Conversational repair in schizophrenic and normal children

Clinical features and comorbidity in very early-onset schizophrenia: a systematic review

Background

Very early-onset schizophrenia (VEOS) is a form of schizophrenia that manifests before the age of 13 years and is characterized by the presence of positive, negative, and disorganized symptoms. The condition is exceptionally rare and, to date, limited studies have been conducted, resulting in incomplete information about its clinical features.

Methods

The present study involves a systematic review of the existing literature regarding the clinical features and comorbidities of VEOS.

Results

The first search retrieved 384 studies. Of these, 366 were removed following the application of exclusion criteria, resulting in 18 studies for the final set.

Conclusion

The results highlight that VEOS shares similarities with early-onset and adult-onset schizophrenia but also exhibits distinct and recognizable characteristics, including a more severe clinical profile (particularly in females), increased visual hallucinations, and high comorbidities with neurodevelopmental disorders. These findings may support clinicians in formulating early diagnoses and developing effective treatment strategies for pediatric and adolescent patients with psychosis.

Quirky conversations: how people with a diagnosis of schizophrenia do dialogue differently

People with a diagnosis of schizophrenia (PSz) have difficulty engaging in social interaction, but little research has focused on dialogues involving PSz interacting with partners who are unaware of their diagnosis. Using quantitative and qualitative methods on a unique corpus of triadic dialogues of PSz first social encounters, we show that turn-taking is disrupted in dialogues involving a PSz. Specifically, there are on average longer gaps between turns in groups which contain a PSz compared to those which do not, particularly when the speaker switch occurs from one control (C) participant to the other. Furthermore, the expected link between gesture and repair is not present in dialogues with a PSz, particularly for C participants interacting with a PSz. As well as offering some insights into how the presence of a PSz affects an interaction, our results also demonstrate the flexibility of our mechanisms for interaction. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

Linguistic and neurocognitive correlates of probabilistic classification learning in schizophrenia

Individuals with schizophrenia demonstrate impaired implicit learning on cognitively complex tasks and preserved implicit motor learning. However, little is known about how implicit learning may be related to other linguistic and cognitive variables, including development of complex language including comprehension and syntax. This study explored the relationship between probabilistic classification learning, a type of implicit learning style, and linguistic and cognitive skills in schizophrenia. This was done by examining how schizophrenia patients perform on the Weather Prediction Task (WPT) relative to controls, particularly during a dual-task interference condition that assesses task automaticity. Individuals with schizophrenia (N = 34) demonstrated depressed cognitive functioning relative to the controls (N = 18) across nearly all cognitive functions. On the Weather Prediction Task, the schizophrenia group performed less accurately than the control group in later blocks and had a relatively flat learning curve. A significant Group X Block effect when controlling for age and sex suggested differential learning throughout the task. A subgroup of patients did not develop automaticity during the repeated blocks of trials. For those patients who did not develop automaticity over the course of the WPT, linguistic and cognitive skills were strongly correlated with their Block 1 performance. For patients who developed automaticity, overall neurocognitive ability was correlated with their ultimate level of performance on the WPT but not with their Block 1 performance. That language was related to differential learning emphasizes the role of explicit, verbal processes on making initial rapid improvement on the WPT.

Examining Self-Reported Thought Disorder: Continuous Variation, Convergence with Schizotypy, and Cognitive Correlates

When measured from the perspective of a clinician, the severity of 'objective' thought disorder (TD) has been found to vary continuously between people with and without psychosis-related diagnoses, and has been linked with semantic and executive dysfunctions in people with psychosis. Measures of 'subjective' TD that are derived from a first-person perspective have also been produced, but their relationships with objective TD and cognition are unclear. The aims of the current study were: to determine whether responses on a self-report TD questionnaire correspond with responses to a self-report measure of schizotypal disorganization; and to explore the association between these self-reported subjective TD severities and cognitive performance. Data was collected from a sample of 33 people without psychiatric diagnoses and 38 people diagnosed with schizophrenia or schizoaffective disorder evincing mild symptomatology, and this data was pooled for analysis in accordance with the continuum model. Self-reported TD frequencies were associated with the endorsement of disorganized schizotypal experiences. Moreover, self-reported TD frequencies showed relationships with measures of semantic and executive functioning. Thus, at mild severities, self-reported TD shows continuous variation and is associated with altered cognitive function.

The Clinical Presentation of Childhood-Onset Schizophrenia: A Literature Review

This literature review explores the research on the clinical presentation of childhood-onset schizophrenia (COS) that was conducted in the period 1994–2004. A literature search was done using Internet search engines and psychological databases to collect English-language journal articles from 1994 onwards. Research indicates that COS is a stable diagnosis. Generally, there is a clear history of premorbid abnormalities, an insidious onset and a deteriorating course. For the majority of cases there seems to be a poor outcome. Despite the limitations in the research conducted thus far, findings provide important insights into COS and several possibilities for future research.

Recognition and repair of communicative failures: the interaction between Theory of Mind and cognitive complexity in schizophrenic patients

The aim of the present research is to perform a detailed and empirical investigation of schizophrenia patients' deficits in recognizing and recovering a communicative failure. In particular, this paper investigates the role of Theory of Mind (ToM) and of the complexity of the mental representations involved in explaining patients' deficits in recognizing and recovering different kinds of communicative failures, i.e. failure of the expressive act, failure of communicative meaning and failure of the communicative effect. Twenty-two patients with schizophrenia and an equal number of healthy controls took part in the experiment. The experimental protocol consisted of videotaped stories in which two agents interact, showing a communicative failure; the participants were asked to recognize and repair the observed failure. Some classical ToM tests (Sally and Ann, Modified Smarties and a selection of six Strange Stories) were also administered. Our results revealed a deficit in patients, when compared with healthy controls, in recognizing and recovering communicative failures. Furthermore, focusing on schizophrenia patients' performance per se, we observed a trend with regard to the increasing difficulty of understanding and recognizing different kinds of communicative failures, i.e. failure of expression act, failure of communicative meaning, and failure of the communicative effect.

LEARNING OUTCOMES

The reader becomes aware that schizophrenic patients perform less well than healthy controls in recognizing and recovering different kinds of communicative failures, and of the role played by Theory of Mind, and representational complexity involved in such different kinds of failures, in explaining patients' performance.

Semantic Processing and Thought Disorder in Childhood-Onset Schizophrenia: Insights from fMRI

Impairments in language processing and thought disorder are core symptoms of schizophrenia. Here we used fMRI to investigate functional abnormalities in the neural networks subserving sentence-level language processing in childhood-onset schizophrenia (COS). Fourteen children with COS (mean age: 13.34; IQ: 95) and 14 healthy controls (HC; mean age: 12.37; IQ: 104) underwent fMRI while performing a semantic judgment task previously shown to differentially engage semantic and syntactic processes. We report four main results. First, different patterns of functional specialization for semantic and syntactic processing were observed within each group, despite similar level of task performance. Second, after regressing out IQ, significant between-group differences were observed in the neural correlates of semantic and, to a lesser extent, syntactic processing, with HC children showing overall greater activity than COS children. Third, while these group differences were not related to effects of medications, a significant negative correlation was observed in the COS group between neuroleptic dosage and activity in the left inferior frontal gyrus for the semantic condition. Finally, COS children's level of thought disorder was significantly correlated with task-related activity in language-relevant networks. Taken together, these findings suggest that children with COS exhibit aberrant patterns of neural activity during semantic, and to a lesser extent syntactic, processing and that these functional abnormalities in language-relevant networks are significantly related to severity of thought disorder.

Establishing mutual understanding in interaction: an analysis of conversational repair in psychiatric consultations

The therapeutic relationship is the greatest predictor of treatment outcome, yet its relationship to communication is largely unevaluated. This study explored how psychiatrists and people with a diagnosis of schizophrenia establish mutual understanding in naturalistic communication, and associations with the therapeutic relationship, patient satisfaction and symptoms. In conversation analysis, the concept of repair focuses on how participants in interaction create mutual understanding and address misunderstanding. A standardized protocol measuring the frequency of repair was applied to 15 outpatient consultations. Correlations between repair and the therapeutic relationship, patients' experience of the consultation and symptoms were explored. Patients made most effort to make their contribution understandable, whereas psychiatrists made most effort to repair misunderstandings. The more positively psychiatrists rated the relationship, the more effort they made to understand patients. Although psychiatrists' efforts were not associated with patients' overall view of the relationship, patients felt better emotionally, despite, feeling less understood. Psychiatrists used fewer repairs when patients were more symptomatic. Both parties prioritized understanding similar topics but psychiatrists focused more on medication and patients on voices. Quantifying repair offers a new way of analyzing how mutual understanding is established in interaction, and links communication processes with treatment outcomes.

Thought disorder and frontotemporal volumes in pediatric epilepsy

The aim of this study was to determine if volumes of frontotemporal regions associated with language were related to thought disorder in 42 children, aged 5-16 years, with cryptogenic epilepsy, all of whom had complex partial seizures (CPS). The children with CPS and 41 age- and gender-matched healthy children underwent brain MRI scans at 1.5 T. Tissue was segmented, and total brain, frontal lobe, and temporal lobe volumes were computed. Thought disorder measures, IQ, and seizure information were collected for each patient. The subjects with CPS had more thought disorder, smaller total gray matter and orbital frontal gray matter volumes, as well as larger temporal lobe white matter volumes than the control group. In the CPS group, thought disorder was significantly related to smaller orbital frontal and inferior frontal gray matter volumes, increased Heschl's gyrus gray matter volumes, and smaller superior temporal gyrus white matter volumes. However, significantly larger orbital frontal gyrus, superior temporal gyrus, and temporal lobe gray matter volumes and decreased Heschl's gyrus white matter volumes were associated with thought disorder in the control group. These findings suggest that thought disorder might represent a developmental disability involving frontotemporal regions associated with language in pediatric CPS.

The Use of Conversational Repairs by African American Preschoolers

Purpose

This study aimed to describe the types and frequency of conversational repairs used by African American (AA) children in relationship to their geographic locations and levels of performance on commonly used speech-language measures.

Method

The strategies used to initiate repairs and respond to repair requests were identified in audiovisual records of spontaneous speech sampled from 120 Head Start students in Michigan ( n = 69) and Louisiana ( n = 51) at 3 years of age. The 30–40-min samples were elicited with common stimuli and activities while the children interacted with an adult examiner.

Results

All participants initiated repairs and responded to examiner requests for conversational repairs. Some repair strategies were observed more often than others. The frequency, but not the types, of some of the strategies used varied significantly with participant location and level of speech-language performance.

Conclusion

AA children used the same types of conversational repair strategies that have been observed among young speakers of Standard English varieties.

Clinical Implication

Use of conversational repairs should be included among the pragmatic behaviors expected for 3-year-old AA children.

Thought disorder: A developmental disability in pediatric epilepsy

This study compared thought disorder (i.e., impaired use of language to formulate and organize thoughts) in 93 children with complex partial seizures (CPSs) and 56 children with primary generalized epilepsy with absence (PGE) and its relationship to age, seizure, cognitive, and linguistic variables. By the use of psychopathology, social competence, academic achievement, and school problem measures, the functional implications of thought disorder in these two groups were compared. When demographic variables were controlled for, there were no significant differences in thought disorder scores between the CPS and PGE groups. However, the profile of age, gender, seizure, and cognitive variables related to thought disorder differed in the CPS and PGE groups. Within each group, different aspects of thought disorder were associated with different seizure variables. Thought disorder was related to psychopathology, school problems, decreased academic achievement, and poor peer interaction in the CPS group, but with school problems in the PGE group. These findings suggest that CPS and PGE affect the normal maturation of children's discourse skills, albeit through different mechanisms. The relationship of thought disorder to behavioral, academic, and social problems implies that these discourse deficits are one component of the developmental disabilities or comorbidities associated with pediatric CPS and PGE.

Thought disorder and nucleus accumbens in childhood: a structural MRI study

Thought disorder has been described as a hallmark feature in both adult and childhood-onset schizophrenia. The nucleus accumbens (NAc) has been repeatedly proposed as a critical station for modulating gating of information flow and processing of information within the thalamocortical circuitry. The aim of the present study was to investigate the relationship of thought disorder measures, which were administered to 12 children with schizophrenia and 15 healthy age-matched controls, and NAc volumes obtained from high-resolution volumetric magnetic resonance imaging analyses. The propensity for specific thought disorder features was significantly related to NAc volumes, despite no statistically significant differences in the NAc volumes of children with schizophrenia and normal children. Smaller left NAc volumes were significantly related to poor on-line revision of linguistic errors in word choice, syntax and reference. On the other hand, underuse of on-line repair of errors in planning and organizing thinking was significantly associated with decreased right NAc volumes. The results of this pilot study suggest that the NAc is implicated in specific thought patterns of childhood. They also suggest that subcortical function in the NAc might reflect hemispheric specialization patterns with left lateralization for revision of linguistic errors and right lateralization for repair strategies involved in the organization of thinking.

Conversational repair in pediatric epilepsy

This study examined if children with complex partial seizures disorder (CPS) and primary generalized epilepsy with absence (PGE) were impaired in the use of self-initiated repair during a conversation compared to normal children. Transcriptions of speech samples of 92 CPS, 51 PGE, and 65 normal children, ages 5-16 years, were coded for self-initiated repair according to Evans (1985). The WISC-R, a structured psychiatric interview, and seizure-related information were obtained for each child. We found impaired use of repair in both the CPS and PGE groups compared to the normal subjects. The CPS patients, particularly those with a temporal lobe focus, overused self-initiated corrections of referents and syntax compared to the PGE and normal subjects. The CPS and PGE patients with frontal lobe involvement underused fillers compared to the normal children. These findings provide additional evidence that both CPS and PGE impact the ongoing development of children's communication skills.

Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. American Academy of Child and Adolescent Psychiatry

This practice parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Recommendations are based on the limited research available, the adult literature, and clinical experience. Early-onset schizophrenia is diagnosed using the same criteria as in adults, and it appears to be continuous with the adult form of the disorder. Noted characteristics of youth with schizophrenia include predominance in males, high rates of premorbid abnormalities, and often poor outcome. Differential diagnosis includes psychotic mood disorders, developmental disorders, organic conditions, and nonpsychotic emotional/behavioral disorders. Treatment strategies incorporate antipsychotic medications with psychoeducational, psychotherapeutic, and social and educational support programs. The advent of atypical antipsychotic agents has enhanced the potential for effective treatment.

Childhood schizophrenia: responsiveness to questions during conversation

OBJECTIVES

This study characterized further the communicative deficits associated with childhood-onset schizophrenia. It examined the use of speech functions that involve responses to Yes/No and Wh- questions in children with schizophrenia and normal children during conversation. It also ascertained the relationship of these speech functions with cognition and thought disorder.

METHOD

Speech function variables, formal thought disorder, and cohesion were coded in 32 schizophrenic and 34 normal children, aged 5.6 to 12.4 years, from speech samples elicited with the Story Game.

RESULTS

The schizophrenic children were significantly more impaired in the use of speech functions than the normal children. Other than the association of a subset of the speech functions with distractibility and loose associations, the speech function measures were unrelated to cognitive and thought disorder measures.

CONCLUSIONS

Speech function analysis detects communication deficits not captured by thought disorder measures in children with schizophrenia.

Language disorders: a 10-year research update review

OBJECTIVE

To review the past 10 years of research in child language or communication disorders, which are highly prevalent in the general population and comorbid with childhood psychiatric disorders.

METHOD

A literature search of 3 major databases was conducted. The child language literature, describing the domains of language development--phonology, grammar, semantics, and pragmatics--is reviewed.

RESULTS

Disorders of grammar, semantics, and pragmatics, but not phonology, overlap significantly with childhood psychiatric disorders. Receptive language disorders have emerged as high-risk indicators, often undiagnosed. Language disorders and delays are psychiatric risk factors and have implications for evaluation, therapy, and research. However, they are often undiagnosed in child mental health and community settings. The research has focused mostly on monolingual English-speaking children.

CONCLUSION

Awareness of basic child language development, delay, and deviance is crucial for the practicing child and adolescent psychiatrist, who must diagnose and refer relevant cases for treatment and remediation. Future research needs to address the growing language diversity of our clinical populations.