Elsevier

Schizophrenia Research

Volume 184, June 2017, Pages 45-51
Schizophrenia Research

The interplay of childhood behavior problems and IQ in the development of later schizophrenia and affective psychoses

https://doi.org/10.1016/j.schres.2016.12.010Get rights and content

Abstract

Schizophrenia and affective psychoses are both associated with impaired social functioning, but the extent to which childhood behavioral impairments are present prior to onset of illness is less well studied. Moreover, the concurrent relationship of childhood behavior problems and premorbid IQ with subsequent psychotic disorder has not been established. We investigated whether childhood behavior problems are associated with increased risk for adult schizophrenia or affective psychosis, independently and in combination with IQ. The study included individuals with schizophrenia (N = 47), affective psychoses (N = 45) and non-psychotic controls (N = 1496) from the New England Family Study. Behavior problems were prospectively assessed from standardized clinician observations at ages 4 and 7. IQ was assessed with the Stanford-Binet at age 4 and the Wechsler Intelligence Scale for Children at age 7. We found externalizing problems at age 4 and externalizing and internalizing problems at age 7 were associated with later schizophrenia, and both internalizing and externalizing problems at ages 4 and 7 were associated with later development of affective psychoses. Lower IQ at ages 4 and 7 was associated with schizophrenia, while lower IQ was associated with affective psychoses at age 7 only. Examined simultaneously, both lower IQ and behavior problems remained associated with risk of schizophrenia, while only behavior problems remained associated with affective psychoses. Behavior problems appear to be a general marker of risk of adult psychotic disorder, while lower childhood IQ is more specific to risk of schizophrenia. Future research should clarify the premorbid evolution of behavior and cognitive problems into adult psychosis.

Introduction

The neurodevelopmental model of schizophrenia posits that the disorder originates in the prenatal, perinatal and early childhood periods (Murray and Lewis, 1987, Weinberger, 1987), with precursors evident prior to the prodromal period and onset of the full syndrome (Fish, 1977). While there is clear evidence for childhood motor and cognitive problems among individuals who later develop schizophrenia (Seidman, 1990, Olin and Mednick, 1996, Niemi, 2003, Keshavan et al., 2005, Liu et al., 2015), relatively less is known about premorbid behavioral problems (Tarbox and Pogue-Geile, 2008). Suggestive evidence can be found in early life history descriptions of schizophrenia patients by Kraepelin (Kraepelin, 1919) and Bleuler (Bleuler, 1950), and studies that find affective problems may precede onset of psychosis for some individuals (Yung and McGorry, 1996, Weiser et al., 2002, Weiser et al., 2008).

Evidence of premorbid neurodevelopmental abnormalities in affective psychotic disorders is less clear than for schizophrenia, at least with respect to premorbid cognitive impairment, with some studies suggesting individuals who later develop affective psychoses exhibit better neurocognitive performance in childhood than those who develop schizophrenia (Seidman et al., 2013, Agnew-Blais et al., 2015). However, whether the finding of less premorbid impairment for affective psychoses compared with schizophrenia extends to childhood behavior problems is uncertain, nor is it clear whether the age of onset, severity and type of behavior problems differ between those who develop schizophrenia and affective psychoses. We have previously found that children of individuals with schizophrenia and affective psychoses showed elevated risk for behavior problems, including internalizing and externalizing behaviors at age 7 (Donatelli et al., 2010); however we have not investigated behavior problems among children who later develop these disorders themselves in later life.

Moreover, little research has been done regarding the relationship between cognition and behavior in the early premorbid period among individuals who later develop psychotic disorder. It may be that behavioral and cognitive problems tend to co-occur in childhood among individuals who later develop psychosis, or alternatively, that premorbid impairments in these domains are largely independent, suggesting more distinct pathways in relation to later psychosis risk.

Schizophrenia and affective psychosis have overlapping symptomatology and genetic susceptibility (Murray et al., 2004, Lichtenstein et al., 2009, Smoller, 2013), and a better, comparative understanding of the premorbid course of childhood development in these two disorders could shed light on differences in their neurodevelopmental trajectories and susceptibility profiles. This issue takes on increasing importance as the field moves to develop early intervention strategies (Liu et al., 2015, Seidman and Nordentoft, 2015). Given that these disorders share common symptoms of psychosis, a direct comparison of premorbid behavior problems and cognition among the psychoses provides a strong test of similarities and differences between them. Our aim was to investigate whether childhood behavior problems were associated with increased risk for adult schizophrenia or affective psychosis, independently and in combination with IQ. We hypothesized that: (a) premorbid behavior problems at ages 4 and 7 would be more strongly related to schizophrenia than affective psychoses, and (b) both lower IQ and behavior problems would be independently associated with increased risk of later schizophrenia. As we did not have a strong a priori hypothesis regarding whether internalizing versus externalizing problems would be differentially related to later risk, we examined these problems separately to identify potential specificity associated with type of behavior problem.

Section snippets

Study population

The Collaborative Perinatal Project (CCP) was established over half a century ago to study the pre- and perinatal origins of neurologic disease. The CPP followed pregnant women during prenatal visits and then their offspring at ages 4, 8 and 12 months and 4 and 7 years during visits that included physical, neurological and psychological evaluations (Broman, 1984). The New England Family Study (NEFS) includes the Boston, Massachusetts (MA) and Providence, Rhode Island (RI) sites of the CPP, and is

Results

Behavior problems at ages 4 and 7 were more common among children with later schizophrenia and affective psychoses than controls: both internalizing and externalizing problems were significantly elevated for these groups, with the exception of internalizing problems at age 4 for schizophrenia. As we have found previously (Seidman et al., 2013, Agnew-Blais et al., 2015), mean IQ was significantly lower among later schizophrenia cases than controls at ages 4 (p < 0.001) and 7 (p = 0.002); IQ scores

Discussion

Childhood internalizing and externalizing behavior problems were associated with risk of schizophrenia and affective psychoses in this general population birth cohort. Cognition in childhood tended to be less impaired among individuals who later developed affective psychoses compared to schizophrenia. In this report, we show for the first time that both behavior problems and lower IQ remained significantly associated with schizophrenia when examined simultaneously, while only behavior problems

Author contributions

All authors made substantial contributions to the conception and design or analysis and interpretation of the data, and to drafting the article or revising it critically for important intellectual content, as well as had final approval of the version to be published.

Role of the funders

The funders played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflicts of interest

The authors do not have any personal or financial conflicts of interest to disclose.

Acknowledgements

J Agnew-Blais was supported during work on this manuscript by NIMH T32MH017119 and was part of J Agnew-Blais's doctoral disseration supervised by SL Buka, LJ Seidman, GM Fitzmaurice and JW Smoller. Larry J. Seidman is supported by the Commonwealth of Massachusetts (SCDMH82101008006) and NIMH R21 MH091461.

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  • 1

    Drs Buka and Seidman share senior authorship.

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