Overview and Summary: Twenty-five-year Followup of High-risk Children

Abstract

We report a 25-year followup of a group of 50 children at genetic risk for schizophrenia (by virtue of having a parent with the disorder) and 50 matched controls. The children who eventually developed schizophrenia spectrum disorders, including schizophrenia, were identifiable by cognitive-psychophysiological, neurointegrative, and social/personality traits in the preteenage period. The children at risk were also more likely to develop other Axis I disorders, chiefly affective. Moreover, the risk of Axis I disorders was significantly greater among children raised in the group atmosphere of a kibbutz than among those raised in their own nuclear families in cities and towns in Israel. The study is a unique contribution to knowledge of factors underlying the development of psychopathology.

Implications for the Neural Basis of Social Cognition for the Study of Schizophrenia

“…Despite the fact that high-risk and follow-back studies indicate that impairments in social functioning predate the onset of schizophrenia (3,(132)(133)(134)(135)(136)(137)(138)(139)(140), there has been little work on the role of social cognition in the development of psychosis. The most notable exception is the finding that an external locus of control in adolescence, which is similar to attributional style, was predictive of poor mental health in adulthood in an Israeli high-risk study (141).…”

The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment

“…Investigations of younger individuals may eliminate some of the confounds posed by adult studies, and also present an opportunity to examine the emergence of impairments during a period of rapid change in brain and behavior. A substantial literature has developed indicating that social impairments in individuals with schizophrenia predate formal diagnosis, not only during the prodromal phase in adolescence (Addington et al 2008b; Ballon et al 2007; Cannon et al 2008) but also during early childhood (Asarnow 1988; Isohanni et al 2000; Jones 1997; Jones and Tarrant 2000; Mirsky et al 1995). These studies highlight the protracted developmental course of schizophrenia and demonstrate that social deficits are not simply a byproduct of symptoms that occur with formal onset of the illness (e.g., anhedonia), but rather an early-emerging, defining, and persistent characteristic of the disorder.…”

When Mothers Leave Their Children Behind

“…Adoption studies find the same incidence of schizophrenia in high-risk offspring raised with, or apart from, their mentally ill parents, 26 and a study of high-risk offspring in Israel found that those children raised with their nuclear families, including those with one schizophrenic parent, had a significantly lower incidence of Axis I disorders than index children raised on a kibbutz (whereas the kibbutz environment did not change the incidence of Axis I disorders in the control groups). 27 There is consequently evidence that a mother's diagnosis of mental illness alone, even schizophrenia, does not necessarily bring with it damaged parenting. The stigma of mental illness is powerful, however, and undermines a mentally ill mother's ability to care for her children through negative family and social attitudes, impoverished social services, and the mother's internalization of assumptions about her own incapability.…”