Tardiff, K. and A. Sweillam

Assault, Suicide, and Mental Illness

1980

9,365 patients admitted to public psychiatric hospitals in a one year period.

Data taken from information from the New York State Dept. of Mental Hygiene. Type of data-demographics, DSM II diagnosis, and prior use of psychiatric or other human services.

21% of patients had some type of violent, assaultive, or suicidal problems, isolated or in combination, prior to admission. Found increased assaultive behavior for male patients (females of lower socioeconomic class more assaultive behavior). Evidence that assaultive behavior is associated with lower socioeconomic class. Did not confirm that patients with assaultive problems are more likely to have a history of seizure activity.

Krakowski, M., J. Volavka, and D. Brizer

Psychopathology and Violence: A Review of the Literature.

1986

Clinical lit. Review paper

The authors examine the role of psychopathology in the occurrence of violence. They review several studies in order to determine what variables play a crucial role in this relationship.

Violence is indicative of different psychiatric impairments dependent upon the nature of the psychiatric illness of which it is a manifestation. In order to be understood, violence cannot be isolated from various other clinical characteristics of the disorder of which it is a part. Carrying out of assaultive acts involves a certain amount of ''intact functioning which is not compatible with severe impairment found in disorganized psychotic states," it is not solely based on specific dysfunction.

Karson, C., and L. B. Bigelow

Violent Behavior in Schizophrenic Inpatients

1987

140 inpatients 97 of the patients were diagnosed schizophrenic. Mean age = 29 yrs. (71 men and 26 women). The remaining 43 (34 men and 9 women) had other diagnoses. Mean age= 31. None had responded well to neuroleptic treatment.

Chart review. Should be aware that patients with a history of violent attacks on others were, as best could be determined, excluded for admission.

41 of the 97 patients with schizophrenia became assaultive during hospitalization. Only four of the 43 patients with other diagnoses became assaultive (p<.0001). These assaultive patients were significantly younger and had a greater proportion of previous history of violence than nonassaultive patients.

Robertson, G.

Arrest Patterns among Mentally Disordered Offenders.

1988

Four groups of prisoners. One group consisted of 61 schizophrenic men, one of 30 men who were suffering from an affective illness, usually of psychotic intensity, one of 35 men with no record of a psychotic or other serious mental illness, but with a criminal history of violence, and a fourth group of 41 normal men with no history of mental illness and no record of serious violence. All groups were matched for age.

The experimenters examined the variables involved in the offense (circumstances, living arrangements at the time of the offense), the arrest, and the detention of the subjects. Information was obtained through an interview with the subject prior to cognitive testing.

The author clearly states that the normal groups in the present study are quite atypical of the offender population in general. Crimes of violence are greatly overrepresented. However, the comparisons made concerning the personal circumstances of the subjects and the offenses indicate real differences between the normal and mentally ill offenders and the difference would probably have been even larger if the population had been less atypical. The study showed that the schizophrenic men were more isolated, usually without a home. "Many of the offenses committed by the schizophrenic men involved petty larceny or criminal damage, and it is argued that the social incompetence and debilitated state of these men made them vulnerable to detection and detention. Furthermore, it is proposed that this increased vulnerability is large enough to make it very difficult indeed to compare the rate of criminal offending of the mentally ill with that of the general population."

Convit, A., Nemes, Z. C., Volavka, J.

History of Phencyclidine Use and Repeated Assaults in Newly Admitted Young Schizophrenic Men.

1988

Letter

79 schizophrenic men 36 years or younger.

The men were administered a test battery which comprised a quantified neurological evaluation, drug and alcohol use questionnaires and a psychosocial assessment. Through chart reviews, ward journals and "as-needed" medication records behavior of each was monitored for 6 months or until discharge. Assaults were defined as physical contact made with another patient or a staff member. The intraclass correlation coefficient between those rating assaultive behavior was 0.95. The purpose was to compare patients with a history of phencyclidine (PCP) use to those with no history of PCP use. Use of PCP was determined through self-report mainly because patients were not identified until several days following admission and PCP cannot be tested for in urine or blood beyond 6 hours following ingestion.

24 of the patients had reported using PCP at least once. No significant differences were found with respect to time of follow-up, age, race, age at first psychiatric hospitalization, history of violent crime, neurological abnormality score, and other drug or alcohol use between those who had used PCP and those who had not. PCP users were, however, significantly more likely to repeatedly assault during the 6 months of follow-up. They also had more assaults than nonusers. The authors state that although their findings are tentative they should stimulate further research in the role of PCP in assaultive behavior of psychiatric inpatients.

Herrera, J. N, Sramek, J. J., Costa, J. F., Roy, S., Heh, C. W., and Nguyen, B. N.

High Potency Neuroleptics and Violence in Schizophrenics.

1988

16 males, mean age of 33.3 years (range 25 – 40 years), with a DSM-III diagnosis of schizophrenia. They were shown to be resistant to previous attempts at neuroleptic treatment. These patients did not have unusual histories of violence as determined by a retrospective chart review. Patients with organic cerebral brain disease, mental retardation or those who did not exhibit active symptoms were excluded from the present study. Also, those younger than 18 or older than 55, those with a physical illness, or those who had abused illicit drugs or alcohol in the 2 weeks before the study were excluded.

The study began with a preliminary 14 day washout period using placebo capsules. Following this period, a 6 week clinical trial of fixed-dose haloperidol was started. This was followed by a second placebo period and another 6-week double-blind medication trial. Patients were administered fixed dosages of either clozapine or chlorpromazine. Those given haloperidol and chlorpromazine were given benztropine as well while on these drugs. Clinical changes were evaluated at entrance and weekly during the placebo washout period using Brief Psychiatric Rating Scale, Simpson-Angus Rating Scale for Extra-pyramidal Effects, and the Abnormal Involuntary Movement Scale. The Lion Scale of Inpatient Violence was completed on a daily basis.

Patients were significantly more violent during haloperidol treatment than during treatment with low-potency neuroleptic drugs or during the placebo period. Through examining Lion data taken during the haloperidol period, two distinct patient groups were established. A violent group and a nonviolent group were formed. The violent subgroup showed a deterioration on BPRS scores during the halperidol treatment. From these findings it seems that some patients display increased violent behavior when given moderately high-dose haloperidol. It is not evident whether this effect is specific to haloperidol or specific to the relatively high dosage.

Buydens-Branchey, L., M. H. Branchey, D. Noumair, and C. S. Lieber

Age of Alcoholism Onset

1989

112 male alcoholic patients, ages 25 to 60, who had been admitted consecutively to a detoxification unit for one week and then to a rehabilitation unit for four to six weeks.

Each received a Structured Clinical Interview, SADS, a questionnaire and the Buss-Durkee Inventory for aggressive tendencies. Blood was taken one to two days after admission, then weekly until discharge. Plasma free tryptophan levels were determined.

Each received a Structured Clinical Interview, SADS, a questionnaire and the Buss-Durkee Inventory for aggressive tendencies. Blood was taken one to two days after admission, then weekly until discharge. Plasma free tryptophan levels were determined.

Coid, J.

Alcoholism and Violence

1982

Coid, J.

Alcoholism and Violence

1982

The author examines five different hypotheses of association between violent behavior and alcoholism.

"No direct relationship is apparent." It would, however, still be one of the alcoholic's various alcohol-related problems. He found a strong association between previous personality abnormalities and violence by alcoholics. Perhaps there is a common origin. There remains a tremendous need for research into behavioral disorders. He suggests research into alcohol-induced brain damage and how it can contribute to violent behavior as an area with more potential.

Bear, D. M., and P. Fedio

Quantitative Analysis of Interictal Behavior in Temporal Lobe Epilepsy.

1977

Fifteen patients with right temporal and twelve with left temporal foci were compared with twelve normal adults comparable in age, education, socioeconomic class, and geographic distribution. Nine of the controls suffered from debilitating neurological disease.

Eighteen traits were assessed. Both patients and one observer for each patient completed the same true-false questionnaire. Clinical records were used to obtain epidemiological variables for the patients.

Patients with right temporal foci exhibit "polishing" behavior, or exaggeration of valued qualities. They deny anti-social behavior. Left temporal patients emphasize negative qualities and minimize outstanding conscientious behavior. The psychological features found in these two groups were not found in patients with socially debilitating neurological disorders. Continual behavior, thought, and affect changes, then, appear to be specific to patients with temporal elipthic focus. The present results support the theory that man possesses a hemispheric asymmetry in expression of affect.

Bear, D., L. Schenk, and H. Benson

Increased Autonomic Responses to Neutral and Emotional Stimuli in Patients with Temporal Lobe Epilepsy.

1981

Three male and two female patients with an unambiguous history of complex partial seizures and EEG localization of epileptic spike foci to temporal lobes. Ages 25 – 54 Two male and five female control subjects. Ages 21 – 30.

Seventeen 35 mm color slides served as the stimuli. Subjects were asked to rate each photo on a 5-point scale (1 - most pleasant and 5 - most unpleasant). Silver-silver chloride cup electrodes on the nondominant hand (which was restrained) measured the Galvanic skin conductance changes.

The patients with temporal lobe epilepsy exhibited significantly greater palmar conductance in response to emotionally neutral or charged visual stimuli. This result shows consistency with "increased emotional responsivity." This increase in autonomic response was seen in interictal periods with no obvious association to clinical seizures. Further investigation into different populations is necessary to study the specificity of the enhanced autonomic responding. If these findings are confirmed they may serve as implications for treatment strategies

Devinsky, O., and D. Bear

Varieties of Aggressive Behavior in Temporal Lobe Epilepsy.

1984

Five patients with temporal lobe epilepsy

Case reports

Aggressive behavior in each case occurred subsequent to the development of an "epileptic focus clinically localized to the limbic system." Aggressive behavior occurs in different patterns for various cases of temporal lobe epilepsy. Most temporal lobe epileptics do not display overt violent behavior. The authors do, however, consider aggression an important behavioral disturbance related to this illness and suggest different forms of treatment including psychotropic medication, psychoterapy and "in select cases" neurosurgery.

Engel, J. S. Caldecott-Hazard, and R. Bandler

Neurobiology of Behavior: Anatomic and Physiological Implications Related to Epilepsy.

1986

Clinical Lit. Review

The authors address the controversial issue of whether enduring alterations in neuronal function in that result in interictal behavior disturbances can be produced by epileptic seizures.

Some disorders in interictal behavior may reflect unrecognized ictal events. The evidence they reviewed implicates that not all behavioral problems suffered by epileptic patients can be attributed to psychosocial factors. Behavioral disturbances attributed to antiepileptic drugs or certain structural lesions could also stem partially from epileptogenic mechanisms.

Lewis, D. O., S. S. Shanok, M. Grant, and E. Ritvo

Homicidally Aggressive Young Children: Neuropsychiatric and Experiential Correlates.

1983

55 children admitted to a psychiatric service. Primarily a diagnostic service where patients remain 90 days on the average 21 were homicidally aggressive.

Data were obtained from hospital records, which included family, medical, developmental histories, psychiatric evaluations, physical examinations, neurological assessments, educational assessments, psychological testing, and EEGs (for most). Also reviewed the types of medications that had been prescribed. Four raters determined from information provided by the chart whether the individual had ever been homicidally aggressive.

Homicidally aggressive children were significantly more apt to have had a seizure, have a father who displayed violent, often homicidal, behavior, have a mother with a history of hospitalization for a psychiatric disorder, and have attempted suicide. The homicidal and nonhomicidal children were not distinguished by psychiatric symptoms and diagnoses. The most significant variable appeared to be whether the child had been exposed to a violent father. Witnessing irrational violence engenders rage that can be expressed through suicidal behavior when turned inward or aggressive (homicidal) behavior when directed outward.

Perini, G. I.

Emotions and Personality in Complex Partial Seizures

1986

Eleven patients with left temporal epileptogenic foci and thirteen patients with right temporal foci were included. They did not differ in seizure frequency, age of onset, or type of aura.

Eight personality traits were measured using the emotion profile index (EPI). The personality inventory (PI) (Bear & Fedio, 1977) was used to assess specific behavioral changes.

Results showed that left patients gave a negative image of themselves and displayed a paranoid, depressed personality they were more guilt ridden and aggressive than right patients. On the other hand, right patients rated themselves positively. Both groups manifest epileptic behavioral syndrome according to the PI.

Weiger, W. A., and D. M. Bear

An approach to the Neurology of Aggression.

1988

Clinical lit. Review paper highlighting hierarchical neural controls over aggression and characteristic syndromes of human aggression due to lesions in various areas

The authors compare and contrast the functions of the hypothalamus, amygdaloid complex, and orbital prefrontal cortex. The examine sensory inputs, effector channels and integration principles drawn from observations in human and animal studies. The authors then speculate on the application of this approach to research on criminal violence.

Abnormalities (or lesions) at various levels of the brain yield distinctive forms of aggressive behavior. The authors note that although aggressive behavior may result from neurological lesions, it is not necessarily of organic origin. Neurological abnormalities may be the result of, rather than the cause of aggressive behavior. Further research in this area is suggested. Three specific brain structures are central to the discussion of the functional anatomy of aggression (the hypothalamus, the amygdala and temporolimbic cortex, and the frontal neocortex. The authors do mention, however, that other brain structures and certain neurotransmitters are factors involved in the control of aggressive behavior.

Hermann, B. P.

Neuropsychological Functioning and Psychopathology in Children with Epilepsy.

1982

Fifty children with epilepsy ages 8 – 12 yrs. Two groups were created based on neuropsychological function. 25 had good neuropsychological function and 25 had poor neuropsychological function. The subjects were also classified according to seizure type.

Each child received a complete neurological evaluation including an EEG. The two groups were compared in several domains. Social competence and behavioral functioning were measured using the Child Behavior Checklist. For neuropsychological data each child completed the Luria-Nebraska Neuropsychological Battery - Children's Version.

A highly significant relationship between adequacy of neuropsychological function and the level of aggressive behavior in children with epilepsy was determined. Those subjects with a poor performance on the neuropsychological battery also retained significantly higher scores on the Aggression scale of the CBCL as compared with children who performed better on the neuropsychological tests. Neuropsychological functioning was also associated with increased scores on the Total Behavioral Problems measure and decreased scores on the Total Social Competence scale.

Virkkunen, M.

Psychomotor Epilepsy and Violence.

1983

Letter to the Editor

Letter discussing "Psychomotor Epilepsy and Violence in a Group of Incarcerated Adolescent Boys." (Lewis, 1982)

The author criticizes Lewis's definition of psychomotor epilepsy citing that Livingston et al. (1980) defined the characteristics that should not be considered symptoms of psychomotor epilepsy and that the two are conflicting. Evidence exists that aggression in epileptics is "a multifactorially determined interictal, not ictal, phenomenon." The author provides several clinically supported examples of aggressive behavior, with the specific symptoms described by Lewis, originating from disorders other than epilepsy.

Stone, A. A.

Violence and Temporal Lobe Epilepsy.

1984

Letter to the Editor

The letter is in regard to "Varieties of Aggressive Behavior in Temporal Lobe Epilepsy" (Devinsky & Bear, 1984).

The author criticizes Devinsky's and Bear's presentation of the types of treatment potentially helpful in suppressing aggression in temporal lobe epileptics. Their mention of neurosurgery, he feels, did not indicate the risk involved and "perpetuate[s] the misleading impression about the positive benefits of neurosurgical intervention to control violence" in this population. The author states that increase in aggression may merely be a very human reaction to the knowledge of the limiting nature of the possibly incurable disease that the epileptic endures. He claims that they can draw no new conclusions from the evidence gathered in their study.

Treiman, D. M.

Epilepsy and Violence: Medical and Legal Issues

1986

Clinical Lit. Review

Review of literature focused on the relationship between epilepsy and violent crime.

A two-to fourfold greater prevalence of epilepsy was found in a prison population as compared with a control population. This prevalence is, however, similar to that found in other lower socioeconomic populations from which a majority of prisoners come. The prevalence of epilepsy in persons convicted of violent crimes is no greater than that in other prisoners used as normal controls. No evidence was found in support of the notion that violence is more common among epileptics than others or that temporal lobe epileptics are more violent than persons with other forms of epilepsy. Ictal violence rarely occurs and when it does is considered "resistive." Finally, they list five criteria that should be used to determine whether an epileptic seizure was the cause of a particular violent act (Delgado-Escueta et al., 1981).

Delgado, A. V., R. H. Mattson, L. King, E. S. Goldensohn, H. spiegel, J. Madsen, P. Crandall, F. Dreifuss, R. J. Porter

The Nature of Aggression During Epileptic Seizures.

1981

19 patients believed to display aggressive behavior during epileptic seizures. These 19 were taken from a group of approximately 5400 epileptic patients. On closed-circuit television, 13 showed aggressive motions during their seizures. These 13 were then rated.

Aggressive behavior was analyzed by closed-circuit television. The panel used its own rating scale.

1 -nondirected aggressive motion

2 -violence to property

3 -threatening violence to a person

4 -mild violence to a person

5 -moderate violence to a person

6 -severe violence to a person

The panel compiled five relevant criteria to be used in determining whether a certain violent crime resulted from an epileptic seizure.

1. The diagnosis of epilepsy should be established by one or more neurologists with ''special competence" in epilepsy.

2. The presence of epileptic automatisms should be recorded by closed-circuit television, EEG biotelemetry, and the history.

3. Aggression during epileptic automatism should be confirmed in a videotape-recorded seizure. Ictal epileptiform patterns must be recorded by EEG

4. The act (aggressive or violent) should be typical of the patient's seizures.

5. Clinical judgement should be provided by a neurologist regarding the credibility that such an act was part of a seizure.

Andrew, J. M.

Are Left Handers Less Violent?

1980

139 probationed juvenile delinquents mean age = 15.5. The group was made up of offenders from the intensive supervision probation program (with the exception of the left-handed Anglo females who were taken from a non-intensive unit.

The Violence Scale (Andrew, 1974) was used as the measure of violent crime. The scale gives a numerical value for each type of crime (from 1.0 to 56.0). Handedness was determined solely by the hand used in writing (though different degrees of hand dominance exist).

Violence Scale scores were higher for right-handed juvenile offenders than they were for left-handed juvenile offenders. The most violent subgroup was right-handed boys and the least violent was left-handed girls. Left-handers are overrepresented among male offenders, but not among female offenders or violent male offenders. The authors reexamined previous studies and were not able to explain these results. They suggest further research into types of left-handedness, cerebral organization and consideration of sex-handedness interaction.

Bach-Y-Rita, G., J. R. Lion, C. E. Climent, and F. R. Ervin

Episodic Dyscontrol: A Study of 130 Violent Patients.

1971

130 Patients - chief complaint - explosive violent behavior

A two-year study. "When pertinent and possible," EEGs, neurological and psychological tests, pneumoencephalograms, and other tests.

Found abnormalities in EEGs, histories of seizure-like impairment. Feel interaction with environment is a crucial factor leading to episodes. See patients as having problems with coping with demands place on their insufficient egos. Both the physiological/neuroanatomical and the psychological areas require further research.

Brickman, A. S., M. McManus, W. L. Grapentine, and N. Alessi

Neuropsychological Assessment of Seriously Delinquent Adolescents.

1984

71 subjects (40 male; 31 female) were chosen based on four criteria:

1. commission of violent felonies

2. commission of multiple non-violent felonies

3. multiple placements within the training school system; and

4. assaultive in-program behavior requiring medical attention for the victim. Mean age=16.3 yrs. 39 of the subjects were white, 26 - black, 3 - Hispanic 3 - mixed race.

The Luria-Nebraska Neuropsychological Battery (LNNB) was administered to all subjects. This examination consists of 269 items organized into 11 categories: Motor, Rhythm, Tactile, Visual, Receptive Language, Expressive Language, Reading, Writing, Arithmetic, Memory, and Intelligence. Educational levels for the subjects were assessed (as accurately as possible).

Violent and recidivist delinquents display a distinctly abnormal pattern of functioning. This pattern is not limited to higher "intellectual" functions, but rather encompasses a wide range of functions. The only significant differences between the subgroups, however, are in expressive speech and memory scales. This could be attributable to education or concentration problems. Upon reviewing the specific neurpsychological dysfunction, the authors suggest that the temporal lobe may be implicated.

Eichelman, B.

The Limbic System and Aggression in Humans.

1983

Clinical lit. Review paper

Review includes the following areas.

1. naturally occurring and iatrogenic brain lesions.

2. electrical disturbances

3. pharmacologic intervention.

4. central neurochemical concentrations - possible limbic lobe involvement

Neuroanatomic and EEG data tend to link the limbic system with human aggression." However, the existence of limbic pathology does not necessitate the induction of aggressive behavior, and aggressive behavior can occur without clear demonstration of specific limbic pathology. The author feels that concentration should not focus solely on limbic regions as a generating source.

Mungas, D.

An Empirical Analysis of Specific Syndromes of Violent Behavior.

1983

138 neuropsychiatric out-patients. Five homogeneous subgroups: two - closely resembled episodic dyscontrol syndrome (differed in severity); one infrequent but severe violence; one-infrequent, less severe violence; one - no history of violence.

Violent behavior was rated in four parameters. The violent behavior could be directed either toward others or toward property. The four parameters are: frequency; severity; appropriateness to environmental context; organization of the act/directedness. Seven historical variables were rated as well: behavior disorder as a child; developmental abnormalities; independent functioning level; home environment as a child; drug abuse; neurodiagnostic evaluation; head trauma. Ratings were made retrospectively based on an in-depth chart review.

Results showed that violent behavior is not necessarily a result of brain dysfunction in general. Perhaps more specific kinds of abnormalities predispose one to this behavior. Evidence is provided that distinct sub-groups of patients displaying violent behavior exist that can be differentiated according to behavior patterns and clinical correlates. Results did not support a specific etiology of violence. A relationship between temporal lobe abnormalities and violence is not supported by these results. The author notes that this is probably not a representative sample of violent persons in the population as a whole due to the nature of the clinical population. Suggests further research in delineating relationships between specific etiologies and behavioral symptoms to aid in creating guidelines for differential diagnoses and treatments.

Volkow, N. D. and L. Tancredi

Neural Substrates of Violent Behavior. A Preliminary Study with Positron Emission Tomography.

1987

four psychiatric patients (inpatients) with a history of repetitive purposeless violent behavior.

All subjects received full psychiatric, physical, and neurological examinations. All had a CT scan (with and without contrast), an EEG, and PET using oxygen-labelled water for cerebral blood flow and fluorodeoxy-glucose measurement. Left vs. right temporal lobes, and frontal vs. occipital cortices were compared using PET images of three slices at the thalamic level.

All of the patients displayed temporal cortex asymmetry. The left showed lower metabolism and blood flow that seen in the right. These patients displayed defects in cerebral function that were widespread, not originating from one focal brain lesion. All subjects showed signs of temporal dysfunction. The authors emphasize that violent behavior in these cases is not purely organic in origin. They support the idea that violent behavior springs from complex interactions involving environmental stimuli, hormones, neurotransmitters, and various neural systems. PET seems to have much potential in studying cerebral function and dysfunction in individuals exhibiting violent behavior.

Langevin, R., Pen-Aron, M., Wortzman, G., Dickey, R., and Handy, L.

Brain Damage, Diagnosis, and Substance Abuse among Violent Offenders.

1987

18 males who faced charges of murder or manslaughter. 21 males facing non-homicidal violence charges (assaulters). All of these men had physically attacked another person. 16 males charged with nonviolent nonsex offenses (controls). 43% of the killers' victims and 33% of the assaulters' victims were male. The controls faced charges of property offenses.

Each subject received the Halstead-Reitan, the Luria-Nebraska batteries and the WAIS-R. CT scans were done. EEGs of baseline, hyper-ventilation, and photic stimulation were done (in some cases sleep and alcohol EEGs were done). ICD9 diagnoses were assigned, the MMPI and Assertiveness Inventory were administered. The MAST and Clarke Drug Use Survey were administered to assess substance abuse.

Killers were found to be more like nonhomicidal violent offenders than nonviolent offenders. Neuropsychological variables were significant in one-fifth to one-quarter of violent offenders. No epileptics were present in any group. Based on present results, almost one-third of killers can be expected to show clinically significant neuropsychological impairment on the Reitan. The neurological impairment was not significantly associated with diagnosis, drug and alcohol abuse, age, intelligence or education. "Overrepresentation of alcohol and drug abusers in all groups, however, may be masking differences between violent and nonviolent groups." Killers and assaulters were more often considered alcoholic, they abused alcohol with a higher frequency and experienced mood dysphoria, congruent with their behavior (i.e. hostility, paranoia) rather than feelings of relaxation and pleasure normally experienced. "The best predictor of assaultive behavior has been the use of alcohol and drugs, but its role in violence is far from established." It may be the interaction of neuropathology and substance abuse along with other factors which underlie the commission of homicide. Perception of the violent offenders themselves may be distorted according to this study. This study was carried out in a medium security setting; the authors suggest that it should be replicated in a maximum security setting as well as others.

Lewis, D.O., Pincus, J.H., Feldman, M., Jackson, L., and Bard, B.

Psychiatric, Neurological and Psychoeducational Characteristics of 15 Death Row Inmates in the United States.

1986

15 death row inmates chosen because of the imminence of their deaths rather than for evidence of neurological damage.

Detailed family, medical, social, educational and neurological histories on all subjects were recorded. All received psychiatric evaluations. Eleven subjects were run through batteries of psychological tests (Wechsler Adult Intelligence Scale-Revised, the Bender-Gestalt test, and the Rorschach test). Psychoeducational assessments with selected subtests were obtained for eight of the subject.

Many condemned individuals in the U.S. are probably victims of, until now, unrecognized psychiatric illnesses or neurological disorders. This information should be pertinent in considerations of reducing the severity of sentences. The authors suggest that, given that this group is a sufficient representation of the entire population of death row inmates, these individuals may be less capable of obtaining services or presenting the information essential for purposes of mitigation. Comparisons of with violent inmates not sentenced to death would be beneficial in further investigating this possibility.

Langevin, R., Ben-Aron, M., Coulthard, R., Heasman, G., Purins, J., Handy, I., Hucker, S., Russon, A., Day, D. Roper, V., Bain, J., and Webster, C.

Sexual Aggression: Constructing a Predictive Equation A Controlled Pilot Study

1985

Twenty sexual aggressives (SAs) charged with rape, attempted rape, or indecent assault. Twenty nonviolent non-sex offenders served as controls and were matched with SAs on age and education. Controls faced charges of theft, fraud, and drug possession. SAs mean age = 26.75 and controls mean age = 24.5. SAs were also broken down into sadists (n=9) and nonsadists (n=11). Assignment to the sadist group was based on erotic preference for control of victims their fear, terror, destruction, torture and/or unconsciousness.

The phallometric study consisted of four classes of audiotaped stimuli: 1. normal consenting intercourse 2. intercourse plus aggression (rape) 3. aggression to a female with no sex contact, and 4. neutral statements. The twenty stimuli (5 in each category) were recorded by a female. This method was devised by Abel et al., 1977). Subjects received a 10 min. relaxation tape because it increases overall responsiveness. Penile volume change in the first 10 seconds and a max volume change in the 100 second interval were the dependent variables. Abel's rape index was also used (response to rape stimuli/total response to intercourse stimuli). The Derogatis Sexual Functioning Inventory and the Clarke SHQ were used to compare sex history of the two groups. The Bem Sex Role Inventory and the Feminine Gender Identity Scale were used in examination of androgyny and gender identity. A CT-Scan and the Reitan Battery were used to assess brain pathology. Subjects had blood drawn between 8:00 am and 10:30 am (in 15 min intervals) for hormone analysis. Medical histories were examined. The MAST scale and penile reactions to erotic stimuli were used to compare the groups. Then each received enough alcohol to produce a BAL of 50 mg.% and then shown erotic slides. Max

[Extensive lit review in introduction] A summary of findings is provided on p. 6.:

Rape Index: does not discriminate rapists and nonrapists. Sex History: sadists show more toucherism and frottage, exhibiting and sadomasochism. Some SAs crossdress orgasmically. Gender Identity: sadists are femine identified or undifferentiated. Alcohol & Drugs: abuse common in all groups, but least in sadists. Sex Hormones: LH and FSH may be abnormal in some sadists. DHAS, cortisol and prolactin may be elevated in rapists in general. Brain Pathology: Right temporal lobe abnormalities in sadists. Aggression: not discriminating.

SAs generally reacted more to audiotaped stimuli than did controls, but not differentially to rape and consenting intercourse. Both SAs and controls reacted significantly more to rape and consenting intercourse than to violence or neutral stimuli. Nonsadistic sexual aggressives experienced double the penile output of controls and sadists responded the least. Sadists were more common in the present sample of SAs than in many others (45%). As far as the nature of their acts is concerned, "we know that control, fear and terror, injury, and unconsciousness play a role but we are ignorant about the relative importance of each of these components and what other factors may be important." That orgasmic crossdressing was consistently found does not fit the authors' stereotype of SAs. Sex hormone results showed that alcohol and drug abuse were associated with normal testosterone levels. The "incongruous levels of both testosterone and LH/FSH" were informative. A complete hormone profile on a substantial number of rapists would be beneficial. 45% of all subjects showed some brain pathology, but no significant differences were found in the two groups. Sadists alone, however, showed significant temporal lobe damage - 56%. Most often it was right temporal horn dilation and atrophy. The CT scan detected the temporal lobe anomaly but WAIS and Reitan

Langevin et al.

1985

penile volume change within 30 and 60 seconds after stimulus onset were the dependent variables. A drug survey was given that asked about current frequency, max frequency, and accompanying affect. The Buss-Durkee Hostility Inventory, MMPI and Clarke History of Aggression Test were administered to look at aggressive tendencies. Three psychiatrists (independently) examined SAs on dangerousness using a Dangerousness Rating Scale and assessment of the amount of force used in the offence, likelihood of recidivism, the extent of force likely to be used in foreseeable future offenses, and global rating of dangerousness.

findings only suggested it. The authors suggest possible exclusion of the latter two in future investigations. Ascribing sexual aggression to substance abuse is difficult in this study because abuse was prominent in both SAs and controls. "We can surmise that alcohol increases sexual reactivity and elicits erotic reactions that are indiscriminate." The study of aggression in this particular sample was difficult. The authors indicate that psychometrically acceptable measures of aggression/violence proneness are almost nonexistent. The question arose, "Are measures of general aggression/violence inadequate or are sexual aggressives not really generally aggressive after all?"

Hucker, S., Langevin, R., Dickey, R., Handy, L., Chanbers, J., and Wright, S.

Cerebral Damage and Dysfunction in Sexually Aggressive Men

1988

51 sexually aggressive men charged with, or convicted of, rape, attempted rape, indecent assault or sexual assault. (20 taken from Langevin et al., 1985). 22 sadists and 21 nonsadistic sexual aggressors and eight were unclassified. All victims of the offenses were females 16 years of age or older. 36 nonviolent nonsex

The Clarke Sex History Questionnaire, criminal history, medical records and interview by experienced sexological investigators were used to determine whether a diagnosis of sexual sadism was appropriate according to DSM III criteria. Reliability of the diagnosis was checked using two raters to interview and examine records of the same 10 sex offenders and two controls - 92% agreement overall was found. CT scans with no contrast material were carried out. 14 slices were taken

Reliability of both CT scan interpretations and DSM III diagnoses of sexual sadism were examined. There was 90% interrater agreement. CT scans showed a larger proportion of right temporal lobe abnormalities in sadistic sexual assaulters than in both nonsadists and controls. Results of the Luria-Nebraska Neuropsychological Battery showed that nonsadistic sexual assaulters were most impaired and that this impairment tended to be global, not lateralized to one or the other hemisphere. "The ability of the Luria battery to localize brain pathology is poor and hampered by lack of established normative data." The authors suggest that tests (such as EEG or PET) focusing on brain activity during sexual arousal would be very helpful in studying brain pathology in these groups. The fact that the CT scan, Luria battery and Reitan battery results do not

Hucker, S. et al.

1988

offenders served as controls. They had charges of theft, fraud, or other property offences.

from skull base to vertex. To further focus on the temporal horns overlapping cuts were taken in the temporal area and primary coronal cuts were taken through the middle fossa. Temporal lobes were specially examined because of an expected "association of damage to that area and sexually anomalous behavior." The Luria-Nebraska Neuropsychological Test battery and Hartford Shipley Aptitude Test were given to 31 sexual assaulters and 12 controls seen after the 1985 study. WAIS was administered to the original sample. The Hartford Shipley and the WAIS scores were combined and all converted to WAIS Full Scale IQ equivalents. Alcohol and drug abuse variables were examined The Clarke Sex History Questionnaires were examined to delineate erotic preferences and better classify groups.

overlap needs to be considered. Although the temporal lobe has been implicated in sexual behavior, the structures of the limbic system and temporal regions that are related to sexual arousal in humans have not been clearly identified. When these temporal lobe sub-structures have been clarified, MRI and PET techniques may be very useful for more detailed research. Studying a larger number of sexual assaulters who have no history of drugs and alcohol abuse (i.e., adolescent sex offenders) may reduce the "problem of diffuse brain damage due to such habits which may have influenced the present results by obscuring small localized abnormalities.

Garnett, E.S., Nahmias, C., Wortzman, G. Langevin, R. and Dickey, R.

Positron Emission Tomography and Sexual Arousal in a Sadist and Two Controls.

1988

Two males, ages 23 and 26 were screened for physical and mental health, using the MMPI, Clarke Sex History Questionnaire, Gender Identity Scale, MAST, Halstead-Reitan Neuropsychological test battery, WAIS-R, Clarke Drug Use Survey, and Clarke Medical History They were considered normal. One 30 year old male sadist with a history of antisocial behavior and admitted interests in bondage, crossdressing, and sadomasochistic acts. His crimes focused on ritualized rape with torture.

The study comprised three sessions. The first was a pretest for habituation to the PT (this session was the same as the others except for the injection of radioactive substance). In subsequent sessions the subject was injected with FDG. Then he listened to a 40-minute erotic or sexually neutral tape while laying still with closed eyes. Both tapes were recorded by same male voice. Penile circumference changes were monitored.

The controls showed significant (p<.0001) differences in penile circumference between the erotic and the neutral stimuli, with few or no penile reactions during the neutral stimuli. They were aware of sexual arousal while listening to the erotic tape but not the neutral tape. Arousal was greatest at 15 min. after stimulus onset. The men did show reduction of arousal during periods of blood sampling. For the sadist, penile reactions were smaller and more erratic than for the controls. He was also aware of mild sexual arousal to erotic stimuli and no arousal to neutral stimuli. He showed peaks of arousal during blood sampling periods. In the PT scans for the controls, both temporal lobe areas were most activated (as should be expected during sustained auditory stimulation). There was, however, an unexpected lack of differential activation of the limbic area during erotic stimulation. Greater levels of erotic stimulation may be required to excite specific limbic centers to prepare for actual sexual behavior rather than merely fantasy. "The predominant accumulation of radioactivity occurred in the right hemisphere and spread across the whole cortex in the right side of the brain." Both types of stimuli showed similar patterns of activation. More energy was apparent in the erotic as compared with the neutral stimuli. These observations also held true for the sadist but with one interesting difference. The metabolic activation was in the cortex of both hemispheres, unlike predominant right hemisphere activation in controls.

Langevin, R., Worzman, G., Wright, P., and Handy, L.

Studies of Brain Damage and Dysfunction in Sex Offenders.

1989

160 extrafamilial child sexual abusers, 123 incest perpetrators, 108 sexual aggressors against adult females. The sexual offenders were either facing charges of sexual assault, had been convicted of this type of offence, or were involved in a post-prison treatment program for sex offenders. 36 non-violent, nonsex offenders with charges of theft and/or fraud served as the control group. "This group controls for both patient and offender status as well as, in general, being better matched on age, education and social class."

Erotic preferences were checked when possible using a phallometric test of sexual preference (Freud et al., 1972). Each offender received the Halstead-Reitan Neuropsychological Test Battery including WAIS-R. CT scans were carried out with no contrast material. Scans were interpreted by a neuroradiologist blind to the nature of participants and test results. They also received the Wechsler Memory Scale and the Differential Aptitude Test Space Relations Test. Information on age, education, admitter status, substance abuse, and history of violence was gathered. The MAST DAST, Clarke Drug Use Survey, and Clarke Violence Scale were given.

Intelligence scores of sex offenders were basically average but the distribution was skewed to below normal. Especially in pedophiles, verbal abilities tended to be lower than nonverbal abilities. This was not a consistent effect, however. Homosexual and heterosexual pedophiles displayed lower abilitiesthan controls in overall IQ. Bisexual pedophiles displayed lower abilities than controls in performance but not in verbal. The difference in scores (Verbal - Performance) reached significance which, the authors feel, suggests right hemispheric brain impairment. HR battery results showed greater impairment in pedophilic offenders than in controls. "Results for heterosexual and homosexual men suggested left hemisphereic language-mediated problems but also frontal lobe rigidity and perhaps impulsiveness, compared to the other groups." The CT results were inconsistent with earlier work carried out by the authors. They suggest that it is important to determine which techniques (EEG, CT, MR, etc.) will best identify the structures in and functions of the brain associated with sexual aggression. They feel that CT scans may miss important features that MR scans may target. The Wechsler Memory Scale did not differentiate subgroups of the offenders ''Brain damage and dysfunction among sex offenders, if critical in the etiology of their sexual anomalies, is likely to be subtle and may well be specific to sexual behavior." The authors provide suggestions for further research.

Hendricks, S. E., Fitzpatrick, D. F. Hartmann, K. Quaife, M. A. Stratbucker, R. A. and Graber, B.

Brain Structure and Function in Sexual Molesters of Children and Adolescents.

1988

Sixteen male patients charged specifically with sexual assault against individuals 14 years of age or younger. Mean age = 34 (20 to 63 years). A control group comprised of two women and fourteen men. Mean age=30.1 (23 to 47 years).

Hemispheric rCBF was measured using the Xenon inhalation technique of Orbist as modified by Meyer. CT images were taken (11 or 12 axial slices for each subject).

Child molesters exhibited relatively low rCBF values. This finding replicates the finding in Graber et al. (1982). Skull thickness and density seemed to be a major difference between the control and child molester groups. Two potential explanations for this are variation in ventricular size and variation in overall brain size. In this study significant negative correlations between skull thickness and ventricular area for the two higher slices were found. No evidence was found suggesting a relationship between skull thickness and amount of total brain tissue. The authors do not draw any conclusions about the variations in cerebral structure and function and their potential causative relationship to sexual molestation of children. They suggest further research in this area.

Langevin, R., Bain, J., Wortzman, G. Hucker, S., Dickey, R., and Wright, P.

Sexual Sadism: Brain, Blood and Behavior.

1988

Lit review

Literature review on sadism. The authors focus on behavior patterns, endocrine abnormalities, and brain abnormalities.

"The behavior of sadists is bizarre and poorly understood. There are gross endocrine and brain abnormalities in a small number of these men. Approximately two-fifths show subtle temporal lobe brain abnormalities that are logically linked to sexual behavior and require further exploration. It would be interesting to explore the interface of the endocrine system and the brain - that is, to determine if there are interactive processes that may be related to the development of sexual anomalies, perhaps early in life as suggested by Kolarsky et al. Certainly, biological factors cannot determine whether an individual will act on his sexual impulses. Many psychological factors, such as family background and substance abuse, play a significant role in the dangerousness of the individual. However, it appears that biological factors are noteworthy in sexual sadism. Brain pathology, especially, shows some correlation with force used in offenses and likelihood of recidivism, and for this reason alone it merits further study" (p. 170).

Schnur, D. B., Mukherjee, S., Silver, J., Degreef, G. and Lee, C.

Electroconvulsive Therapy in the Treatment of Episodic Aggressive Dyscontrol in Psychotic Patients.

1989

Five cases of episodic aggressive dyscontrol. All of them met the DSM-IIIR criteria for Organic Delusional Disorder. They would also meet DSM-IIIR criteria for Intermittent Explosive Disorder except for their chronic schizophrenia-like psychosis. Their aggressive behavior was severe and they displayed actual violence directed at and sometimes injuring staff members and other patients. Four patients exhibited recurrent spontaneous seizures which a counseling neurologist diagnosed as epilepsy.

ECT was administered on an alternate day, three per week schedule. ECT was given with a constant current, brief pulse, bidirectional square wave stimulus with the use of a MECTA device. Seizures were monitored by the cuff method and EEG. The standard bifrontotemporal electrode placement was used. A retrospective review of clinical records was used to determine the number of spontaneous seizures and episodes of aggression during the month prior to ECT. They were also observed during ECT treatment and one month thereafter. Only violent acts that resulted in physical danger to the victim or the perpetrator were considered aggressive episodes. Medication alterations during ECT included only reductions in neuroleptic and anticonvulsant medications. Actual case reports are provided.

Each patient experienced a reduction in frequency of episodic aggressive behavior associated with ECT. The improvement tended to occur early in the treatment schedule. A modest reduction in psychosis was also observed. ECT was associated with total remission of seizures in all patients but one in which the postictal state was modified. Gross clinical evidence of an organic brain syndrome was not associated with ECT. Clinical improvement in aggressive behavior often remained the same for long periods following the discontinuation of ECT. Whether this is directly related to ECT or a reflection of post-ECT pharmacotherapy is not clear. Only one patient showed improvement in psychotic symptoms. "In cases of episodic aggressive dyscontrol, the antiaggressive effects of ECT may be independent of its antipsychotic properties. The possible specificity may not be generalizable to other variants of aggressive behavior." The authors do not wish to claim that ECT is efficacious in the treatment of aggressive behavior in general.

De Cuyper, H., H. M. van Praag, D. Verstraeten

The Effect of Milenperone on the Aggressive Behavior of Psychogeriatric Patients

1985

20 female in-patients (of a psychogeriatric ward) with chronic aggressive behavior toward others seen as negativism, dysphoria, verbal and/or motor excitation

A double-blind study where the therapeutic activity of milenperone is compared with a placebo. The patients were divided into two random groups. The second phases involved a doubling of the dosage in both groups. Two scales were used as measures. The Paranoid Belligerence Scale and a scale developed from the Visual Analogue Line

Addition of milenperone to the psychotropic medication already in use significantly decreased the aggressiveness scores. Both groups did show a proportional improvement at the start. In the last phase of the study, however, aggressive behavior in the placebo group increased again.

Stewart, J. T., M. L. Mounts, and R. L. Clark

Aggressive Behavior in Huntington's Disease: Treatment with Propranolol

1987

Three white males ranging in age from 44 to 50 and ranging in history of diagnosed Huntington's disease from 5 to 7 years.

Three case reports. Treatment with Propranolol.

Propranolol therapy was effective in all three patients. Careful titration on an individual basis is stressed.

Monroe, R. R.

Anticonvulsants in the Treatment of Aggression.

1975

Literature Review.

"A significant number of violent acts are committed by individuals in whom central nervous system instability can be demonstrated by special EEG activation procedures utilizing alpha-chloralose as the activating agent. Furthermore, subcortical electrograms suggest that this instability is related to a circumscribed ictal phenomenon in the limbic system. The abruptness of the aggressive act, the fact that the behavior is so often out of character for the individual and inappropriate for the situation, as well as the confusion and partial amnesia which accompany these episodes lend clinical support for the ictal hypothesis. Some anticonvulsants not only block the activated abnormalities on the EEG but also lead to dramatic clinical improvement in those individuals showing repeated and frequent aggressive behavior. For instance, in one study 46.7 per cent and 53.3 per cent of the patients demonstrated activated abnormalities on no drug and placebo, respectively. When these same patients were receiving chlorpromazine or trifluoperazine, the activation rates were 60.0 per cent and 73.3 per cent, respectively. On the other hand, when these same patients were placed on a regimen of chlordiazepoxide the activation rate was reduced to 20 per cent (p<.01).

Another study involved severely disturbed chronically hospitalized psychotic patients whose aggressive uncontrolled outbursts relegated them not only to a locked ward, but often to isolation rooms despite high doses of phenothiazines. A regiment of chlordiazepoxide and/or primidone added to their current medication led to dramatic improvement in 23 patients and some improvement in 17 others. Only 15 subjects showed no response to this regimen."

Sano, K., and Y. Mayanagi

Posteromedial Hypothalamotomy in the Treatment of Violent, Aggressive Behavior.

1988

60 cases operated on between 1962 and 1977. 29 were under the age of 15. There were 44 males and 16 females. Most patients had a history of epileptic seizure connected with a certain amount of mental retardation preceding the development of the behavior disorder.

excellent

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Ramamurthi, B.

Stereotactic Operations in Behavior Disorders: Amygdalotomy, Hypothalamotomy.

1988

603 operations for control of conservatively untreatable aggression. 481 cases of bilateral amygdalotomies and 122 cases of mostly secondary posteromedian hypothalamotomy. Most of the patients were children below the age of 15. Some had epilepsy.

The types of behavior problems that required this treatment were: aggression, hyperkinesis, destructive and self-destructive tendencies, and wandering tendency. The stereotactic operations were decided upon following two years of treatment with psychotropic drugs yielding no appreciable relief. Pre- and post-operative psychological assessments were available for only 60 of the patients.

The stereotactic operations were beneficial for approximately 60% of the patients. When the disorder was accompanied by epilepsy the chances of improvement increased. Following the bilateral amygdalotomies 39% of the patients showed good to excellent results, and 37% showed moderate improvement. When the amygdalotomy failed after the first attempt the patient underwent a second one. Half of the patients who required this showed improvement following the second operation. Results of a 3 year follow-up showed that 55% maintained good condition, 15% maintained moderate condition, and 30% failed to respond to the treatment. Benefits from the operation were assessed from 3 points of view. (1) improvement in restlessness or violence-good/excellent when the subject remained calm and quiet despite provocation and moderate when aggression is absent or diminished when not provoked. (2) the beneficial effect of a quiet patient on the siblings and relatives of the patient: measured by responses of the parents and relatives whose quality of life has rapidly improved, and also by the increase in demand for these operations. (3) better possibilities of child educating measured by improvement in restlessness. The authors suggest that gastric acid levels could potentially be factors significant to prognosis.

Dieckmann, G., B. Schneider-Jonietz, and H. Schneider

Psychiatric and Neuropsychological Findings after Stereotactic Hypothalamotomy, in Cases of Extreme Sexual Aggressivity.

1988

14 cases; 8 had thorough psychiatric and psychological examinations during the follow-up.

1970 – 1972. Unilateral ventromedial hypothalamotomy in the non-dominant hemisphere for aggressive sexual delinquency. The 8 with thorough examinations each underwent

1 a physical examination

2 physiological recordings (EEG, EMG).

3 external anamnesis and behavior observation (psychiatric exploration, semistructured interview)

4 questionnaires (Frieburg personality inventory)

5 psychological tests (HAWIE, LPS, BENTON, d2, GIESE, TAT, FPT)

Results showed a decrease in domination by sexual drive, an increase in rapidity of visual image formation, and increase in fluency in semantic contexts, an increase in coordinative perception processes, positive changes in some personality dimensions (i.e. openness, self-criticism, poise), an increase in appetite, and a decrease in color perception. Of greatest importance in this study is that the structure of the individual's sexuality did not change, but a decrease in the probability of specific aggressive behavior was observed. The authors stress that a complete psychic and organic investigation is of great importance to the success of this type of treatment. They also state that it has been shown that intervention by psychosurgery does not hinder an individuals self-development and does not prevent him from making decisions about how to live.

Mirsky, A. F. and Rosvold, H. E.

The Case of Carolyn Wilson—A 38-year Follow-Up of a Schizophrenic Patient with 2 Prefrontal Lobotomies

1990

Case history of a woman who suffered from schizophrenia for at least 11 years. She received a prefrontal lobotomy in December 1946 at 37 years of age and another, more posterior one, in July of 1947.

This case report looks at Ms. Wilson's life since surgery, reconstructs the events leading up to the surgery, and summarizes the neuropsychological studies conducted over the past 40 years. The authors also conducted a psychophysiological evaluation of P300 in a go/no go task in which the target stimulus is a rare tone. She was also given a full-scale neuropsychological evaluation and a neurological evaluation which included a full battery of neurological tests, a CT scan and a PET scan.

It appears that the first lobotomy (December 1946) had not substantial effect on Carolyn's behavior. For this reason, the authors decided to consider both procedures as a single, radical prefrontal lobotomy. Preoperatively she displayed florid psychotic behavior which included mania, both verbal and physical aggression, incontinence of urine and feces. Along with these characteristics, she refused to eat, drink or care for herself. She was considered a dangerous patient. When examined several months following the July 1947 procedure and just prior to discharge, Carolyn's assaultive, destructive, and delusional behavior had largely disappeared. She was approachable and tractable. In the postoperative examinations, her demeanor was described as placed and unruffled. Strong affect or emotion was rarely if ever seen. Most IQ assessments over the last 40 years have shown that Carolyn is in the bright-normal to superior range. When tested at age 75 an across-the-board reduction in intellectual capacity was observed (not necessarily unusual for this age). Carolyn had a pervasive remote memory deficit. Next to this the most prominent cognitive loses are in tasks requiring a flexible approach to problem solving and ability to modify behavior to suit the situation. This was most apparent in performance on the Wisconsin Card Sorting Test. The scalp distribution of the P300 was not typical of a 72 year old. Carolyn showed an atypical distribution (in elderly subjects P300 is usually of equal amplitude at Fz, Cz and Pz) which may be due to the extensive prefrontal damage. The PET scan revealed that "the anterior 30–40% of the entire cerebrum, comprising primarily the prefrontal regions, was severely, if not totally, hypometabolic. This suggests that the prefrontal areas of Carolyn's brain are largely nonfunctional."

Lansdell, H.

A Sex Difference in Effect of Temporal-Lobe Neurosurgery on Design Preference.

1962

22 patients with temporal-lobe epilepsy were tested before and 13–31 (mean=17) days after unilateral temporal-lobe surgery (on the side considered nondominant for speech) for relief of their epilepsy. 42 other cases were tested only after 1–8 yrs (mean=4.2) after such surgery. One man and two women had operations on the left because test showed that the dominant hemisphere for speech in them was on the right.

Subjects were tested on the Graves design judgment test. This test measures "certain components of aptitude for the appreciation or production of art structure." In the 22 cases, the amount of tissue removed was less than usual, 3–51/2 cm from the tip of the lobe on the right and 21/2–41/2 cm on the left.

The men having had resections in the non-dominant hemisphere showed a drop in mean aptitude score post-operatively. Women with the same operation showed a rise in mean score. For those groups of men and women with resections in the dominant hemisphere, the opposite effect was observed. Men showed a rise in score while women showed a drop. There was, however, a significant interaction of sex and side only post-operatively. Three patients had score changes that were opposite to the general trend, and two others showed no change. Three of these five did have atypical operations which may help explain the inconsistency in behavior. The changes in scores on the Graves test were not found to be related to changes in scores on the Wechsler-Bellevue intelligence tests and, therefore, do not appear to be "intellectual" changes. "Although the post-operative changes on the Graves test are clear, they appear to be transitory. No significant relation to the surgery was discernible for either sex or side of operation in the group of 42 patients tested a year or more after their operations." The results of the women tested do not support the hypothesis that an "impairment in some aspect of human visual perception occurs after removals from the temporal lobe of the non-dominant hemisphere." "Effects of the operations suggest that some physiological mechanisms underlying artistic judgment and verbal ability may overlap in the female brain but are in opposite hemispheres in the male.''

Lansdell, H.

Sex Differences in Hemispheric Asymmetries of the Human Brain.

1964

Letter

Review of a study done by Conel (1963) who investigated eight brains of 4-year-old children for hemispheric differences. Only when the sexes were separated were two noteworthy differences found. Myelination was greater in the left FAy-hand area than in the same area in the right hemisphere in 4 of the 5 female brains. In the 3 male brains this was reversed. Secondly, in the 4 female brains the number of exogenous fibers in layer I of areas FAy and PB is greater on the right. In 2 of the 3 male brains this number was greater on the left. Though the results provided did not reach statistical significance, the author speculates whether "these anatomical differences could be related to the finding that side differences in the tactual thresholds on the thumbs of young children are not the same for the two sexes." An earlier study by Matsubara, cited by Lansdell, suggests that the right vein of Troland is larger than the left in girls. This was not true for boys. This is the major vein in the hemisphere opposite to that used in speech so differences in venous drainage could possibly be related to the superiority of girls over boys in certain verbal skills. He suggests that "the sex of the patients is a factor which should be heeded in investigation of the laterality of cerebral function."

Lansdell, H. and Urbach, N.

Sex Differences in Personality Measures Related to Size and Side of Temporal Lobe Ablations.

1967

46 epileptic patients who had had unilateral temporal lobe removals. Others excluded had IQs below 90, invalid MMPIs, and possible complicating factors in the lateralization of their damage and its effects. 18 of the 46 had left temporal removals (13 men (ML), 5 women (WL)). 28 had right temporal removals (12 men (MR), 16 women (WR)). Mean age of all = 33.6 years and an average of 3.4 years had elapsed since surgery at the time of the questionnaire.

Subjects received the card form of the MMPI. Only MMPI records with <60 and L<9 were included in the analysis. The Wechsler-Bellevue Intelligence Scale was also frequently administered at the same time, but for some a year or more earlier. Subjects also received the Graves Design Judgment Test.

"The mean extent of right temporal removals, 5.1, was greater than the mean of the left removals, 4.5 (p<.01) this difference was slightly greater for women than for men, and the range of the extent of the removals was greater in men, 1.0 to 7.6, than in women, 2.5 to 7.3. Men showed a larger correlation between size of ablation and WB verbal to nonverbal ratio. The difference in range of extent of removals may account for this. It would not, however, account for differences found in the signs of the correlations on the DJT and MMPI. DJT results suggest that the larger the left temporal removal in males, the stronger their preference for simple forms. The correlation between extent of removal and scores on the "Schizophrenia" scale of the MMPI was negative for the MR group, distinguishing it from the other three groups. The ML group showed a relatively lower verbal component of the WB ratio. This is consistent with previous documentation of selective effect (in males) of left temporal removals on the interpretation of proverbs. The same analyses were performed and the same pattern of results found in a less selected group of 76 Ss. "As suggested by the results of this investigation, research on the lateralization of cerebral function may often benefit from checking for the presence of sex differences."

Lansdell, H.

Sex Differences in Brain and Personality Correlates of the Ability to Identify Popular Word Associations.

1989

117 neurosurgical subjects. 89 had previously had temporal lobe surgery and 28 had subcortical surgery (which involved coagulations in the thalamus). Mean age = 51.1 yrs. Neurosurgical subjects were tested three times - with the third test occurring about 17.6 months post-surgery with temporal lobe patients and 16.4 months post-surgery for subcortical patients. A group of 55 (of the 89) temporal lobe patients were only tested once - a year or more post-surgery. Mean = 60.2 months post-surgery. 306 nonsurgical subjects served as comparisons. 164 had epilepsy, 80 were classified as "other neurological patients," and 62 visitors or patients who appeared to be normal neurologically. Mean age=36.3 yrs.

Subjects were administered the multiple choice Word Association Test (WAT) and the Minnesota Multiphasic Personality Inventory (MMPI), box form. The MMPI was only administered to those subjects whose IQs were average or above. The two factor scores A (anxiety) and R (repression) were used for this study. Form I of the Wechsler-Bellevue Intelligence Scale (WB) was used prior to surgery and again one year or longer later. Form II was used in the period immediately following surgery.

The mean WAT error score was no different for the neurological subjects as compared to a college and a university sample in a previous study. Somewhat of an affect on the WAT scores was observed after neurosurgery to the left hemisphere. The most obvious impairment was observed a year or so later in the males. The female patients showed improvement on the third test (one year or more post-surgery). Results on the WAT for the 55 temporal lobe patients, who were first tested years after surgery, also showed that the scores for males were more affected than those for females when intelligence was controlled for. "These unique results with these operations show a resiliency of the female brain, compared with the male brain, with regard to these two types of surgery and the ability assessed by the WAT." Scores of the MMPI and WB did not show comparable changes post-surgery. In the males tested after temporal lobe surgery, a higher number of errors on the WAT tended to be associated with higher A and lower R scores (MMPI). High A and low R scores usually indicate that the person is ''introspective, ruminative" and "lacking in common sense" among other characteristics. "These results with the WAT are unique in implying that most men undergoing these types of neurosurgery can suffers some permanent selective impairment that affects this aspect of their understanding of normal human thought processes." The authors note marked controversy in reports of sex differences in the effect of lateralized brain damage.

Sundet, K.

Sex Differences in Cognitive Impairment Following Unilateral Brain Damage.

1986

Patients were taken from a neuropsychological register of brain-injured patients. 232 of them were tested with WAIS and of these 83 met the criteria for inclusion in the present study. The criteria were: (1) lesion diagnosed as positively unilateral either through operation or autopsy, or through use of CT, angiography, or pneumoencephalogram; (2) nonaphasic; and (3) functionally right-handed. Of the 83, 19 were males with left-sided brain lesions (LBL), 32 were males with right-sided brain lesions (RBL), 15 females with LBL, and 17 females with RBL.

Patients were administered the authorized Norwegian version of the WAIS. Information on age, time since onset, etiology, and intra-hemispheric localization was collected from the records.

The author states that "sex differences in the pattern of WAIS impairment following unilateral brain damage may be regarded as a cross-cultural phenomenon." Results showed that the WAIS discrepancy score did diagnose laterality of lesion in the males but did not in the females. The author believes that this indicates a sex-related difference in cognitive functioning. Some references to previous studies are made in support of these findings. The author suggests that characteristics of cognitive strategies and how they "compensate for chronic deficits" be the focus of further research on sex differences.

Hampson, E. and Kimura, D.

Reciprocal Effects of Hormonal Fluctuations on Human Motor and Perceptual-Spatial Skills.

1988

34 spontaneously cycling women ranging from 20–39 years (mean=24.65 yrs.). They were predominantly university students. Their menstrual cycles were regular (25–25 days). 32 were right-handed.

The portable version of the Rod-and-Frame test was administered. The battery includes a finger-tapping test, the Purdue Pegboard, and the Manual Sequence Box. Each was tested twice, once during menstruation when levels of estrogen and progesterone are low (day 3 – day 5) and once during the midluteal estrogen and progesterone high (7 days before expected menstrual onset). Days 1 and 2 were avoided because of possible confounders (i.e., physical discomfort, etc.).

A number of investigators have previously reported that males are significantly more accurate than females (to 2 and even 3 degrees) on both the original and the portable versions of this test. Subjects showed significantly less accuracy at aligning the rod to true vertical during the midluteal phase test than during menstruation. On the other hand, performance improved during the midluteal phase on most tests targeting manual skill. Subjects showed greater speed and accuracy on these tests. A mood inventory was given prior to each test. No significant phase-related mood differences were observed. "We have thus demonstrated reciprocal performance fluctuations over the menstrual cycle in two types of skills, namely speeded manual coordination and a perceptual-spatial skill. The dissociation in the pattern of change is particularly interesting in light of the sex differences usually reported for these tests: High levels of female hormones enhanced performance on tests at which females excel but were detrimental to performance on a task at which males excel. The size of the hormone effect in relation to the size of the sex difference exceeded 75% for the Rod-and-Frame test and 65% for the Manual Sequence Box task. Together these suggest that the sex differences on these, and perhaps other cognitive tests, may have a substantial hormonal basis."

Jutai, J. W. and Hare, R. D.

Psychopathy and Selective Attention During Performance of a Complex Perceptual-Motor Task.

1983

39 white male inmates of a medium security prison. Based on Cleckley's conception of psychopathy (1976), each subject was rated by two investigators on a 7-point scale of psychopathy and a 22-item psychopathy checklist. Two groups were established. A high psychopathy group (Group H) comprised 11 inmates with a combined rating of 12–14 and a mean checklist score of 35.36. The low psychopathy group (Group L) comprised 10 inmates with a combined rating of 3–8 and a mean checklist score of 20.35.

Electrodes were attached to record ERPs. Subjects went through some pregame tasks which included alternating periods of just listening to a series of tone pips through headphones and 5-min eyes open 5-min eyes closed periods. These were carried out to determine whether auditory ERP differences between groups existed. The main experiment consisted of a set of tank games and a set of jet games. During the trials, subjects were instructed to score as many hits as possible on the enemy target. Tone pips were presented during each trial, but the subjects were told that the pips were task-irrelevant. At the end of testing, subjects used 4-point scales to rate how difficult and how exciting each type of game was.

No group differences in heart rate or electrodermal activity were found. The authors believe that this lends support to the view that most autonomic differences between psychopaths and other comparison groups are more prone to occur when tasks involved are monotonous or threatening than when they art the notion that psychopathy is not associated with abnormal electrocortical responsivity during tasks involving passive attention. No group differences were found in amplitude or latency of N100 and P200 of the auditory ERPs during the passive attending periods. The question remains whether or not the similarity in electrocortical responses during passive attention in psychopaths and others is due to the use of similar behavioral and cognitive strategies. In the main part of the experiment where attention was divided between tone pips and the primary task, groups H and L differed in attention allocation. Specifically, Group H showed much smaller N100 responses in the first trial than Group L. It appears that Group L was less successful initially at ignoring the task-irrelevant stimuli in order to focus attention on the primary task than Group H. This was concluded from the fact that the responses of Group H were less than half as large in the first trial as during the passive attention to the tones; those of Group L were slightly larger. As the task progressed Group L became better at shifting attention toward relevant features and away from irrelevant ones, N100 responses got smaller and performance improved. Although the N100 responses were small from the onset for Group H, they were not associated with especially good performance. Also, during later trials performance deteriorated. "While psychopaths may have found it easy to ignore stimuli they had been told were irrelevant, they may have failed to develop an efficient strategy for the distribution of their attentional resources among the various elements of the primary task."

Jutai, J. W., Hare, R. D., and Connolly, J. F.

Psychopathy and Event-Related Brain Potentials (ERPs) Associated with Attention to Speech Stimuli.

1987

33 white male inmates selected from a medium security institution. The subjects were consistently right-handed, had normal (or corrected to normal) eye sight and normal hearing. A 7-point psychopathy scale was used to assess psychopathy in attempts to maximize separation between the two groups. Also, a 22-item psychopathy checklist was used to aid in this assessment. Two groups were established. Psychopaths (group P) comprised 11 inmates with a global rating of 7 and a score on the psychopathy checklist of at least 34. Nonpsychopaths (group NP) comprised 13 inmates with a global rating of 1–4 and a score on the psychopathy checklist of at most 24. There was no significant difference between groups in age and years of formal education.

Two phonemes, /v/ and /ts/, with onset and offset characteristics served as the speech stimuli. They were presented binaurally through stereo headphones. Subjects received 64 presentations of each phoneme. One block of 32 simply required passive listening and the other block of 32 required pressing of a microswitch on each presentation. This was a preliminary experiment to determine whether group differences in the nature of the ERPs elicited by phonemes or in the effect of motor activity on the ERPs existed. No significant differences were found. The experiment itself consisted of a Single-Task, in which one phoneme (the target stimulus) was presented less often than the other, a Game-only condition, which served as a baseline for the Dual-Task, and a Dual-Task, where the subject played the video game as best he could. In the Dual-Task the subject performed the phonemic oddball paradigm while simultaneously playing some sort of video game (essentially a combination of the Single-Task and Game-only tasks). Subjects received $.05 for each point scored and lost $.05 for each target stimulus missed. ERPs were recorded throughout.

Results of this study and a previous study (Jutai and Hare, 1983) both failed to find inter-hemispheric differences in N100 responses in psychopaths attending to tones in a passive listening task. Thus the hypothesis that "psychopaths are characterized by asymmetric low left-hemisphere arousal" is not supported by these ERP data. In the Single-Task, ERPs of the psychopaths were normal. In the Dual-Task, however, the ERPs of the psychopaths showed a prominent slow wave which was most apparent at Cz and T3. "Because there were no differences between Groups P and NP in the amplitude of N100 responses, and because the N100 responses of both groups were the same in the Dual-Task as they were in the Single-Task, Group P's slow wave in the Dual-Task is not readily explainable in terms of the group differences in central arousal. It is unlikely that Group P was uncertain (or equivocal) about the outcome of target discrimination, because target detection rates were high and false alarms were rare. Rather, Group P may have failed to learn as much as did Group NP about the likelihood that a target would appear on a subsequent trial, and consequently, equivocated about stimulus probability, producing a large slow wave." Slow wave activity was much more prominent in T3 than in T4 for the psychopaths. This could indicate some type of left hemisphere dysfunction, or, perhaps, these subjects differ in cerebral organization of language functions. The authors are cautious about speculation because of "relative lack" of empirical data on cognitive functioning and perception in psychopaths.

Hare, R. D. and Jutai, J. W.

Psychopathy and Cerebral Asymmetry in Semantic Processing.

1988

39 white male inmates of a medium security prison. Each subject was right-handed. To establish groups, each was evaluated with a 22-item Psychopathy checklist. The inmates were divided into high, medium and low (H, M, L) psychopathy groups. Each group consisted of 13 inmates. The mean checklist scores were: H>32; L<23 and M=23–32. 13 right-handed men recruited from a federal employment center served as a noncriminal comparison group (NC). Groups were similar on demographic and socio-economic variables.

The examiners were blind to the group each subject was assigned to. A divided visual field procedure was used to research cerebral organization of language processes in psychopaths. A 2-field Cambridge tachistoscope was used to present the 4-letter concrete noun printed on a white card that served as the stimulus. The stimuli were presented in either the left or the right visual hemifield. Subjects participated in three tasks: the SR task where the stimulus had to match a pretrial word, the SC task where the stimulus was an exemplar of a specific category and the AC task where the stimulus was an exemplar of an abstract category.

Reaction times did not differ significantly among Groups H, L and NC. Responses in each of these groups were somewhat faster to stimuli that appeared in the right visual hemisphere than those that appeared in the left visual hemisphere. In general, reaction times were faster in the SR task than in the AC task as expected. Of most importance was the finding that psychopathic criminals differed from other criminals and noncriminals in the asymmetry of errors on an abstract categorization task. Group H showed normal asymmetry on the SR task, but showed a left visual field advantage (reversed asymmetry) on the AC task. In actuality the psychopaths made a large number of errors in the right visual field and thus a right visual field deficit may be more descriptive than a left visual field advantage. Group H did not show improvement in right visual field performance during the AC task. "The results, along with those obtained in a recent dichotic listening study, lead us to speculate that psychopathy may be associated with weak or unusual lateralization of language function, and that psychopaths may have fewer left hemisphere resources for processing language than do normal individuals."

Andrew, J. M.

Imbalance on the Weights Test and Violence among Delinquents.

1981

41 adjudicated Caucasian male legal offenders within four age groups: 7 age 12–14 yrs 13 age 15–16 yrs 10 age 17–20 yrs 11 age 21–29 yrs. Only right-handed subjects were included. These males were consecutively referred for psychological evaluation for treatment planning.

Each subject received the Weights Test (a psychological test of proprioceptive motor/cognitive function) and was rated for violence on the Violence Scale. Each offender's most serious crime was rated according to the Violence Scale and used in the study.

Results from the Weights Test, as hypothesized, divided the sample of Caucasian male offenders into more versus less violent groups. Scores from the Violence Scale were highest for subjects considered mildly impaired, according to the Weights Test, and lowest for those subjects considered less impaired and those considered more impaired ("moderately impaired"). The authors speculate on the applicability of the deficit theory and the imbalance theory to these results. They do not provide any concrete conclusions.

Brickman, A. S., M. McManus, W. L. Grapentine, and N. Alessi

Neuropsychological Assessment of Seriously Delinquent Adolescents.

1984

71 subjects (40 male; 31 female) were chosen based on four criteria:

1. commission of violent felonies

2. commission of multiple non-violent felonies

3. multiple placements within the training school system; and

4. assaultive in-program behavior requiring medical attention for the victim. Mean age=16.3 yrs. 39 of the subjects were white, 26 - black, 3 - Hispanic 3 - mixed race.

The Luria-Nebraska Neuropsychological Battery (LNNB) was administered to all subjects. This examination consists of 269 items organized into 11 categories: Motor, Rhythm, Tactile, Visual, Receptive Language, Expressive Language, Reading, Writing, Arithmetic, Memory, and Intelligence, Educational levels for the subjects were assessed (as accurately as possible).

Violent and recidivist delinquents display a distinctly abnormal pattern of functioning. This pattern is not limited to higher "intellectual" functions, but, rather, encompasses a wide range of functions. The only significant differences between the subgroups, however, are in expressive speech and memory scales. This could be attributable to education or concentration problems. Upon reviewing the specific neuropsychological dysfunction, the authors suggest that the temporal lobe may be implicated.

Hermann, B. P.

Neuropsychological Functioning and Psychopathology in Children with Epilepsy.

1982

Fifty children with epilepsy ages 8 – 12 yrs. Two groups were created based on neuropsychological function. 25 had good neuropsychological function and 25 had poor neuropsychological function. The subjects were also classified according to seizure type.

Each child received a complete neurological evaluation including an EEG. The two groups were compared in several domains. Social competence and behavioral functioning were measured using the Child Behavior Checklist. For neuropsychological data each child completed the Luria-Nebraska Neuropsychological Battery - Children's Version.

A highly significant relationship between adequacy of neuropsychological function and the level of aggressive behavior in children with epilepsy was determined. Those subjects with a poor performance on the neuropsychological battery also retained significantly higher scores on the Aggression scale of the CBCL as compared with children who performed better on the neuropsychological tests. Neuropsychological functioning was also associated with increased scores on the Total Behavioral Problems measure and a decreased scores on the Total Social Competence scale.

Lewis, D. O., Lovely, C. Yeager, and D. Della Femina

Toward a Theory of the Genesis of Violence: A follow-up Study of Delinquents

1988

77 more violent and 18 less violent males incarcerated at a correctional school. The mean age was 15.3 yrs. (12.4–17.4). 41% of the subjects were black, 37% white, 21% Hispanic, and 1% Oriental.

A follow-up study (Lewis et al., 1979). Data were taken from adult F.B.I. and state police records.

All subjects, with the exception of six, had an adult criminal record. The average number of adult offenses was 11.58. Seventy-seven percent of the more violent juveniles along with sixty-one percent of the less violent juveniles went on to commit adult aggressive offenses. It seems, then, that juvenile violence, as the only variable, did not predict which individual would go on to exhibit violent criminal behavior as an adult and which would not. The authors suggest studying neuropsychological, cognitive and psychiatric variables; history of abuse, and familial vulnerabilities may also play a role. Studying the interaction of these variables may lead to a more accurate model from which to predict adult violent crime.

Lewis, D. O., S. S. Shanok, M. Grant, and E. Ritvo

Homicidally Aggressive Young Children: Neuropsychiatric and Experiential Correlates.

1983

55 children admitted to a psychiatric service. Primarily a diagnostic service where patients remain 90 days on the average. 21 were homicidally aggressive.

Data were obtained from hospital records, which included family, medical, developmental histories, psychiatric evaluations, physical examinations, neurological assessments, educational assessments, psychological testing, and EEGs (for most). Also reviewed the types of medications that had been prescribed. Four raters determined from information provided by the chart whether the individual had ever been homicidally aggressive.

Homicidally aggressive children were significantly more apt to have had a seizure, have a father who displayed violent, often homicidal, behavior, have a mother with a history of hospitalization for a psychiatric disorder, and have attempted suicide. The homicidal and nonhomicidal children were not distinguished by psychiatric symptoms and diagnoses. The most significant variable appeared to be whether the child had been exposed to a violent father. Witnessing irrational violence engenders rage that can be expressed through suicidal behavior when turned inward or aggressive (homicidal) behavior when directed outward.

Miller, L.

Neuropsychology of the Aggressive Psychopath: An Integrative Review.

1987

Clinical lit. Review paper on aggressive psychopaths

The review has been compiled according to the hypothesis that neuropsychological approaches may be useful on this domain because they allow for elaboration on the relationship between cognitive and affective dimensions, and generate new hypotheses about brain-behavior correlations.

It is hypothesized that the "disinhibited psychopath" suffers from a neurodevelopmental maturational deficit that accounts for decrease in, and practically lack of ability to regulate attention, affect, thought, and behavior through inner speech. In situations involving social frustration or confusion, behavior regresses and more primitive aggressive reaction strategies are employed to cause changes in the social milieu. The author argues that psychopathy is not a "frontal lobe disease," but that derangements in development of the frontal system foundations for the control of attention, cognition, affect, and volition may lead to subsequent disorders in this area that allow for antisocial behavior in a specific group of aggressively disinhibited persons. The author feels that a neuropsychological approach would be complimentary to the psychodynamic and cognitive approaches already in use in studying this area.

Mungas, D.

Psychometric Correlates of Episodic Violent Behaviour.

1988

Three groups of neuropsychiatric out-patients

1. (n=35); frequent, impulsive violence

2. (n=57) non-violent group

3. (n=31) much less frequent violence and more provoked

Subjects were given the Minnesota Multiphasic Personality Inventory (MMPI), the Holtzman Inkblot Technique (HIT), and neuropsychological tests battery measuring cognitive ability. Specifically, four categories of cognitive functioning were tested: attention and concentration, visual-perceptual abilities, memory and new learning, and language-related abilities (these tests included WAIS subtests among others).

Results of this study apply mainly to impulsive, poorly provoked violent behavior. Violent individuals often showed abnormalities in language and visual-perceptual skills and in ability to perceive and evaluate complex environmental situations effectively, but not in other cognitive areas. The groups were not significantly discriminated by IQ measure or by the cognitive index. Violent behavior and poor language skills could be related through lack of adaptive verbal mediation of behavior in environmental situations that are emotionally charged. It may also be that the relationship of language deficits to violent behavior is not a causal one, and that dominant hemisphere dysfunction itself could be the cause. Results of this study support the first hypothesis. The authors strongly support a neuropsychological model in brain abnormality research.

Piacentini, J. C.

Language Dysfunction and Childhood Behavior Disorders.

1987

Chapter/Clinical Lit. Review

The chapter describes the nature of the relationship between language dysfunction and behavior disorders in children. Literature examining the relationship from the standpoint of either domain is reviewed.

Children with language dysfunctions are at higher risk to develop behavior disorders than are children who show no language disorders. Further investigation into the chronology of development of language and speech and behavior disorders would provide necessary etiological information that is beneficial to development of appropriate treatments. The author suggest that population studies should follow in order to determine how environmental, familial, genetic, and biological variables affect this type of relationship.

Tarter, R. E., A. M. Hegedus, N. E. Winsten, and A. I. Alterman

Neuropsychological, Personality, and Familial Characteristics of Physically Abused Delinquents.

1984

101 delinquent adolescents consecutively referred to Western Psychiatric Inst., by a judge, for a comprehensive neuropsychiatric assessment. 82% were male, 18% female, 35% black 65% Caucasian, 27% physically abused, remaining 74% - control group.

Developmental and familial information was obtained through psychiatric evaluation, social worker's report, probation officers and past records. From this the environmental correlates of child abuse were assessed. A battery of cognitive, behavioral, and personality tests were also given. Cognitive Measures: Wechsler Intelligence Scale for Children-Revised (for 16 and under), Wechsler Adult Intelligence Scale, Peabody Individual Achievement Test, Detroit Tests of Learning Aptitude, Pittsburgh Initial Neuropsychological Test System. Behavioral and Personality Measures: Matching Familiar Figures Test, Minnesota Multiphasic Personality Inventory, Devereux Adolescent Behavior Scale. Familial and Developmental Indices: Family Environment Scale, Family History, Developmental Measures.

Abused delinquents performed relatively more poorly than nonabused delinquents on specific intellectual, educational, and neuropsychological measures. Abused delinquents are more likely to commit assaultive crimes. They present themselves as less domineering but, also, are less likely to exhibit feelings of inferiority. They generally come from more disrupted families, often involving parental alcoholism, criminality, and separation. Cognitive impairments in abused children were primarily focused in verbal or linguistic areas. The authors support the proposed notion (Luria, 1966; Lewis, 1979) that this may ''indicate an underlying inability to self-regulate behavior or acquire rule governed behavior." The authors suggest that the distinguishing characteristics found in an abusive family seem to place these abused delinquents at high risk for a poor subsequent adulthood.

Walsh, A., and J. A. Beyer

Violent Crime, Sociopathy and Love Deprivation among Adolescent Delinquents.

1987

131 male delinquents previously on probation with the Ada County Juvenile Probation Dept., Idaho. All were white. Age is a constant since all cases were drawn from inactive files - each contained the subjects delinquency history up to the age of eighteen.

Based on the observation by Wechsler that adolescent sociopaths tend to score higher on performance than on verbal sections of the Wechsler IQ scale. Examined P-V discrepancy, love deprivation, and delinquency and their interaction. Asked social workers and probation officers to rate items in probation files on how well they indicate love deprivation (1–10). Used all items above 6 as indicators and subsequently rated subject's family file. All crimes on each record were scored using the Violence Scale (Andrew, 1978)

Results showed that the a good deal of the explanatory power of characteristically higher scoring on the performance than on the verbal sections of the Wechsler IQ scale among juvenile delinquents with regard to violent behavior is mediated by love deprivation. Low verbal scores, lower full-scale scores, or social class were not significantly related to performance > verbal, only love deprivation was. The authors feel this evidence supports the hypothesis that early emotional stresses affect development of autonomic nervous system function.

Woods, B. T., and M. D. Eby

Excessive Mirror Movements and Aggression.

1981

170 inpatients in a child psychiatric unit

170 patients (113 males; 57 females) ages 10 – 15. Received neuropsychological testing which included standardized testing for mirror movements. Patient assigned a DSM II diagnosis of the following were classified as aggressive. 1. Unsocialized Aggressive Reaction. 2. Impulsive, Explosive, Sociopathic or Antisocial or Dissocial Relevancy or Character Reaction. 3. GAP diagnosis of Tension Discharge Disorder

Aggressive patients, especially the subgroup of aggressive males, had significantly more mirror movements than the nonaggressive patients. The authors feel that this may reflect an underlying effect in brain function: "a lack of inhibition of inappropriate activity."

Yeudall, L. T., D. Fromm-Auch, and P. Davies

Neuropsychological Impairment of Persistent Delinquency.

1982

99 adolescents (64 males; 35 females) were consecutively admitted to the Youth Development Centre. Mean age = 14.8 years (13 – 17) for delinquent group. Eight were on medication at the time of testing. High percentage of nonprescription drug usage. The nondelinquent group: 47 adolescents from regular classrooms (29 males; 18 females). Mean age = 14.5 yrs.

Subjects received the Halstead-Reitan Battery along with 12 other neuropsychological tests (total = 40 tests in standard order) Ages 16 and under were required to complete the Wechsler Intelligence Scale for Children-Revised. Subjects ages 17 and up were given the Wechsler Intelligence Scale.

84 per cent of the profiles were abnormal in the delinquent; 11 per cent were abnormal in the non-delinquent group. In other words, a high percentage of delinquents showed a neuropsychological deficit. There was a high degree of statistical difference between the control and delinquent groups based on neuropsychological and psychological test scores. Following further analysis of these deficits, it appeared that these deficits implicated anterior dysfunction that is greater in the nondominant than in the dominant hemisphere. Using these results the authors suggest that delinquents may be deficient in ability to plan their actions and perceive consequences of these actions. These conclusions are discussed with regard to a low number of violent adolescents in the sample as compared with a high percentage of delinquents showing signs of depression.

Kindlon, D., Sollee, N. and Yando, R.

Specificity of Behavior Problems Among Children with Neurological Dysfunction.

1988

248 children, 172 boys and 76 girls, aged 4 – 16 years. They were broken down into three groups: the neurological dysfunction (ND) group comprised 81 children who had to have either (1) a diagnosis of neurological dysfunction such as cerebral palsy, seizure disorder, or head injury with resultant coma lasting at least 1 week or (2) findings definitively indicative of brain damage on the EEG, CT scan, or BEAM. The specific developmental disorders group (SDD) - based on DSM-II designation - comprised 167 children. They showed no hard evidence of neurological dysfunction, or history of serious head injury, or abnormalities on EEG, CT scan, or BEAM. The psychiatric clinic populations (PC) comprised 856 children described by Achenbach (1978). All groups were broken down by age and sex: ages 6-11 and 12-16.

Parents or guardians of the children in the ND and SDD groups completed the CBCL (either at the time of evaluation or three years later - retrospectively). This same data were obtained for the PC group from Achenbach (1979). Children in each group were divided into three levels of socioeconomic status.

Children in the ND and SDD groups had a higher rate of disturbance on many factors, but they exhibited less aggressivity and delinquency than did the PC group. Although children with neurological dysfunction (as a group) show various psychological problems, these problems are less likely to be characterized as externally directed aggressive types of behavior. SDD and ND samples are more alike than PC. This indication of lower Aggressiveness and Delinquency for the nonpsychiatric groups is particularly apparent in the younger ages. For both sexes in the 6–11 age group, differences were not explainable on the basis of socioeconomic status. On the contrary, in boys in the 12–16 age group, lower socio-economic status was associated with higher scores on the Aggressiveness and Delinquency

Mednick, S. A., and Kandel, E. S.

Congenital Determinants of Violence.

1988

173 recidivistically violent offenders who had committed two or more violent offenses (potential "specialists") were isolated from a Danish birth cohort consisting of 31,436 men born in Copenhagen between Jan. 1944 and Dec. 1947. 28,879 were still alive at the time of the study. At 27 years of age 37.8% (10,918) had had at least one police contact for a criminal law offense; 2.5% (721) had committed at least one violent offense and 173 had committed two or more violent offenses These 173 account for 0.6% of the 28,879 and were held accountable for 43.4% of the violent offenses.

For the adoption study, also in Denmark, a birth cohort of 14,427 non-familial adoptions from 1924–1947 were used.

The authors examine various types of studies designed to determine whether congenital factors contribute to a predisposition to repeated violent behavior. These include family, twin and adoption studies. The authors include both inherited characteristics and perinatal experiences in their idea of contributing congenital factors. They feel adoption studies "provide the most fertile ground for study." For each adoption psychiatric hospital diagnoses and court conviction histories were recorded for the adoptee, the biological mother and father, and the adoptive mother and father. Occupation was included as a record of socioeconomic status.

Calculations showed that a first-time violent offender was 1.94 times more likely to commit a violent act in the future than was a first-time property offender. When analyses were limited to offenses committed prior to 18 years of age the effect was still prominent, thus, the data indicate that "specialization'' for violence can also be found in juvenile offenders. The authors define specialization as such: "Specialization has been observed if an individual who commits a violent offense is more likely to commit a subsequent violent offense than an individual who commits a property offense." Results of the adoption study showed a "definite relationship between biological parent and adopted-away son for property convictions, but there is no significant relationship for violent offenses." A study by Cloninger et al. (1987) found similar results. However a study by Moffit (1984) did show a genetic effect for violence. As far as perinatal factors are concerned, the authors briefly describe two studies (Mednick, 1983 and Drillie, 1964) which found that perinatal problem indices related to later violent crime than property offenses. They also showed, however, that stable family rearing appeared to compensate for perinatal damage.

Walker, E., Downey, G., and Bergman, A.

The Effects of Parental Psychopathology and Maltreatment on Child Behavior: A Test of the Diathesis-Stress Model.

1989

Of a total subject pool of 144 children included in a longitudinal study of risk factors in development, 53 boys and 49 girls were selected for the present study. Mean ages were 9.75 and 9.24 yrs. respectively. 44 of the boys and 40 of the girls were located for a second behavioral evaluation. Families were distributed across three groups (schizophrenia, psychiatric control, and normal control). Number of children in each parental diagnosis group were as follows. Schizophrenia/maltreatment: 5 boys and 4 girls Schizophrenia/no maltreatment: 9 boys and 6 girls; psychiatric comparison/maltreatment: 9 boys and 5 girls; psychiatric comparison/no maltreatment: 5 boys and 4 girls; normal comparison/maltreatment: 8 boys and 16 girls; normal comparison/no maltreatment: 17 boys and 14 girls.

This study was designed to investigate "the main and interactive effects of parental psychopathology and maltreatment on child behavior." The Achenbach Child Behavior Checklist was used. Parents (of the 84 for whom a second evaluation was obtain) completed a the CBCL a second time one year later. It was often necessary to rely on the disturbed parent to complete the CBCL since many households were single-parent homes. Despite this possible weakness, the ratings did show "adequate internal consistency and test-retest reliability." Two variables were used as measures of quality of rearing environment: maternal educational level and household composition (single- vs. two-parent households).

The emphasis in this study was on the importance of investigating multiple risk factors simultaneously. The authors were interested in testing the assumptions of the diathesis-stress model. Boys from maltreating homes displayed significantly greater "externalized behavior problems". These included aggression and delinquency (first assessment). Girls from maltreating homes displayed increased aggression as well (first assessment). The combination of parental schizophrenia and maltreatment was associated with a progressive increase in delinquency in both sexes over time. "These results support a diathesis-stress model of psychopathology."

Lansdown, R.

Lead, Intelligence, Attainment and Behaviour.

1986

Lit Review

Lit Review

The body of large-scale surveys suggests at least a possibility that lead is causally related to deficits in cognitive functioning. Even the most recent epidemiological studies have failed to produce convincing consistent evidence for an association between moderate levels of lead and behavioural patterns in general; even less is the evidence on lead and hyperactivity. There have been several suggestions and the work on chelation means that the topic should not be dismissed. More than this cannot be said." The author claims that many of the early investigations in this field were based on a population of socially disadvantaged children. He points out that the more recent studies in Germany and Britain have indicated that there may be "virtually no causal relationship among children from more advantaged homes." If this is proven to be true, perhaps the contradictions in the earlier studies can be explained.

Needleman, H. L., and Gatsonis, C. A.

Low Level Lead Exposure and the IQ of Children: A meta-analysis of modern studies.

1988

12 studies of childhood exposure to lead and intellectual performance. Each study employed multiple regressions analyses with IQ as the dependent variable, lead as the main effect, and controlled for non-lead covariates. 12 other studies were excluded from the analysis because of inadequate analysis, over-control or under-control of covariates or clinical toxicity. Of these 5 showed a lead effect and 7 did not. Of those used for the meta-analysis 7 used blood lead levels and 5 used tooth lead levels - they were classified as such.

A meta-analysis of 12 studies drawn from all studies on lead exposure and children's neurobehavioral development published since 1972. 8 studies measured IQ by the WISC-R scales, two used the Stanford Binet IQ scales, one used the British Ability Scales, and one used the McCarthy Scales.

Of four previous reviews on the studies of lead at low dose one came to a qualified negative conclusion, one to a positive conclusion and two found the evidence inconclusive. These reviews were inconsistent partly due to a "limitation inherent in the method of narrative reviewing." By using the meta-analysis method, 11 of the 12 studies reported a negative coefficient for lead (the range of the effect size measured by the t-value for the lead term was - 3.86 to - .03). Sample sizes ranged from 75 to 724. Joint p-value for the 7 blood lead studies was <.0001 (for all three methods of analysis). This did not change when any of the 7 studies was excluded. Joint p-value for the 5 tooth studies fell between .004 and .0003. When any one study was excluded the p-value for the remaining 4 ranged from .025 to <.0005. "The hypothesis that lead impairs children's IQ at low dose is strongly supported by this quantitative review. The effect is robust to the impact of any single study."

Needleman, H. L., Schell, A., Bellinger, D., Leviton, A. and Allred, E.

Long Term Effects of Childhood Exposure to Lead at Low Dose; An Eleven-Year Follow-Up Report

1989

132, of an original 270 children tested in 1979, 18 to 19 year olds.

Dentine levels measured in 1976–1977 for each subject were used to for computing mean concentrations. Venous blood lead levels were obtained in the present study as well. After the first 48 subjects, in which lead levels exceeding 7 µg/dl did not exist, venous blood withdrawal was discontinued. One examiner, blind to lead status, rated subjects on behavior. Subjects were administered the CPT, Symbol digit substitution, hand-eye coordination, simple visual reaction time, finger tapping, pattern memory, pattern comparison, serial digit learning, vocabulary, switching attention, mood scales, California Verbal Learning Test, Boston Naming Test, Rey-Osterreith Complex Figures Test, Word Identification Test, Self Report of Drug Use, Self Report of Delinquency, and review of school records was carried out.

The present study showed that the effects of lead on academic progress and cognitive function found in earlier studies continue to be apparent in this population as young adults. A seven-fold increase in failure to graduate from high school was found along with lower class standing, greater absenteeism, impaired reading skills (scores 2 grades below expected - which qualify as reading disability), deficits in vocabulary, fine motor skills, reaction time and hand-eye coordination. All of these indicate "a serious impairment in life success." The estimates of cognitive and academic difficulties made on the basis of these 132 subjects taken from the original sample are probably conservative. Those not tested in the present study tended to have more lead, lower IQ scores, lower teachers' ratings and were generally of lower socioeconomic status than those tested. "The association between lead and outcome reported here meet six observational criteria that support the validity of causal inference: proper temporal sequence, strength of association, presence of a biological gradient, non spuriousness, consistency and biological plausibility."

Thomson, G. O. B., Raab, G. M., Hepburn, W. S., Hunter, R., Fulton, M., and Laxen, D. P. H.

Blood-Lead Levels and Children's Behaviour--Results from the Ed Edinburgh Lead Study

1989

501 boys and girls ages 6–9 years in ta defined central Edinburgh area. 43% of the families of these children were in social class I or II and 85% owned their own homes.

These 501 children were tested in school by a trained psychologist. The British Ability Scales and tests of mental speed were administered. The children's teachers completed the Rutter behavior questionnaire. The family of each child was interviewed and one parent (usually the mother) received an ability test. Shed deciduous teeth were collected and the child's exposure to environmental lead was assessed.

Results showed a significant relationship between blood-lead and measures of deviant behavior taking into account any confounding variables. The 501 children tested had a mean blood-lead level value of 10.4 µg/dl. The measures of deviant behavior were shown to be influenced by sex, mother's performance on a matrices test, history of family disruption and total number of cigarettes smoked in the household. There was a stronger effect for boys than for girls in a lead by sex interaction, but evidence for such an interaction is limited. Data from the Edinburgh study suggest that a small tendency exists for an association between blood-lead and deviant behavior even after controlling for confounders. "This relationship may reflect a causal association whereby low level lead exposure acts to influence deviant anti-social and hyperactive behaviour in pupils." Lead and behavior could possibly be associated by reverse causality which means the way children behave may lead to variations in body lead burden. "The hyperactive, acting out aggressive child may well behave in ways which increase his/her lead levels. Despite this caveat the results reported here add to the growing evidence that lead at low levels of exposure probably has a small but harmful effect on children's behavior."

Streissguth, A. P., Martin, D. C., Barr, H. M., and MacGregor Sandman, B. Kirchner, G. L., Darby, B. L.

Intrauterine Alcohol and Nicotine Exposure: Attention and Reaction Time in 4-Year-Old Children.

1984

452 singleton-born children - a 4-year-old follow-up cohort. The present study is part of a longitudinal prospective study which started when the mothers were pregnant. Those included in the longitudinal study were children of heavier drinkers, more moderate drinkers, infrequent and nondrinkers. For the present evaluation, subjects were 4 years and 3 months of age. The mothers were predominantly white (87%); married (86%); and middle-class (80%). For the 4-year olds in the present study, follow-up rate was 86% from those seen at 8 months.

Independent variables measured were maternal alcohol use, maternal nicotine use, maternal caffeine, maternal drug use, and maternal diet. A psychometrist, blind to the drinking history of the children's mothers and prior assessments of development, administered a vigilance task at the end of a 1.5 hr test battery. The child was required to press a button each time a kitten appeared on the window of a Victorian house. The psychometrist recorded the total amount of time (in the 13 minute task) that the child was nonoriented to the stimulus board and whether the child was oriented to the apparatus at each stimulus presentation.

Both alcohol and nicotine were related significantly to errors of omission and commission, and to the ratio of correct responses to total responses. "These findings held up even when the test for alcohol was adjusted for nicotine, when the test for nicotine was adjusted for alcohol, and when both were also adjusted for maternal caffeine use, nutrition and education and child's birth order." Alcohol effects were still present upon removal of the children of the smoking mothers from the analysis leaving 248 subjects. Upon deletion of the heavier drinkers from the analysis, leaving 285 subjects who were children of lighter drinkers, a significant nicotine main effect remained. That increased attentional errors and longer reaction time occurs in 4-year-old children exposed to heavier doses of alcohol in utero is a new finding. These children pressed to significantly fewer of the target stimuli and made significantly more extraneous button presses. They did not differ significantly in their orientation to the target stimuli. Speed of responding, in these children, became significantly slower as the session went on. On the contrary, nicotine exposed children showed significantly less frequent orientation to the target stimuli. Their errors of omission could be explained by this. Alterations in reaction time were no associated with nicotine exposure. Decreased orientation and attention in children exposed to nicotine is consistent with studies carried out by Denson et al. (1975) and Nichols and Chen (1981) that showed a relationship between hyperkinesis in young children and maternal smoking during pregnancy. "Attentional errors assessed from a vigilance paradigm such as the one used in the present study have been previously associated with poor academic achievement (Kirchner and Knopf, 1974) and hyperactivity (e.g., Porrino et al., 1983) in school-age children." These attentional errors are considered to be the basis of learning disabilities found in school-age children (Doyle, 1976).

Streissguth, A. P., Barr, H. M., Sampson, P. D., Parrish-Johnson, J. C., Kirchner, G. L., and Martin, D. C.

Attention, Distraction and Reaction Time at Age 7 Years and Prenatal Alcohol Exposure.

1986

486 subjects of the original 500 that began the longitudinal study (Streissguth, 1981) were brought in for the 7.5 year examination. Of these, 475 had a least partial valid data for this study. This sample included 255 boys and 220 girls. Age range was from 6.5 to 8.5 yrs.

Again the independent variables were maternal alcohol use, maternal smoking, maternal caffeine use, maternal drug use and maternal diet. The subjects were administered the CPT vigilance task. They participated in both the X and the AX tasks. Subjects were examined, after a 2.5 hour psychological battery by one of eight examiners blind to prior developmental assessments and mother's scores on independent variables.

Following statistical adjustment for a variety of variables that may be potentially confounding, results showed that prenatal alcohol exposure was significantly related to attentional deficiencies and reaction time. The results remained "essentially unchanged" even in the presence of various potential confounders. Levels of alcohol exposure where effects on attention can be observed appear to depend on the task and the type of alcohol score used. "Among the tasks derived from this CPT paradigm, MRT and EC-AX (EC = errors of commission), by virtue of their highly significant partial correlations with terms linear in alcohol exposure, were the most sensitive attentional outcomes for assessing the long term effects of prenatal alcohol exposure." It seemed for these two measures that the magnitude of the effect increased with increased exposure or increased number of drinks per occasion. The authors suggest that strong conclusion can only be drawn from these two measures and the vigilance summary score. The fact that EC-AX seemed to be a more sensitive result than EC-X may be due to the subjects' inability to withhold a response (i.e. responding to A in anticipation of X). This would be consistent with the clinical observation (made by the authors) that children suffering from FAS are frequently uninhibited and impulsive (1985). An alternative explanation may be that EC-AX was the last task in the battery and attention was probably waning. Observations made by examiners on distractibility also showed that the most highly exposed children were most easily distracted. The authors state that an important consideration in choosing outcome variables for such studies is that they are suitable for all subjects in the population. In the present study, one child out of 475 was not able to take the CPT task and only 3% showed some resistance to it. They conclude that the CPT is a "suitable endpoint" for attentional studies in these children.

Streissguth, A. P., Sampson, P. D., and Barr, H. M.

Neurobehavioral Dose-Response Effects of Prenatal Alcohol Exposure in Humans from Infancy to Adulthood.

1989

Study 1 included 92 subjects with FAS or FAE (Fetal Alcohol Effects) who were 12 yrs. of age or older. Age range was 12 – 42 with a mean of 18.4 years. 58 were diagnosed as having FAS and 34 as having FAE. 61% were male, 55% were reservation Indians, 22% nonreservation Indians, and 23% non-Indians.

Study 2 included a cohort of about 500 children whose mothers were interviewed in the fifth month of pregnancy Of the 1,500 women interviewed all heavier drinkers and a proportion of moderate, light, and infrequent drinkers and nondrinkers were included. The women in this sample were predominantly white (87%) married (86%), middle class (80%), and well educated (58% - some college)

Study 1.

Each subject was administered the following tests (standardized conditions were maintained): an IQ test appropriate for the age of the subject; WISC-R or WAIS-R; an auditory receptive ability test; the PPVT; an adaptive and maladaptive behavior test; the VABS; and the Symptom Checklist (SC) developed for this study. Data are not available for all subjects on all tests.

Study 2.

To measure maternal alcohol, a quantity-frequency-variability interview was conducted and scored according to 25 alcohol scores. Alcohol scores were taken twice, once "during pregnancy" and "prior to pregnancy" (a month or two prior). Both were self reports. The use of cigarettes, caffeine, and other drugs was also taken into consideration. Information on other variables such as major life changes mother-child interaction, age of siblings, injuries and illnesses, etc. were obtained to assess influence on development. A full list of the 150 covariates examined here can be gotten from Streissguth et al. (1986). Dependent variables were assessed on the first and second day, at 8 and 18 months, and at 4 and 7 years.

"Prenatal alcohol exposure produces a wide variety of effects of offspring including intellectual decrements, learning problems, attentional and memory problems, fine and gross motor problems, and difficulty with organization and problem solving. In patients with FAS/FAE, psychosocial problems are observable in adolescence and adulthood that may have their roots in early cognitive deficits. Psychosocial problems associated with moderate exposure levels have not yet been evaluated." In general, prenatal alcohol exposure effects on neurobehavioral variables show a dose response relationship where ''high levels of exposure are associated with large magnitude effects, while moderate levels of exposure are associated with more subtle effects." Self-reported binge drinking (5 drinks or more at a given time) and self-reported drinking in the period prior to pregnancy recognition are two of the strongest predictors of later neurobehavioral deficits. No evidence was found that these effects are due to confounding with other drugs or can be accounted for by a small group of outliers. "The comparable findings from the clinical study, the epidemiologic study and the animal literature present convincing evidence of the neuroteratogenicity of alcohol and the long-lasting effects on prenatally-exposed offspring."

Chasnoff, I. J., and Griffith, D. R.

Cocaine: Clinical Studies of Pregnancy and the Newborn.

1989

Two groups of cocaine using women. Group 1 comprised 23 women who reached abstinence by the end of the first trimester and did not use cocaine for the remainder of the pregnancy. Group 2 comprised 52 women who used cocaine throughout the pregnancy.

The neonates were all examined at birth by a physician who did not know of the prenatal history. Weight, crown to heel length, and fronto-occipital head circumference were measured. When the infants reached 12 to 72 hours of age the Neonatal Behavioral Assessment Scale was administered.

Performances on the NBAS showed that the children of both groups of women demonstrated impairment in motor ability, orientation, state regulation, and number of abnormal reflexes. Group 1 showed significantly poorer performance on motor cluster than Group 2. 7 of 16 in Group 1 and 8 of 36 in Group 2 could not reach alert states at all during testing and thus were unable to engage in any orientation. Those infants in Group 1 were significantly more fragile and "less robust" in capability to complete the testing. This study did show that reaching abstinence from cocaine use at the first trimester increased the number of pregnancies carried to term and improved obstetric outcome. Results of this study support findings that "exposure to cocaine during the prenatal period leads to significant impairment in neonatal neurobehavioral capabilities." The greater impairment in Group 1 infants is difficult to explain. The authors suggest replicating the study with larger samples.

Chasnoff, I. J., Burns, W. J., Schnoll, S. H., and Burns, K. A.

Cocaine Use in Pregnancy.

1985

23 infants born to cocaine-using women. The women were divided into groups according to use or nonuse of narcotics along with the cocaine. These groups were compared to two control groups. Group 1 was made up of 12 women who had conceived while using cocaine, had not history of opiate use, 4 used alcohol at least twice monthly, 6 used marijuana at least 3 times monthly in the first two trimesters of pregnancy. 7 smoked cigarettes throughout pregnancy. Group 2 comprised 11 women who had conceived while using both cocaine and heroin. 2 used alcohol at least twice monthly, 5 used marijuana at least 3 times monthly through the first two trimesters, and 8 smoked cigarettes throughout pregnancy. Group 3 comprised 15 women who conceived while using heroin. 3 used alcohol at least twice monthly, 7 used

marijuana at least three times monthly in the first two trimesters, and 11 smoked throughout pregnancy. Group 4 comprised 15 women who did not abuse drugs. However, 3 used alcohol at least twice monthly, 7 used marijuana at least three times monthly in the first two trimesters, and 10 smoked cigarettes throughout pregnancy.

Group 2 and Group 3 women were started on methadone treatment upon admission to the Perinatal Addiction Project. About 60% of the women in Groups 1 and 2 used cocaine throughout pregnancy. All women except those in Group 4 were enrolled in the Perinatal Addiction Project. Experimenters reviewed the reproductive history of all of the women in the study. Groups 1 and 2 had used cocaine in all prior pregnancies, and Group 3 women had used opiates.

At birth all neonates were weighed, measured from crown-to-heel, and fronto-occipital head circumference was recorded. At three days of age, the infants were administered the Brazelton Neonatal Behavioral Assessment Scale by examiners blind to the child's prenatal history.

Results showed that infants exposed to cocaine in utero showed and increase in depressed interactive abilities and significant impairment in organizational abilities as compared with infants whose mothers used methadone and control infants. "Cocaine exposure in utero interferes with an infant's ability to maintain adequate state control in the neonatal period. This puts the infant at high risk. Group 2 infants displayed weaker reflexes and decreased state control than did control infants (Group 4), but they showed no significant deficits in orientation, neither auditory nor visual. The authors feel that this may be the result of a Type II error. The interaction of cocaine and methadone in these infants may have been antagonistic since one is a CNS depressant and one a CNS stimulant. Alcohol, marijuana, and nicotine use in all four groups was similar and thus could not account for discrepancies in the findings.

Olofsson, M., Buckley, W., Andersen, G. E., and Friis-Hansen, B.

Investigation of 89 Children Born by Drug-Dependent Mothers.

1983

A reinvestigation of 72 of 89 previously examined children 11 months to 10 years of age (mean = 3.5 yrs.). 62 mothers (10 of which had 2 children among the 89). None of the mothers had been drug-free for 5 years or more. 19% had been drug-free for 14 days to 5 years. 45% were taking mainly i.v. opiates, 26% were taking methadone, and 10% were using minor tranquilizers. 66% had no job, 16% were working, 18% were in prison on sick leave or participating in an educational program.

Psychomotor development of the children was determined by the Denver Development Screening Test (DDST). Data on physical, social and behavioral history were obtained from interviews with guardians and/or mothers, and other professionals involved in the child's life (i.e. private practitioners visiting health nurses, social welfare authorities and school- and day-care personnel.

Fifteen children (21%) showed an impaired psycho-motor-development. Two of the fifteen retarded children showed major organic abnormality and in another four minor brain damage was suspected. 56% were considered behaviorally abnormal. Lack of concentration, hyperactivity, aggressiveness and lack of social inhibition were the predominant signs.

Rush, D. and Callahan, K. R.

Exposure to Passive Cigarette Smoking in Child Development.

1989

Extensive Literature Review.

The authors looked at the designs of and highlight strengths and weaknesses of all of the studies on maternal smoking and fetal development known to them. They then summarized relationships with somatic, cognitive and behavioral development across all studies. Detailed results are provided in tables within the text.

There is a consistent pattern of depressed cognitive development and tests of school achievement associated with maternal smoking during pregnancy. It still remains beyond current knowledge that these are causally related though a trend is apparent. A consistent pattern of behavioral abnormalities are also reported. Several studies are cited. Again, a causal relationship was not supported based on the available data. A strong and highly significant relationship between amount of cigarette smoking prior to pregnancy and the psychomotor developmental index was observed.

Wilson, G. S., McCreary, R., Kean, J. and Baxter, J. C.

The Development of Preschool Children of Heroin-Addicted Mothers: A Controlled Study.

1979

77 children, 40 boys and 37 girls, 3 years 1 month to 6 years 4 months of age (mean = 4 years 7 months). 30 had Latin American surnames, 30 were black, 17 were Anglo-American Three groups were compared with the heroin exposed group. Heroin exposed group: 22 children of mothers who used heroin (as the predominant drug) continuously throughout pregnancy. In one case use of all drugs was terminated at one month of gestation, in another methadone was substituted at six months, and another two substituted other drugs in the last trimester. 7 abused other along with the heroin. Drug environment group: 20 children of mothers who did not use heroin during pregnancy but were involved in the "drug culture". The high-risk comparison group: 15 children labelled as such because of medical factors such

Hospital records were examined for maternal drug use, obstetric complications, amount of prenatal care, complications of labor or delivery, one-minute Apgar score, gestational age, birth weight, type and severity of nursery morbidity, and duration of hospitalization. They received a general physical exam and a neurological evaluation. A structured social service interview was carried out at each child's home. A 19-item scale (Kasmar and Altman) was used by a social worker to rate physical environment of each home. Parental Attitude Research Inventory was given. Standardized tests used: Illinois Test of Psycholinguistic Abilities, the Columbia Mental Maturity Scale, the McCarthy Scales of Children's Abilities, and the Minnesota Child Development Inventory. A perceptual battery designed by Deutsch and Schumer was modified and administered. Parents completed the three subtest of Child Behavior Rating Scales. Pediatricians rated the subjects on alertness, cooperation, attention, activity level, and intensity. During a 5-minute free-play period children were videotaped and rated on attention, activity level, cooperation, independence and confidence by a psychologist. Speech was assessed by a speech pathologist during the

No significant difference was found in the educational attainment, occupational level, and Hollingshead index of social position of the families. Heroin exposed children lived with a substitute mother more commonly than children in any of the three comparison groups. No group differences were found in physical environment. IQ did not differ between groups. Heroin-exposed children showed poorer performance than comparison groups on the General Cognitive Index, on three out of five subtests of the McCarthy Scales of Children's Abilities (perceptual performance, quantitative and memory), on measures of visual, tactile, and auditory perception. The McCarthy tests of skills are "considered organizational processes in the ITPA categorization. They require attention, concentration, short-term memory and the internal manipulation of symbols. Groups did not differ significantly on verbal and motor scales. They were rated as more active, and by parents as having increased difficulty in self-adjustment, social-adjustment and physical-adjustment areas. Group differences could not be based on age, sex, ethnic group, socioeconomic status, or participation in school readiness programs. These were controlled for initially. "Behaviorally, the problems of the heroin-exposed group were related to impulsiveness, aggressiveness, and peer relations. These behavior problems may also be manifestations of impaired attention and organizational abilities."

Wilson, G. S., McCreary, R., Kean, J. and Baxter, J. C.

The Development of Preschool Children of Heroin-Addicted Mothers: A Controlled Study.

as dysmaturity, intra-uterine growth retardation, fetal distress, and disturbed transition. Mothers claim to have abstained from psychotropic drug use at any time. Finally, the socioeconomic comparison group: 20 children who were born without complications. There were no significant group differences in age, sex or socioeconomic status.

same doll play task.