title: Systematic meta-analysis of childhood social withdrawal in schizophrenia, and comparison with data from at-risk children aged 9-14 years.
abstract: Social withdrawal is a robust childhood risk factor for later schizophrenia. The aims of this paper were to assess the evidence for childhood social withdrawal among adults with schizophrenia and, comparatively, in children aged 9-14 years who are putatively at-risk of developing schizophrenia. We conducted a meta-analysis, including cohort and case-control studies reporting social withdrawal measured by the Child Behavior Checklist (CBCL) in adults with schizophrenia vs. controls. Further, an experimental study compared CBCL withdrawal scores from typically-developing children with scores from two groups of putatively at-risk children: (i) children displaying a triad of replicated antecedents for schizophrenia, and (ii) children with at least one first- or second-degree relative with schizophrenia or schizoaffective disorder. Six studies met inclusion criteria for the meta-analysis (N = 3828), which demonstrated a large effect of increased childhood social withdrawal in adults with schizophrenia (standardized mean difference [SMD] score = 1.035, 95% CI = 0.304-1.766, p = 0.006), with no indication of publication bias, but considerable heterogeneity (I(2) = 91%). Results from the experimental study also indicated a large effect of increased social withdrawal in children displaying the antecedent triad (SMD = 0.743, p = 0.001), and a weaker effect in children with a family history of schizophrenia (SMD = 0.442, p = 0.051). Childhood social withdrawal may constitute a vulnerability marker for schizophrenia in the presence of other antecedents and/or genetic risk factors for schizophrenia.
authors.affiliation: Schizophrenia Research Institute, Level 7, 45 Liverpool Street, Darlinghurst, NSW 2010, Sydney, Australia. s.matheson@schizophreniaresearch.org.au
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Matheson
authors.forename: Hena
authors.initials: H
authors.lastname: Vijayan
authors.forename: Hannah
authors.initials: H
authors.lastname: Dickson
authors.forename: Alana M
authors.initials: AM
authors.lastname: Shepherd
authors.forename: Vaughan J
authors.initials: VJ
authors.lastname: Carr
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Laurens
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D057189:Checklist; D002648:Child; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D002658:Developmental Disabilities / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D012929:Psychological Distance; D012307:Risk Factors; D012559:Schizophrenia / Q000150:complications*; D012920:Social Behavior Disorders / Q000209:etiology*