Schizophrenia: Early Warning

The Harvard Mental Health Letter, November 1992

Psychiatrists analyzing the results of several studies conducted over the last forty years believe they can identify signs of vulnerability to chronic schizophrenia in the first year of life. Although most researchers dismiss the evidence from studies of infants as inconsistent, the authors say they have discerned a certain complex pattern of uneven growth: irregular visual and motor development, with periods of falling behind and periods of catching up; abnormal performance on neuropsychological tests (the child fails some simple tests while passing more complex ones); and delayed physical growth. The authors call this syndrome pandysmaturation (PDM).

The evidence for the significance of PDM comes mainly from two studies, one conducted in New York since the 1950s and the other conducted in Jerusalem since the 1970s. In the New York study, 12 children of chronic schizophrenic mothers (high-risk infants) and 12 controls matched for social class were followed from birth until the present. Most of the high-risk infants were raised in warm stable homes by grandparents or adoptive parents. Nevertheless, seven had the symptoms of PDM, and all seven have had serious psychiatric symptoms at least since the age of six. They are now in their thirties. Three have been psychiatrically hospitalized, and four are severely impaired. One has been schizophrenic since the age of 19, and each of the other six has been diagnosed by at least one judge as a schizotypal or paranoid personality. Only one child in the control group had PDM symptoms, and none have developed schizophrenia or schizotypal personality.

In the Jerusalem study, 19 children with a schizophrenic parent were compared to 23 children of parents with other mental illnesses (mainly mood and personality disorders) and 16 children of healthy parents. On tests of infant development administered et the ages of four, eight, and twelve months, the children of schizophrenic parents, on the average, scored considerably lower than the two control groups. Thirteen of the 19 were also slow in achieving upright posture and the ability to reach and grasp; four had low birth weights unrelated to obstetrical complications. Reexamined at the age of ten, half the children of schizophrenic parents but only about 20 percent in the other two groups showed signs of poor cognitive and motor functioning. Examining the records for signs of PDM, the authors find that it occurred only in children of schizophrenic parents and was associated with a high level of impairment at age ten. These children are now reaching the age at which schizophrenic symptoms begin to develop.

The authors cite seven other less conclusive studies in which children of schizophrenic parents were found to have lower birth weights, delayed motor development, and inconsistent performance on cognitive tests. They also mention three retrospective studies in which childhood records of schizophrenic patients revealed various neurological deficiencies. They conclude that PDM signals a profound failure in the regulation of development that is evidence of a hereditary or other congenital predisposition to schizotypal personality and, by extension, to schizophrenia.

Barbara Fish, Joseph Marcus, Sydney L. Hans et al. Infants at risk for schizophrenia: sequellae of a genetic neurointegrative defect. Archives of General Psychiatry, 49:221-235 (March 1992).

President and Fellows of Harvard College, 1992.
Reprinted with permission.

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