Suicide Attempts in Preadolescent Child Psychiatry Inpatients

This paper describes a preliminary study examining the relative power of measures of perceived family support, hopelessness, and depression for the classification of suicide attempters and nonattempters in a series of 8- to 13-year-old psychiatric inpatients. Results of a stepwise discriminant-function analysis indicated that a measure of a child's perceived family support discriminated between suicide attempters and nonattempters with an 88% accuracy rate. The addition of measures of hopelessness and depression at later steps did not lead to improved classification. The results are interpreted as providing strong support for a link between suicide attempts in children and perceptions of low family support.     

Is Expressed Emotion a Specific Risk Factor for Depression or a Nonspecific Correlate of Psychopathology?

Five Minute Speech Sample Expressed Emotion (FMSS-EE) was examined in families of youth with depressive disorders, nondepressed youth with attention deficit/hyperactivity disorder (ADHD), and community controls screened for the absence of depression and ADHD. Consistent with the hypothesis that FMSS-EE shows some specificity as a risk factor for depression, rates of critical EE were significantly higher among mothers of youth with depression as compared to mothers of nondepressed youth with ADHD, or mothers of controls. When both mothers' and fathers' scores were used to generate family EE ratings, rates of overall EE and critical EE were significantly higher for the depressed group than the control group, but the nondepressed ADHD group did not differ significantly from the other groups. Results support the hypothesis that critical EE in mothers shows some specificity as a risk factor or correlate of depression in youth.     

Brain abnormalities observed in childhood-onset schizophrenia: a review of the structural magnetic resonance imaging literature

Childhood-onset schizophrenia (COS) is a rare, severe form of schizophrenia in which there are structural brain abnormalities that may be related to the psychotic symptomatology and neurocognitive deficits found in these patients. While there are numerous structural imaging studies of the adult-onset variant of schizophrenia (with many conflicting findings), relatively few brain imaging studies of COS have been conducted. This paper summarizes the extant literature of magnetic resonance imaging (MRI) studies of structural brain abnormalities in COS, and compares findings to similar studies of adult-onset patients. Volumetric MRI studies of COS patients have consistently shown evidence for increased ventricular volume, reduced cerebral gray matter, and increased caudate volume, consistent with findings from adult-onset studies. Other volumetric brain abnormalities are observed in COS patients, such as reduced total brain volume, but not consistently across all studies. Voxel-based morphometric analyses have revealed abnormalities in the shape and spatial location of structures in COS such as the corpus callosum, caudate, and thalamus that could not be observed in the more traditional volumetric assessments. Similar findings also are observed in adult-onset patients. Progressive degenerative changes, such as ventricular enlargement, appear to occur in COS only until young adulthood where there is an apparent asymptote with no further degenerative changes. This is consistent with the lack of progressive changes noted in most longitudinal studies of adult-onset schizophrenia.     

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.     

Family-expressed emotion,childhood-onset depression,and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to express their appreciation to Sybil Zaden and Ana Magana-Amato for their assistance coding the FMSS-EE data, to Gwen Gordon for her assistance with data analysis, and to the families participating in the project.     

The Reasoning View and Defeasible Practical Reasoning

According to the Reasoning View about normative reasons, facts about normative reasons for action can be understood in terms of facts about the norms of practical reasoning. I argue that this view is subject to an overlooked class of counterexamples, familiar from debates about Subjectivist theories of normative reasons. Strikingly, the standard strategy Subjectivists have used to respond to this problem cannot be adapted to the Reasoning View. I think there is a solution to this problem, however. I argue that the norms of practical reasoning, like the norms of theoretical reasoning, are characteristically defeasible, in a sense I make precise. Recognizing this property of those norms makes space for a solution to the problem. The resulting view is in a way analogous to the familiar defeasibility theory of knowledge, but it avoids a standard objection to that theory.     

Family interaction and the course of adolescent psychopathology: An analysis of adolescent and parent effects

This study focused on evaluating the utility of three family measures for predicting outcome in a sample of disturbed but nonpsychotic adolescents: (a) the affective quality of the adolescents' voice tone when communicating with his/her parents; (b) the predominant affective quality of the parents' voice tones when communicating with the adolescent, and (c) the affective quality of the content of the parents' verbalizations to the adolescent. These measures were derived from 5-minute face to face discussions between parents and their disturbed adolescent. Results indicated that adolescents using positive or neutral voice tones during emotionally laden discussions with their parents tended to show relatively adequate levels of psychosocial adjustment as young adults, while adolescents using exclusively negative voice tones tended to show sufficient adjustment difficulties in early adulthood to warrant diagnoses within the extended schizophrenia spectrum. Although adolescent voice tone was associated with outcome, considering both adolescent and parent affective response led to improved prediction, with consideration of adolescent and parent variables leading to accurate prediction of outcome for 30 of the 33 sample cases.     

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.     

Components of Visual Search in Childhood-Onset Schizophrenia and Attention-Deficit/Hyperactivity Disorder

This study tested the hypotheses that visual search impairments in schizophrenia are due to a delay in initiation of search or a slow rate of serial search. We determined the specificity of these impairments by comparing children with schizophrenia to children with attention-deficit hyperactivity disorder (ADHD) and age-matched normal children. The hypotheses were tested within the framework of feature integration theory by administering children tasks tapping parallel and serial search. Search rate was estimated from the slope of the search functions, and duration of the initial stages of search from time to make the first saccade on each trial. As expected, manual response times were elevated in both clinical groups. Contrary to expectation, ADHD, but not schizophrenic, children were delayed in initiation of serial search. Finally, both groups showed a clear dissociation between intact parallel search rates and slowed serial search rates.