Assessment of neurological 'soft signs' in adolescents: reliability studies.

The validity and reliability of a scoring system for 'neurological soft signs' in teenagers was assessed. Six scales were adapted and fitted into the framework of a conventional neurological examination. The following emerged: each of the three multi-item scales had high internal consistency; inter-rater agreement on mirror movements of 'live' subjects was satisfactory; ratings of videotapes agreed among examiners for mirror movements and dysdiadochokinesis but not for choreiform movements; data-based cut-off scores defining present vs. absent were congruent with the ratings of outside neurologists; and each examiner was consistent in rating mirror movements and rapid alternating movements from videotapes over several months.

Ten-year consistency in neurological test performance of children without focal neurological deficit.

To assess 'soft-sign' persistence and its correlates outside a referred sample, 159 members of a local birth cohort of the United National Collaborative Perinatal Project were traced and their performance on six neurological test scales was measured at age 17 by examiners blind to their status at age seven. A comparison group was also formed, who had been 'sign-free' at age seven. On four of the six tests (dysdiadochokinesis, mirror movements, dysgraphesthesia and motor slowness) index boys did significantly worse than the comparison boys; by contrast, index girls scored significantly worse than comparisons only on motor slowness.

Incompetent misdemeanants--pseudocivil commitment.

Prior to Jackson v. Indiana, psychiatric hospitalization of those found to be incompetent to stand trial often led to an inordinately long confinement, a particularly invidious consequence if the patient had been accused only of a misdemeanor. After a highly publicized murder perpetrated by a patient originally in this category, New York State instituted a rather cumbersome set of procedures designed to assure several layers of review, including involvement of the legal system, prior to increasing privileges or discharging someone committed pursuant to a criminal court order. The effect of this new law on patient care is examined by looking at the hospital course of 52 incompetent misdemeanants at one state facility. They are demographically and clinically quite similar to a control group of persons civilly committed, except for an increased length of inpatient stay. When compared with those sent to the county penitentiary after conviction, the study population differs on several important parameters. Looking like a patient, the incompetent misdemeanant is, however, treated more as a criminal with no indication that public safety is thereby increased or that individual therapeutic objectives are enhanced.

Neurological soft signs. Their relationship to psychiatric disorder and intelligence in childhood and adolescence.

Sixty-three male and 27 female adolescents known to have had neurological soft signs at the age of 7 years were compared with controls with no soft signs at age 7. Adolescents with early soft signs had significantly lower IQs and were more likely to have a psychiatric disorder characterized by anxiety, withdrawal, and depression. All the girls and 80% (12/15) of the boys with an anxiety-withdrawal diagnosis showed early soft signs. There was no relationship between early soft signs and attention deficit or conduct disorders. Examination of the relative contributions of anxiety at age 7, IQ, and social and family disadvantage to later diagnosis showed that most of the variance was accounted for by soft signs independently of IQ. Soft signs and anxious dependent behavior at age 7 were strongly predictive of persistent psychiatric disorder characterized by anxiety and withdrawal.

Dangerousness and violence in hospitalized mentally ill offenders.

Clinical judgments of dangerousness depend not only on patient characteristics, but are greatly influenced by the perspective of the rater and the context for which the assessments are made. Similarly, institutional violence is determined not only by patient characteristics, but is also a function of contextual variables such as physical milieu, important clinical events not under the control of the patient, etc. To increase the predictive validity of assessments of dangerousness it is essential to specify the vulnerabilities and strengths of the patient, the current life stressors, and the contextual triggers to which the patient is likely to react violently. The momentary contextual triggers may be useful to predict the type and severity of violence and perhaps the most likely victims as well. Analyses of previous violent incidents may provide markers for contextual triggers, e.g., type of weapon, victim, severity of violence, etc.