Parent, Child, and Family Predictors of Dropout in Psychosocial Treatment for Pediatric Bipolar Disorder

Premature termination and dropouts are ongoing problems among children and adolescents receiving psychosocial treatment for mental health needs. A growing body of literature has identified parent, child, and family characteristics that contribute to poor treatment engagement among children seeking or utilizing mental health services across diagnoses. However, little is known about the role of these factors specifically among children with pediatric bipolar disorder (PBD). Thus, the present study explored baseline characteristics, including indicators of parent functioning (stress, coping, self-efficacy, and psychopathology), child symptom severity (mania and depression), and family functioning (coping, adaptability and cohesion), as predictors of dropout among a sample of 71 youth with PBD participating in family-based psychosocial treatment. In this study we chose to focus on characteristics that are likely to be impaired in families affected by PBD—aspects of parent, child, and family functioning—that we believe are modifiable through targeted treatment approaches. Results indicate that aspects of parent and family functioning demonstrated the greatest potential as predictors of dropout, while child symptomatology was not associated with dropout. In addition, our findings suggest that the influence of some aspects of parent and family coping behaviors on dropout may vary as a function of the type of treatment delivered. An intensive family-based treatment specifically developed to meet the needs of families affected by PBD may be particularly beneficial for engaging parents and families with poor coping behaviors. Results from this study have important implications for how we design and tailor interventions to meet the needs of families affected by PBD. Future work is needed to optimize treatment outcomes for these families.