(PS12-11) Adolescent Social Impairment and Parent Communication in a Clinical Adolescent Sample: Concurrent Trajectories of Change

Research suggests that social functioning is an important treatment target for youth with depression and suicidality. However, factors associated with changes in this area in the context of treatment are not well understood. Parent-child communication may be one factor associated with changes in youth social impairment. For example, youth may be more accepting of parental guidance around social difficulties if communication is effective. Through treatment, parents may also model effective communication in social circumstances which may improve youth social functioning. We hypothesized that increases in effective parent-child communication would be associated with decreases in youth social impairment in the context of family-focused cognitive-behavioral treatment.

We tested this hypothesis in a clinical adolescent sample of 147 adolescents (76.2% female; M_age = 14.91; 93.8% white) and their primary caregivers (81.4% female; M_age = 43.45; 92.1% White) enrolled in a randomized controlled clinical trial for depressed youth hospitalized for suicide risk with an additional high-risk behavior (non-suicidal self-injury, prior suicide attempt, substance abuse). Youth received treatment-as-usual (TAU; n=73) or family-focused cognitive behavioral therapy (CBT; n=74). Caregivers completed a self-report measure of effective communication with their child (PRQ, communication subscale) and youth completed a self-report measure of social impairment (BADS) at baseline (BL), 6 months (M6), and 12 months (M12) after the start of treatment. Bivariate latent growth curve analyses were conducted in Onyx to examine changes in parent-child communication and social impairment over time, and the relations between the two variables at BL, M6, and M12. To compare changes across treatment groups, separate models were run for each condition (i.e., TAU and CBT). Correlations between latent intercepts and latent slopes for each model and overall model fit were examined.

Bivariate growth models for the CBT (𝜒²(7)=7.56, RMSEA=0.02, CFI=0.99, SRMR= 0.05) and TAU (𝜒²(7)=13.52, RMSEA=0.08, CFI=0.92, SRMR=0.04) conditions had strong fit. In the TAU model, neither youth social impairment nor parent-child communication changed significantly across timepoints. In the CBT condition, youth social impairment decreased significantly (p=0.01) and parent-child communication increased significantly (p=0.02) over time. However, slopes and intercepts of each variable were not correlated with the other within both the CBT and TAU models.

Results indicate that family-focused CBT for depressed youth with suicidality and other high-risk behavior, may meaningfully impact both social impairment and parent-child communication, but that youth receiving TAU may not experience these same outcomes. In addition, changes in parent-child communication and adolescent social functioning were not associated with one another. Thus, positive changes in these areas may be associated with different mechanisms of change. Future studies should further explore factors associated with changes in social impairment in the context of mental health care.