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Early-Onset Bipolar Disorder 335modified therapy, 21 sessions of FFT-A were administered to 20 adolescents withBD who had an exacerbation of manic, depressed, or mixed symptoms within theprevious 3 months. In addition to an introductory session and a final, wrap-upsession, the sessions were divided into 9 sessions of psychoeducation, 5 of enhancingcommunication skills, and 5 of learning problem solving skills. This opentreatment trial found that FFT-A, in combination with standard pharmacotherapy,was associated with improvements in both depression and mania symptoms, aswell as decreased behavioral problems over the course of 1 year. This efficacy ofthis intervention is currently being further studied in a multisite, randomized,controlled trial.Psychotherapeutic Interventions for the Prevention of BDOf the existing psychosocial interventions for children with BD, it appears evidentthat implementing a family therapy treatment model would be most effective forbipolar offspring at high risk for developing BD. Focusing on the family unit isessential given that children and adolescents typically live with their parents andare more dependent on their families than adults. Moreover, by definition, one ormore of the parents of the at-risk bipolar offspring will have BD themselves. Ingeneral, family environmental factors are correlated with the course and occurrenceof mood disorders (Miklowitz & Hooley, 1998) and when several individuals arestruggling with mood regulation, the likelihood of a chaotic and potentially stressfulfamily environment increases greatly. Several studies have found that adult bipolarpatients who have parents or spouses who express high levels of criticism,hostility, or are emotionally overinvolved (or families with high expressed emotion)have poorer outcomes than BD patients with more healthy or low expressedemotion environments (Honig, Hofman, Rozendaal, & Dingemans, 1997; Miklowitz& Hooley, 1998). Also, many of the children at high risk for developing BD arealready on complicated medication regimes that can be hard to maintain in a chaoticfamily environment. In order to prevent BD in high-risk children and adolescentsit is important to treat the whole family, thus enabling all members to betterunderstand the signs and symptoms of the illness, develop treatment plans, managestressors, and promote an overall healthy family environment.We are currently developing a study to test the efficacy of a modified versionof FFT-A for symptomatic bipolar offspring. FFT-A currently consists of threephases: psychoeducation, communication enhancement, and problem-solvingskills training. All three topics will be addressed, but a special emphasis will beplaced on monitoring and prevention issues most salient to a high-risk population.Another unique aspect of the planned interventions is the inclusion of sessionsdesigned to enhance mood stability in the bipolar parent as well as the child at highrisk for developing the illness themselves. We will then be able to determine whetherparental stability is linked to improved offspring outcome as well. We anticipatethat early intervention with FFT-A will decrease mood and behavioral symptoms,