Eva P. Lester

Children of parents with manic-depressive illness: a follow-up study.

Thirty-seven offspring from 21 families with a manic-depressive parent were studied 3 to 7 years following initial evaluation. The study examined both pedigree information and psychosocial variables including parental, marital and overall adjustment, measures of chronicity and severity of parental illness and family assessment measures in rleationship to offspring functioning. Nine of the 37 offspring (24%) received a positive DSM-III diagnosis, which is a similar percentage of positive diagnosis of children as we found previously. The diagnoses clustered in the affective illness spectrum. When the presence of affective traits was considered, there was evidence for continuity of psychopathology in most cases. Associations between offspring psychopathology and both non-specific and specific parental risk factors are discussed.

Psychopathology in the offspring of parents with bipolar affective disorders.

Thirty-nine children from intact families with a manic-depressive parent were evaluated by a semi-structured clinical interview and a number of rating scales for the presence or absence of psychopathology. This sample represents a larger one than in an earlier study, which showed minimal offspring psychopathology compared with reports of other investigators. The current study also examines the inter-relationships between the presence or absence of offspring psychopathology with both genetic loading and a number of psychosocial variables including measures of parental marital adjustment, severity and chronicity of proband parent illness and early exposure of children to parental illness. Nine of the thirty-nine children, (23%) received a positive DSM-III diagnosis, with depression of the dysthymic type being the most common. There was no significant correlation between genetic loading and offspring psychopathology. However, there were significant associations between children with psychopathology and paternal marital dissatisfaction and the age and chronicity of illness of the proband parent as compared with the children with no psychopathology.

Studies of the affective state in bereaved children.

The process of bereavement in children ranges from the absence of grief to symptoms of anxiety and conduct disturbances. Some psychoanalytic opinion holds that the absence of grief, associated with lack of cognitive maturity, leads to the development of psychopathology later in life. Other writers describe a mourning response, taking the form of ambivalence, anxiety, and care giving, which may protect against subsequent depression. This paper describes the affective response in 16 children ages four to 17 years, two to three years following the death of a parent, in order to further characterize developmental aspects of the emotional repertoire of bereavement. Only children aged 12 and over were depressed according to the Poznansky Childrens Depression Rating Scale and criteria in the DSM-III. Conduct disturbances were observed in the younger children and some of the older children and were correlated with depression in the group as a whole. This suggests that the expression of depressive affect depends on maturation and that the young child may register grief only through anxiety and negativism. Examples of this spectrum of responses are offered in two case vignettes.

RELATIONSHIP OF PIAGET MEASURES TO STANDARD INTELLIGENCE AND MOTOR SCALES

A 3-yr. longitudinal study of standard IQ tests and Piaget developmental scales for children ages 5 to 8, shows a high relationship (.52, .57, .62) between the tests despite theoretical differences in construction. Tests are equally effective in predicting achievement in Grades I and II. A short-form battery of “best tests” in Piaget and WISC batteries yielded multiple Rs of .80 to .69. Relationship of Piaget tests to motor scales is low (.30) but significant.

Symposium: Anorexia Nervosa and Obesity — Recent Developments

All recent surveys indicate that there is an increase in the incidence of obesity and anorexia nervosa, the two eating disorders which constitute the subject of this symposium. Thirty percent of the population in the U.S. are considered overweight and in a study of private schools for girls in Britain, one out of 200 adolescent girls suffer from anorexia nervosa. For a syndrome once as rare as anorexia nervosa this is a very high incidence and the true incidence may be even higher. At this stage of our knowledge we must rely on a syndrome definition of the disorder, the diagnostic criteria are by necessity confining and many atypical forms are therefore excluded. Such atypical forms as cases with late onset or cases where weight loss is less than the prescribed 25% of body weight might have been better diagnosed if criteria were based on etiologic factors. About 20% of patients with anorexia nervosa have been markedly overweight at the onset of the anorexia or shortly before this. Furthermore, 25% of all patients with anorexia report episodic bulimia and eating binges. In a somewhat smaller percentage of patients, anorexia nervosa and severe weight loss alternate regularly with frank obesity. From the above and other related statistics it is evident that these two disorders of eating are interrelated in their neurophysiological and psycho-developmental mechanisms. The parallel increase in their incidence, observed in recent years, establishes another, more general, relationship which raises important questions. Whatever the psychophysiologic origins of obesity, the fact remains that overweight is directly correlated to overeating; this in turn is related to the abundance of food and the promotion of foods with high caloric content. Although in the past overeating and overweight within privileged groups of a given society was not uncommon, the high incidence of obesity in all socioeco-

Sex differences in the performance of school children.

Marked and consistent differences in academic performance between boys and girls were found in a longitudinal study of young school-age children. Performance, measured by objective tests administered by a psychologist, was higher in girls in all grades (Grade I to Grade V). However, tests of intelligence, perceptual maturity and conceptual ability showed no sex-linked differences — the only tests favouring the girls were those of motor ability. To explain the better academic performance of female children, personality attributes were considered (C.P.I.). Statistically significant differences were found in three personality dimensions: girls were found to be obedient and dependent, sober-minded and quiet, practical and realistic. In contrast the boys were found to be assertive and independent, excitable and happy-go-lucky, sensitive and free thinking. The significance of these findings is discussed in terms of academic achievement and also in terms of culturally-determined sex-typing of young children.

Cognitive structure and achievement in the young child.

Recent findings from a longitudinal study or early school learning indicate that the Piaget measures of cognitive functioning at the Kindergarten level are reliable predictors of achievement in Grades I and II. Their predictive value remains statistically significant even after the I.Q. effect is ‘partialled’ out. A combined ‘test’ including the best Piaget subtest (Seriation and Time) with the Picture Arrangement from the WISC and the total score from the Lincoln Osseretsky (Motor Development test), when administered at Kindergarten, gives a surprisingly high prediction for achievement at Grades I and II. The significance of these findings is discussed. It is suggested that the Piaget tests at this level tap an important dimension of development, possibly that related to individuation and Ego autonomy.

On transference: developmental and clinical considerations

Following a short historical overview of the evolution of the concept of transference, the factors involved in this process are examined. The developmental or dynamic aspects of transference, that is, its illusory character defined by the “potential space” within which transference develops, and the importance of the holding environment at the early stages of therapy for an optimal development of transference are discussed. To understand resistances, Merton Gills distinction of resistances to the awareness of the transference, and resistances to the resolution of the transference are particularly relevant. Finally, the concept of transference neurosis is focused upon. Detailed clinical vignettes are given to illustrate the points made. Although the clinical material is taken from sessions of patients in analysis the theoretical implications pertaining to the transference are equally applicable to the practice of psychoanalytic psychotherapy. It is in this spirit that throughout the paper the terms “therapeutic” and “analytic” are used interchangeably.

Book Review: The Psychoanalytic Study of the ChildThe Psychoanalytic Study of the Child, Vol. 32. Eds. FreudAnna, L.L.D., EisslerRuth S., M.D., KrisMarianne, M.D., NeubauerP.B., M.D. and SolnitAlbert J., M.D. New Haven, Conn.: Yale University Press, 623 pp.,

ter on the biology of aging and its role in depression is an excellent review of available knowledge in this very important area. The social aspects of aging are given equal attention to those of the biological ones. Maddoxs call for a differential gerontology in response to the currently used sterotyping of the elderly is seen as a progressive step. The section on Mental Health and Community Support Systems consists of a set of recommendations, most of which could also be applied in Canada. Societys response or rather the lack of it was pointed out by Busse in describing the neglect of the elderly females sexual role by the womens liberation movement. The roles and attitudes of families in relation to the elderly person, as well as the attitudes of physicians, are discussed by Charles M. Gaitz. These are only some of the issues presented in this volume, many others will be of interest to the reader. The book gives the overall impression that aging is an essentially individual experience which can range from loss and suffering to personal growth and self-realization.

22.50, 1977.

Symbolic behaviour in the young child is closely related to the symbolic thought of this age. This thought is based on the early types of mental representation or imagery, with its particular characteristics. Dysfunctional types of this behaviour, despite their symbolism, should not be taken as indications of neurotic illness. Such an illness should be diagnosed on the basis of developmental as well as clinical findings. It is proposed that the establishment of conceptual thinking (secondary process) may be a necessary precondition for the development of the neurotic symptom, which is a highly composite and structured behaviour.