Commentary: Family Assessment in Pediatric Psychology

The theoretical and research literatures on links between family functioning and pediatric chronic health conditions are extensive both in their comprehensiveness and depth. On the other hand, the assessment of family relationships is no easy task and there appear to be gaps between the quality of our family assessment methods and our theories, research methodologies, and clinical endeavors (Kazak, 2008). Why is the assessment of family functioning so challenging? First, when studying families, the focus of one’s research questions can be on individuals (e.g., the functioning of mothers, fathers, children), dyads (e.g., relations between mothers and children, relations within sibling pairs), the family system (e.g., the level of cohesiveness in the family as a whole), or any combination of these. Second, the same individual may serve different roles within the family (e.g., a mother could also be a spousal partner; an adolescent is a child but could also be a sibling). Third, there are different methods of assessment that can be employed with families (e.g., questionnaires, observational methods, interviews, daily diaries) and these methods often yield nonoverlapping or divergent data. Fourth, with our assessment methods, we are attempting to evaluate the functioning of the families where the individuals themselves as well as their health status are changing over time. Finally, such research is particularly challenging in families with individuals who have chronic health conditions because the assessment of family functioning can be based on generic and/or illness-related family assessment methods. Despite such challenges, empirical studies of families are among the most common types of research in the field of pediatric psychology and have been the basis for entire volumes and special issues of journals. In fact, one of the co-editors of the current special issue authored a review of 29 of the most commonly used family-based measures in pediatric psychology and concluded that the database for 19 of these measures had advanced to the point where they could be classified as “well-established” (Alderfer et al., 2008). Although this is an impressive number of high-quality measures, Alderfer et al. (2008) also advanced several recommendations for those who seek to further the quality of family assessment in the field of pediatric psychology. First, they maintained that many family measures were developed on general populations and that little is known about the psychometric quality of these measures in samples of individuals with chronic health conditions. Second, they suggested that we need more studies that focus on fathers and siblings and that the literature on the effects of factors such as family structure and ethnicity on family functioning in pediatric populations is less well developed. Finally, they suggested that we lack knowledge concerning the clinical utility and treatment sensitivity of our family-based measures (Alderfer et al., 2008). Although one issue of a journal could not possibly address all of the challenges of family assessment or the recommendations of Alderfer et al. (2008), the current special issue moves the field forward by providing new measures (including the development of noncategorical and disease-specific measures of various aspects of family functioning), novel uses of previously developed measures, and new approaches to integrating across existing measures. The contributors are all to be commended for the value of their research in advancing the field of pediatric psychology. In this commentary, we first discuss the many strengths of the articles in this issue. Next, we evaluate the evidence base for the family-based instruments included in these papers by using the checklist for measure development and validation, which we published in the Journal of Pediatric Psychology in 2009 (Holmbeck & Devine, 2009). Finally, we discuss research that is needed to continue our progress in the area of family assessment.