THE CHILD AT RISK
FOR MAJOR PSYCHIATRIC
Clarice J. Kestenbaum
DURING the past two decades, increasing numbers of research projects have focused attention on those children who have a high probability of developing a major psychiatric disorder in adult life. These studies are subsumed under the rubric "risk research" and have been directed for the most part toward determining which children are most vulnerable to eventual schizophrenic illness. 36 Affective disorders have only recently begun to be studied in similar fashion.
"Risk" refers to the greater likelihood that certain individuals will develop a mental disorder than will others selected at random from the same community.36 The children of schizophrenics, for example, are at greater than average risk for developing schizophrenia than the general population (10 to 15 percent for the child with one schizophrenic parent compared with approximately 1 percent for a child with nonschizophrenic parents).
"Vulnerability" implies that each individual is endowed with a degree of vulnerability to illness that under certain circumstances will become manifest. 112 In one vulnerability model two major components are described —inborn and acquired. Inborn vulnerability refers to that which is in the genes and is reflected in the internal environment and neurophysiology of the organism. The acquired component is due to the influence of specific diseases, traumas, perinatal complications, family interactions, and life events that either enhance or inhibit the development of future disorder. For an individual vulnerable to schizophrenia, for instance, periods of acute stress may result in a failure of coping mechanisms so that maladaptation results. 60 According to Arieti, 5 Adolph Meyer became convinced that dementia praecox