Researchers conducted a new study to investigate the connection between persistent and distressing psychotic experiences (PLEs), in youth as well as risk factors for developing psychopathology. Researchers found that youth who have persistent, distressing PLEs have impairment in a variety areas, including cognition and reported psychopathology. This exposes the long-term issues they might face and the need to provide assistance and early intervention. The National Institutes of Health funded the study. It appears in the journal Molecular Psychiatry.
While we are aware that some children have experienced psychotic-like events however, it’s been difficult to determine which children will develop psychotic disorders later in life. This study suggests that children who experience persistent, distressing symptoms reminiscent of psychotic face serious developmental challenges. It is crucial to act early on behalf of any child affected by these experiences, regardless if they develop psychotic disorders later in their lives.
Shelli Avenevoli (Ph.D.), deputy director of the National Institute of Mental Health, NIMH, and study author
Between the ages 9 and 12, more than 17% of children experience PLEs. They are mild perceptual disorders such as delusional thoughts or mild perceptual anomalies. Only a tiny percentage of these children develop psychotic disorders. One factor that could aid in separating clinically relevant PLEs from benign ones is whether the psychotic experiences are persistent and/or distressing. Nicole Karcher, Ph.D. from Washington University School of Medicine, St. Louis and her colleagues studied the relationship between persistent and/or distressing psychotic experiences and risk factors for developing psychosis.
Researchers used data from the Adolescent brain cognitive development (ABCD) study. This massive research effort collects data on the 9 and 10 year-olds in the U.S. Researchers utilized data from the Adolescent brain Cognitive Development (ABCD) study which is a huge-scale research project that collects data on children aged 9 and 10 across the U.S. between Sept. 1, 2016 & Oct. 15 October 15, 2018. The baseline data was collected near the beginning of the study period and data collected one and two years later. At each time point children were screened for PLEs as well as the level of distress that was associated with the events.
The researchers used this data to create four groups: a persistent distressing PLEs group, a transient distressing group of PLEs, a permanant non-distressing group of PLEs, and a transient non-distressing PLEs group. The term “permanent” PLEs” was used to mean that they were reported in at least two rounds of data collection and distress was assessed by a self-report survey.
The researchers then assessed differences in risk factors for psychosis between the four groups. These risk factors, which were assessed at the baseline timepoint, included indicators of psychopathology, functioning (e.g. how children are doing in school and using mental health services) cognitive abilities, developmental milestone achievement, environmental adversity, experiences from childhood that were negative, as well as brain structure and function.
In the study, the highest functional impairments and mental health services utilization were found in those who had persistent and distressing PLEs. Additionally, those who suffered from persistent, distressing PLEs were more likely to experience bipolar, externalizing, and internalizing symptoms than youth without persistent distressing PLEs. Children with persistent, debilitating, PLEs had the most severe cognitive impairments, including a greater deficit in fluid cognition, working memory, and receptive speech. Youth with persistent, distressing PLEs also faced more severe environmental stress than their peers including higher deprivation and more adverse childhood experiences.
The researchers also found that those who experienced distressing PLEs, whether transient or persistent, experienced a delay in developmental milestone achievement, lower cortical and subcortical brain volumes and differences in brain network connectivity compared with children who had non-distressing PLEs.
“These unique longitudinal studies demonstrate that it is often only in the context of distress that persistent PLEs can be connected to impairments,” said Dr. Karcher.
This study found that children who experience persistently distressing PLEs have elevated risk factors in areas such as functioning, psychopathology and cognitive performance. These results suggest that persistent, depressing PLEs represent an important screening indicator for youth who develop long-term challenges regardless of whether or not they develop psychotic disorders, and may be a sign that children are prime candidates for early intervention.
Karcher, N. R., et al. (2021) Persistent and distressing psychotic-like experience using Adolescent Brain Cognitive Development(sm) study data. Molecular Psychiatry. doi.org/10.1038/s41380-021-01373-x.
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