Family Variables

Assuming other individuals or organizations are not raising them, high-risk children have the unique experience of being reared by a schizophrenic parent (or parents). As a result, family factors have been a source of interest, especially in high-risk studies. In a small retrospective study of adult children (n = 9) with a psychotic mother, themes of abuse and neglect, isolation, guilt and loyalty conflicts, dissatisfaction with mental health services, and efforts to seek social supports emerged [72]. Dunn also noted that many of these children were quite resilient: ''As children, study participants described consciously overcoming feelings of shyness, feelings of being different from others, and fear of reprisal from their mother in order to put themselves in safe and affirming situations with peers or adults'' [72]. In the New York High-risk Project, Erlenmeyer-Kimling and Cornblatt [40] noted several variables related to resilience, including a good parent-child relationship, good peer support in adolescence and physical attractiveness. In the Israeli High-risk Study, children reared by a schizophrenic parent had a better outcome than did children who were being raised by professional child-care workers on a kibbutz [35]. These findings offer some insight into factors that may protect high-risk children from developing schizophrenia and serve as a reminder that the majority of high-risk children do not have schizophrenia in adulthood.

Although the aforementioned findings offer some hope in terms of outcome, the family environment of high-risk children may be a useful predictor of later problems. In a British cohort study, schizophrenic mothers were three times more likely to identify their pregnancy as unwanted, a factor which is associated with later social and educational disadvantages [58]. In a longitudinal study, schizophrenic mothers seemed to provide less play stimulation, fewer learning experiences, and less emotional or verbal involvement as compared to depressed or healthy mothers [73]. In their review, Olin and Mednick concluded that poor family environment is a risk factor, especially for boys, and a good foster placement can serve as a protective factor for vulnerable children [62]. Other studies suggest that communication deviance (difficulty maintaining a shared focus) in the family and critical, intrusive parental attitudes are also risk factors for schizophrenia [74,75]. The latter findings are consistent with the work of Brown et al. [76] on expressed emotion in families with a schizophrenic member. The way family members relate to one another can either help or hinder children who are at risk for schizophrenia, depending on the quality and valence of the relationship.

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