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Child Specialty Circumstance Counsel

There are a number of unfortunate incidents that may arise in a child's life that would justify a need for specialty counseling service offerings in order to support a child's un-forseen immediate needs, such as an accident, a serious injury, sudden illness diagnosis or death in or extremely close to the family as well as genetic reasons, environmental reasons and so forth. 

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Development from birth to adolescence of children at-risk for schizophrenia

Sydney L Hans 1, Judith G Auerbach, Aaron G Auerbach, Joseph Marcus

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Abstract

Objective: Offspring of patients with schizophrenia are at-risk for developing schizophrenia in adult life. The aim of this paper is to describe the development from infancy through adolescence of a sample of Israeli young people at-risk for schizophrenia.

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Methods: The Jerusalem Infant Development Study (JIDS) has followed prospectively from birth through adolescence 15 young people who have a parent with schizophrenia. Neurobehavioral data were gathered at infancy, middle childhood, and adolescence. Mental disorder was assessed at adolescence.

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Results: Data suggest that some children whose parents have schizophrenia are at increased risk for a variety of neuromotor, cognitive, and attentional problems during infancy and childhood, compared to children whose parents had no mental disorder or nonschizophrenia mental disorder. Those high-risk children with neurobehavioral signs are also more likely to have poorer social adjustment, greater social withdrawal, and more symptoms within the schizophrenia spectrum. Case studies are presented of two children with early neurobehavioral impairment who, as adolescents, developed disorders within the schizophrenia spectrum.

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Conclusion: Because neurobehavioral impairment may be marking genetic vulnerability to schizophrenia spectrum disorders, clinicians treating children whose parents have schizophrenia need to thoroughly evaluate symptoms of mental disorder--but also neuromotor and neuropsychological functioning.

A 1975 report stated that a schizophrenic genotype may be manifested in infants by a neurointegrative defect called pandysmaturation. Recent evidence supports this: (1) 12 studies found delayed development in schizophrenics' infants and in preschizophrenics; (2) "blind" psychometric evaluations favored an adult schizotypal disorder in four to six of seven high-risk subjects with pandysmaturation in the New York study; and (3) finally, in a partial replication of this method using the Jerusalem data, blind diagnoses of "probable" and "possible" pandysmaturation were significantly related to a parental diagnosis of schizophrenia and to cognitive and motor neurointegrative deficits at 10 years. Obstetrical complications were unrelated to diagnosis, pandysmaturation, or outcome in the overall sample. However, we found a small subgroup of schizophrenic offspring in whom the most severe motor deficits at follow-up were related to obstetrical complications, pandysmaturation, and low birth weight.

The development of school-age children born to parents with serious mental disorders was assessed on a variety of perceptual-cognitive and motoric tasks. These same children have been followed up from birth as part of the Jerusalem Infant Development Study. Children with schizophrenic parents, when compared with children with healthy parents or parents having other psychiatric disorders, were more likely to show neurobehavioral dysfunctioning in perceptual-cognitive and motoric areas. Forty-four percent of the offspring of schizophrenics (11 of 25 subjects) showed such dysfunctioning. Male subjects were overrepresented in this poorly functioning group. A stable subgroup (40%) of the offspring of schizophrenics (six of 15 subjects) showed dysfunctioning during infancy and school age. None of the offspring of nonschizophrenic parents showed dysfunctioning during both age periods. While most of the poorly functioning children with schizophrenic parents showed perceptual-cognitive and motoric signs, only perceptual-cognitive signs were strongly linked to parental diagnosis and infant dysfunctioning. Motoric signs, but not cognitive signs, were related to pregnancy and birth complications. These findings provide further support to the schizotaxia hypothesis that some neurointegrative deficits may reflect vulnerability to schizophrenia and that these deficits are clearly apparent at school age, long before the onset of illness. However, these signs are not exclusive to schizophrenic illness, although they occur with a greater prevalence in this group. Definitive statements about the validity of early neurobehavioral signs as indicators of genetic vulnerability await further longitudinal follow-up into the age of risk for actual schizophrenic breakdown or when a diagnosis of schizotypal personality disorder may be made.

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