Ronald Feldman

Psychopathology in offspring of mothers with borderline personality disorder: a pilot study.

Objective: Children of mothers with borderline personality disorder (BPD) were hypothesized to be at greater risk for psychopathology, particularly impulse spectrum disorders, than children of mothers with other personality disorders. Method: Twenty-one index children were compared with 23 children of mothers with a nonborderline personality disorder. Diagnoses were obtained using the Kiddie Schedule for Affective Disorders and Schizophrenia–Episodic Version (KSADS-E) and the Child Diagnostic Interview for BPD (CDIB), and functioning was rated with the Child Global Assessment Schedule (CGAS). Physical, sexual, and verbal abuse, as well as family violence and placements, were also assessed. Results: The children of the borderline mothers, as compared with controls, had more psychiatric diagnoses, more impulse control disorders, a higher frequency of child BPD, and lower CGAS scores. There were no differences between the groups for trauma. Conclusion: The offspring of borderline mothers are at high risk for psychopathology.

Neuropsychological Factors Associated With Borderline Pathology in Children

OBJECTIVE To determine whether children with borderline pathology have a specific pattern of neuropsychological risk factors. METHOD The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups according to results of the Child version of the Diagnostic Interview for Borderlines. All children were assessed with the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and a neuropsychological battery. RESULTS Children with borderline pathology had abnormal scores on the Wisconsin Card Sorting Test and on the Continuous Performance Test, both of which suggested problems with executive function. Although borderline pathology was highly comorbid with conduct disorder, most results were independent of this comorbidity. CONCLUSIONS Borderline pathology in children has a unique pattern of neuropsychological risk factors that may reflect a diathesis for this syndrome.

Psychological Risk Factors for Borderline Pathology in School-Age Children

OBJECTIVE To determine whether children with borderline pathology have a specific pattern of psychological risk factors. METHOD The subjects were 94 school-age children in day treatment, divided into borderline (n = 41) and nonborderline (n = 53) groups using the child version of the Retrospective Diagnostic Interview for Borderlines. All children were assessed using the Child Behavior Checklist, the Schedule for Affective Disorders and Schizophrenia for School-Age Children, and the Psychosocial Questionnaire. Parental pathology was assessed by a computerized version of the Structured Clinical Interview for DSM-III-R. RESULTS Children with borderline pathology had higher rates of physical abuse, sexual abuse, severe neglect, as well as family breakdown and parental criminality. In multivariate analyses, the discriminating factors were sexual abuse and parental criminality. Borderline pathology was highly comorbid with conduct disorder, but most of these results remained significant in reanalyses comparing children with and without conduct disorder. CONCLUSIONS Borderline pathology in children has a unique pattern of risk factors not accounted for by conduct disorder alone.

Diatheses and stressors in borderline pathology of childhood: the role of neuropsychological risk and trauma

OBJECTIVE To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children. METHOD The subjects were 86 school-age children (75 males, 11 females) referred for psychiatric day treatment. Thirty-five of the children met criteria for borderline pathology. Data on psychosocial risk factors were obtained for each child from a questionnaire completed by members of the childs clinical team and were based on interviews with parents and children, as well as reports from schools and social agencies. Neuropsychological measures included computerized versions of the Wisconsin Card Sorting Test and the Continuous Performance Test. RESULTS Both deficits in executive function and psychological trauma made significant and independent contributions to the variance in borderline pathology. Inclusion of both sets of risk factors produced a model that explained 48% of the variance in borderline diagnosis. CONCLUSIONS Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children.

An integrated approach to family therapy training for psychiatric residents

Unlike nonmedical family therapists, psychiatric family therapists are able to evaluate and treat both the biological and psychosocial components of a problem. They can integrate knowledge of biology, psychopharmacology and individual psychodynamics with family systems theory and family therapy skills. A family therapy training program is presented as a model which prepares psychiatric residents for this unique role. This model emphasizes the importance of having psychiatrists as family therapy teachers, the use of both systems and psychodynamic perspectives in teaching about families, and the principle of presenting concepts and interventive techniques at successively greater levels of difficulty. Illustrative examples are presented. A minimum of two years of family therapy training and supervision is recommended during a four year residency program.

A search for congenital rubella in psychiatric day treatment, language and learning centres.

A search for previously undiagnosed congenital rubella (CR) was made on 672 children who had attended psychiatric day treatment, learning, and speech and language centres. This was done by observing the sero-response of seronegative children to rubella vaccine, since 90% of patients with known CR who are seronegative fail to seroconvert to the vaccine. Of the 225 seronegative children 23 did not seroconvert after a single vaccination. Five of these failed to respond on revaccination. These five children had a high frequency of severe language and learning disability as well as frequent diagnoses of major CNS disorders. It is likely that a far greater number of children in the population studied had CR, since our methods identify only about 20% of those affected. Clinically, a specific diagnosis of CR is helpful in facilitating genetic counselling and in allowing the clinician to offer a more hopeful prognosis.