Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies.

BACKGROUND: Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents.MethodWe conducted a systematic review of all published literature on psychotic symptom prevalence in two age groups, children aged 9-12 years and adolescents aged 13-18 years, searching through electronic databases PubMed, Ovid Medline, PsycINFO and EMBASE up to June 2011, and extracted prevalence rates. RESULTS: We identified 19 population studies that reported on psychotic symptom prevalence among children and adolescents. The median prevalence of psychotic symptoms was 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years. CONCLUSIONS: Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9-12 years) compared to older (13-18 years) children

Risk factors for self-harm and suicidal ideation and behaviour in adolescents and young adults: a protocol for an umbrella review of systematic reviews [version 1; peer review: 2 approved with reservations]

Background:There are many primary studies on the risk and protective factors for self-harm and suicidal ideation and/or behaviour in the adolescent and young adult (AYA) age group.  Moreover, there have been many systematic reviews on these primary studies. Some of these focus on a specific population, a geographic area, a specific risk factor or a socioeconomic group, whereas others are more general in their approach.  An umbrella review of these systematic reviews is an appropriate design to synthesise the available research regarding the main risks and protective factors for self-harm and suicidal ideation and/or behaviour in AYAs and to establish the relative strength of the associations of these risk and protective factors.    Methods and analysis: The PRISMA-P checklist was used for this protocol. The databases to be used for this umbrella review will be Ovid Medline, Embase, APA PsycInfo, the Cochrane Database of Systematic Reviews, CINAHL, and Scopus.  Systematic reviews included will date as far back as the year 2010 and up to the present so as to ensure that the evidence is contemporary and up-to-date.  Two authors, including the first author, will independently screen the results for inclusion.  The AMSTAR 2 checklist will be used for the quality assessment process and the overall strength of the body of evidence will be assessed using the GRADE tool.  </p

Birth weight and childhood psychopathology in the ABCD cohort: association is strongest for attention problems and is moderated by sex

Many studies have shown low birth weight is associated with psychopathology later in life, particularly attention-deficit/hyperactivity disorder (ADHD). The association is well-replicated, independent from a variety of potential familial confounds, and follows a dose–response curve (decreasing birth weight linked with increasing odds of disorder). However, the specificity of the association to attention problems is called into question by the extent of comorbidity in ADHD, and recent findings that the association is stronger for autism than ADHD. We test the relative dose–response strength of birth weight on multiple aspects of behavior to explore specificity of the effect to attention problems. We also test recent suggestions that the association between birth weight and attention problems is driven by males. Our sample consisted of 9,076 children aged 9–10 from the United States (Adolescent Brain Cognitive Development study). Outcomes included 9 problem-scales and the total problems scale from the Child Behavior Checklist (CBCL). Attention problems were the most strongly associated with birth weight after controlling for gestational age, potential familial confounds, and multiple testing, supporting the outcome-specificity of this association. Contrary to recent registry-based findings, an association between birth weight and an autism scale was not observed. Sex moderated the effect of birth weight on total problems, attention problems and aggressive behavior such that these inverse associations were strongly driven by males. Our findings have strong implications for sex-specific prediction and etiological models of childhood psychopathology.</p

Childhood adversity and adolescent psychopathology: evidence for mediation in a national longitudinal cohort study

BACKGROUND: Childhood adversity is a well-established risk factor for psychopathology; however, many who experience adversity do not go on to develop psychopathology. Poor self-concept and poor parental support are known risk factors for adolescent psychopathology, which may account for some of this mechanism.AIMS: To investigate candidate mediators in the relationship between childhood adversity and psychopathology.METHOD: We used data from the age 9 and 13 waves of the child-cohort of the Growing Up in Ireland study. We undertook mediation analysis by path decomposition of the relationship between childhood adversity and psychopathology (internalising and externalising problems) at age 13 and persistent psychopathology. Candidate mediators were self-concept, parent-child relationship and hobby participation at age 9.RESULTS: Childhood adversity was reported by 28.2% of participants, and was significantly associated with internalising and externalising problems. Parent-child conflict mediated the relationship between childhood adversity and both age 13 and persistent psychopathology, accounting for 52.4% of the relationship between childhood adversity and persistent externalising problems (indirect odds ratio, 1.30; 95% CI 1.19-1.43) and 19.2% for persistent internalising problems (indirect odds ratio, 1.24; 95% CI 1.15-1.34). There was a small mediating effect of self-concept. Hobby participation and positive parent-child relationship did not mediate these relationships.CONCLUSIONS: Parent-child conflict explains almost half the relationship between childhood adversity and persisting externalising problems in adolescence, and a fifth of the relationship with persisting internalising problems. This suggests parent-child conflict is a good target for interventions in childhood to prevent adolescent psychopathology.DECLARATION OF INTEREST: None.</div

Prenatal and perinatal complications in the development of psychosis: canaries in the coalmine

Although first suggested as early as the 1930s, the study of obstetric complications as risk factors for later psychotic disorders came to the fore in the late 1980s, when proponents of the neurodevelopmental aetiological model of schizophrenia cited the association between obstetric adversity and later schizophrenia as an essential building block for this theoretical approach. A meta-analytic review of this literature in 2002 concluded that no specific obstetric complications were associated with schizophrenia– rather a host of prenatal and perinatal risk factors of small effect size (typically with odds ratios [ORs] of less than 2).<br

Psychotic-like experiences? Trajectories and typologies of hallucinations and delusions from early adolescence to early adulthood in a population-based sample of Irish youth

Objectives: Hallucinations and delusions that occur in the absence of a psychotic disorder are common in children and adolescents. Longitudinal phenomenological studies exploring these experiences are notably lacking. The objective of the current paper was to explore the phenomenology and characteristics of hallucinations and delusions from early adolescence to early adulthood.Methods: Participants were 17 young people aged 18-21 years from the general population, all of whom had a history of childhood hallucinations and/or delusions. Longitudinal data on the phenomenological characteristics and attributions of reported hallucinatory and delusional phenomena spanning nine years were explored using content analysis.Results: Hallucinatory and delusional phenomena were transient for two-thirds of the sample. The remaining one-third reported reoccurring hallucinatory and delusional phenomena into early adulthood. In those, two typologies were identified: (1) Paranormal typology and (2) Pathological typology. The former was characterised by hallucinatory and delusional phenomena that were exclusively grounded in subcultural paranormal or spiritual belief systems and not a source of distress. The latter was characterised by delusion-like beliefs that were enmeshed with individuals' mood states and a source of distress. The perceived source, the subcultural context and how young people appraised and integrated their experiences differentiated the Paranormal and Pathological typologies.Conclusions: Not all hallucinatory and delusion-like experiences are psychotic-like in nature. To reliably differentiate between pathological and non-pathological hallucinations and delusions, assessments need to explore factors including the phenomenology of individuals' experiences, how people make sense and appraise them, and the subcultural contexts within which they are experienced.</p

Predicting childhood ADHD-linked symptoms from prenatal and perinatal data in the ABCD cohort

This study investigates the capacity of pre/perinatal factors to predict attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. It also explores whether predictive accuracy of a pre/perinatal model varies for different groups in the population. We used the ABCD (Adolescent Brain Cognitive Development) cohort from the United States (N = 9975). Pre/perinatal information and the Child Behavior Checklist were reported by the parent when the child was aged 9-10. Forty variables which are generally known by birth were input as potential predictors including maternal substance-use, obstetric complications and child demographics. Elastic net regression with 5-fold validation was performed, and subsequently stratified by sex, race/ethnicity, household income and parental psychopathology. Seventeen pre/perinatal variables were identified as robust predictors of ADHD symptoms in this cohort. The model explained just 8.13% of the variance in ADHD symptoms on average (95% CI = 5.6%-11.5%). Predictive accuracy of the model varied significantly by subgroup, particularly across income groups, and several pre/perinatal factors appeared to be sex-specific. Results suggest we may be able to predict childhood ADHD symptoms with modest accuracy from birth. This study needs to be replicated using prospectively measured pre/perinatal data. </p

What mediates the longitudinal relationship between psychotic experiences and psychopathology?

Psychotic experiences (PEs) are common in early adolescence and are associated with nonpsychotic psychopathology. However, not all adolescents with PEs have subsequent psychopathology, and vice versa. To date, factors mediating the relationship between PEs and psychopathology have been understudied. The aims of this study were to investigate the bidirectional relationship between PEs and psychopathology in adolescence and to investigate potentially malleable mediators of these relationships. Data from 2 waves (age 13 and 17 years) of Cohort '98 of the Growing Up in Ireland study were examined (n = 6,206). Using KHB pathway decomposition, we investigated the following as potential mediators of the relationship between psychopathology and PEs: parent-child relationship (conflict and positive), self-concept, and child-peer relationship (alienation and trust). Supplementary counterfactual mediation and sensitivity analyses were conducted. Early adolescents with psychopathology had twofold increased odds of late adolescent PEs (internalizing problems: odds ratio [OR] = 2.03, 95% confidence interval [CI; 1.56, 2.62]; externalizing problems: OR = 1.99, CI [1.51, 2.60]). Parent-child conflict explained between 23% and 34% of the associations between internalizing and externalizing problems and subsequent PEs. Early adolescents with PEs had increased odds of late adolescent psychopathology (internalizing problems: OR = 2.01, CI [1.61, 2.50]; externalizing problems: OR = 1.70, CI [1.25, 2.31]). Self-concept alone accounted for 52% of the relationship between PEs and subsequent internalizing problems. There is a bidirectional heterotypic relationship between psychopathology and PEs. Parent-child conflict and self-concept are important characteristics that mediate a proportion of the relationship between PEs and psychopathology. Interventions targeting parent-child conflict in the context of psychopathology and self-concept in the context of PEs may assist in reducing the incidence of poorer outcomes. Psychotic experiences are common in adolescence and are frequently associated with other mental health problems. However, not all young people with psychotic experiences have mental health problems, and most with mental health problems do not have psychotic experiences. We found that psychotic experiences are bidirectionally associated with mental health problems. The relationship between psychotic experiences and subsequent mental health problems may be explained partly by the young person's self-concept. The relationship between mental health problems and subsequent psychotic experiences may be explained partly by conflict between the young person and their primary caregiver

Phenomenological characteristics and explanations of unusual perceptual experiences, thoughts and beliefs in a population sample of early adolescents

Objectives: Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how young people made sense of those experiences.Methods: Participants were 53 young people aged 11-13 years from a population-based study of mental health. All met criteria for UPTBs following clinical interviews as part of the study. Documentary data on UPTBs in the form of transcribed notes, recorded during clinical interviews, were analysed using content analysis. Data on UPTBs were coded, organised into categorical themes and quantified using descriptive statistics. Qualitative themes on how participants made sense of their experiences were identified.Results: Participants reported UPTBs across four domains: auditory verbal, auditory non-verbal, non-auditory perceptual experiences and unusual thoughts and beliefs. UPTBs were phenomenologically rich and diverse. Young people sought to make sense of their experiences in multiple ways: normalising them, externalising them by attributing them to paranormal entities and distancing them from psychiatric explanations. Uncertainty about the source of UPTBs was identified as a superordinate theme.Conclusion: Findings from this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in young people.

Changes in self‐concept and risk of psychotic experiences in adolescence: a longitudinal population‐based cohort study

BACKGROUND: Psychotic experiences (PEs) are commonly reported in adolescence and are associated with a range of negative outcomes. Few targets for intervention for PEs have been identified. One potential target is self-concept: an individual's beliefs about his/her personal attributes. Improvements in self-concept have been shown to reduce psychotic symptoms in patients with schizophrenia but no study has investigated the relationship between changes in self-concept and risk of PEs in the general population. We aimed to investigate: (a) the relationship between child and adolescent self-concept and adolescent PEs; and (b) whether changes in self-concept between childhood and adolescence were associated with risk of adolescent PEs. METHOD: Using data from age 9 and age 13 (n = 7,423) of the child cohort (Cohort'98) from the Growing Up in Ireland study we investigated the relationship between self-concept at age 9 and age 13 and PEs at age 13. PEs were measured using the Adolescent Psychotic Symptoms Screener and self-concept was measured using the Piers Harris-II. Using a stratified analysis, we investigated the relationship between change in self-concept between age 9 and age 13 and the risk of PEs at age 13. Additionally we investigated changes across the six self-concept subscales. RESULTS: Psychotic experiences were reported by 13% of participants at age 13. 'Very low' self-concept at age 9 was associated with an increased risk of PEs at age 13 (Adjusted-OR: 2.74, CI: 1.80-4.19), and 'High' self-concept at age 9 was associated with a decreased risk of PEs at age 13 (Adjusted-OR: 0.77, CI: 0.60-0.97). The stratified analysis indicated that improvements in self-concept reduced the odds of adolescent PEs and decline in self-concept increased the odds of adolescent PEs. This effect was noted across the majority of the self-concept subscales. CONCLUSIONS: There is a strong relationship between self-concept and PEs. The antecedents of low self-concept may be a useful target for preventative psychiatry. Broad-spectrum interventions targeting self-concept in childhood may help to reduce the incidence of PEs in adolescence.</p