Introduction to Special Issue: Advancing the Science of Family Assessment in Pediatric Psychology

Abstract

For children with chronic medical conditions, as with typically developing children, family is of central importance (Kazak, 2008; Schumm, 1982). Consistent with the Burmese proverb, ‘‘In times of test, family is best’’ (Hla Pe, 1985), numerous studies have demonstrated the role of the family as a potential protective factor in the adaptation of children with chronic medical conditions and as a key to successful disease management at home (see Alderfer & Stanley, in press, for a brief review). In turn, families are greatly impacted by childhood illness; they experience increased stress, must expand definitions of their roles (e.g., ‘‘parent’’), and learn to communicate and work together to meet medical demands (Kazak, 2001; Radcliffe, Barakat, & Boyd, 2006). Thus, reliable and valid family assessments are critical to pediatric psychology: (a) for research that aims to further outline the various aspects of family functioning that are impacted by medical conditions in childhood and influence child and family adaptation and quality of life over time, and (b) for clinical practice, to inform the direction of clinical interventions and serve as an evaluation of clinical outcomes (Cook & Kenny, 2004). The call for improved family assessment methods is a refrain in the broad family psychology literature. For example, Cook and Kenny (2004) argued that most family assessment tools do not provide a sufficient degree of detail, and Cook (2005) further noted the importance of developing assessment approaches that take into account reciprocal influences among individuals, dyads, and the family group. Echoing this call within the realm of pediatric psychology, Palermo and Chambers (2006) argued that family measures should better specify the pathways by which family factors play a role in children’s pain and disability. A path to achieving this goal is for family assessment to occur at multiple, integrated levels to identify how individual factors work in concert with dyadic and family factors to impact pain and functional outcomes. Efforts have been made to summarize the current literature regarding the use of family measures within pediatric psychology and to provide frameworks for categorizing these types of assessments for use in research and practice. Alderfer and colleagues (2008) reviewed the evidence base of family measures including self-reports, observer ratings, and interviews and delineated three broad assessment areas: (a) normative family processes (i.e., separation and individuation) assessed in families of children with chronic health conditions; (b) impact of childhood chronic health conditions on the family; and (c) family and/or parental coping with childhood illness or disability. While most reviewed measures were deemed ‘‘well-established’’ (reliable and valid) or ‘‘approaching well-established’’ (approaching reliability and validity), Alderfer and colleagues (2008) argued that more attention must be given to the psychometric properties of family measures when used in pediatric populations since many of the measures have been exclusively utilized within the general population. Further, recommendations were made to increase cultural sensitivity of measures so as to capture cultural definitions of family that extend beyond the traditional nuclear family dynamic, to use multiple family informants including fathers and siblings to account for how each family member perceives the family situation, and to determine whether family measures can be used to inform clinical interventions (i.e., are they predictive of treatment outcomes and sensitive to change?). Thus, while some general measures of family functioning are applicable in the pediatric context (e.g., Family Assessment Device; Epstein, Baldwin, & Bishop, 1983), and other pediatric-specific measures of family functioning