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The need to understand the complex interplay between a number of variables, including genetics, environmental factors, clinical, psychological and social processes, in the development of brain disorders and the resultant behavioural and cognitive deficiencies informed the urge to evaluate and critique the article by de la Serna and colleagues, titled “Relationship between Clinical and Neuropsychological Characteristics in Child and Adolescent First Degree Relatives of Subjects with Schizophrenia.”
In particular, the topic is of great interest in the study of brain and behaviour because schizophrenia affects the growth and development of many children and adults, not only in terms of their psychological wellbeing but also their cognitive and social skills.
The critiqued article was retrieved from the ScienceDirect database of the Elsevier Databases using the search terms “schizophrenia”, “cognition” and “neuropsychology.”
This particular article stood out from the rest due to the new knowledge it sought to divulge, particularly on the influence of diagnosis for schizophrenia on cognitive variables in children at high risk of developing the mental disorder (de la Serna et al, 2010).
The questions that arose upon reading the abstract of the article included: 1) Is schizophrenia associated more with genetic factors than with environmental processes, and 2) what cognitive and/or behavioural disorders may be predominant in siblings of a family with a history of schizophrenia.
The article under review purposed “…to describe the clinical and neuropsychological characteristics of children and adolescents at high risk for schizophrenia compared to healthy controls, and to investigate the influence of diagnosis on clinical symptoms and cognitive assessment” (de la Serna et al, 2010, p.160).
The authors were informed by the need to fill the dearth in knowledge that existed on drawing the relationship between the diagnoses for schizophrenia on the one hand and cognitive and behavioural manifestations of people considered at high-risk on the other. It is important to note that the authors of the article did not formulate any research questions or hypothesis to guide the study.
The participants for the study included 26 high-risk children who were first-degree relatives of individuals already clinically diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. For comparison purposes, the researchers also engaged 20 control children and adolescents of individuals with no history of any psychotic disorder according to the DSM-IV criteria (de la Serna et al, 2010).
The experimental and the control groups were evaluated and interviewed by a trained clinical psychologist using a semi-structured interview and other rating scales, such as the Conner’s Parent Rating Scales (CPRS-48) to assess psychopathological symptomatology, the Hollingshead Redlich Scale to estimate the socio-economic status, and the Wechsler Intelligence Scale for Children-Forth Edition (WISC-IV to evaluate the intelligence quotient (IQ).
The results of the study demonstrated that 4 in every 10 participants in the experimental group (high-risk) had a diagnosis of one or more psychiatric disorders according to the DSM-IV criteria, with attention deficit/hyperactivity disorder (ADHD) and the generalized anxiety disorder taking the first and second place, respectively (de al Serna et al, 2010).
Another major finding of the study was that high risk children and adolescents scored highly than the control group not only on the prodromal symptoms, behavioural challenges and premorbid adjustment, but also on the majority of other scales intended to measure intelligence, social adjustment, cognition, working memory and logical memory.
Still, the findings demonstrated clinical variations between high-risk children with attention deficit disorder (HR-ADD), high-risk children without attention deficit disorder (HR-NADD), and the control group, particularly in prodromal symptoms, behavioural challenges and premorbid adjustment.
In particular, it was found that HR-ADD children had substantially higher scores on prodromal symptomatology than did HR-NADD participants and the control group, in large part due to attentional difficulties, behavioural inhibition and absence of social competence. According to de la Serna et al (2010), “…cognitive assessment revealed significant differences between HR children and controls on the majority of cognitive domains evaluated: intelligence, working memory, verbal memory and learning” (p. 165).
Equally, the high-risk children achieved considerably lower scores than the control group when their level of intelligence was evaluated using various scales such as the WISC-IV.
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The study concluded that “…HR children had elevated rates of prodromal symptomatology, psychopathology and psychiatric diagnosis, especially ADHD, compared to normal controls” (de la Serna et al, 2010, p. 165). Additionally, it was concluded that HR children and adolescents had more cognitive difficulties in IQ, behavioral problems, and other challenges related to the working and logical memory than did the control group.
Lastly, there were no considerable cognitive differences between HR-ADD and HR-NADD subjects, implying that HR samples seem to have a comparable cognitive pattern that is not only widespread in both subgroups but is independent of the underlying clinical diagnosis. However, it is important to note that the study was limited by the small sample size, difficulties in conducting the clinical and cognitive assessment, and lack of demographic information (birth histories) of the experimental and control groups (de al Serna et al, 2010).
As is the case with other published research articles, this particular study has its own merits, particularly in the light of new knowledge on clinical and neuropsychological characteristics of children and adolescents at an elevated risk for schizophrenia when compared to the general population.
The study has also brought into the limelight the influence of diagnosis of schizophrenia on clinical symptoms and cognitive evaluation of individuals with the aim of analyzing the risks involved. These are important findings in schizophrenia research, particularly in the preparation and administration of clinical and psychological interventions to individuals who may be considered at greatest risk of developing the neurodevelopmental disorder.
The article, in my view, is focused and written in a coherent manner, particularly in the introduction section and the review of related literature. However, there exist some obvious limitations that require to be addressed with the view to add more value to the study. First, it has been noted that the researchers utilized very many data collection tools in the methodology section, almost leaving the reader confused.
The researchers are also not clear on the type of research design used, leaving the reader to assume that they might have used a mixed-methods research design since they used semi-structured interviews as well as scales to collect data. The study, in my view, could have been more coherent if the researchers included some research questions or hypotheses.
Sadly, this was not done despite the fact that the researchers dealt with a broad research objective, which could have been fragmented into several research questions to attain clarity of responses.
Although the findings infer causation from a correlational design by virtue of the fact that predisposition towards people with schizophrenia is positively correlated with the development of cognitive and behavioural challenges, it is generally felt that the development of research questions could have enabled the reader to understand the relationships explained in the findings section.
The results are valid in as far as they have been corroborated by other previous studies. However, a larger sample size could have made the results to be more generalizable across a bigger population.
The most important implication that arises from this study is that children and relatives of people with schizophrenia, considered to be high-risk population, can be introduced to preventative interventions early in life as it has been demonstrated that they have a higher chance of developing mental, behavioural, psychological and cognitive impairments than children and adolescents sampled from the general population.
Consequently, the article is not only enjoyable to read but also informative since it comes up with new knowledge that could be used by clinical psychologists to address the symptoms of schizophrenia.
If this research study was to be repeated in the future, it could have been imperative for the researchers to devote more time into the development of an all-inclusive data collection tool to collect the required data from the experimental as well as the control groups. Additionally, it could have been plausible for the researchers to develop a set of key research questions to guide the research process.
As suggested by the authors, “…future research is needed to identify specific cognitive and neuropsychological markers that would predict later onset of schizophrenia and help define clinical groups at enhanced risk” (de al Serna et al, 2010).
In considering the relevance of the article to the course, the idea that brain functions and behavioural orientations are innately linked has been reinforced. It has been demonstrated that some cognitive and behavioural orientations can be explained through genetics.
Personally, it has been learned that schizophrenia definitely has genetic connotations in that children from families with incidences of schizophrenia have been found to be at a high risk of developing behavioural and cognitive difficulties than children from the general population. Such knowledge, in my view, is fundamental in professional practice since it can assist clinical psychologists and counsellors to develop intervention measures to be used by at-risk groups before succumbing to the neurodevelopmental disorder.
de la Serna, E., Baeza, I., Toro, J., Andres, S., Puig, O., Sanchez-Gustau, V…Castro-Fornieles, J. (2010). Relationship between clinical and neuropsychological characteristics in child and adolescent first degree relatives of subjects with Schizophrenia. Schizophrenia Research, 116, 159-167