Cognitive Slippage in Children Vulnerable to Schizophrenia

Psychological deficit research with adult schizophrenics has been hindered by numerous methodological problems that may be avoided by the prospective study of children vulnerable to the disorder. An object sorting task was administered to 156 children of schizophrenic patients, 102 children of depressed patients, and 139 children of normal parents. The children were between 6 and 15 years old. The children of schizophrenic parents made fewer superordinate sorting responses than those of normal parents, and more complex sorts (a category of inadequate responses) than children of either normal or depressed parents. Our analyses showed that these deficits could not be explained by differences in intelligence. These deficits in conceptual performance may reflect the genotypic predisposition to schizophrenia and/or represent an early precursor of later maladjustment.This research was supported by grant MH 21145 from the National Institutes of Mental Health and by funds from the William T. Grant Foundation. We would like to thank Linda Doll, Diane Liebert, and Jean C. Sullivan for testing the children, and Barbara Mosbacher and Rochelle Weinberger for scoring the protocols.     

Parent and Child Effects on Cognitive Performance: An Experimental Approach to the Etiological and Responsive Theories of Schizophrenia

While many theorists have assumed that the family has an etiological part in the development of schizophrenia, most findings, since they come predominantly from observations after the illness has occurred, could plausibly be interpreted as family responses to the illness. In this experimental study, we constructed artificial families in order to measure independently of each other the effects of parents of schizophrenics on children and the effects of schizophrenic children on parents. Findings from a cognitive task requiring abilities to attend and abstract show that the presence of a schizophrenic child has only minor disruptive effects upon the performance of normal parents; parents of schizophrenics also have little effect upon normal children. Instead, the most consistent effects are those of normal parents on the schizophrenic child. Adolescent schizophrenic patients whose cognitive performance deficit is apparent prior to the experiment show significant improvement after having worked on the cognitive task with normal parents; their cognitive deficit disappears, and their performance is not different from matched normal children. Further investigation will center on the quality of the normal parents' “normalizing” effects.     

Rorschach Developmental Level in the offspring of patients with schizophrenia and manic-depressive illness

The Developmental Level (DL) score was assessed from Rorschach inkblot tests of 305 children. Children were either the offspring of one schizophrenic, one manic-depressive, one physically ill, or of two normal parents. Socioeconomic status, age, and intelligence were treated as covariates. Children of one schizophrenic parent had lower DL scores than children in the other three groups.     

Cognitive and attentional deficits in children vulnerable to psychopathology

Cognitive and attentional deficits were assessed in children with either a schizophrenic, an affectively disordered or a normal parent. The children were grouped both by their parents' DSM-II diagnoses (broadly defined group of schizophrenics and heterogeneous group of depressives)and by a new set of diagnoses (narrowly defined group of schizophrenics, unipolar depressive group and bipolar group). Children whose parents met the more stringent criteria for schizoprhenia performed somewhat more deviantly than children whose parents met only DSM-II criteria. In addition, the importance of splitting the heterogeneous depressive group into more homogeneous subgroups is indicated by the findings that children of unipolar parents generally could not be distinguished from children whose parents are schizophrenic. On the other hand, children of bipolar parents performed reliably better than children of schizophrenics. These findings are viewed within the context of current high-risk studies and psychological deficit literature and suggest that diagnostic issues require more attention by researchers in these areas.This research was supported by Grant MH 21145 from the National Institute of Mental Health. The authors are indebted to Lina Jandorf for assistance in testing the children and with the data analyses.     

Psychopathology in children of parents with recurrent depression

We examined the prevalence of psychopathology in children of parents with recurrent major depression (n=61)and children of normal control parents (n=46).Rates of psychopathology in the children of depressed parents were consistently higher when compared either with the control children or with rates of disorder reported for nonclinically referred children from other studies. Forty-one percent of high-risk children met criteria for at least one psychiatric disorder compared with 15% of low-risk children. Significant differences between groups were found for affective disorders and attention deficit disorder, and a nonsignificant trend was noted for anxiety disorder, all of which were more prevalent in the children of depressed parents.This work was supported, in part, by a W. T. Grant Foundation Faculty Scholar Award, No. 8308700.     

Family interaction styles of children with depressive disorders, schizophrenia-spectrum disorders, and normal controls

Family interaction processes during a problem-solving task were examined in children with depressive disorders, children with schizophrenia-spectrum disorders, and a normal control group of community children screened for the absence of psychiatric disorder. Major findings were: a) children with depressive disorders were more likely than children with schizophrenia-spectrum disorders and children with no psychiatric disorder to direct guilt-inducing comments toward their parents; and b) parents of children with schizophrenia-spectrum disorders were more likely to direct harsh critical comments toward the child than were parents of depressed children or parents of normal controls. In addition, children's and mothers' use of benign criticism was linked, while children's harsh criticism was associated with intrusion from the father, and children's self-denigrating comments were related to specific paternal criticism. Implications of these results for understanding transactional processes associated with childhood-onset depressive and schizophrenia-spectrum disorders are discussed.     

Children of parents with unipolar depression: A controlled 1-year follow-up

An earlier cross-sectional study indicated that children's health and adjustment is at risk when their parents are depressed. Here, we report the associated longitudinal changes in children and families when parental depression either remits or continues. Comparisons are made among three groups established at a 1-year follow-up: previously depressed parents whose symptoms have remitted (N = 34 remitted parents), previously depressed parents who continue to be depressed (N = 23 nonremitted parents), and sociodemographically matched control families (N = 95). Although remitted parents and their family social environments improved, their children were still functioning more poorly than children of controls. Both the children and the families of nonremitted parents continued to function more poorly than controls. A social-environmental framework indicates that parents' functioning as well as family stressors and resources are concurrently and predictively linked to children's health.     

A comparison of cognitive/neuropsychological impairments of nonretarded autistic and schizophrenic children

The performance of children meeting DSM-III criteria for schizophrenic disorder and infantile autism and of normal children (ages 7 years 10 months to 14 years 4 months) was compared on the Wisconsin Card Sorting Test, Rey's Tangled Line Test, Benton Judgment of Line Orientation, Digit Symbol Substitution Test, and Peabody Picture Vocabulary Test. The mean performance IQ of the schizophrenic and autistic children was equal and in the normal range. The normal children were of average intelligence as estimated by the PPVT. As compared to normal children, both autistic and schizophrenic children were impaired on the DSST and RTLT. The autistic children had significantly lower scores on the PPVT than schizophrenic and normal children. The schizophrenic children made significantly more perseverative responses on the WCST than did normal children. They significantly increased their nonperseverative errors on the second half of the WCST, after having been taught the correct sorting principles. It is argued that in schizophrenia a core deficit in momentary processing capacity underlies the above performance pattern. In contrast, in autism the core cognitive deficit involves an inability to use language to regulate and control ongoing behavior.Preparation of this article was supported in part by a John D. and Catherine T. MacArthur Foundation Grant to Robert Asarnow, and NIMH Grant MH 30897 to the UCLA Clinical Research Center for the Study of Childhood Psychoses. We gratefully acknowledge the assistance of Michael J. Goldstein, Ph.D., who acted as reseach advisor to the first author over the course of this study; Delores Adams, who assisted us in data analysis; and Sara Lerner, who enthusiastically helped us in data collection. We also acknowledge the assistance of the staff of the Clinical Research Center for the Study of Childhood Psychosis at UCLA, as well as the many children who participated in this study, and their parents.     

Comparisons of children of depressed and nondepressed parents: A social-environmental perspective

Several lines of evidence indicate that a parent's depression may be a significant health and adaptational risk factor for his or her children. In a controlled comparison, children of 133 depressed parents had significantly more symptoms of emotional, somatic, and behavioral impairment than did children of 135 nondepressed parents. Additional results suggest that the more negative milieu found among families of depressed parents was a mediator of the effects of parental depression. A social-environmental perspective helped to identify aspects of parents' functioning, family stressors, and resources that were related to children's health. Variations in these stressors and resources were strongly related to the probability of disturbance among children of depressed parents.We gratefully acknowledge the assistance of Sarah Buxton, Marlene Koltin, Ruth Lederman, Roger Mitchell, and Deborah Shields in data collection and of Dani Lawler in data collection and analysis. We thank Susan Spinrad for her help in preparing this article. This work was supported in part by Veterans Administration Medical Research funds and NIAAA Grant AA02863.     

The discourse of thought-disordered schizophrenic children

The conversations of two thought-disordered schizophrenic children and two age- and sex-matched normal children were studied in three different contexts. Cohesive relations and retrieval categories were analyzed. The thought-disordered schizophrenic and normal children demonstrated divergent patterns of discourse. These patterns closely paralleled those previously reported for adults by S. Rochester and J. R. Martin (1979, Crazy talk: A study of the discourse of schizophrenic speakers, New York: Plenum) for schizophrenic and normal adults, although some discrepancies were also observed. Recommendations for future research are offered.     

Attributional style and self-control behavior in depressed and nondepressed children and their parents

Do the reformulated model of learned helplessness and the self-control model apply to clinically depressed children? Are the related cognitive patterns specific to depression? Are the cognitive deficits associated with depression learned from one's parents? To address these questions this investigation examined three groups of children (ages 8–12) and their parents: nonclinic (n =25),nondepressed clinic (n=22),and depressed clinic (n=15).Children were diagnosed depressed on the basis of Kiddie-SADS interview data. Depressed clinic children self-reported more depression, had a more depressive attributional style, and had more self-control problems. There were more depressed mothers in the clinic than in the nonclinic sample. Depressed clinic children had more depressed mothers than did nondepressed clinic children. There were no differences among the three groups of parents in their cognitive patterns. No relationship was found between the attributional style and self-control behavior of children and their parents.     

Weight and health status of inner city African American children: Perceptions of children and their parents

Poor socioeconomic status and African American (AA) ethnicity contribute to an increased risk of obesity for many inner city children. One hundred and forty six AA children and 108 AA parents attending an inner city health fair completed surveys regarding perceptions of their own (or their child's) weight and the impact of weight on health. The children were measured and their body mass indexes were calculated. Thirty-seven percent of the child respondents (n = 52) were at risk of overweight or overweight; of these, 67% perceived themselves as normal weight, and 77% thought their weight was healthy. Weighing more was felt to be healthy by 17% of children and 29% of parents. Of 39 parents whose children were at risk of overweight or overweight, 68% felt their child's weight was normal and 80% thought it was healthy. These results suggest that inner city AA children and their parents often do not recognize being overweight or the health implications of being overweight.     

The association between parenting stress, depressed mood and informant agreement in ADHD and ODD

OBJECTIVE: In Attention Deficit Hyperactivity Disorder (ADHD) agreement between parents and teachers is often low. Parental depressed mood and parenting stress are considered to decrease informant agreement. This study examined informant agreement in children with ADHD and the association between parental depressed mood, parenting stress and agreement in the ratings of ADHD, ODD and CD symptoms. METHOD: 65 parents completed questionnaires on ADHD behavior of their child, parenting stress and depressed mood, teachers reported on ADHD behavior. RESULTS: Low agreement was found for hyperactive and moderate agreement for inattentive, ODD and CD symptoms. Stepwise regression analyses showed that parenting stress, and not parental depressed mood accounted for 12% of the variance in inattention symptoms disagreement, 14% of the variance in hyperactive symptoms disagreement and 9% in oppositional behavior disagreement. No significant predictors were found for CD disagreement. The found effect was independent of stimulant medication use. CONCLUSION: Parenting stress, but not parental depressed mood, was associated with the disagreement between parents and teachers on both ADHD and ODD symptoms. These results emphasize the importance of considering parenting stress in diagnosing ADHD and comorbid ODD.     

Children of depressed parents: an integrative review

This article reviews the various literatures on the adjustment of children of depressed parents, difficulties in parenting and parent-child interaction in these families, and contextual factors that may play a role in child adjustment and parent depression. First, issues arising from the recurrent, episodic, heterogeneous nature of depression are discussed. Second, studies on the adjustment of children with a depressed parent are summarized. Early studies that used depressed parents as controls for schizophrenic parents found equivalent risk for child disturbance. Subsequent studies using better-defined samples of depressed parents found that these children were at risk for a full range of adjustment problems and at specific risk for clinical depression. Third, the parenting difficulties of depressed parents are described and explanatory models of child adjustment problems are outlined. Contextual factors, particularly marital distress, remain viable alternative explanations for both child and parenting problems. Fourth, important gaps in the literature are identified, and a consistent, if unintentional, "mother-bashing" quality in the existing literature is noted. Given the limitations in knowledge, large-scale, long-term, longitudinal studies would be premature at this time.     

Communication deviance in families of schizophrenic and manic patients

Levels of communication deviance (CD) distinguish parents of schizophrenic patients from parents of nonpsychotic patients, but the prevalence of intrafamilial CD in other psychotic disorders has not been examined. Levels of CD were compared across biological parents of schizophrenic (n = 39) and bipolar manic (n = 16) patients and across patients themselves. CD ratings were based on Thematic Apperception Test protocols (parents only) and family interactions (parents and patients). Total levels of CD did not distinguish between groups of parents or patients. However, instances of odd word usage were more frequent among parents of manic patients than among parents of schizophrenic patients on both CD measures. Also, during the interaction task, odd word usage was more frequent among manic patients, whereas schizophrenic patients made more ambiguous references. Results suggest that high levels of intrafamilial CD are not unique to schizophrenia.     

Emotional experience and expression in schizophrenia and depression.

The emotional responses of schizophrenic, depressed, and normal subjects and whether differences in the emotional responding of these groups depended on how emotional responses were elicited or measured were examined. Twenty-three blunted and 20 nonblunted schizophrenics, 17 unipolar depressed subjects, and 20 normal subjects were exposed to a series of affect-eliciting stimuli. The stimuli varied in valence (positive vs. negative) and in level of cognitive demand. Subjects reported their subjective experiences, and their facial expressions were videotaped. Blunted schizophrenics were the least facially expressive, although their reported subjective experiences did not differ from those of the other groups. The nonblunted schizophrenics were more responsive than the depressed subjects to the positive stimuli, although the two groups did not differ in their clinical ratings of affective flatness.     

Child,mother, and father evaluations of depression in psychiatric inpatient children

The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6–13) and their mothers and fathers independently completed selfreport and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between childmother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.This investigation was supported in part by a Research Scientist Development Award (1 K02 MH00353) to the first author from the National Institute of Mental Health and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915-05) from the National Institute of Mental Health. The authors are grateful to the clinical research team of the Child Psychiatric Treatment Service.     

Cognitive deficit or cognitive distortion in childhood depression

Three studies were conducted to evaluate cognitive disturbance and depression in children. In Study I, 47 sixth-grade children, including 17 who received a DSM-III diagnosis of depression, and their parents were independently interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and they completed the Parent-Child Depression Inventory. Children completed the Children's Depression Inventory, the Matching Familiar Figures Test, and the My Standards Questionnaire. Results of Study 1 were consistent across raters and measures: Depression was associated with a negative style of processing self-evaluative information, while being unrelated to a processing deficit. A second study was initiated to replicate the results of Study 1 and to extend them to a wider age range of children. Thirty- eight third-, fourth-, fifth-, and sixth-grade children, half of whom were depressed and half of whom indicated a minimum of depressive symptomatology on the Children's Depression Inventory, completed the Matching Familiar Figures Test and the My Standards Questionnaire. Results were very similar to those found in Study 1. A third study was conducted to test whether the self-perceptions of depressed children were accurately negative or negatively distorted, as judged against their teachers' observations of them. Results supported the hypothesis that depressed children exhibit a distorted style of processing self-evaluative information. The implications of the results for theory and treatment were discussed.This research was funded by the Hogg Foundation for Mental Health, The University of Texas at Austin. The first two authors contributed equally to this investigation, and the order of their authorship was determined by the flip of a coin.     

Exploratory Eye Movements to Pictures in Childhood-Onset Schizophrenia and Attention-Deficit/Hyperactivity Disorder (ADHD)

We investigated exploratory eye movements to thematic pictures in schizophrenic, attention-deficit/hyperactivity disorder (ADHD), and normal children. For each picture, children were asked three questions varying in amount of structure. We tested if schizophrenic children would stare or scan extensively and if their scan patterns were differentially affected by the question. Time spent viewing relevant and irrelevant regions, fixation duration (an estimate of processing rate), and distance between fixations (an estimate of breadth of attention) were measured. ADHD children showed a trend toward shorter fixations than normals on the question requiring the most detailed analysis. Schizophrenic children looked at fewer relevant, but not more irrelevant, regions than normals. They showed a tendency to stare more when asked to decide what was happening but not when asked to attend to specific regions. Thus, lower levels of visual attention (e.g., basic control of eye movements) were intact in schizophrenic children. In contrast, they had difficulty with top-down control of selective attention in the service of self-guided behavior.     

Is there atypical handedness in schizophrenia?

Ninety-three schizophrenic patients and 105 normal controls were tested in a single session on an 8-item repeat-administration handedness test. The schizophrenic group, in contrast to the normal controls, showed a shift in the distribution away from right-handedness, which was due to an increase in the proportion of mixed-handers. Additional analyses revealed that the increase in mixed-handedness was largely due to an increase of within-item variability in the schizophrenic group, which we refer to as ambiguous handedness. Nearly 20% of the schizophrenic patients were inconsistent on 3 or more items compared with 3.8% of the normal controls. This increased incidence of atypical handedness is discussed within the context of disorders of attention and neurodevelopment.