The self-concept of traumatized children and adolescents with or without PTSD

This study compared the Piers-Harris 2 scores of youth with PTSD (n=30) to the scores of traumatized youth without PTSD (n=60) and a non-traumatized comparison group (n=39). In the absence of major comorbid disorders, youth with PTSD evidenced significantly lower scores than the traumatized PTSD negatives and controls on five of six Piers-Harris 2 scales. With the exception of scores on an index of perceived parental acceptance of child behavior, trauma exposure in the absence of PTSD was not associated with lower Piers-Harris 2 scores.     

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.     

The intellectual performance of traumatized children and adolescents with or without posttraumatic stress disorder

This study compared the Wechsler Intelligence Scale for Children-III (WISC-III) scores of traumatized youth with posttraumatic stress disorder (PTSD) to the scores of trauma-exposed and nonexposed comparison groups without PTSD. All groups were free of additional major childhood psychiatric disorders. The PTSD group scored significantly lower than the comparison groups on verbal subtests, but not on performance subtests. The scores of the trauma-exposed PTSD negatives and nontrauma exposed controls were not significantly different. Accordingly, PTSD and not a history of trauma exposure in the absence of PTSD was associated with lower verbal IQ.     

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 protocols from children and adolescents with Asperger's disorder

Rorschach protocols from 24 boys with Asperger's Disorder matched by age to 24 boys with other emotional or behavioral disorders (the contrast group) were compared to each other and to Exner' s (1995) normative data. Eight variables based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria and a review of the literature for Asperger's Disorder were predicted to discriminate between groups with the Asperger's group having more extreme scores. Five variables (COP, CDI, H, M, and EA) were significantly different from the contrast group and T and WSumC were significantly different from the normative data in both the Asperger's group and the contrast group.     

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.     

Appraisal of suicidal risk among adolescents and young adults through the Rorschach test

The aims of this study are to investigate suicidal behaviors among adolescents and young adults and to test an index composed using Rorschach test responses related to an increased risk of suicide. Using a cross-sectional design, 4 groups were studied (according to criteria of the Columbia Classification Algorithm of Suicide Assessment [Posner, Oquendo, Gould, Stanley, & Davies, 2007]): A group with suicidal ideation (n = 30), a group with parasuicidal behavior (n = 30), a group with near-lethal suicide attempts (n = 26), and a control group (n = 30). Responses to the Rorschach test yielded 6 potential indicators of suicidal behavior (scored according to Exner's Comprehensive System and the Suicidal Index for Adolescents; Silberg & Armstrong, 1992 ). Rorschach scores including at least 4 of these 6 indicators selected 69% of the people who had committed serious suicide attempts. The Rorschach Suicidal Index reached an acceptable reliability and was related to other criteria of suicide risk, such as the Beck Depression Inventory (BDI; Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961) and Linehan Reasons for Living Inventory (RFL-I; Linehan, Goodstein, Nielsen, & Chiles, 1983). Moreover, the Rorschach Suicidal Index showed incremental validity over the BDI and the RFL-I to predict suicidal behavior. A path analysis additionally showed that low social support was an important mediator between the Rorschach Suicidal Index and the number of suicide attempts committed by participants.     

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.     

Eye movement desensitization and reprocessing as a therapeutic intervention for traumatized children and adolescents: a systematic review of the evidence for family therapists

Eye movement desensitization and reprocessing (EMDR) is a relatively new form of psychotherapy for post‐traumatic symptoms of relevance to systemic therapists. The literature available on individual EMDR in traumatized children is reviewed in this article. A sample of eight studies was examined, consisting of three controlled trials, two uncontrolled studies and three case reports or series. The controlled trials compared EMDR with waiting list controls or cognitive behavioural therapy (CBT). The study samples were small and their methodological quality variable. In all the studies, the results suggested a positive effect for EMDR but did not appear superior to CBT. It is therefore possible that systemic interventions may be improved by the integration of EMDR and family therapy with children and adolescents.     

Behavioral expectations of retarded and nonretarded children

Two experiments were conducted to examine the effect of the mental retardation (MR) label on impression formation among retarded and nonretarded children and adolescents. The first experiment, conducted with nonretarded children in a mainstreamed school, indicated that they have pessimistic expectations of retarded children with regard to cognitive and ability-related behaviorsand, to a lesser extent, social behaviors (i.e., getting married). However, their reactions were not as pessimistic nor as “patronizing” as were those demonstrated by college students in previous research. In the second experiment, mentally retarded adolescents indicated that they also have negative behavioral expectations of retarded children, however, their self expectations were negative only for social behaviors. The results suggest that, among retarded persons, the expectations associated with the MR label are negative for social behavior, but apparently less pessimistic for cognitive and ability related tasks.     

The Rorschach and structured tests of perception as indices of intellectual development in mentally retarded and nonretarded children

In a study of the developmental significance of certain perceptual activities, the Rorschach and four structured tests of perception were administered to five groups of children at various CA, MA, and IQ levels. All three Rorschach measures were significantly related to MA, as were all four of the structured tests. The Childrens' Embedded Figures Test was the best predictor of MA; it accounted for 52% of the variance, while the six remaining measures yielded nonsignificant increments to a multiple regression equation. In a factor analysis the four structured tests loaded on one factor (51% of total variance), while the three Rorschach variables loaded on a second (17%); MA loaded on both (.669 and .447, respectively). In an additional finding, Zigler's “developmental” hypothesis that level of development and not IQ determines cognitive competence, received partial support from 13 of 14 statistical tests.     

A Rorschach study of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents.

We investigated the constructs of attachment and anxiety in inpatient conduct-disordered and dysthymic adolescents. Texture, diffuse shading, and pure human content (Exner, 1986) Rorschach indices were compared between 48 subjects who met the criteria for conduct disorder and 30 subjects who met the criteria for dysthymia, according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987). We also compared mild, moderate, and severe conduct-disorder groups on the three selected Rorschach variables and investigated certain family characteristics for the two groups. We found a lower frequency of texture and pure human content responses in conduct-disordered subjects and a greater frequency of diffuse shading responses in the dysthymic subjects. The conduct-disordered subjects also came from homes in which the mother figure was significantly less present. Our psychometric findings of lessened attachment and diminished anxiety in the conduct-disordered adolescents are similar to adult psychopaths. We urge that an attachment or socialization disturbance criterion be reintroduced into the forthcoming DSM-IV conduct-disorder diagnosis.     

Group psychotherapy as a technique for assisting ego-impaired children and adolescents

This paper describes an approach to working with egoimpaired children and adolescents. The structure and process of psychotherapy groups within a residential program are discussed. We describe how insight-oriented groups act as a collective superego, thereby encouraging maturation. Functions of the group relating to socialization, milieu issues, peer issues, family relationships, personal issues, selfesteem, empowerment, and special issues are discussed. The focus of the discussion is on the structure and process of the groups. Brief clinical vignettes are utilized to illustrate components of the approach.     

Nighttime fears of children and adolescents: frequency, content, severity, harm expectations, disclosure, and coping behaviours

The present school-based study investigated the nighttime fears of 511 children and adolescents, aged 8-16 years. Participants were assessed using a structured interview about the frequency, content, severity, harm expectations, coping strategies, and disclosure of nighttime fears. Results indicated that nighttime fears are a common experience, with nearly two-thirds (64.2%) of children and adolescents reporting nighttime fears. Fear of intruders/home invasion was the most frequently reported nighttime fear. Females more frequently reported nighttime fears than males (72.9% and 54.6%, respectively) and a greater number of children reported nighttime fears compared to adolescents (79.4% and 48.8%, respectively). Nighttime fears were given moderate severity ratings, and harm expectations were most strongly associated with 'personal security' fears. Respondents reported a variety of coping strategies to manage their nighttime fears with self-control/distraction techniques being the most common. Most respondents reported disclosing their nighttime fear(s) to another person. The clinical implications of these findings and the methodological limitations are discussed.