The interplay of childhood behavior problems and IQ in the development of later schizophrenia and affective psychoses
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.
References (37)
- et al.
Premorbid indicators and risk for schizophrenia: a selective review and update
Schizophr. Res.
(2005) - et al.
Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study
Lancet
(2009) - et al.
A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder
Schizophr. Res.
(2004) - et al.
An application of the U.S. Bureau of the Census socioeconomic index to a large, diversified patient population
Soc. Sci. Med.
(1968) Childhood developmental abnormalities in schizophrenia: evidence from high-risk studies
Schizophr. Res.
(2003)- et al.
North American Prodrome Londitudinal Study (NAPLS 2): the prodromal symptoms
J. Nerv. Ment. Dis.
(2015) - et al.
Early childhood IQ trajectories in individuals later developing schizophrenia and affective psychoses in the New England Family Studies
Schizophr. Bull.
(2015) - et al.
Relationship between childhood behavioral disturbance and later schizophrenia in the New York High-Risk Project
Am. J. Psychiatry
(1999) - et al.
A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia
Schizophr. Bull.
(2000) Dementia Praecox or the Group of Schizophrenias
(1950)
The Collaborative Perinatal Project: An Overview
Children of parents with affective and nonaffective psychoses: a longitudinal study of behavior problems
Am. J. Psychiatry
Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11
Br. Med. J.
Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition, Version 2
Neurobiologic antecedents of schizophrenia in children. Evidence for an inherited, congenital neurointegrative defect
Arch. Gen. Psychiatry
Specificity of the transmission of schizophrenia psychosis spectrum and affective psychoses in the New England Family Studies high risk design
Arch. Gen. Psychiatry
Prenatal maternal immune disruption and sex-dependent risk for psychoses
Psychol. Med.
Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort
Arch. Gen. Psychiatry
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Drs Buka and Seidman share senior authorship.