Surgery for symptomatic infant-onset epileptic encephalopathy with and without infantile spasms

Children undergoing surgery with infant-onset epilepsy were classified into those with medically refractory infantile spasms (IS), successfully treated IS, and no IS history, and the groups were compared for pre- and postsurgery clinical and Vineland Adaptive Behavior Scale (VABS) developmental quotients (DQ). Children without an IS history were older at surgery and had longer epilepsy durations than those with IS despite similar substrates, surgeries, and seizure frequencies. In all groups, better postsurgery VABS-DQ scores were associated with early surgical intervention indicating that infant-onset epilepsy patients with or without IS are at risk for seizure-induced encephalopathy.

Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes

OBJECTIVE

To compare hemispherectomy patients with different pathologic substrates for hospital course, seizure, developmental, language, and motor outcomes.

METHODS

The authors compared hemispherectomy patients (n = 115) with hemimegalencephaly (HME; n = 16), hemispheric cortical dysplasia (hemi CD; n = 39), Rasmussen encephalitis (RE; n = 21), infarct/ischemia (n = 27), and other/miscellaneous (n = 12) for differences in operative management, postsurgery seizure control, and antiepilepsy drug (AED) usage. In addition, Vineland Adaptive Behavior Scale (VABS) developmental quotients (DQ), language, and motor assessments were performed pre- or postsurgery, or both.

RESULTS

Surgically, HME patients had the greatest perioperative blood loss, and the longest surgery time. Fewer HME patients were seizure free or not taking AEDs 1 to 5 years postsurgery, but the differences between pathologic groups were not significant. Postsurgery, 66% of HME patients had little or no language and worse motor scores in the paretic limbs. By contrast, 40 to 50% of hemi CD children showed near normal language and motor assessments, similar to RE and infarct/ischemia cases. VABS DQ scores showed +5 points or more improvement postsurgery in 57% of patients, and hemi CD (+12.7) and HME (+9.1) children showed the most progress compared with RE (+4.6) and infarct/ischemia (-0.6) cases. Postsurgery VABS DQ scores correlated with seizure duration, seizure control, and presurgery DQ scores.

CONCLUSIONS

The pathologic substrate predicted pre- and postsurgery differences in outcomes, with hemimegalencephaly (but not hemispheric cortical dysplasia) patients doing worse in several domains. Furthermore, shorter seizure durations, seizure control, and greater presurgery developmental quotients predicted better postsurgery developmental quotients in all patients, irrespective of pathology.

Schizophrenia and schizophrenia-spectrum personality disorders in the first-degree relatives of children with schizophrenia: the UCLA family study

BACKGROUND

This study tested the hypothesis that childhood-onset schizophrenia (COS) is a variant of adult-onset schizophrenia (AOS) by determining if first-degree relatives of COS probands have an increased risk for schizophrenia and schizotypal and paranoid personality disorders.

METHODS

Relatives of COS probands (n = 148) were compared with relatives of attention-deficit/hyperactivity disorder (ADHD) (n = 368) and community control (n = 206) probands. Age-appropriate structured diagnostic interviews were used to assign DSM-III-R diagnoses to probands and their relatives. Family psychiatric history was elicited from multiple informants. Diagnoses of relatives were made blind to information about probands' diagnoses. Final consensus diagnoses, which integrated family history, direct interview information, and medical records, are reported in this article.

RESULTS

There was an increased lifetime morbid risk for schizophrenia (4.95% +/- 2.16%) and schizotypal personality disorder (4.20% +/- 2.06%) in the parents of COS probands compared with parents of ADHD (0.45% +/- 0.45%, 0.91% +/- 0.63%) and community control (0%) probands. The parents of COS probands diagnosed as having schizophrenia had an early age of first onset of schizophrenia. Risk for avoidant personality disorder (9.41% +/- 3.17%) was increased in the parents of COS probands compared with parents of community controls (1.67% +/- 1.17%).

CONCLUSIONS

The psychiatric disorders that do and do not aggregate in the parents of COS probands are remarkably similar to the disorders that do and do not aggregate in the parents of adults with schizophrenia in modern family studies. These findings provide compelling support for the hypothesis of etiological continuity between COS and AOS.

Thought disorder in childhood schizophrenia: replication and update of concept

OBJECTIVES

To examine whether measures of thought disorder differentiated schizophrenic from normal children and to examine the relationship of these measures with developmental and cognitive factors.

METHOD

The speech samples of 88 schizophrenic and 190 normal children, aged 9 to 13 years, were coded with the Kiddie Formal Thought Disorder Rating Scale and Halliday and Hassan's analysis of cohesion.

RESULTS

Above and beyond differences in mental age, gender, and neuroleptic status, the patients had significantly more formal thought disorder (FTD) and cohesive deficits than the normal children matched by mental age. The younger schizophrenic and normal children had significantly more thought disorder than the older children with these diagnoses. Combined FTD and cohesion scores correctly identified 76% of schizophrenic and 88% of normal children with little variability across mental age. The thought disorder measures generated 2 independent components: FTD and cohesion.

CONCLUSIONS

Thought disorder measures that include both FTD and cohesion provide a quantitative diagnostic tool of childhood-onset schizophrenia.

Attention in HIV-infected children: results from the Hemophilia Growth and Development Study

Attentional functioning was examined in three groups of 7- to 19-year-old male participants with hemophilia: (1) HIV seronegative controls (HIV-, N = 66), (2) HIV seropositive participants with CD4+ lymphocyte counts greater than or equal to 200 (HIV+ CD4+ > or = 200, N = 79), and (3) severely immune suppressed HIV seropositive participants (HIV+ CD4+ < 200, N = 28). Two measures sensitive to attention deficits were used: the Continuous Performance Test (CPT) and the Span of Apprehension (Span). On the CPT, there was a decrement in attention in both HIV+ groups, as indexed by an increase in false alarm rate from Block 1 to Block 3, that was not present in the HIV- group. The longer the HIV+ children were required to sustain attention to the CPT, the more they responded to the incorrect stimulus. This effect decreased as age increased. Span percent correct and latency to correct were associated with the presence of a premorbid history of intracerebral hemorrhage, but were not sensitive to HIV status or degree of immune suppression in the HIV+ children, suggesting morbidity related to hemophilia. The remaining CPT and Span variables--hit rate, sensitivity, latency, percent correct, and latency to correct--showed the expected associations with age, but none showed conclusive associations with HIV status or immune suppression in the HIV+ participants.

Neuropsychological deficits in pediatric patients with childhood-onset schizophrenia and psychotic disorder not otherwise specified

OBJECTIVE

Children with transient psychotic symptoms and serious emotional disturbances who do not meet current criteria for schizophrenia or other presently recognized diagnostic categories commonly present diagnostic and treatment problems. Clarifying the connections between children with narrowly defined schizophrenia and children with a more broadly defined phenotype (i.e., Psychotic Disorder Not Otherwise Specified, PD-NOS) has implications for understanding the pathophysiology of schizophrenia. In this study, the neuropsychological test performance of a subgroup of children with atypical psychosis was compared with that of patients with childhood-onset schizophrenia (COS).

METHOD

Cognitive function was assessed with neuropsychological test battery regimens in 51 neuroleptic-nonresponsive patients within the first 270 at NIMH testing (24 PD-NOS, 27 COS) were included in this analysis. Seventeen (39%) of 44 COS subjects were unavailable for this study as their IQ tested <70. The PD-NOS patients were younger than the COS patients at the time of testing (12.0+/-2.8 vs 14.4+/-1.8years, respectively, p<0.004). The test levels of these groups were compared with each other.

RESULTS

The neuropsychological test results for the PD-NOS and COS patients were 1-2standard deviations below normative data across a broad array of cognitive functions. There were no overall differences in the test levels for the six summary scales (F=2.82, df=1, 36, p=0.10) or in the profile shape (F=1.70, df=5, 180, p=0.14) between the PD-NOS and COS groups. For the COS patients, there was a significant difference between their mean full-scale WISC IQ (84.7+/-16.2) and their average standard scores for both the spelling (97.7+/-16.1, n=23, t=4.0, p=0.001) and reading decoding subtests (97.7+/-13.7, n=23, t=3.7, p=0.001) of the Kaufman Test of Educational Achievement.

CONCLUSIONS

Treatment-refractory PD-NOS and COS patients share a similar pattern of generalized cognitive deficits, including deficits in attention, learning and abstraction which are commonly observed in adult patients with schizophrenia. These data support a hypothesis that at least some of the PD-NOS cases belong within the schizophrenic spectrum, which is of importance for future genetic studies planned for this cohort.

Relevance of the cerebellar hemispheres for executive functions

The aim of the present study was to elucidate the role of the cerebellar hemispheres in executive functions. The findings are relevant because of the large number of children who survive cerebellar tumors. Neuropsychologic assessments of four patients (8-21 years of age) who had undergone neurosurgery for removal of tumors in the cerebellar hemispheres were conducted and compared with the assessments of six children who had been diagnosed with temporal lobe tumors or cysts. The executive functions were assessed using the Wisconsin Card Sorting Test. IQs were average in both groups. As expected, patients with cerebellar hemispheric lesions had impaired executive functions. In particular, they appeared to have difficulty generating and testing hypotheses regarding the matching rules on the Wisconsin Card Sorting Test. Patients with temporal lesions had a different pattern of deficits on this test. The findings are consistent with the theories that propose that the cerebellar hemispheres are involved in cognitive processes. The findings also demonstrate that subtle deficits in executive functions can be masked by a normal IQ in survivors of cerebellar tumors and highlight the need to design interventions targeted toward problem-solving skills.

Accelerated age-related decline in processing resources in schizophrenia: evidence from pupillary responses recorded during the span of apprehension task

Cognitive impairment in schizophrenia may be related to reduced availability of information-processing resources (resource limitations hypothesis). An abnormally accelerated age-related decline in processing resource availability may also occur in older patients with schizophrenia (neurodegeneration hypothesis). To test these hypotheses, pupillary responses were recorded as an index of processing resource availability during performance of the span of apprehension (SOA) task in 33 middle-aged and older patients with schizophrenia and 37 age-comparable nonpsychiatric participants. Consistent with the resource-limitations hypothesis, the patients with schizophrenia showed impaired detection accuracy and abnormally small pupillary responses (reduced resource allocation) only in the higher processing load SOA conditions. This pattern of results suggests that the patients depleted their available processing resources at lower processing loads than the nonpsychiatric participants. Consistent with the neurodegeneration hypothesis, cross-sectional analyses showed abnormally accelerated rates of age-related decline in SOA performance and pupillary responses in the patients with schizophrenia relative to age-comparable normal participants.

Parallel and serial search in two teenagers with lesions of the mesial parietal cortex

Visual-spatial attention was examined in two 14-year-olds who had undergone occipital-parietal craniotomies for removal of mesial parietal tumors, one in the right and one in the left hemisphere. Neither patient showed clinically significant visual neglect. They were administered two visual search tasks from Treisman and Souther [43] that make significantly different demands on visual spatial attention. In feature-present (parallel) search, they searched for the presence of a feature. In feature-absent (serial) search, they searched for its absence. Search rate was estimated from the slope of the function relating display size to response time. Both patients had flat slopes in feature-present search to target-present (TP) displays, indicating that they could conduct parallel search at the same rate as controls. Although the patient with the right-hemisphere lesion also had a flat slope to target-absent (TA) displays, the patient with the left-hemisphere lesion had a steep slope (30 ms/item) in this condition. In feature-absent search, the patients had equally slow search rates compared to controls, suggesting that the mesial parietal cortex is part of the network that mediates serial shifts of attention. Results support the distinction between detection of the target in parallel vs serial search and suggest that processes involved in TP and TA trials in parallel search are also dissociable.

Neurocognitive impairments in schizophrenia: a piece of the epigenetic puzzle

This paper is a review of studies examining the neurobehavioral antecedents of schizophrenia which flesh out neurodevelopmental models of schizophrenia by detailing the time course of the ontogeney of neurobehavioral impairments in schizophrenia. A follow back design was used to identify precursors of psychotic symptoms in children with a schizophrenic disorder. The vast majority of children with a schizophrenic disorder had significant developmental delays beginning early in life. For example, gross deficits in early language development were found in almost 80% of the schizophrenic children. Somewhat later in development impairments in fine motor and bi-manual coordination are noted. Some of these early developmental delays are transitory. For example, basic language skills are among the best preserved neurocognitive functions in children and adults with schizophrenia. The results of our cross-sectional neurocognitive studies suggest that children with schizophrenia suffer from limitations in the ability to engage in effortful cognitive processing or impairments in working memory. The links between these elementary neurocognitive impairments and the development of formal thought disorder as well as discourse deficits in children with a schizophrenic disorder will be discussed.

Persistent Post-Concussive Syndrome: A proposed methodology and literature review to determine the effects, if any, of mild head and other bodily injury

Following mild head injury, a subgroup of individuals exhibit a constellation of chronic symptoms, a condition Alexander (1995) labeled Persistent Post-Concussive Syndrome (PPCS). He implicated neurological factors in the initial phase of the syndrome but psychological factors in the maintenance of symptoms. However, it is unclear as to whether an initial mild head injury is necessary or sufficient to cause the symptoms of PPCS. We first outline a study design comparing a mild closed-head injury group to both a normal and an other injury control group to answer this question. Next, we review the literature since 1960 to determine the findings of any studies using this design. The results of the literature review indicate that few such studies exist. To date, those that have been done suggest that there is no strong evidence for a specific effect for mild head injury on cognitive functioning. We discuss directions for future research given these findings.

Neurobehavioral deficits at adolescence in children at risk for schizophrenia: The Jerusalem Infant Development Study

BACKGROUND

The Jerusalem Infant Development Study is a prospective investigation comparing offspring of schizophrenic parents with offspring of parents who have no mental disorder or have nonschizophrenic mental disorders. During infancy and school age, a subgroup of offspring of schizophrenic parents showed global neurobehavioral deficits that were hypothesized to be indicators of vulnerability to schizophrenia. The purposes of the present investigation were to determine if neurobehavioral deficits were present in the offspring of schizophrenics at adolescence, to examine their stability over time, and to explore their relation to concurrent mental adjustment.

METHODS

Sixty-five Israeli adolescents were assessed on a battery of neurologic and neuropsychological assessments. They were also administered psychiatric interviews from which best-estimate DSM-III-R diagnoses and scores of global adjustment were derived.

RESULTS

Adolescents with poor neurobehavioral functioning were identified from composites of motor and cognitive-attentional variables. A disproportionate number of offspring of schizophrenic parents (42%; 10/24), and especially male offspring of schizophrenic parents (73%; 8/11), showed poor neurobehavioral functioning relative to offspring of nonschizophrenic parents (22%; 9/41). Adolescent offspring of schizophrenics with poor neurobehavioral functioning had been poorly functioning at earlier ages and had poor psychiatric adjustment at adolescence. All 4 offspring of schizophrenics receiving schizophrenia spectrum diagnoses by adolescence showed a pattern of poor neurobehavioral functioning across developmental periods.

CONCLUSIONS

Results are consistent with the hypothesis that individuals at genetic risk for schizophrenia may display lifelong neurobehavioral signs that are indicators of vulnerability to schizophrenia and that are associated with psychiatric adjustment generally and schizophrenic spectrum disorder specifically.

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.

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.

Continuous-processing related ERPS in adult schizophrenia: continuity with childhood onset schizophrenia

BACKGROUND

Previous work with schizophrenic children disclosed deficits on two continuous performance tests (CPTs) and ERP indices of reduced attentional resource allocation.

METHODS

The two CPTs were administered to adult schizophrenics and matched control subjects. The simple CPT required only that the subject respond whenever the target digit was displayed. The complex version required a response whenever any digit was displayed on two successive trials. Event-related potentials (ERPs) were recorded during task performance.

RESULTS

Schizophrenics had fewer hits on both CPT versions, showed a greater drop in performance from the simple to the complex CPT, and took longer to respond than controls. The processing negativity (Np) showed a greater amplitude increase from nontarget to target in normals than in schizophrenics, and the overlapping P2 component was more negative in normals. P3 latency was longer in schizophrenics, but P3 amplitude did not differ.

CONCLUSIONS

Group performance and processing negativity effects replicated those from an earlier study of schizophrenic and normal children administered the same versions of the CPT, suggesting similar abnormalities in the allocation and modulation of information processing resources.

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.

Working memory in childhood-onset schizophrenia and attention-deficit/hyperactivity disorder

We investigated verbal and spatial working memory in participants with childhood-onset schizophrenia (N=13), attention-deficit/hyperactivity disorder (ADHD; N=31) and age-matched normal children (N=27). The ages of the participants ranged from 9 to 20 years, with an average age of approx. 14 in all groups. Diagnoses were based on structured interviews (Kiddie-Schedule for Affective Disorders and Schizophrenia) with the children and their parents and made using DSM-III-R criteria. Verbal working memory was assessed by the highest number of digits recalled in forward and backward order on the Digit Span subtest of the Wechsler Intelligence Scale. Results showed that normal children recalled more digits than schizophrenic and ADHD children, who did not differ. Spatial working memory was assessed with the Dot Test of Visuospatial Working Memory: The children were presented with a dot on a page for 5 s and asked to mark its location on a blank page immediately after presentation or 30 s later. A distracter task was used during the delay to prevent verbal rehearsal. The average distance between the target dot and the child's mark in the 30-s condition was shorter for normal than for schizophrenic and ADHD children, who did not differ. Thus, both schizophrenic and ADHD children showed deficits in verbal and spatial working memory. These results suggest that in both disorders, the capacity of the sensory buffers may be diminished, and/or the availability and allocation of resources to the central executive may be limited.

Neuropsychological, psychosocial and vocational correlates of the Glasgow Outcome Scale at 6 months post-injury: a study of moderate to severe traumatic brain injury patients

Traumatic brain injury (TBI) subjects at Glasgow Outcome Scale levels 3 (severe disability), 4 (moderate disability), 5 (good recovery), and an other-injury control group (OIC) were compared in terms of neuropsychological, psychosocial, and vocational functioning 6 months after injury. Subjects were a sample of 100 patients with a moderate to severe traumatic brain injury (TBI) and a matched sample of 30 other-injury control subjects (OIC) enrolled in the UCLA Brain Injury Research Center study of TBI outcome. Overall, the results showed a systematic decrease in mean neuropsychological test performance as a function of increasing GOS severity, as well as an increased prevalence of symptoms of depression and lower ratings on measures assessing employability and capacity for self care. TBI patients in the 'severe' and 'moderate disability' groups were distinctly inferior to the 'good recovery' and 'OIC' groups, who were quite similar to each other in terms of cognitive, psychosocial, and vocational outcomes. The results demonstrate overall support for the predictive and concurrent validity of the GOS 6 months post injury. Despite these results, which strengthen the utility and appeal of the GOS for multicentre studies, concerns still remain regarding GOS category 4 (moderate disability), which was shown to lack sufficient discriminability in this study.

Depressive symptoms in the early course of schizophrenia: relationship to familial psychiatric illness

OBJECTIVE

This study examined the relation between the presence of depressive symptoms in schizophrenic patients with a recent first psychotic episode and affective disorders among their relatives.

METHOD

Data on depressive symptoms in 70 patients with schizophrenia diagnosed according to the DSM-III-R criteria, who had had a recent first psychotic episode, and psychiatric diagnostic information on 293 of their first-degree and 674 of their second-degree relatives were collected. Depressive symptoms in the schizophrenic probands were examined at the index psychotic episode (at study entry) and systematically over a 1-year follow-through period. The majority of first-degree family members were interviewed in person with the use of semistructured diagnostic interviews.

RESULTS

The linear regression findings confirmed the hypothesis that depressive symptoms in the early course of schizophrenia are associated with a family history of unipolar affective illness.

CONCLUSIONS

Because depression in the patients was associated with a family history of depression, this suggests that depression in schizophrenia is not solely either a reaction to having had a psychotic episode or part of the recovery process. The findings are consistent with a model in which a familial genetic liability to affective disorder, when present, is viewed a s exerting a modifying influence on the patient's schizophrenic illness to increase expression of depressive symptoms.

Event-related potential correlates of linguistic information processing in schizophrenics

Event-related potentials (ERPs) were recorded from adult schizophrenics and age- and education-matched normal controls during performance of an idiom recognition task involving judgments of the meaningfulness of idiomatic, literal, and nonsense phrases. Schizophrenics produced more errors and had prolonged reaction times while attempting to correctly differentiate meaningful from meaningless phrases. An ERP correlate of that deficit was a larger than normal N400 to idioms and literals, with no difference in N400 amplitude to nonsense phrases. This result was interpreted as evidence that the influence of the linguistic context provided by the first word of two-word idiomatic and literal phrases is reduced in schizophrenia. Schizophrenics also showed reduced amplitude P300.

Pupillary responses index overload of working memory resources in schizophrenia

The authors examined the hypothesis that schizophrenia patients have reduced availability of working memory resources by using pupillary responses as an index of resource overload. Pupillary responses were recorded during a verbal working memory task (digit recall) in 24 schizophrenia patients and 32 normal controls. Pupil size increased with increased processing load (digit-span length) but changed little or declined when processing demands exceeded available resources (overload). The schizophrenia patients showed impaired digit recall and abnormally small pupillary responses during digit presentation only in the higher processing load conditions, but they showed abnormally small pupillary responses during digit retrieval in all processing load conditions. The results suggest reduced availability of slave store and central executive working memory resources in schizophrenia. This study serves as an example of how pupillography methods can be used to test current hypotheses regarding overload of cognitive capacities in schizophrenia patients.

Pupillary responses index overload of working memory resources in schizophrenia

The authors examined the hypothesis that schizophrenia patients have reduced availability of working memory resources by using pupillary responses as an index of resource overload. Pupillary responses were recorded during a verbal working memory task (digit recall) in 24 schizophrenia patients and 32 normal controls. Pupil size increased with increased processing load (digit-span length) but changed little or declined when processing demands exceeded available resources (overload). The schizophrenia patients showed impaired digit recall and abnormally small pupillary responses during digit presentation only in the higher processing load conditions, but they showed abnormally small pupillary responses during digit retrieval in all processing load conditions. The results suggest reduced availability of slave store and central executive working memory resources in schizophrenia. This study serves as an example of how pupillography methods can be used to test current hypotheses regarding overload of cognitive capacities in schizophrenia patients.

Developmental outcomes in children receiving resection surgery for medically intractable infantile spasms

Two-year postsurgical developmental outcomes were assessed in 24 children with infantile spasms who underwent resective surgery. The mean age of onset of infantile spasms was 12.0 weeks and the mean age at surgery was 20.8 months. Developmental outcomes were assessed using the Vineland Adaptive Behavior Scales (VABS). There was a significant increase in developmental level at 2 years postsurgery compared with presurgical levels. At 2 years postsurgery only one of the children in this series was severely retarded. The developmental outcomes of patients in the series were better than those in prior studies of symptomatic patients receiving medical treatment for infantile spasms. It is surprising that the children in the UCLA series frequently had developmental outcomes equal to and sometimes superior to other groups of children with infantile spasms, since all the UCLA patients were symptomatic, had neurologic deficits and had failed to respond to adrenocorticotrophic hormone (ACTH) and antiepileptic drugs. The 2-year postsurgery developmental outcomes were best for the children who received surgery when they were relatively young and who had the highest level of developmental attainments presurgically.

Continuous-processing--related event-related potentials in children with attention deficit hyperactivity disorder

Visual information processing in children with attention deficit hyperactivity disorder (ADHD) was studied using event-related potentials recorded during two versions of the Continuous Performance Task (CPT). ADHD children made more errors, and had longer reaction times than normal children on both the single- and dual-target CPT. Event-related potential waveforms were normal in the ADHD children with reference to early processing stages, i.e., contingent negative variation, P1-N1 laterality, and processing negativities, suggesting that ADHD children did not differ in their level of preparedness or their ability to mobilize resources for target identification and categorization. With respect to later processing, P3 amplitude was reduced in the ADHD group, whereas P3 latency was longer than normal. ADHD children had a diminished late frontal negative component, suggestive of reduced involvement in postdecisional processing.

Display visual angle and attentional scanpaths on the span of apprehension task in schizophrenia

The effect of display visual angle on span of apprehension (SOA) task performance was investigated in patients with schizophrenia and nonpsychiatric individuals. Narrow and wide visual-angle presentations of 3- and 10-letter arrays were compared. Detection rates were significantly higher with narrow than wide visual angle for nonpsychiatric individuals; the performance of those with schizophrenia was stable across visual-angle conditions. Patients with schizophrenia were best discriminated from nonpsychiatric individuals in the narrow-angle, 10-letter condition. Scanpath analyses, which were based on the pattern of detection rates across different target quadrant locations, suggested that the patients with schizophrenia used a similar number and path of covert scan moves as did the controls. Hypotheses are discussed regarding which of the multiple cognitive processes tapped by the SOA task may be impaired in schizophrenia.

Pupillary responses index cognitive resource limitations

Cognitive task-evoked pupillary responses reliably index information-processing loads. However, previous studies have reported inconsistent findings regarding the nature of the pupillary response when processing demands approach or exceed available processing resources. This condition was examined in 22 normal undergraduates by using pupillometric recordings during a digit span recall task, with 5 (low load), 9 (moderate load), and 13 (excessive load) digits per string. Pupillary responses increased systematically with increased processing load (to-be-recalled digits) until the limit of available resources (memory capacity of 7 +/- 2 digits), when they reached asymptote and then declined with resource overload (> 9 digits). These findings suggest that pupillary responses increase systematically with increased processing demands that are below resource limits, change little during active processing at or near resource limits, and begin to decline when processing demands exceed available resources.

Span of apprehension deficits in older outpatients with schizophrenia

Performance on the span of apprehension task, a well-studied information processing task in schizophrenia research, was examined in 11 schizophrenia patients and 11 normal comparison participants, all over the age of 45 years. Subjects detected "T' and "F' targets in briefly-flashed arrays of 1, 6, and 12 letters on the span task. Consistent with previously reported findings in younger schizophrenia patients, the older patients detected significantly fewer targets in the larger (12-letter), but not smaller (1-, or 6-letter), arrays. The older schizophrenia patients also showed significantly slower reaction times in all array-size conditions. Neither age of onset nor duration of illness was significantly correlated with span task performance. The characteristic span of apprehension task deficit found in the older schizophrenia patients suggests that late-life schizophrenia shares a common cognitive impairment with childhood and young adulthood schizophrenia, and provides supportive evidence for a possible stable vulnerability trait deficit in schizophrenia that is independent of age of onset and duration of illness.

Display visual angle and attentional scanpaths on the span of apprehension task in schizophrenia

The effect of display visual angle on span of apprehension (SOA) task performance was investigated in patients with schizophrenia and nonpsychiatric individuals. Narrow and wide visual-angle presentations of 3- and 10-letter arrays were compared. Detection rates were significantly higher with narrow than wide visual angle for nonpsychiatric individuals; the performance of those with schizophrenia was stable across visual-angle conditions. Patients with schizophrenia were best discriminated from nonpsychiatric individuals in the narrow-angle, 10-letter condition. Scanpath analyses, which were based on the pattern of detection rates across different target quadrant locations, suggested that the patients with schizophrenia used a similar number and path of covert scan moves as did the controls. Hypotheses are discussed regarding which of the multiple cognitive processes tapped by the SOA task may be impaired in schizophrenia.

Children's color trails

Color Trails for Children was developed in response to the need for instruments which minimize cultural bias in neuropsychological testing. The test, similar in format to Trail Making, was designed to provide an evaluation of speeded visuomotor tracking while minimizing the influence of language. The present research involves two exploratory studies which examine the relationship between Color Trails for Children and Trail Making, factors that may affect performance times, and discriminant validity. Results indicate that the tests appear to measure the same neuropsychological domains, and administration of Trail Making did not significantly alter performance times on Color Trails. Increasing age and IQ were related to quicker completion time for both tests. Females were found to complete Color Trails 2 and Trail Making Part B more quickly than males in this sample. Comparison between children diagnosed with learning disabilities, attention deficits, or mild neurological conditions and a preliminary standardization sample supported the discriminant validity of Color Traits to distinguish between normal controls and children with altered neuropsychological functioning. Comparison between clinical conditions indicated that Color Trails 2 was particularly sensitive in discriminating among the groups. Although further research is needed, results suggest that Color Trails has the potential to be an effective research and clinical tool in child neuropsychological assessment.

Children with a schizophrenic disorder: neurobehavioral studies

This paper summarizes retrospective and cross-sectional neurobehavioral studies of schizophrenic children. Retrospective studies of schizophrenic children reveal that during early childhood, prior to the first onset of schizophrenic symptoms, most schizophrenic children showed delays in language acquisition and/or impairments and delays in visual-motor coordination. These impairments appear to be developmental delays rather than fixed neurobehavioral impairments, because cross-sectional studies conducted when the children are at least 10 years of age, after the first onset of psychosis, fail to detect the same deficits. The results of behavioral, cognitive/neuropsychological studies as well as the study of event-related potentials measured during performance of cognitive tasks suggests that schizophrenic children suffer from limitations in processing resources. It is argued that the developmental delays observed in schizophrenic children represent the greater time it takes them to automate certain skills. The delay in automation may reflect their limited information-processing capacity.

Persisting negative symptoms and information-processing deficits in schizophrenia: implications for subtyping

To test the hypothesis that schizophrenic patients with persisting negative symptoms have stable information-processing impairments compared with schizophrenic patients without persisting negative symptoms, 20 chronic schizophrenic outpatients were trichotomously subgrouped on the basis of the level of negative symptoms that they displayed across multiple rating periods over a 1-year period. Brief Psychiatric Rating Scale assessments of negative symptoms were used to assign subjects into either an operationally defined persisting negative symptom (PNS), transient negative symptom (TNS), or no negative symptom (NNS) subgroup. The level and pattern of these subgroups' performance on a visual information-processing task, the Span of Apprehension Test (SPAN), were compared. Although the three groups did not differ statistically in level of SPAN performance during a drug-free baseline, the PNS group had significantly poorer SPAN performance than the other two groups at the 1-year followup assessment. The SPAN performance of the TNS and NNS groups improved while the SPAN performance of the PNS group did not improve over the 1-year followup period.

Reduced attention-related negative potentials in schizophrenic adults

Event-related potentials were recorded from outpatient adult schizophrenics receiving maintenance doses of neuroleptics and from normal control subjects during performance of a reaction time task and a complex visual discrimination task, the Span of Apprehension. Difference potentials were computed to isolate endogenous activity associated with the processing demands of the Span task. Schizophrenics produce significantly less early endogenous negative activity than do normal subjects. This processing-related negativity reflects pattern matching activity to an attentional trace during the serial scan of the visual icon. We previously reported an identical reduction in processing-related negativity in childhood-onset schizophrenia, suggesting that this deficit is age independent. Both frontal contingent negative variation and an early frontal P3 were larger in the schizophrenics than in normal subjects, suggesting an inappropriate mobilization of nonspecific attentional resources. A later posterior P3 was significantly smaller in schizophrenics than in normal subjects.

Continuous-processing related ERPS in schizophrenic and normal children

The continuous performance task (CPT) has proven to be sensitive to schizophrenic impairments. Multichannel event-related potential (ERP) data were recorded from schizophrenic and normal children during performance of easy and hard versions of the CPT. Schizophrenics produced fewer hits, more false alarms, and prolonged reaction times. Poor performance in schizophrenics was associated with four ERP abnormalities: (1) Schizophrenics did not exhibit the normal increase in amplitude of an early-onset, processing-related negativity from nontarget to target stimuli, suggesting a failure to appropriately allocate attentional resources to discriminative processing. (2) Although P3 amplitude to targets was not significantly smaller in schizophrenic children, the distribution of P3 amplitude between target and nontarget responses in the easy and hard versions of the CPT was abnormal, suggesting that schizophrenics differed in the strategic allocation of resources in later stages of CPT processing. (3) In all task conditions schizophrenics showed a parietal negative component with a latency of 400 msec seen in younger, but not older normal children, suggestive of maturational lag. (4) ERP data demonstrated absence of right-lateralized P1/N1 amplitude in schizophrenic children. Taken together these data indicate that at several stages of information processing, schizophrenics are deficient in the control and strategic allocation of processing resources.

Information-processing deficits across childhood- and adult-onset schizophrenia

Event-related potentials were recorded for childhood- and adult-onset schizophrenia subjects performing the span of apprehension (Span) task, which is sensitive to vulnerability factors in schizophrenia. Subjects responded to the onset of the Span arrays in a reaction time condition and then responded differentially to the presence of one of two target letters in the Span condition. While neither the childhood- nor the adult-onset group exhibited abnormalities in preparatory contingent negative variation activity, both groups produced significantly less endogenous negative activity between 100 and 300 ms after Span stimulus onset than age-matched normals. This endogenous negative activity reflects attentional effort associated with serial search and stimulus identification. These results support the position that schizophrenia subjects are impaired in their ability to allocate adequate attentional resources for processing Span stimuli. Moreover, the similarity of this information-processing deficit in the two groups suggests that childhood- and adult-onset schizophrenia lie on a continuum in this regard.

Childhood-onset schizophrenia: editors' introduction

Descriptions of various psychotic symptoms in children began to appear in the psychiatric literature at about the same time as descriptions of psychotic symptoms in adults. For example, Kraepelin estimated that at least 3.5 percent of his cases of dementia praecox had onsets before age 10. The construct of "childhood schizophrenia" initially emerged from attempts to classify a broad range of psychotic children. By the late 1940s and 1950s, the diagnosis of "childhood schizophrenia" was given to many disturbed children who today would be considered to have infantile autism and other developmental disabilities. In the early 1970s infantile autism and its variants was differentiated from schizophrenia of childhood onset. These changes were incorporated in DSM-III, which returned to the practice before 1930 of diagnosing schizophrenia in children using the same criteria as for adults, with minor allowances for differences in the manifestations of these symptoms during childhood. The studies presented in this issue of Schizophrenia Bulletin use DSM-III, DSM-III-R, or ICD-9 criteria for schizophrenia.

Cognitive/neuropsychological studies of children with a schizophrenic disorder

This article summarizes a series of cognitive/neuropsychological studies of children with schizophrenia. One set of studies, which surveyed a broad range of neuropsychological functions, revealed no evidence that children with schizophrenia are consistently impaired in sensory, perceptual, or language functions. Rather, the studies showed that children with schizophrenia performed poorly on tasks requiring sensory, perceptual, and language processing that made extensive demands on information-processing capacity. A second series of studies, which examined visual information processing by manipulating the processing demands of span of apprehension tasks, yielded similar findings. The key characteristic of tasks that elicit impaired performance in children with schizophrenia is that the task makes extensive demands on processing resources. This suggests that these children have limited information-processing capacity. Three hypotheses are proposed concerning the cognitive processes that are impaired in children with schizophrenia: (1) the cognitive processes that seem to be impaired in these children are part of a more general, hierarchically organized attention system; (2) the component processes of the system are subserved by different brain structures; and (3) the structures are part of a network that includes the frontal lobe and thalamus in interaction with the reticular activating system.

Effects of attention training on information processing in schizophrenia

This study evaluated the impact of a cognitive retraining intervention designed to enhance the attention skills of schizophrenia patients. The dependent variables included measures of perceptual sensitivity and sustained vigilance derived from a visual continuous performance test, as well as visual span of apprehension and world-list recall. Sixteen subjects received approximately 15 hours of repeated practice with computer-mediated vigilance tasks. Seventeen subjects were assigned to a no-treatment control group. All subjects were rated on measures of negative and positive symptoms before treatment. Despite improved performance on the training tasks, no significant changes on the outcome measures were observed following treatment. Thus, it is suggested that cognitive rehabilitation interventions with schizophrenia patients stress the teaching of behavioral strategies that bypass deficits, rather than remediating deficiencies in basic abilities, such as attention.

Event-related potentials in high-functioning adult autistics: linguistic and nonlinguistic visual information processing tasks

Event-related potentials (ERPs) were recorded from high-functioning adult autistics and age- and IQ-matched normal controls during performance of two non-linguistic information processing tasks, the Continuous Performance Task (CPT) and Span of Apprehension (SPAN), and an Idiom Recognition Task (IRT) involving idiomatic, literal and nonsense phrases. The autistics exhibited behavioral deficits only when attempting to identify idiomatic phrases. The ERP correlate of that deficit was greatly reduced N400 to idioms. In addition, autistics produced larger N1 amplitudes in all tasks, and larger P3s in the IRT and CPT.

Preliminary associations between motor procedural learning, basal ganglia T2 relaxation times, and tardive dyskinesia in schizophrenia

The hypothesis that the caudate nucleus is involved in the pathophysiology of tardive dyskinesia (TD) in schizophrenia was investigated by examining motor procedural learning on the pursuit rotor task and basal ganglia T2 relaxation times (T2) determined using magnetic resonance imaging (MRI). Increased severity of TD was associated with shortened caudate T2 and decreased motor learning. Motor-learning scores of schizophrenic patients with and without TD did not differ significantly from those of normal control subjects, but motor learning in the schizophrenic patients correlated with caudate T2. The results suggest that a corticocaudate system subserves motor procedural learning and provide converging evidence from neuropsychological and MRI measures suggesting caudate involvement in TD.

Span of apprehension in schizophrenic patients as a function of distractor masking and laterality

Twenty schizophrenic patients, 10 depressed control patients, and 20 normal control subjects were compared in a forced-choice, target-detection method for assessing the span of apprehension. The detection task required the subject to report which of 2 target letters was presented among 7 other (distractor) letters. Performance accuracy was examined as a function of target location and whether the distractor letters were masked after their presentation. The backward masking of the distractors improved target-detection accuracy of both control groups but reduced accuracy of the schizophrenic group. In addition, schizophrenics performed particularly poorly on targets located in the left half or lower half of the display. These results suggest that response to the masking of distractors may be a new index of attentional shortcoming in schizophrenia. Various theoretical explanations for the target location findings are also discussed.

Span of apprehension in schizophrenic patients as a function of distractor masking and laterality

Twenty schizophrenic patients, 10 depressed control patients, and 20 normal control subjects were compared in a forced-choice, target-detection method for assessing the span of apprehension. The detection task required the subject to report which of 2 target letters was presented among 7 other (distractor) letters. Performance accuracy was examined as a function of target location and whether the distractor letters were masked after their presentation. The backward masking of the distractors improved target-detection accuracy of both control groups but reduced accuracy of the schizophrenic group. In addition, schizophrenics performed particularly poorly on targets located in the left half or lower half of the display. These results suggest that response to the masking of distractors may be a new index of attentional shortcoming in schizophrenia. Various theoretical explanations for the target location findings are also discussed.

Reduced attention-related negative potentials in schizophrenic children

ERPs were recorded from normal and schizophrenic children during performance of a reaction time task (RT) followed by a complex visual discrimination, the span of apprehension task (Span), sensitive to vulnerability factors in schizophrenia. Subjects responded rapidly to the onset of the visual arrays in the RT condition and differentially to the presence of 1 of 2 target letters in the Span condition. The EEG was recorded at 19 scalp sites and ERPs included activity 1 sec before through 1 sec after Span array onset. Difference potentials (Span-RT) were computed to remove unvarying exogenous activity, thus isolating endogenous activity associated with the processing demands of the Span task. When RT and Span task ERPs are compared, schizophrenic children produced a significantly smaller than normal increment in endogenous negative activity. This endogenous negativity differed in its topography and time course from the exogenous components (P1, N1 and P2), and most likely reflects attentional effort associated with serial search, pattern recognition and stimulus identification. We believe that the current results support the position that schizophrenics are impaired in their ability to allocate adequate attentional resources for the processing of the Span stimuli. It is important to note that this deficit is apparent quite early in discriminative processing.

Interrater reliability of the Structured Clinical Interview for DSM-III-R, Axis II: schizophrenia spectrum and affective spectrum disorders

Three interviewers (second raters) blindly rated 15 audiotapes each of the Structured Clinical Interview for DSM-III-R, Axis II (SCID-II) administered to the first degree relatives of probands with either DSM-III-R schizophrenia, schizoaffective disorder, or bipolar disorder, for a total of 45 second ratings. Interrater reliability was determined using the intraclass correlation coefficient and ranged from 0.60 to 0.84. The previous studies of the reliability of structured interviews for diagnosing personality disorders are summarized and compared to the present findings. We conclude that the SCID-II can be reliably used to diagnose schizophrenia-spectrum and affective spectrum disorders in the first degree family members of probands with schizophrenic or bipolar affective disorders.

Behavior problems and adaptive functioning in children with mild and severe closed head injury

Assessed behavior problems and adaptive functioning in children with mild or severe closed head injuries, on average more than 2 years postaccident. To ensure that any problems detected in the present study were not merely preexisting problems, potential subjects were excluded if there was a history of preexisting CNS damage, significant developmental delay, or behavior problems. Children with severe head injuries had an excessive rate of behavior problems and impaired adaptive functioning. Children with mild head injuries also had an excessive rate of behavior problems (comparable to that of children with severe head injuries) but did not have impaired adaptive functioning. Results are discussed in terms of six alternative ways brain injury and behavior problems can be related functionally.

Genetic factors for the span of apprehension test: a study of normal twins

The Partial Report Span of Apprehension test has been found to detect cognitive deficits in some first degree relatives of schizophrenic patients. To assess the relative contribution of genetic vs. environmental factors on this measure, 19 monozygotic and 14 dizygotic female twin pairs, selected from a normal population, were tested on the Span of Apprehension test and an IQ test. Both Span of Apprehension test performance and IQ score had high heritabilities: 0.65 and 0.71, respectively. The mode of transmission for performance on the Span of Apprehension test appears to operate in a nonadditive manner. A multivariate behavioral-genetic model applied to the Span of Apprehension and IQ measures indicated that slightly less than half of the genetic effects important for the Span of Apprehension test are found in common with the genetic factors important for IQ. The phenotypic correlation between the Span of Apprehension and IQ measures can be attributed entirely to genetic factors. The influence of unique genetic components in the performance of the Span of Apprehension test in the general population heightens the promise of this measure as a genetic marker for schizophrenia.

Controlled information processing resources and the development of automatic detection responses in schizophrenia

The relation between resource limitations and the type of processing (automatic vs. controlled) on a multiple-frame search task (MFST) was examined in 15 schizophrenic and 15 normal control subjects. After 320 trials of consistently mapped practice, the patients' detection accuracy was normalized, and the effect of processing load (letter array size) on their detection accuracy was eliminated, which suggests automatization. Changes in load effects with practice could not be used as an index of automatization in control subjects, because of their unexpected lack of load effects at the beginning of practice. In a dual-task (MFST during auditory shadowing) condition after MFST practice, patients' MFST accuracy deteriorated nonsignificantly, and patients' shadowing declined significantly. The findings suggest schizophrenics have reduced available processing resources, but research is needed to determine whether this is due to abnormal automatization.