Increased likelihood of distressing and functionally impairing psychotic-like experiences among children with co-occurring internalising and externalising problems

Among children with psychotic-like experiences (PLEs), the presence of co-occurring psychopathology may distinguish children's self-report of clinically significant experiences (i.e., PLEs that are distressing and/or impairing of daily functioning) from reports of more benign experiences. The aim of this study was to examine whether the likelihood of distressing or impairing PLEs differed according to type of co-occurring psychopathology symptoms. A community sample of 5268 children aged 9-12 years were recruited from Greater London, UK. Participants completed the Psychotic-Like Experiences Questionnaire for Children, and the Strengths and Difficulties Questionnaire to measure internalising and externalising problems. Multinomial logistic regressions were used to determine the likelihood of PLEs being distressing and/or impairing (vs. not) among children with different co-occurring symptom profiles (PLEs only; PLEs with internalising problems only - PLE-I; PLEs with externalising problems only - PLE-E; and PLEs with both internalising and externalising problems - PLE-IE). Children with co-occurring internalising and/or externalising problems had greater odds of distressing and/or impairing PLEs compared to children without co-occurring psychopathology (PLEs only). These associations were moderate for PLE-E and strong for PLE-I and PLE-IE, with the greatest odds of distressing and impairing PLEs evident in the presence of internalising plus externalising comorbidities (odds ratios [with 99 % confidence intervals] for PLE-IE relative to PLE-I = 2.00 [1.34-2.99]; PLE-IE relative to PLE-E = 5.46 [3.78-7.90]). These results affirm the importance of screening for the presence and type of co-occurring psychopathology among children with PLEs to demarcate potentially different treatment needs.

Trajectories of Mismatch Negativity and P3a Amplitude Development From Ages 9 to 16 Years in Children With Risk Factors for Schizophrenia

BACKGROUND

Mismatch negativity (MMN) and P3a amplitude reductions are robust abnormalities of sensory information processing in schizophrenia, but they are variably present in different profiles of risk (family history vs. clinical high risk) for the disorder. This study aimed to determine whether these abnormalities characterize children presenting replicated risk factors for schizophrenia, using longitudinal assessment over the ages of 9-16 years in children with multiple replicated antecedents of schizophrenia (ASz) and with family history of schizophrenia (FHx), relative to typically developing (TD) peers.

METHODS

A total of 105 children (52 female) sampled from the community were assessed at ages 9-12 years and approximately 2 and 4 years later. Linear mixed models were fitted to MMN and P3a peak amplitudes and latencies, with intercept and slope estimates from 32 ASz and 28 FHx children compared with those of 45 TD peers.

RESULTS

In ASz relative to TD children, MMN amplitude initially increased and then prominently decreased during adolescence. Both ASz and FHx children had greater P3a amplitude than TD children at 11 years, which decreased with age, in contrast to P3a amplitude increasing during adolescence in TD youths. MMN abnormalities were specific to ASz children who continued to present symptoms during follow-up.

CONCLUSIONS

Age-dependent MMN and P3a abnormalities demarcate adolescent development of ASz and FHx from TD children, with auditory change detection abnormalities specific to ASz children with continuing symptoms and attention-orienting abnormalities characterizing both ASz and FHx risk profiles. Follow-up is required to determine whether these abnormalities index vulnerability for schizophrenia or an illness nonspecific developmental delay.

Criterion validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C)

Psychotic-like experiences (PLEs) are perceptual and thought disturbances that, although common among children, increase risk for future psychopathology, particularly if persistent. Clinical interviews are too time-consuming and costly to administer at a population level, but the criterion validity of a brief questionnaire for screening community samples of children as young as 9 years for PLEs has not been established. This study aimed to test the criterion (concurrent and predictive) validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C). The PLEQ-C (9-item self- and 10-item parent-report versions) was administered to 139 children aged 9-12 years and their caregivers recruited from Greater London, UK. Children additionally completed a diagnostic interview assessing hallucinations and delusions and three further PLEQ-C assessments at approximately 24-month intervals. Concordance of child- and caregiver-reports of PLEs on questionnaire (PLE-Q) was low. Self-reports of any PLE-Q demonstrated good sensitivity (73.3%), specificity (78.5%), positive and negative predictive values (PPV: 72.1%; NPV: 79.5%) for any PLE determined by interview (PLE-I), whereas caregiver-reports of any PLE-Q performed poorly (sensitivity 51.7%, specificity 78.5%, PPV 64.6%, NPV 68.1%). Multinomial regression analyses indicated that children reporting any PLE-Q at screening were at significantly increased risk of reporting PLEs on multiple assessments during adolescence relative to no PLEs, closely replicating the pattern and magnitude of effects (large-to-very large) obtained for children with any PLE-I. The PLEQ-C offers a valid, brief, feasible, and cost-effective means of community screening to identify children who present with PLEs and could be assessed with clinical interview.