from a larger number of subjects, and due to the large number of analyses conducted on a small sample, these analyses must be considered exploratory. Nonetheless, these results expand upon previous findings (Asarnow et al., 1982
) by utilizing contemporary assessment instruments to identify those at UHR for psychosis. As this is the first study to our knowledge to examine family problem solving interactions as predictors of clinical symptoms and social functioning in youth at UHR for psychosis and with recent onset psychotic symptoms, these initial findings clearly warrant further investigation in future studies.