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

Abstract

PurposeThe London Child Health and Development Study (CHADS) is a prospective, longitudinal investigation of children, sampled from the general community aged 9–11 years and assessed biennially, who present premorbid risk markers for schizophrenia. The study aims to characterise developmental trajectories of psychological, cognitive, and biological functioning in at-risk children and identify potential targets for early preventative intervention. This review summarises CHADS findings, discusses these in the context of recent theory regarding aetiology and prevention of schizophrenia, and highlights challenges to be addressed with future research.MethodsWe review (1) epidemiological information on the prevalence and correlates of developmental antecedents of schizophrenia in the general child population, (2) evidence of psychosocial, cognitive, and biological dysfunctions in at-risk children presenting multiple antecedents of schizophrenia and at-risk children with a family history of schizophrenia, and (3) related findings from an associated sample of help-seeking children receiving intervention.ResultsCommunity-based screening of 9–11-year olds identified ~9 % with a triad of antecedents of schizophrenia [including psychotic-like experiences (PLEs)] who are putatively at-risk of psychosis; these children reported greater exposure and responsivity to stressors, impairments in general intelligence and specific cognitive functions, brain structure and function abnormalities, and neuromotor dysfunction. Preliminary evidence suggests distressing PLEs are a viable target for cognitive-behavioural intervention in at-risk children.ConclusionsIntervention in early, premorbid phases of illness might alleviate current difficulties and avert future schizophrenia using benign treatments. The CHADS programme has identified several markers that may index early pathophysiology and constitute potential targets for preventative intervention.

Conditional Disclosure on Pathways to Care: Coping Preferences of Young People at Risk of Psychosis

“…Participants were recruited from families involved in the London Child Health and Development Study (CHADS); an ongoing prospective investigation of children recruited via population screening conducted in primary schools in Greater London, United Kingdom, between 2005 and 2010 when aged 9 to 11 years, over-representing families from deprived, ethnically-diverse inner-city areas (Laurens & Cullen, 2016). Young people from a subsample of the CHADS longitudinal community cohort (n=407; as reported in (Gronholm et al, 2015)) who met the following two criteria were eligible to participate in the present study: (1) at least one child-reported "certainly true" response among nine items assessing psychotic-like experiences (PLEs) (Laurens et al, 2007) at the CHADS screening assessment, and at least one "certainly true" or "somewhat true" response at follow-up data collection (on average two years later; see (Downs, Cullen, Barragan, & Laurens, 2013)); (2) internalizing or externalizing problems in the clinical (abnormal) range (approximately top 10% on population norms) as measured by child-reported 8 Emotional Symptoms, and/or caregiver-reported Conduct Problems, Hyperactivity-Inattention, and/or Peer Relationship Problems on the Strengths and Difficulties Questionnaire (SDQ) (R. Goodman, 1997) at CHADS screening, and at clinical or borderline range (approximately top 20% on population norms) at follow-up.…”

“…Furthermore, explorations of how stigma might impact on initial coping preferences and pathways to care (i.e., helpseeking from both informal and formal sources of support, and possible service contact) amongst individuals in at-risk stages are even less common. It is thus not clear how early stigma-related concerns might manifest amongst people at increased risk of developing psychosis, and how they might influence the early stages of their pathways to care.It is suggested that the presence of psychotic-like experiences (PLEs) can be used to assess early stages of increased risk of developing psychotic disorders, before the illness proceeds to a stage where prodromal symptom criteria are met (Keshavan, DeLisi, & Seidman, 2011;Laurens & Cullen, 2016).PLEs reflect attenuated psychotic symptoms below the threshold of frank psychosis. They are common in the population, and generally transient in nature (Keshavan et al, 2011;van Os & Linscott, 2012).…”

“…Persistent PLEs, or PLEs that occur comorbidly with social, emotional, or behavioral problems might be particularly indicative of increased risk for psychosis (Laurens & Cullen, 2016). Early, proactive and preventative interventions targeting early distress and psychotic-like symptomatology could ameliorate the impairment and persistence associated with PLEs, potentially reducing future risk for those with putative vulnerability for developing psychosis (Dimitrakopoulos, Kollias, Stefanis, & Kontaxakis, 2015;Maddox et al, 2013).…”

Childhood antecedents of schizophrenia: Will understanding aetiopathogenesis result in schizophrenia prevention?

“…In this issue, Laurens and Cullen summarise the methodology and key findings of CHAD to date [6]. Baseline screening for antecedents of schizophrenia was conducted in a large community sample (n = 7966) of children aged 9-12 years.…”

“…A sub-sample (n = 111) comprising of typically developing children (n = 46), those with a family history of schizophrenia (n = 26), those with antecedents of schizophrenia (n = 33) and those with both family history and antecedents (n = 6) have been investigated longitudinally. Psychopathological, neurobiological and cognitive markers have been examined biennially in these children as they grow through the developmental stage where schizophrenia typically emerges [6].…”