In general, my research informs knowledge regarding language, perception, and psychosis. Grounded in social work and social justice, my research program is interdisciplinary and bounded by a cognitive neuroscientific framework. The influence of linguistics, psychology, psychiatry, and anthropology are encompassed by this framework and in particular, I rely heavily on literature from developmental, cultural, and cognitive psychology.
I am interested in the cognitive processes underlying receptive and expressive sign language ability and how these processes interact with the symptoms of schizophrenia. I am also interested in how experience with sign language and more broadly, Deaf culture, interacts with non-linguistic visuospatial cognition (e.g., affect processing, context processing). Visual spatial cognition is oft-studied in non-clinical deaf samples and a substantial body of work provides evidence for enhanced abilities among signers, and early sign language learners in particular. [See Karen Emmorey, Rachel Mayberry, Susan Goldin-Meadow, Jenny Singleton, David Corina.] Though rarely investigated in deaf clinical samples, preliminary evidence from the projects described herein reveal ability trends that both mimic and vary from those found in the general deaf population. Not surprisingly, the relevance of early language leaning for later cognitive and social cognitive ability was evident, replicating a well-established finding among nonclinical deaf samples. A novel finding was that visual context processing appeared relatively unimpaired among deaf compared to hearing subjects with schizophrenia. In order to separate the influence of deafness from that of the symptoms associated with schizophrenia a simple two-by-two design is needed whereby four groups are represented: deaf and hearing individuals with and without schizophrenia.
The study of deafness in the context of schizophrenia creates opportunities to disentangle visual from linguistic factors that influence symptoms such as disorganized thinking and the formation of hallucinations. Data from this line of research may lead to unique rehabilitative interventions to promote more effective treatment outcomes for both deaf and hearing people with serious mental illness.
Perception and cognition in the deaf: Sequelae among subjects with and without schizophrenia.
PI: Heather K. Horton, Ph.D.
Previous research by the PI investigated deaf and hearing subjects with schizophrenia in order to determine functional differences explained by hearing status. The current project investigates deaf subjects with and without schizophrenia in order to examine differences explained by schizophrenia.
Specific aims of this preliminary study are to: 1) delineate and compare linguistic, cognitive, and symptom profiles across clinical and non-clinical deaf subjects; and, 2) investigate perceptual organization and context processing across early and late sign language learners. Early sign language learning may be a stronger correlate of context processing than clinical status (schizophrenic, non-schizophrenic). The largest context sensitivity differences however, are likely to be seen between healthy, early sign language learners and clinical, late sign language learners. Reduced visual context processing is also expected to be evident among disorganized subjects and in this case, will diminish the enhanced sensitivity generally seen in deaf samples.
The study is part of a growing body of work regarding perceptual organization in schizophrenia. It is theorized that context processing underlies the coherent processing of both language and vision in the general population. Schizophrenia patients display deficits in both domains; notably, the disruption is more severe among disorganized subjects (Silverstein et al., 1996; Uhlhaas et al., 2006).
In a recent study (see Horton & Silverstein, 2011) we found that deaf subjects with schizophrenia were more context sensitive than were their hearing peers. The enhanced ability was particularly strong among non-disorganized deaf subjects. (Disorganized deaf subjects were only slightly more context sensitive than hearing disorganized subjects.) In the current project, healthy deaf subjects are also expected to be exceedingly context sensitive and, if deaf subjects with schizophrenia perform similarly, especially non-disorganized early learners, evidence will be provided that intensive experience with sign language minimizes the context processing deficits associated with schizophrenia. Moreover, deaf people with schizophrenia can be viewed as performing "normally" in terms of visual integration.
This line of research has a goal of producing findings relevant to clarifying the extent of bottom-up vs top-down contributions to perceptual organization in schizophrenia, which is still being debated (see Silverstein & Keane, 2011). Given that deafness alters processes of language acquisition, and in the context of data indicating that the susceptibility to visual illusion develops on the basis of visual experience, preliminary data suggest that perceptual organization dysfunction in schizophrenia is plastic and may be amenable to remediation, especially in the form of practice with visual integration.
Future research will simultaneously investigate multiple groups (4) in order to fully disentangle deafness related influences from ones related to schizophrenia.
Funding: Faculty Research Award Program (10K)
Social Cognition and Interaction Training (SCIT) Program
PI: Heather K. Horton; Co-PI: Rebecca Leland
Developed by Penn, Roberts, Combs, Sterne (2007), SCIT is a group-based intervention delivered over a six-month period, with the purpose of improving both social cognition (eg, facial affect processing, Theory of Mind) and social functioning among persons with schizophrenia spectrum disorders.
After modifying the intervention for use with deaf people we conducted a single-group, pre/post-test design to determine the effectiveness of SCIT in a sample of deaf inpatients with schizophrenia. Early results indicate that with important modifications to the intervention, SCIT may be effective at improving certain aspects of facial affect processing in deaf people with schizophrenia.
Funding: Faculty Research Award Program (4K)
Language, Cognition, and Mental Health
While current symptom models of schizophrenia are valid in both hearing and Deaf samples, data on relationships between cognition, symptoms, and outcome from the general (hearing) literature cannot be generalized to Deaf people. For Deaf people with schizophrenia, differences in the form and processing of language interact with illness features to generate different pathways to disability than those found among hearing samples (Horton, 2010).
Visual Context Processing Deficits in Schizophrenia: Effects of Deafness and Disorganization
Visual illusions allow for strong tests of perceptual functioning, as impairment can produce superior task performance (i.e., more veridical perception) in a brief assessment where the cognitive mechanisms are largely outside of conscious control. Using a task based on the Ebbinghaus illusion, a perceptual phenomenon where the perceived size of a central target object is affected by the size of surrounding inducers, we tested hypotheses related to visual integration in deaf (n=31) and hearing (n=34) patients with schizophrenia. Relationships between integration ability, linguistic skills, and disorganization were examined. The primary implications of the data were that perceptual organization impairment in schizophrenia is plastic, and that it is related to a broader failure in coordinating cognitive activity (Horton & Silverstein, 2011).
Deafness and Mental Health Services: Barriers and Facilitators in New York's Capital Region
A recent focus group held at the University at Albany revealed significant barriers to the provision of mental health services for deaf people in the region. Participants included deaf and hearing advocates, consumers, interpreters, academics, University students, and mental health professionals.
In addition to the typical barriers experienced by the population (e.g., Medicaid does not provide funding for interpreters, a lack of qualified mental health interpreters, and a geographically widespread and heterogeneous population), the group identified barriers specific to the New York Capital Region. Namely, a county-based system of service delivery that impedes access to qualified mental health professionals for the deaf. In short, quality mental health services for this population may be unavailable because referrals outside of one's home county are currently unfunded. When combined with the fact that out-of-pocket costs for interpreters are prohibitive for the potential Deaf consumer as well as the provider, the state of affairs can be considered discriminatory. Indeed, the faulty system not only marginalizes the deaf via exclusion from culturally and linguistically appropriate mental health services - that others easily access - but results in unnecessary hospitalizations and ultimately inappropriate long-term institutionalization for those who are the most ill. Many deaf people with mental illness would live successfully in their home communities--with minimal support--if high quality services were provided early in the illness trajectory (Horton, Kim & Mills, 2012).
Shu-Chen Li's (2003)* cross-level dynamic biocultural coconstructive metatheoretical framework of life span development integrates interactive processes and developmental plasticity across multiple levels to piece together recent findings from various subfields of developmental and life sciences. Li' delineates cultural and cumulative developmental influences that are particularly salient for deaf people who typically present with a range of language learning and socialization experiences.
When Dr. Li's ideas are applied to deaf studies, a potentially useful research program is revealed:
Juxtaposing the results from cognitive neuroscience studies on cortical functional lateralization (including deaf people with brain lesions) with the cognitive–behavioral research on Deafness, language, and cultural influences on cognitive style, it seems plausible to integrate designs with both culture-sensitive and culture-invariant cognitive tasks in the cognitive neuroscience approach to examine how environmental and cultural influences interact with schizophrenia at the behavioral, cognitive, and neurobiological levels.
A study including both deaf and hearing subjects with and without schizophrenia is anticipated as part of a federal grant application to explore interactions between Deafness, culture, cognition, and schizophrenia.
*Li, Shu-Chen (2003). Biocultural Orchestration of Developmental Plasticity Across Levels: The Interplay of Biology and Culture in Shaping the Mind and Behavior Across the Life Span (Psychological Bulletin, Vol. 129 No. 2, 171-194).
Students! Please contact me if you are interested in working on one or more of the projects described above.
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NIMH Division Translational Research (DTR)
The DTR directs, plans, and supports programs of research and research training that translate knowledge from basic science to discover the etiology, pathophysiology, and trajectory of mental disorders and develops effective interventions for children and adults. DTR supports integrative, multidisciplinary research on the following areas: the phenotypic characterization and risk factors for psychiatric disorders; neurobehavioral mechanisms of psychopathology; trajectories of risk and resilience based on the interactive influences of genetics, brain development, environment, and experience; and design and testing of innovative psychosocial, psychopharmacologic, and somatic treatment interventions.
Adult Psychopathology and Psychosocial Intervention Research Branch
This Branch supports research on the foundations of psychopathology and its associated disability. The Branch promotes translational research that is directed toward an understanding of how the development, onset, and course of adult psychopathology may be studied in terms of dysfunction in fundamental biobehavioral mechanisms such as emotion, cognition, motivational processes, and interpersonal relationships. The program includes research on modifiable risk and protective factors for disorder and on the use of modern psychometric techniques to guide refinements in the conceptualization and assessment of disorder.
Emphasis is placed on studies that combine approaches from neuroscience and behavioral science to elucidate the role of psychosocial factors in the alterations of brain functioning associated with mental disorders and to produce integrative models of risk, disorder, and recovery. An important feature of the Branch is the support of interdisciplinary basic research on emotion, mood, temperament, and motivational systems that is explicitly conceived and designed with respect to its potential for direct translation to the psychopathology of disorders, and to the development of new preventive and treatment interventions. The overarching goal is to foster new science-based behavioral strategies for assessment, prevention, treatment, and recovery.
"...models of complex genetic disorders predict a ballet choreographed interactively over time among genotype, environment, and epigenetic factors, which gives rise to a particular phenotype" (Gottesman and Gould, 2003, p.636) (Am J Psychiatry 2003;160:636-645).
Schizophrenia Spectrum Disorders Research Program
This program supports research into the origins, onset, course, and outcome of schizophrenia, schizoaffective disorder, and such related conditions as schizotypal and schizoid personality disorders. The goals of the program are to discover mechanisms that transform vulnerability characteristics into active illness; to identify valid markers of illness onset; to develop psychometrically sound methods for assessing the cognitive, affective, and behavioral response systems believed to underpin clinical symptoms and functional impairments; and ultimately to channel scientific findings from each of these areas into the development of effective methods of mental illness prevention, treatment, and rehabilitation.
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NIMH Division of Adult Translational Research and Treatment Development (DATR)
The Division of Adult Translational Research and Treatment Development (DATR) plans, supports, and administers programs of research, research training, and resource development aimed at understanding the pathophysiology of mental illness and hastening the translation of behavioral science and neuroscience advances into innovations in clinical care. The Division supports a broad research portfolio, which includes studies of the phenotypic characterization and risk factors for major psychiatric disorders; clinical neuroscience to elucidate etiology and pathophysiology of these disorders; and psychosocial, psychopharmacologic, and somatic treatment development. In addition, the Division supports an integrated program to clarify the psychopathology and underlying pathophysiology of psychiatric disorders of late life and to develop new treatments for these disorders. The focus of DATR is to support research on the etiology and pathophysiology of mental illness in order to: