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.     

Sex-typed responses in the Rorschach protocols of children with gender identity disorder.

A coding system was developed to measure sex-typed responses in the Rorschach protocols of children with gender identity disorder (n = 79). Their responses were compared to that of sibling (n = 25), psychiatric (n = 26), and normal (n = 28) controls. Results show that children with gender identity disorder gave significantly more cross-sex responses than same-sex responses, whereas the psychiatric and normal controls gave significantly more same-sex responses than cross-sex responses. The siblings did not differ in the number of same-sex and cross-sex responses. Results are discussed with regard to various assessment issues in the study of children with gender identity disorder.     

Brief Rorschach records with children and adolescents

In order to determine the frequency with which children and adolescents give brief Rorschach (R less than 14) records and to test the hypothesis that brief records represent a resistance to testing, the psychological evaluations of 439 admissions to an inpatient unit were reviewed. Of the records reviewed, 16.6% were found to contain less than 14 responses. When the complete test protocol of those subjects who provided brief records were compared with those of a matched group, it was found that the group with brief records failed to complete the other parts of the evaluation significantly more often than did those subjects who did not give brief records. There was no significant difference between the two groups on IQ scores or on self-report scores of depression, anxiety, and social desirability. Result are interpreted as supporting Exner's (1988) hypothesis that brief records represent a form of resistance to being tested.     

Superior fluid intelligence in children with Asperger's disorder

Asperger's disorder is one of autistic spectrum disorders; sharing clinical features with autism, but without developmental delay in language acquisition. There have been some studies of intellectual functioning in autism so far, but very few in Asperger's disorder. In the present study, we investigated abstract reasoning ability, whose form of intelligence has been labeled fluid intelligence in the theory of Cattell [Cattell, R. B. (1963). Theory of fluid and crystallized intelligence: A critical experiment. Journal of Educational Psychology, 54, 1-22.], in children with Asperger's disorder. A test of fluid intelligence, the Raven's Standard Progressive Matrices Test, was administered to 17 children with Asperger's disorder and 17 age-, gender-, and FIQ-matched normal children. The results showed that children with Asperger's disorder outperformed on the test of fluid reasoning than typically developing children. We suggest that individuals with Asperger's disorder have higher fluid reasoning ability than normal individuals, highlighting superior fluid intelligence.     

Rorschach Egocentricity Index and self-concept in children and adolescents

In a sample of 65 child and adolescent psychiatric inpatients, the hypothesized relation between the Egocentricity Index from the Rorschach and standard self-report measures of self-concept was not supported. Although the sample as a group had a markedly low mean Egocentricity Index, self-reported self-concept was at a normative level. The validity of the Egocentricity Index and self-report measures of self-concept is discussed, and guidelines for their interpretation are presented.     

Rorschach Depression indices with children and adolescents: concurrent validity findings.

Exner (1983, 1986) developed and recently revised (1990b) a Rorschach Depression Index based on scores from variables in the Comprehensive System. This study evaluated both the original and the revised DEPIs for child and adolescent outpatient (n = 67) and inpatient (n = 99) samples in order to assess the diagnostic utility of these indices. There were no significant relationships between the original form and the revised form of the DEPI and clinical elevations on the Depression scale of the Personality Inventory for Children in the outpatient sample or treatment team diagnostic judgments in the inpatient sample. These findings sound a strong cautionary note for using only Rorschach Depression indices to diagnose depression in children and adolescents.     

Bipolar disorder in children and adolescents

There is increased recognition that bipolar disorder has an early age of onset. The prevalence of bipolar disorder in prepubertal children has not been determined, however the prevalence in adolescence is approximately 1%. Bipolar disorder in children poses a diagnostic challenge since the symptoms may differ from those in late adolescence and adulthood. Comorbid disorders, such as attention-deficit/hyperactivity disorder, further complicate both the diagnosis and course of the disorder. There is increasing evidence of the chronicity and severity of this disorder in youths. Bipolar disorder significantly disrupts a child's psychosocial development including impairments in academic functioning, family functioning, and relationship with peers. Although this disorder has significant morbidity in children and adolescents, there is a paucity of controlled studies to assess the efficacy and safety of mood stabilizers in the treatment of this disorder in youths. The treatment literature consists largely of case studies, retrospective chart reviews, and open-label studies. There is a compelling need for double-blind, placebo-controlled trials to determine whether commonly used medications to treat this disorder are significantly superior to placebo. Since many children in clinical practice require more than one psychotropic medication to adequately manage this disorder, studies of combination treatments are warranted. This review will provide an overview of the literature of bipolar disorder in children and adolescents, including discussion of the prevalence, diagnosis, epidemiology, course of the illness, and treatment issues.     

Prediction of differences in Rorschach protocols from the Personality Assessment System

The Personality Assessment System (PAS) is derived from certain subtest scores on any Wechsler test by rather simple calculations. It purports to measure, among other personality attributes, developmental changes in the Internalized-Externalized (I-E) dimension of personality, which is akin to the Introversion-Extroversion construct reflected by some Rorschach measures. PAS scores from a tightly defined sample of normal adults were contrasted with Experience Balance (EB) and Body-image (B) scores derived from Rorschach protocols by "blind" scorers. Significant relations were found between EB ratios produced via the Exner and Klopfer scoring systems and the primitive (early childhood) I-E scores from the PAS. The B scores produced by the Body Image scoring system were related to the basic (adolescent) I-E PAS scores. Although significant, the PAS-Rorschach correlations were relatively poor, in part because it was difficult to define the center of the internalization-externalization continuum in terms of the Rorschach protocols. It is, nevertheless, provocative that traditional scorings of the Rorschach responses of adults assess differences not only in this personality trait, but also in its development, as determined from scaled scores on Wechsler subtests.     

A study of nonpatient preadolescent Rorschach protocols

There is a paucity of peer-reviewed, nonpatient Rorschach studies in psychological journals, particularly for children. This study examined 100 preteenage children, using the Comprehensive System to code their Rorschach protocols. The participants were also evaluated with the Conners Parent Rating Scale-93 (Conners, 1989) and 5 exclusionary behavior criteria. The 100 participants demonstrated better than average behaviors. The results presented include all the ratios and indexes found in the nonpatient statistics for the Comprehensive System. We discuss interrater reliability issues and offer recommendations for further cross-validating research.     

Marital discord and psychiatric disorder in children and adolescents

The relationship between marital discord and any DISC-2.1/DSM-III-R child psychiatric diagnosis was explored. Interview data from a community sample of 90 parent/child pairs and a clinic sample of 37 parent/child pairs were analysed. The data were collected at Columbia University/the New York State Psychiatric Institute as part of the pilot project of a multi-site methodological study. Rates of marital discord and DISC diagnoses were found higher in the clinic sample than in the community sample. The association between marital discord and any diagnosis remained significant when other risk and protective factors were controlled. Policy implications and recommendations for future research strategies suggested by the current exploratory study were discussed.     

Symptom patterns in children and adolescents with obsessive-compulsive disorder (OCD)

OBJECTIVE: Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms. The present study examines symptom patterns in OCD in children and adolescents in order to search for the presence of diagnostic heterogeneity. SUBJECTS AND METHODS: Two hundred and thirteen outpatients with primary OCD participated. The patients' and primary caretakers' responses on the Children's Yale-Brown Obsessive-Compulsive Scale were used to generate severity ratings for 61 OCD symptoms, and cluster analysed them. RESULTS: A five cluster solution was judged to be the most clinically and theoretically relevant model. The clusters were named: (1) "Mental Rituals, Touching & Ordering", (2) "Contamination & Cleaning", (3) "Superstitions", (4) "Obsessions/Checking & Confessing" and (5) "Somatic Concerns". The symptom patterns of the groups differed, and three groups were particularly homogeneous. In addition, there were differences in severity, number of symptoms and age. CONCLUSIONS: OCD in children and adolescents is a heterogeneous disorder and discrepancies vis-à-vis adult studies indicate that childhood OCD may have developmentally specific traits. The sub-groups obtained are likely to have implications for the assessment of OCD symptoms in children, their prognosis and outcome in treatment research.     

Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research

Previous studies suggest elevated rates of gender variance (GV), the wish to be of the other gender, in those with autism spectrum disorder (ASD). This study aimed to understand the rate of GV in children and adolescents with ASD and explore differences in sex, age, and emotional-behavioral problems relative to those referred to clinical services for mental health concerns (“referred”) and to the general population (“non-referred”). A secondary analysis of data from the National Database for Autism Research was used to explore GV using a child behavior checklist, parent report, in 176 children aged 6 to 18 year with ASD compared to referred and non-referred cohorts. GV was present in 4.0% of the ASD group, higher than for the non-referred group (0.7%) but similar to the referred group (4.0%). There were no significant sex differences in GV prevalence (males 3.7%, females 6.0%) in the ASD group. That the GV rate was elevated in ASD relative to non-referred samples but similar to clinically referred samples suggests that elevated rates of GV were not specific to ASD and may be more broadly associated with neurodevelopmental and psychiatric disorders of childhood. Further population-based research using clinical assessment for gender dysphoria is required in individuals with ASD and other neurodevelopmental disorders.     

Interpretation of white space responses in children's Rorschach protocols

While most texts continue to assert that the Rorschach white space response (S) indicates hostility and oppositionality, several studies suggest that such responses are more accurately reflective of cognitive differentiation and autonomous strivings. In addition, there are no studies which have systematically explored the significance of S responses in children's protocols. To shed light on these issues, 47 children (7 to 13 yr.) were administered the Rorschach, Thematic Apperception Test, and the WISC-R, while their parents completed a behavioral checklist. Subjects with high S-response, independent of age, IQ, or perceptual accuracy, used the whole blot more often than those who made less frequent use of white space. They also had higher frequencies of shading determinants and blends and used more content categories. These results were interpreted as suggesting a tendency for subjects showing high S-response to construe the world in more complex terms. No differences were found between subjects high and low on S-response on either behavioral ratings or projective indices of hostility or negativism.     

Evaluating reading and metacognitive deficits in children and adolescents with attention deficit hyperactivity disorder

The reading achievement of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) has scarcely been explored in research conducted in the Spanish language and when it has, the results have been contradictory. The focus of the present research is to analyze participants' reading competency and metacognitive strategies as they carry out reading comprehension tasks. The sample was comprised of 187 Argentine schoolchildren aged 9 to 13 years old. 94 constituted the control group and the clinical group consisted of 93 schoolchildren diagnosed with ADHD. The metacognitive assessment was made up of two metacognitive tests, the Reading Awareness Scale (ESCOLA; acronym in Spanish) and a Spanish adaptation of Metacognitive Awareness of Reading Strategies Inventory (MARSI), and one test of reading comprehension, the Evaluation of Reading Processes for Secondary Education Students (PROLEC-SE; acronym in Spanish). Students with ADHD had lower achievement on tests o reading comprehension compared to the control group. Nevertheless, our results suggest their difficulties did not stem from readin comprehension problems, but rather from alterations in their Executive Functions, because when subjects' reading comprehensio was equalized, students with ADHD still exhibited a lower level of Metacognition, particularly when it came to planning.     

Social perception and WAIS-IV Performance in adolescents and adults diagnosed with Asperger's Syndrome and Autism

Previous research using the Wechsler scales has identified areas of cognitive weaknesses in children, adolescents, and adults diagnosed with Autism or Asperger's syndrome. The current study evaluates cognitive functioning in adolescents and adults diagnosed with Autism or Asperger's syndrome using the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and the Social Perception subtest from the Advanced Clinical Solutions. Deficits in social perception, verbal comprehension, and processing speed were found in the Autism sample. Additionally, they exhibited inconsistent performance on auditory working memory and perceptual reasoning tasks. The Asperger's syndrome group had better overall cognitive skills than the Autism group, but compared with controls, they had weaknesses in processing speed, social perception, and components of auditory working memory. Both groups had relatively low scores on the WAIS-IV Comprehension subtest compared with the other verbal comprehension subtests. Clinical application and utility of the WAIS-IV and Social Perception in Autism Spectrum Disorders are discussed.     

Obsessive-compulsive disorder in children and adolescents: Clinical syndrome and treatment

Abstract

Obsessive-compulsive disorder (OCD) in children and adolescents has been relatively neglected by clinicians and researchers. We aim to show that childhood OCD is a serious condition that requires early identification and treatment. The DSM-III-R criteria for OCD are presented along with recent findings on psychopathology. Clinical management of childhood OCD is a challenging and difficult task for mental health professionals. We briefly describe and evaluate advances in behavioural treatment — mainly in vivo exposure and response prevention. Also the adjunctive use of anti-depressant medication is examined. Whilst these clinical innovations are promising, further controlled evaluations are necessary before the efficacy of behaviour therapy can be confidently asserted     

Biased expectations of burned or traumatized children and adolescents as revealed through predictions of Rorschach responding

This study examines helper bias through predictions of burned and traumatized children's and adolescents' Rorschach responding on ten content variables: human, fictional human, animal, anatomy, blood, clothing, explosion, food, fire, and sex. Two groups of helpers consisting of 139 inexperienced individuals and 48 members of the American Burn Association who worked directly with patients were asked to predict Rorschach content responding for children and adolescents who had been severely burned (n = 86) or traumatized (n = 75). Inaccurate and inconsistent predictions are interpreted as evidence of biased expectations which could influence the therapeutic relationship between helpers and patients. To control for the confound of Rorschach knowledge, 11 psychologists with Rorschach expertize also made predictions. An analysis of Rorschach responding in the two groups of children and adolescents is also presented.