Annotation: childhood-onset schizophrenia: clinical and treatment issues.

BACKGROUND: In the past 10 years, there has been increased research on childhood-onset schizophrenia and clear advances have been achieved. METHOD: This annotation reviews the recent clinical and treatment literature on childhood-onset schizophrenia. RESULTS: There is now strong evidence that the syndrome of childhood-onset schizophrenia exists and there are several similarities between childhood- and later-onset schizophrenia. Schizophrenia in youth can be reliably diagnosed using the same criteria employed with adults, and childhood-onset schizophrenia is predictive of schizophrenia or schizophrenia spectrum disorders in adulthood. Data is accumulating to guide pharmacological treatment strategies, and practice parameters have been developed to guide clinical care. CONCLUSIONS: Despite significant advances, there remains an urgent need for additional research on treatment and service delivery strategies. Promising work with adults highlights the importance of attending to psychosocial as well as pharmacologic treatment strategies, and the potential value of preventive interventions.

[Psychotherapeutic and sociotherapeutic aspects in schizophrenic psychoses in childhood and adolescence]. / Psychotherapeutische und soziotherapeutische Aspekte bei schizophrenen Psychosen des Kindes- und Jugendalters.

A critical review is given of modern psychotherapeutic and sociotherapeutic approaches used with children and adolescents with schizophrenic disorders. Therapeutic strategies are evaluated within the framework of emprical data on biological and psychosocial facets of schizophrenia. Major treatment goals are discussed that go beyond differences in psychotherapeutic methodology, e.g. attainment of biographical continuity, improvement of strategies for social interaction and conflict resolution, stabilization of self-structures, mastery of age-dependent developmental tasks and, finally, coordination of different therapeutic interventions. It is stressed that psychotherapy and sociotherapy are equally important in the treatment of children and adolescents with schizophrenia.

Childhood-onset schizophrenia: a followup study.

This article is an overview of our studies of childhood-onset schizophrenia. Data are presented demonstrating that (1) the majority of the sample showed continuing schizophrenia as they progressed through adolescence; (2) there was considerable variability in outcome, defined by global adjustment scores, with 56 percent of the sample showing improvement in functioning during a 2- to 7-year followup period and the other 44 percent showing minimal improvement or a deteriorating course; (3) schizophrenia in childhood could be diagnosed by the same criteria used for adults and was associated with severe dysfunction; and (4) some intrafamilial attributes found to be associated with schizophrenia in adults were also associated with schizophrenia in children, but there were some differences in the family environmental correlates of childhood- and later-onset schizophrenia. These data are consistent with the hypothesis that childhood- and later-onset schizophrenia represent the same illness or illnesses. Additional research is needed, however, to clarify the etiologic and clinical significance of the atypical early onset in childhood cases.

Clinical features and outcome of child and adolescent schizophrenia.

Subjects admitted 12 months or more previously to two child and adolescent psychiatric units in New Zealand and the United States with a diagnosis of non-organic, nonautistic psychosis, were contacted and those who received a DSM-III-R diagnosis of schizophrenia were studied (n = 33 [New Zealand] and n = 24 [United States]). Premorbid and first-episode data were obtained from the admission record using global clinical measures of moderate reliability, outcome diagnosis and status by interviews, and professional and family reports. Mean ages at onset were 13.9 (New Zealand) and 15.6 (United States). Premorbid and clinical features resembled those in adult schizophrenia, though there were probable quantitative differences. At outcome (mean interval = 4 years) few subjects were symptom-free or independent, and mean global assessment of functioning had fallen from 55 to 40. Outcome was much worse in schizophrenia than bipolar disorder. Despite a 59 percent attrition rate and higher rates of initial misdiagnosis in the United States, and some demographic differences, New Zealand and United States samples resembled each other clinically and in outcome. Initial misdiagnosis of bipolar disorder as schizophrenia was not due to minimizing mood symptoms, which were common in both disorders. Within this age range (mostly 11-17), age at onset had only minor effects. Outcome was best predicted by premorbid personality.

[Problem of rehabilitative correction of mental defects in children with schizophrenia]. / K voprosu o vosstanovitel'noi korrektsii defektnykh sostoianii u bol'nykh shizofreniei detei.

Problems of rehabilitative correction of defect conditions associated with schizophrenia that had occurred in early childhood remain little studied. After the disease attacks the schizophrenic children usually develop severe defect conditions. With no rehabilitation provided to such children, the defect gravity increases due to super-addition of secondary retardation of mental development. The characteristic features of defect conditions were investigated on a material of the follow-up of 75 persons who had suffered schizophrenic attacks of varying structure at the age under 3 years. A complex of measures for their rehabilitation has been elaborated.

[External difficulties and their management in catamnestic studies (home visits)]. / Aussere Schwierigkeiten und ihre Uberwindung bei katamnestischen Untersuchungen (Hausbesuche).

It is reported on som difficulties arising an attempt to trace former children whom we wanted to follow-up. On the one hand there were individuals who had been treated in childhood in our hospital many years ago, on the other hand some individuals concerned had been cared in a long stay-nursery during their first years of life. Furthermore, we traced adult patients to follow-up them and also visited some of their relatives in their homes. It is described how much persistent and time-consuming efforts had to be made to trace the probands and their relatives, for they, frequently, had altered their names and their addresses. However, the visits to the individuals' homes were worth while. Only in this way we were enabled to satisfactorily carry out the tasks, we had set to ourselves.

[Follow up of early childhood schizophrenics. Progress of 6 cases over 25 years]. / Katamnesen frühkindlicher Schizophrenien. Weiterverfolgung von 6 Fällen über 25 Jahre.

Around the year 1950, we observed five cases of infantile schizophrenia; these patients were personally re-examined in 1956 and 1977. Another patient, under the care of the psychiatrists of the Public Health Department was included at a later date. One case of periodic catatonia is distinguished from other cases by a normal development up to puberty. The other five cases suffer from a "systematic" catatonia with characteristic syndromes and a slowly progressing course. As early as at the age of two or five years, they were noticeable for autism and psychomotor syndromes. The diagnosis of the catatonic subform was confirmed after 25 years. Although originally able children their intellectual development came to a standstill during the progressing process as did the maturing of the personality. A causative factor of the early development can be seen in the lack of stimulation to which four only children and one child brought up in a home were exposed.

Effects of the vestibular system on human development, part 2: Effects of vestibular stimulation on mentally retarded, emotionally disturbed, and learning-disabled individuals.

In Part 1 of this two-part series, studies concerned with the effects of vestibular stimulation on human development and function were reviewed and some implications for therapy were suggested. In Part 2, three categories of dysfunction with possible links to the vestibular system are discussed. Studies in the category of mental retardation evaluate motor development and sensory preference. Possible vestibular associations with emotional disturbance are examined by review of studies concerned with etiology, motor activity, speech, and clinical observations. A brief review of studies concerned with early identification and speech and language factors of learning-disabled children constitutes the third category. Interpretations are drawn and some implications for therapy are made.

A comparison of human and automated instruction of autistic children.

While it appears reasonable to assume that the autistic child might benefit from the development of programmed instruction and teaching machines to teach imitation, concepts, and receptive vocabulary skills, no systematic research to date has seriously investigated such possibilities. The purpose of this study was to compare the effects of automated versus teacher-controlled instruction in the education of autistic children. Four autistic children, each with extreme deficits in language, social, and self-care behaviors, were trained on a matching-to-sample task under three different instructional situations within an intrasubject replication design and multiple baseline procedure. Analysis of the data showed the following results: (1) The teacher, manually operating the teaching machine, was able to teach and maintain the matching-to-sample task; (2) the same autistic children did not acquire or maintain the task when taught by the machine alone; and (3) the teacher alone (without the machine) was able to teach and maintain the task. The results suggest that automated instruction may, at least, serve as a valuable aid to teachers of autistic children. However, before machines can be used without the participation of a trained teacher, further research appears necessary. Several areas, including the role of motivation in automated instructional settings, the saliency and effectiveness of reinforcers, and the importance of controlling antecedent stimulus conditions and off-task behavior are discussed as areas of primary concern in the development of automated instruction for autistic children.

Implications of the normalization principle for psychotic children.

The evolution of the normalization principle is described. Whereas the principle initially advocated normalizing individual lives and routines, it presently is being applied to entire human service delivery systems. The need for more data supporting proposals to normalize human service systems is discussed, as well as some disadvantages in applying this approach with psychotic children. It is concluded that a wide range of treatment options for psychotic children is needed and that these options should be evaluated based on their effectiveness with individual children.