Parental Communication Deviance and Affective Style Predictors of Subsequent Schizophrenia Spectrum Disorders in Vulnerable Adolescents

TLDR: Adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood, and adolescents of parents who had both lower levels of communicationDeviance and a benign affectivestyle had offspring with healthier outcomes.

Abstract: \s=b\In an attempt to assess the contributory role of family factors to the development of schizophrenia-like disorders, measures of parental communication deviance and affective styles of communication were obtained for a sample of families of disturbed but nonpsychotic adolescents. Outcome was assessed five years later. Absence of a pathologic affective style was associated with a benign outcome, but neither parental variable alone allowed precise identification of the schizophrenia-spectrum cases. However, an index using a combination of both variables was statistically predictive of subsequent psychiatric status at follow-up. Thus, adolescents whose parents had both a pathologic affective style of communication and a high level of communication deviance had schizophrenia-like disorders develop in young adulthood. Adolescents of parents who had both lower levels of communication deviance and a benign affective style had offspring with healthier outcomes. (Arch Gen Psychiatry 1981;38:679-685) Disordered family relationships may be an important factor in the development of schizophrenia, but meaningful empirical evidence of the process is difficult to obtain. Most of the evidence comes from cross-sectional studies in which families with a diagnosed schizophrenic offspring are contrasted with families with psychiatrically disturbed or normal offspring. Such designs, of course, cannot separate antecedent family patterns from accom¬ modations to the presence of a psychotic offspring. We report a prospective longitudinal study of family relation¬ ships to examine whether specific disordered patterns of intrafamilial relationships antedate the actual onset of schizophrenic and schizophrenia-like symptoms in the offspring. There are several recent reviews of the cross-sectional studies.'-' Those measuring communication disorder have shown the most consistent results. In particular, the Singer and Wynne index of parental communication deviance (CD) has identified parents of schizophrenics and border¬ line schizophrenics in diverse measurement contexts.410 This index reflects an inability of the parent or parents to establish and maintain a shared focus of attention during transactions with another person. The theory maintains that the extent to which parents fail to communicate effectively reflects the extent to which the child will become confused, lost, distressed, and more vulnerable to subsequent breakdown.1 Such findings have been repli¬ cated in several cross-sectional studies, although in one study" the parental-group separation was less sharp than in the Singer-Wynne studies. The implication of these cross-sectional studies is that communication deviance (CD) may play a contributory role in the development of schizophrenia. However, before any etiological role is considered, it is necessary to demonstrate that this parental attribute is present substantially before the onset of prodromal or actual clinical features of a schizophrenic disorder. A basic goal of the present study is to determine whether parental CD does indeed antedate the onset of schizophrenia and related disorders. The subjects in our study were first studied in midadolescence, at a time when all were disturbed but when none showed any prodromal or clinical signs of schizophrenic disor¬ ders. While most of the cross-sectional studies have focused on issues of the family's potential role in the etiology of schizophrenia, Vaughn and Leff,'- building on the work of Brown et al,'3 reported that the course of the disorder may be affected by the affective tone or expressed emotion (EE) of the family environment to which the patient returns after hospitalization. Expressed emotion is a con¬ struct that includes negative attitudes directed toward the target patient, including criticism, hostility, and overinvolvement; the likelihood of relapse is greater when patients return to high-EE environments.