Rorschach Protocols From Children and Adolescents Diagnosed With Posttraumatic Stress Disorder

Rorschach protocols from 35 children and adolescents with posttraumatic stress disorder (PTSD) and 35 with oppositional defiant disorder (ODD) were compared. Both groups revealed significant differences from the normative tables on the same 12 variables: SCZI, DEPI, CDI, X+%, EgoC, Afr, T, EA, P, WSumC, RawSumSS, and WgtSumSS. However, as predicted, 4 of those variables, the Schizophrenic Index (SCZI) and 3 of the criterion tests that comprise it (X+%, RawSumSS, and WgtSumSS) were significantly different between the PTSD and ODD groups, with the PTSD group responding with more extreme scores. These findings contradict Exner's (1993) statement that only people with schizophrenia can be "defined or conceptualized as having both the problems of disordered thinking and inaccurate perception" (p. 356). Children and adolescents with PTSD also display these problems when trauma interrupts the child's naive belief that the world has predictable rules, the people in it are trustworthy and fair, and punishment and pain are consequences of bad behavior. When young victims cannot comprehend or make sense of what has happened to them, life becomes irrational, illogical, and confusing. Exner's SCZI does what it was designed to do: identify individuals with disordered thinking and inaccurate perception. Therefore, SCZI should be renamed the Perception and Thinking Index (PATI) to reflect its function rather than a diagnostic category.     

The relationship of the Rorschach Schizophrenia Index to psychotic features in a child psychiatric sample

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.     

Assessment of disordered thinking in children and adolescents: the rorschach perceptual-thinking index.

The new Rorschach Perceptual-Thinking Index (PTI; Exner, 2000a, 2000b) was designed to assess thought disorders more accurately than the Schizophrenia Index (SCZI; Exner, 1993). Using a sample of child and adolescent inpatients, we examined the relation of Rorschach variables (PTI, SCZI, M-, and X- %) to thought disorder indexes on a behavior rating scale (Behavior Assessment System for Children; Reynolds & Kamphaus, 1992) and a self-report measure (Personality Inventory for Youth; Lachar & Gruber, 1995). Results indicate that, when used in a categorical manner, the PTI differentiated between those patients with and without elevated thought disorder scores on the other measures. Of all Rorschach variables, M- was most related to the other measures, indicating that this variable may be a particularly robust indicator of thought disorder among children and adolescents.     

The Rorschach Comprehensive System Egocentricity Index in psychiatric inpatients

This paper reports an exploratory study of potential correlates of Exner's Rorschach Egocentricity Index, a measure of self-focusing, in a sample of 70 psychiatric inpatients. We examined the relationship of the Index of the MMPI Ego Strength scale and to other MMPI and Exner Comprehensive System Rorschach variables, using Pearson Product-Moment correlations with partialling of the number of Rorschach responses. There were seven meaningful significant correlations between the Index and Rorschach variables: M, FM, X +%, F +%, Lambda, D, and A%. The Index-MMPI correlations were not significant. Sex differences and differences between these intercorrelations and some reported by Exner (1983) are discussed.     

Correlates of the Egocentricity Index in child and adolescent outpatients

This study examined the Rorschach and MMPI covariates of Exner's Egocentricity Index, 3r + (2): R, in a sample of child and adolescent outpatients (n = 46). Consistent with previous findings on adult psychiatric inpatients (Barley, Dorr, & Reid, 1985), significant positive correlations were obtained between the Index and M, FM, X + %, and D when controlled for the number of protocol responses. The Egocentricity Index was negatively associated with lambda and, in a subsample of adolescents (n = 19), depression scores. The index bore no significant relationship to either Minnesota Multiphasic Personality Inventory (MMPI) validity or clinical scales, also congruent with earlier investigations. Implications for the interpretation of childrens' Egocentricity Indices are discussed.     

Perception and the Rorschach

In this study we investigated the reliability and validity of the Rorschach Schizophrenia Index (SCZI) from Exner's (1978, 1993) Comprehensive System for a sample of 413 child psychiatric inpatients by examining relationships with the Personality Inventory for Children-Revised (PIC-R) and chart diagnoses. Interscorer reliability and internal consistency were acceptable. Multivariate analyses of variance results revealed significantly different PIC-R profiles for those with and without elevated SCZI scores, with significant differences emerging on the PIC-R Psychosis (PSY) scale and 2 cognitive triad scales (Intellectual Screening and Development), which have been reported to be more frequently elevated in PIC-R profiles of children with psychotic disorders. Significant differences were found across SCZI groups for the PSY scale, Reality Distortion scale, reality testing critical items and chart diagnoses of psychotic disorder. Implications for clinical interpretation of the SCZI with children and issues for further research with this population are discussed.     

Three Dimensions of Oppositionality in Autism Spectrum Disorder

In autism spectrum disorder (ASD), symptoms of oppositional defiant disorder (ODD) are common but poorly understood. DSM-5 has adopted a tripartite model of ODD, parsing its features into ‘angry and irritable symptoms’ (AIS), ‘argumentative and defiant behavior’ (ADB) and ‘vindictiveness’. This was based on findings in non-autistic populations that each of these dimensions of oppositionality has a distinct constellation of associations with internalising and externalising psychopathology. We applied the tripartite DSM-5 ODD model to ASD to test its generalisability beyond non-ASD populations; and to elucidate the nature of ODD symptoms in ASD. Participants were 216 verbally-fluent young people (mean age?=?9.6 years, range 3.0 to 16.2 years, 82 % male) with ASD. Cross-sectional parent-and teacher-report data were analysed using bootstrap multiple regression to test the following predictions, derived from studies of non-ASD young people: (1) AIS will be the main predictor of internalising problems; (2) ADB will be the main predictor of ADHD symptoms; (3) all ODD traits will independently predict conduct disorder symptoms; (4) vindictiveness will be the main predictor of aggressive conduct problems. Our findings using both parent and teacher data were consistent with the non-ASD ODD literature. AIS were associated with internalising but not externalising problems; ADB and vindictiveness were associated with externalising but not internalising problems; and vindictiveness was the main predictor of aggression. The DSM-5 tripartite model of ODD appears to be generalisable to ASD: for people with an autistic disorder, AIS, ADB and vindictive dimensions of oppositionality have distinct associations with concurrent psychopathology, suggesting the need to assess them as separate constructs.     

MMPI correlates of Exner's Egocentricity Index in an adolescent psychiatric population

This research examined the relationship between Exner's Egocentricity Index (EI) and Minnesota Multiphasic Personality Inventory (MMPI) Scales 2, 4, and 9 in an adolescent psychiatric population. Subjects with a low EI had significantly higher MMPI Depression (D) scale elevations compared to those with a high EI. Furthermore, of the adolescents who had Scale 2 scores in the clinical range, 68% also had an EI in the bottom half of the distribution. There was no relationship between the EI and MMPI scales 4 and 9. These findings are discussed in light of the generally poor correlations between MMPI and Rorschach variables.     

Examining Anxiety and Depression as Moderators of the Associations Between ADHD Symptoms and Academic and Social Problems in Hispanic Adolescents

The effects of attention-deficit/hyperactivity disorder (ADHD) symptoms on the psychosocial functioning of Hispanic youth have been understudied. It also remains unclear if the well-established associations between ADHD symptoms and academic and social impairment are exacerbated by co-occurring internalizing symptoms. The purposes of the present study were to (1) examine whether ADHD symptoms would be associated with academic and social problems while also controlling for oppositional defiant disorder (ODD) symptoms, and (2) test the hypothesis that anxious and depressive symptoms would moderate the relations between ADHD symptoms and academic and social problems. Participants were 142 at-risk Hispanic adolescents (54 % male, ages 14–19) who reported on their anxious and depressive symptoms, as well as their teachers who reported on adolescents’ ADHD symptoms, ODD symptoms, academic problems, and social problems. When the psychopathology variables were included simultaneously in a path model, ADHD was the only domain significantly positively associated with academic problems. In contrast, ODD and depressive symptoms were the only domains significantly positively associated with social problems when all of the psychopathology variables were included in the path model. No moderation effects were found in relation to academic problems, although a significant ADHD × depression interaction was found in relation to social problems. Specifically, ADHD symptoms were not associated with social problems among adolescents who reported low levels of depressive symptoms, but the association between ADHD symptoms and social problems was significant at higher levels of depression. In addition to targeting oppositionality, attending to the combined presence of ADHD and depressive symptoms will be important for reducing the social impairments among Hispanic adolescents.     

Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions,family beliefs and conflicts,and maternal psychopathology

A group of 83 adolescents with attention deficit hyperactivity disorder (ADHD) were subdivided into those with ADHD alone (n = 27) and those with ADHD and oppositional defiant disorder (ADHD/ODD, n = 56). They were compared to each other and a community control group (n = 77) on measures of family conflicts, family beliefs, maternal adjustment, and observations of mother-adolescent interactions during both a neutral and conflict discussion. Both ADHD groups had more topics on which there was conflict and more angry conflicts at home than control adolescents on parent reports. Only the ADHD/ODD adolescents reported more such conflicts, endorsed more extreme and unreasonable beliefs about their parent-teen relations, and demonstrated greater negative interactions during a neutral discussion than the control teenagers. Similarly, only mothers of the ADHD/ODD teens displayed greater negative interactions during a neutral discussion, more extreme and unreasonable beliefs about their parent-teen relations, greater personal distress, and less satisfaction in their marriages than the mothers in the control group. Most findings for the ADHD only group were between the control group and the group with mixed ADHD/ODD but did not differ from either group. Results imply that it is the combination of ODD symptoms with those of ADHD that is associated with the greater-than-normal conflicts, anger, poor communications, unreasonable beliefs, and negative interactive styles seen in ADHD adolescents. These same characteristics typify their mothers' interactions as well such that both the adolescents' ODD symptoms and maternal psychological distress (hostility) make unique contributions to the degree of conflict and anger in the parent-teen relations of ADHD adolescents.     

Factor Structure and Criterion Validity of Secondary School Teacher Ratings of ADHD and ODD

Attention-Deficit Hyperactivity Disorder (ADHD) is currently viewed as a heterogeneous disorder with two factors: inattention and impulsivity–hyperactivity. This conceptualization of ADHD is based primarily on research with children or samples that mix children and adolescents. To examine if the 2-factor ADHD model is appropriate for adolescents and if the ADHD factors are distinct from Oppositional Defiant Disorder (ODD) in adolescents, teacher rating data were collected for 2 samples of adolescents. The results of a confirmatory factor analysis supported the convergent and divergent validity of a model with separate but correlated factors for inattention, impulsivity–hyperactivity, and defiant behavior. Further evidence of construct validity was found when factor scores were examined relative to the criterion variables of academic performance and rule-breaking behavior. The results support the utility of teacher ratings of ADHD and ODD in the assessment of adolescents, and the applicability of the DSM-IV conceptualization of these disorders to adolescents.     

Rorschach indices for discriminating between two schizophrenic syndromes

Thinking disturbance and disorder of affects may be different in two subtypes of schizophrenia, the "florid" and the "withdrawal" syndromes. In Exner's approach to the Rorschach system, the diagnostic indicators of disordered thinking may point out large differences not only between schizophrenic and control subjects but also between different types of schizophrenics. The Rorschach protocols of 45 subjects (15 "florid" schizophrenics, 15 "withdrawn" schizophrenics, and 15 controls of the same age and education, matched by sex) were examined on several Exner indices. Compared with the control group, both schizophrenic types confirmed an impairment of perceptual accuracy and of reality testing as well as a reduced emotional control. Compared with the "withdrawn" group, the "florid" schizophrenic subjects showed significantly higher indices of poor perceptual functioning, of an inadequate organizational activity (more Whole and Z responses characterized by negative Form Quality) and greater disordered ideational production.     

Neuropsychological characteristics and test behaviors of boys with early onset conduct problems.

School-age children and adolescents with conduct problems typically exhibit deficits in verbal IQ, language abilities, and executive functions. This study examined the extent to which this pattern was evident in a clinic group of preschool boys with early onset conduct problems who met criteria for oppositional defiant disorder (ODD) with and without attention deficit hyperactivity disorder (ADHD). A 2nd question focused on the strength of relation between clinic boys' uncooperative or inattentive test behaviors and their test performance. As expected, the clinic boys showed a neuropsychological profile highly similar to the one found in older conduct problem populations. Verbal tests distinguished clinic from matched comparison boys even after controlling for observers' ratings of disruptive behavior during testing. Clinic boys with ODD and ADHD had lower verbal and executive function scores than clinic boys with ODD alone. After general vocabulary knowledge and test behavior were controlled, clinic boys were found to have poorer vocabularies for describing affective states than comparison group boys.     

The role of a lifetime history of oppositional defiant and conduct disorders in adults with ADHD: implications for clinical practice

IntroductionAttention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are frequently co-occurring disorders in children and adolescents. However, their clinical status among adults is still under discussion. This study analyzes how the current clinical presentation of adult ADHD might be influenced by a lifetime history of CD and ODD. METHODS: We compared three groups of patients: ADHD without history of CD/ODD (n = 178), ADHD + history of ODD (n = 184), and ADHD + history of CD (n = 96). RESULTS: A history of CD (and to a lower extent ODD) is associated with a more severe and externalizing profile.ConclusionPast CD and ODD entail a significant negative mental health impact on persistent ADHD, reinforcing the importance of actively assessing the developmental history of adult ADHD patients.     

Examination of Negative Peer Contagion in a Residential Care Setting

There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a residential care program, and the extent to which caregiver experience and youth time-in-program mediated that relationship. The study used archival data for 1,438 first-time admissions to a large Midwestern out-of-home residential program for youth with emotional and behavioral problems. Hierarchical Linear Modeling was used to examine the relationship between daily reports of conduct and oppositional defiant disorder (CD/ODD) behaviors and the percentage of conduct disorder youth living in a home. Greater exposure to conduct disordered peers was not related to increased rates of CD/ODD behavior. CD/ODD behavior was directly related to direct care staff level of experience and youth time in program. Implications for residential care are discussed.     

Towards a cognitive-behavioral model of PTSD in children and adolescents

Posttraumatic stress disorder in children and adolescents has been studied only for the past 15–20 years and is the subject of a burgeoning corpus of research. Much research has focused on examining whether children and adolescents have the same responses to trauma as those experienced by adults. Many of the research tools used to investigate children's responses are taken from measures designed for use with adults, and these measures have proven to be useful. However, it has not been established that children's responses to traumatic events are related to the same underlying processes as are adults' responses. The possible application of 2 recent cognitive models of PTSD in adults to understanding PTSD in children and adolescents is discussed in this paper, within the context of what is already known about children's reaction to trauma and existing theoretical accounts of childhood PTSD. Particular attention is paid toward the nature of children's memories of traumatic events and how these memories relate to the reexperiencing symptoms of PTSD, and cognitive processes that may play a role in the maintenance of PTSD. It is proposed that the adoption of a more specific cognitive–behavioral framework in the study of this disorder may be beneficial and lead to better treatment outcomes.     

False memory,attentional bias and future thinking among people living with HIV with posttraumatic stress disorder

People living with HIV can experience posttraumatic stress disorder (PTSD). Complex relationships exist between HIV, PTSD and cognitive impairments. This cross-sectional study compared three cognitive impairments (false memory, attentional bias, deficits in future thinking) among people living with HIV with and without PTSD in Iran. People living with HIV with PTSD (n = 20) and without PTSD (n = 20) completed measures of psychological symptomatology, dot-probe task, Deese Roediger McDermott paradigm and future thinking task at Razavi Khorasan Health Center. The PTSD group, when compared to the non-PTSD group, recognised a significantly greater number of false memories (p < .001; η² = .58), had an attentional bias toward threat-related words (p < .001; η² = .35) and imagined fewer specific future events (p < .001; η² = .31). People living with HIV with PTSD may have difficulties with false memory, attentional biases, and generating future events. Since psychological treatments are limited in Iran, this research highlighted some potential cognitive targets for people living with HIV.     

震后青少年创伤后应激障碍与社会支持、人格的关系

采用问卷调查法对地震地区933名中学生进行调查,考察青少年创伤后应激障碍的状况,并探讨社会支持在人格与创伤后应激障碍之间的调节作用。结果表明：（1）震后六个月,约67.6%的青少年患有PTSD或部分PTSD。（2）大五人格特质中的神经质对事件影响量表总分以及唤醒、侵扰、逃避均有预测作用;宜人性对事件影响量表总分、侵扰、唤醒有预测作用。验证了社会支持在大五人格与逃避、人格与唤醒、人格与事件影响量表总分间调节效应显著的结论。     

Rorschach evaluation of adolescent bulimics

It has become apparent that the excessive dieting engaged in by many girls when they reach puberty frequently serves as an impetus for the later development of eating disorders. While the existence of bulimia nervosa has been well documented in late-adolescent girls, only minimal research has been devoted to delineating the personality characteristics that distinguish bulimics from normal adolescents. The present study utilized the Rorschach to contrast 12 DSM-III-R diagnosed adolescent bulimics with 12 female adolescent controls. Exner's (1986) Comprehensive System was used for scoring the protocols. Statistically significant group differences were detected on both the overall Depression and the Schizophrenia Indices, as well as on several subcomponents of each. Additionally, bulimics averaged a greater number of aggression responses. The data suggested that the adolescent bulimics were more depressed, self-punitive, and negativistic than their peers, and that they had more disordered thoughts, inaccurate perceptions, and impaired judgment. The cognitive disturbances were not limited to the areas of food and weight. The results are alarming for this young population, particularly since the severity of symptoms certainly will increase over time if left untreated. Recommendations are made for early symptom identification and intervention.     

Classroom-based functional and adjunctive assessments: proactive approaches to intervention selection for adolescents with attention deficit hyperactivity disorder.

The present investigation evaluated the utility of classroom-based functional and adjunctive assessments of problem behaviors for 2 adolescents who met diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder (ODD). For children with ADHD-ODD, environmental classroom variables, when systematically manipulated by teachers, were related to the occurrence and nonoccurrence of problem behaviors. Classroom interventions derived from information that was obtained during functional and adjunctive assessments and from subsequent analyses resulted in substantial reductions in problem behaviors. Teacher and student consumer satisfaction ratings indicated that the interventions were effective and feasible in the classroom setting.