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Background For adults with psychosis, international guidelines recommend individual and family based cognitive behavioural therapy interventions. Recommendations are extended to children and adolescents, based on adult research. It is also recommended that psychological interventions are offered for childhood presentations of psychotic-like or Unusual Experiences (UE), in the absence of a formal diagnosis, when these are Distressing (UEDs). Cognitive models underpinning these interventions require testing in adolescent populations, to further refine therapies. We address this need, by testing for the first time, the application of the adult cognitive model of psychosis to adolescent UEDs. Methods We used baseline data from the Coping with Unusual ExperienceS (CUES+) randomised controlled trial for 122 clinically referred adolescents (12–18 years) with self-reported UEDs. Known psychological mechanisms of adult cognitive models of psychosis; negative life events, affect (anxiety and depression), reasoning (jumping to conclusions bias), and schemas were investigated using multiple linear regression models, alongside variables particularly associated with the development and severity of adolescent UEDs and UE type (dissociation, externalising/behavioural problems, managing emotions). Results The psychological mechanisms of adult cognitive models of psychosis explained 89% of the total variance of adolescent UED severity, F (10, 106) = 99.34, p Conclusions Findings suggest that the psychological components of adult cognitive models of psychosis, particularly schemas, are also implicated in adolescent UEDs.

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.

Numerous studies have described attenuated event-related potential (ERP) component amplitudes in schizophrenia (e.g., P300, Mismatch Negativity (MMN), Error Negativity/Error-Related Negativity (Ne/ERN)). Functional magnetic resonance imaging (fMRI) studies have typically shown decreased recruitment of diverse brain areas during performance of tasks that elicit the above ERP components. Recent research suggests that phase-resetting of slow-oscillations (e.g., in the delta and theta bands) underlies the potentials observed in ERP averages. Several studies have reported that slow-oscillations are increased in amplitude in people with schizophrenia at rest. Few studies have examined event-related low-frequency oscillations in schizophrenia. We examined event-related evoked and induced delta and theta activity in 17 people with schizophrenia and 17 healthy controls in two go/no-go task variants. We analyzed stimulus-related and response-related oscillations associated with correct-hits, correct-rejects and false-alarms. Our results reveal a pattern of reduced delta and theta activity for task-relevant events in schizophrenia. The findings indicate that while low-frequency oscillations are increased in amplitude at rest, they are not coordinated effectively in schizophrenia during various information processing tasks including target-detection, response-inhibition and error-detection. This slow-oscillation coordination abnormality may help explain the decreased recruitment of brain areas seen in fMRI studies.

Prospective longitudinal investigations are needed to identify causal processes leading to schizophrenia. However, there is presently no cost-effective way to identify children who are at risk of developing schizophrenia spectrum disorders: Although having a family history of schizophrenia is associated with elevated risk for developing spectrum disorders, the majority of individuals with schizophrenia do not have an afflicted relative. The present study aimed to test the feasibility of screening a community sample of children, aged 9 to 12 years, to identify children who experienced a triad of putative antecedents of schizophrenia that had been identified from previous research, including: (1) speech and/or motor development lags or problems; (2) social, emotional, or behavioural problems; and (3) psychotic-like-experiences (PLEs). 548 children and 264 caregivers completed questionnaires. 9.2% of boys and 4.1% of girls displayed the triad of antecedents. 58.9% of the children reported "certain experience" of one or more PLEs. The results suggest that questionnaire screening of community samples of children for the putative antecedents of schizophrenia spectrum disorders is feasible. Accuracy of identification will only be established by follow-up studies.

Background Persisting psychotic-like experiences (PLEs) are associated with an increased risk of internalising symptoms in adolescence. Whether this association holds similarly for externalising symptoms, and from mid-childhood, is unclear. This prospective study investigated the extent to which PLE persistence was associated with internalising and externalising psychopathology in a community sample of children aged 9–11 years at study commencement. Methods 8099 children (mean age 10.4 years) completed questionnaires assessing PLEs, externalising and internalising symptoms. A subsample of 547 children completed reassessment, on average, two years later. Results Two-thirds (66%) of children reported PLEs at baseline. Approximately two years later, PLEs persisted in 39% of those children. After adjustment for previous psychopathology and other potential confounds, children with persisting PLEs were at higher risk for internalising (odds ratio [OR] = 1.94; 95% confidence interval [CI] 1.13–3.34) and externalising (OR = 1.97; 95% CI 1.19–3.26) psychopathology than children whose PLEs remitted; and, than children who never presented PLEs. Conclusions Persistent PLEs from mid-childhood are associated with later internalising and externalising psychopathology in the general population, whereas transitory PLEs may be part of a spectrum of normative childhood development. Interventions that target persistent PLEs may contribute to a reduction in common childhood psychopathology.

Background We previously developed a novel method of identifying children aged 9–12 years who may be at elevated risk of developing schizophrenia and the spectrum disorders because they present a triad of putative antecedents of schizophrenia (ASz). The present study aimed to determine whether ASz children also present neurocognitive deficits that are commonly observed in patients with schizophrenia. Methods Twenty-eight ASz children and 28 typically-developing (TD) children without the antecedents of schizophrenia completed a battery of neurocognitive tests assessing seven domains of function: General intelligence, scholastic achievement, verbal memory, visual memory, working memory, executive function (EF)–verbal fluency, and EF–inhibition. Results Relative to TD children, the ASz group showed poorer performance on all neurocognitive tests (mean Cohen's d effect size = 0.52). In linear regression analyses, group status (ASz vs. TD) significantly predicted scores on the general intelligence, verbal memory, working memory, and EF–inhibition domains ( p < 0.05). The severity of problems on each of the individual antecedents comprising the antecedent triad did not relate strongly to performance on the neurocognitive domains. Conclusions Children aged 9–12 years who present multiple antecedents of schizophrenia display poorer neurocognition than healthy peers on several domains showing pronounced deficits in schizophrenia, first-episode psychosis, and youth with prodromal symptoms. Longitudinal follow-up is necessary to determine the extent to which poorer neurocognitive performance is specific to those who develop schizophrenia. Subject terms High-Risk

Schizophrenia is characterised by marked disturbances of attention and information processing. Patients experience difficulty focusing on relevant cues and avoiding distraction by irrelevant stimuli. Event-related potential recordings indicate an amplitude reduction in the P3a component elicited by involuntary orienting to task-irrelevant, infrequent novel stimuli presented during auditory oddball detection in patients with schizophrenia. The goal of the present study was to elucidate the functional abnormality underlying the disturbed orienting to novel stimuli in schizophrenia. Twenty-eight stable, partially remitted, medicated patients with schizophrenia and 28 healthy control participants completed a novelty oddball variant during event-related fMRI. Relative to healthy participants, patients with schizophrenia were characterised by underactivity during novel stimulus processing in the right amygdala-hippocampus, within paralimbic cortex in the rostral anterior cingulate and posterior cingulate cortices and the right frontal operculum, and in association cortex at the right temporo-parietal-occipital junction, bilateral intraparietal sulcus, and bilateral dorsal frontal cortex. Subcortically, relative hypoactivation during novelty processing was apparent in the cerebellum, thalamus, and basal ganglia. These results suggest that patients less efficiently reorient processing resources away from the ongoing task of detecting and responding to the task-relevant target stimuli. In addition, trend results suggest that patients experienced increased distraction by novel stimuli.

Background: Subclinical psychotic-like experiences (PLEs) are common among the general population, particularly in children. Nevertheless, they confer elevated risk for later psychotic illness. This risk might be increased only in the context of additional psychosis risk markers, with recent research highlighting associations between depression/anxiety and the persistence of PLEs during adolescence. Yet, schizophrenia and related disorders are predicted by childhood externalising (EXT) as well as internalising (INT) psychopathology. Thus, the present study examined the latent structure underlying PLEs, EXT, and INT symptoms in a community sample of children aged 9-11 years. The study further examined whether longitudinal PLE trajectories over two years, particularly PLE persistence, predicted the presence of later INT and EXT problems. Methods: A community sample of 7,966 children (95% of eligible children; 51% male; mean age 10.4 years) completed questionnaires in class that assessed nine PLEs, EXT symptoms (conduct problems, hyperactivity and INT symptoms (emotional problems and peer relationship problems). A subsample of 547 children (46% male, mean age 12.2 years) completed reassessment after an average of two years, with their caregivers additionally reporting on children’s INT and EXT symptoms at both times (T0 and T1). Data in the longitudinal analysis were weighted to reflect the baseline population sample. Factor analysis of child-reported data in the large community sample (T0) was conducted to determine the latent structure underlying PLEs and other psychopathology in the general child population. In the longitudinal analysis, four PLE trajectories were defined using child-reported PLEs: persistent (PLEs at T0 and T1); remitting (PLEs at T0, but not at T1); incident (no PLEs at T0, but PLEs at T1); and none (no PLEs at T0 or T1). These trajectories were used to predict the presence of child-/parent-reportedINT and EXT problemsat T1. Analyses were repeated after correcting for age, sex, duration of follow-up, and T0 INT and EXT problems. Results: Two thirds (66%) of children aged 9-11 years reported at least one PLE at T0, with individual prevalence on the nine items ranging between 9-35%. All nine PLE items loaded on a single psychotic-like construct, which was discriminable from, though correlated with, latent dimensions representing INT and EXT problems. PLE trajectory prevalence rates over two years were: persistent 25%, remitting 39%, incident 5%, none 31%; with a majority of the children who reported a PLE at T0 no longer doing so at T1 (61%). Children whose PLEs remitted presented comparable rates of T0 and T1 INT or EXT problems to their peers who never presented PLEs. Children whose PLEs persisted were more likely to present T1 INT and EXT problems than their peers who never presented PLEs (INT odds ratio [OR]=3.1; EXT OR=2.4), as well as children whose PLEs remitted (INT OR=1.8; EXT OR=1.8). These associations remained after correcting for potential confounders and prior (T0) INT and EXT psychopathology. Discussion: Among the general childhood population aged 9-11 years, PLEs are common, though transient in the majority. Assessing PLEs at this age is viable, and permits delineation of a subset of children whose PLEs persist two years later, during transition to adolescence. PLE persistence relates to later externalising and internalising problems. Thus, interventions to reduce emotional and behavioural problems might target children presenting persistent PLEs, with some requiring additional strategies to ameliorate anxiety and depression symptoms, and others, behavioural and attentional problems.

The idea that the content of delusions and hallucinations may have meaning or be symbolically significant is not new. From a psychodynamic perspective, the experience of psychosis has long been conceptualised as a defence against unbearable or unmanageable emotions (Martindaleetal2013)andthecontentofpsychoticexperiencesistherefore considered to have meaning and relevance for clinical practice (Martindale 2007). In adult samples, the content of delusions and hallucinations has been found to be associated with the experience of trauma and abuse (Raune et al. 2006, Reiff et al. 2012). To the best of our knowledge, no study to date has examined the content of sub-clinical psychotic-like experiences (PLEs) using non-clinical child or adolescent samples. This study aims to identify the presence of themes in the content of PLEs among children and adolescents from the general population and to examine associations between the content of the psychotic experience and adverse or abusive life events.

Background: A robust marker of brain dysfunction in schizophrenia (Cohen’s d=0.89) is reduction in amplitude of the P3 (or P300) event-related potential (ERP) that indexes attention and working memory processes. It is elicited typically using a two-tone auditory oddball paradigm that presents infrequent task-relevant target stimuli (which require a behavioural response) within a train of frequent task-irrelevant non-target (or standard) stimuli. The P3 amplitude reduction to target stimuli is present at the chronic and first-episode phases of schizophrenia, and may predict transition to psychosis among at-risk adolescents/young adults. We sought to characterise potential premorbid brain function abnormalities among at-risk children aged 9-12 years in detail, using an auditory novelty oddball task variant that dissociates an earlier, automatic frontocentral P3a subcomponent elicited by infrequent task-irrelevant salient novel stimuli from a later parietal P3b sub-component elicited by the infrequent task-relevant target stimuli. Methods: We examined brain function in two at-risk groups, including a group with family history of schizophrenia (FHx; n=20) and a group of children presenting a triad of replicated antecedents of schizophrenia (ASz; n=20), namely (i) psychotic-like experiences; (ii) a social, emotional, or behavioural problem; and (iii) a speech-and/or-motor developmental delay or abnormality. At-risk groups were compared with a group of typicallydeveloping (TD; n=28) peers who had no family history or antecedents of schizophrenia. Groups did not differ significantly on age, sex, ethnicity, socio-economic status, or handedness. Three group (FHx, ASz, TD) x three stimulus (targets, novels, non-targets) x five site (Fz, FCz, Cz, CPz, Pz) repeated-measures ANOVAs on peak P3 amplitude and latency data were conducted, and were repeated as ANCOVAs to control for poorer intellectual function (IQ) among the at-risk groups relative to TD children. Results: A significant group-by-condition interaction indicated reduced novelty P3a amplitude, but not target P3b or non-target P3 amplitudes, in both at-risk groups relative to TD children. This result remained after correcting for IQ differences between groups. No latency differences were observed. Discussion: At-risk children aged 9-12 years, both those with family history and those presenting multiple childhood antecedents, display disturbances in frontal mechanisms supporting involuntary attention orienting to salient stimuli, while more conscious parietal mechanisms supporting stimulus evaluation and context updating are, as yet, unaffected in these children. The latter may emerge more proximally to transition to psychosis; 48month follow-up assessments are underway to ascertain the evolution of these components as participants mature through adolescence.