Modelling psychosocial influences on the distress and impairment caused by psychotic-like experiences in children and adolescents

Abstract

Psychological understanding of psychotic-like experiences (PLEs) occurring in childhood is limited, with no recognised conceptual framework to guide appropriate intervention. We examined the contribution to PLE severity of emotional, cognitive and socio-environmental mechanisms thought to influence the development and maintenance of psychosis. Forty 8-14 year olds referred to a community Child and Adolescent Mental Health Service completed a battery of questionnaires and assessments measuring severity of PLEs, emotional problems, cognitive biases, and negative life events. 85% of children assessed reported having experienced a PLE over the previous year; and 55% reported more than one. 60% had experienced at least one in the previous fortnight. Multiple linear regression demonstrated that each of the variables made a significant and independent contribution to PLE severity, after adjusting for verbal ability and age, accounting together for more than half of the variance (reasoning B = 6.324, p = .049; emotion B = 1.807, p = .005; life events B = 4.039, p = .001). PLEs were common in this clinical sample of children. Psychological factors implicated in the development and maintenance of psychosis in adults were also associated with PLE severity in these children. PLE severity may be reduced by targeting each of these factors in cognitive therapy, at this very early stage. Any improvements in emotional wellbeing and functioning may then increase future resilience.

Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

“…In recent studies, the psychosocial factors implicated in the onset, severity, and maintenance of adult psychosis have been found to also predict the occurrence and severity of childhood UEs [28][29][30][31][32][33][34]. Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30].…”

“…Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30]. We have also shown that reasoning [31] and negative schematic beliefs [32] can both be assessed in children in a similar fashion to adults with psychosis, and could both form useful foci for intervention.…”

“…The current study was designed to build on our earlier findings supporting the general applicability of CBTp, implicating reasoning, emotional problems and negative life events in overall UE severity [30][31][32], by investigating whether the influence of these cognitive, emotional and social processes differed according to particular characteristics of childhood UEs. We studied a sample of clinically referred 8-14 year olds, some of whom were also participants in our earlier research [30][31][32], and considered similar dimensional attributes and content/type characteristics of childhood UEs to those linked with particular psychosocial processes in studies of adult psychotic symptoms.…”

“…These theoretical advances have informed the development of targeted CBTp interventions that focus on changing a particular cognitive or emotional process, in the context of a particular symptom presentation. Larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic, undifferentiated CBTp protocols with heterogeneous therapy foci [23][24][25][26][27].In recent studies, the psychosocial factors implicated in the onset, severity, and maintenance of adult psychosis have been found to also predict the occurrence and severity of childhood UEs [28][29][30][31][32][33][34]. Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30].…”

Toward earlier identification and preventative intervention in schizophrenia: evidence from the London Child Health and Development Study

“…In pretreatment data, negative life events, emotional symptoms, cognitive biases (e.g. probabilistic reasoning and jumping to conclusions biases), and negative schematic beliefs about self and others independently contributed to PLE severity [75,76]. Further, negative schematic beliefs mediated the relationship between experiences of bullying and PLEs [77].…”