controlled childhood diabetes (Ryden et al., 1993) documented better metabolic control, improved behavioral symptoms, and better patient/ family relations associated with intervention. A pilot study of family problem-solving therapy in 14 families documented efficacy in increasing adherence to treatment for diabetes and in decreasing family conflict (Auslander, 1993).

Family therapy was associated with greater clinical improvement than was medical management alone in a small (n=17) randomized study of children with severe asthma (Gustafsson et al., 1986). A larger study of children with severe asthma (n=32) by Lask and Matthew (1979) documented lower daily wheezing scores and lower thoracic gas volumes in the intervention group than in the control group.

None of those studies had well-validated measures of family functioning, so it is unclear whether the interventions exerted their effects by improving family functioning. Indeed, inasmuch as both interventions also taught asthma management strategies, it is possible that the interventions did not directly change family functioning. In contrast, improvement in family communication and parental discipline was documented with pre intervention and post intervention assessments of an intensive rehabilitation program that used family therapy and education for children with severe asthma (Weinstein et al., 1992).

Interventions for Adults and the Elderly with Chronic Disease

Chronic diseases of adulthood have received the least systematic attention with respect to family-focused interventions. There have been, however, many clinical reports and descriptive studies of informal interventions to assist families struggling with chronic disease. Most have been unsystematic and uncontrolled, but they indicate a growing recognition by the clinical community of the need to address family issues and of the utility of basing intervention in a family context. Although reported studies tend to use family-based intervention methods similar to those outlined for children and adolescents (psychoeducation and multifamily groups), there are so few studies on adults that categorizing them by method of intervention is not useful. The studies also appear somewhat scattered among several chronic diseases. Therefore, a few illustrative studies are reviewed below.

Pilot work on a family intervention during hospitalization of 56 stroke patients, which was followed up with telephone tracking for 3 months, showed decreased perceived criticism among family members and de-



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