title: Frequency and pattern of childhood symptom onset reported by first episode schizophrenia and clinical high risk youth.
abstract: BACKGROUND
  Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown.
  
  
  METHODS
  This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at "clinical high risk" (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13-17), or adulthood (18+).
  
  
  RESULTS
  Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset.
  
  
  CONCLUSIONS
  Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States. Electronic address: kwoodber@bidmc.harvard.edu.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Woodberry
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Serur
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Hallinan
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
authors.forename: Raquelle I
authors.initials: RI
authors.lastname: Mesholam-Gately
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychology, Worcester Recovery Center and Hospital, Worcester, MA, United States.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Giuliano
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Wojcik
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
authors.forename: Matcheri S
authors.initials: MS
authors.lastname: Keshavan
authors.affiliation: Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States; University of Massachusetts Memorial Health Care, Worcester, MA, United States.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Frazier
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Brigham and Women's Hospital, Division of Women's Health, Connors Center for Women's Health and Gender Biology, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Division of Psychiatric Neuroscience, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Goldstein
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States; Department of Radiology, Harvard Medical School, Boston, MA, United States; Veterans Affairs Boston Healthcare System, Brockton, MA, United States; Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.
authors.forename: Martha E
authors.initials: ME
authors.lastname: Shenton
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Veterans Affairs Boston Healthcare System, Brockton, MA, United States.
authors.forename: Robert W
authors.initials: RW
authors.lastname: McCarley
authors.affiliation: Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Seidman
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D062706:Prodromal Symptoms; D012189:Retrospective Studies; D012306:Risk; D012559:Schizophrenia / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D057566:Self Report; D055815:Young Adult
keywords: Child; Early onset; Prodrome; Psychosis; Psychotic-like; SIPS