example, attention-deﬁcit hyperactivity disorder). We
also were unable to determine whether attributes
of the parent (e.g., whether it was the mother or
father who had BD, or whether he or she had BD-I
or BD-II) were associated with the degree of
clinical response or attrition rates.
Fortunately, randomized trials of psychother-
apy in BD and MDD youth are beginning to
unravel the role of moderators of response. For
example, we found in an earlier RCT that
adolescents with BD-I or BD-II who were in
high-EE families showed a greater magnitude of
response to FFT than adolescents in low-EE
families (28). In contrast, in the Treatment for
Adolescent Depression Study, adolescents who
described their family environments as more
negative showed a poorer response to cognitive-
behavioral therapy and a better response to
ﬂuoxetine (34). Identifying moderators of response
in high-risk populations will be increasingly
important as the number of evidence-based treat-
ment options grows (35).
Finally, examining the impact of psychosocial
interventions on the social and academic function-
ing and quality of life of high-risk youth—dimen-
sions which are compromised substantially in this
population (4, 36)—should be a key objective of
future trials. Preventing or minimizing the toxic
and impairing eﬀects of early episodes before they
become recurrent may help prevent the long-term
functional disability caused by bipolar illness.
Financial support for this study was provided by National
Institute of Mental Health (NIMH) grants MH077856 and
MH073871 to DJM and an Independent Investigator Award to
KDC from the National Alliance for Research on Schizophre-
nia and Depression (NARSAD). The authors thank David
Axelson, M.D., Victoria Cosgrove, Ph.D., Julia Maximon,
M.D., Kathleen Kline, M.D., Marianne Wamboldt, M.D.,
Christopher Hawkey, Tenah Acquaye, Aimee Sullivan, Erica
Weitz, Dana Elkun, Jedediah Bopp, and Jessica Lunsford for
their assistance. Copies of the treatment manual may be
obtained from DJM. LMD was the statistical consultant.
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