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Original Article
April 2010

Etiological and Clinical Features of Childhood Psychotic Symptoms: Results From a Birth Cohort

Author Affiliations

Author Affiliations: Departments of Psychology and Neuroscience (Drs Polanczyk, Moffitt, Houts, and Caspi) and Psychiatry and Behavioral Sciences (Drs Polanczyk, Moffitt, Keefe, Houts, and Caspi), Institute for Genome Sciences and Policy (Drs Polanczyk, Moffitt, Houts, and Caspi), Duke University, Durham, North Carolina; Department of Psychiatry, University of São Paulo Medical School and National Institute for Developmental Psychiatry, São Paulo, Brazil (Dr Polanczyk); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, England (Drs Moffitt, Arseneault, and Caspi and Mr Ambler); Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin (Dr Cannon); and Department of Psychology and Social Behavior, University of California, Irvine (Dr Odgers).

Arch Gen Psychiatry. 2010;67(4):328-338. doi:10.1001/archgenpsychiatry.2010.14

Context  It has been reported that childhood psychotic symptoms are common in the general population and may signal neurodevelopmental processes that lead to schizophrenia. However, it is not clear whether these symptoms are associated with the same extensive risk factors established for adult schizophrenia.

Objective  To examine the construct validity of children's self-reported psychotic symptoms by testing whether these symptoms share the risk factors and clinical features of adult schizophrenia.

Design  Prospective, longitudinal cohort study of a nationally representative birth cohort in Great Britain.

Participants  A total of 2232 twelve-year-old children followed up since age 5 years (retention, 96%).

Main Outcome Measure  Children's self-reported hallucinations and delusions.

Results  Children's psychotic symptoms are familial and heritable and are associated with social risk factors (eg, urbanicity); cognitive impairments at age 5; home-rearing risk factors (eg, maternal expressed emotion); behavioral, emotional, and educational problems at age 5; and comorbid conditions, including self-harm.

Conclusions  The results provide a comprehensive picture of the construct validity of children's self-reported psychotic symptoms. For researchers, the findings indicate that children who have psychotic symptoms can be recruited for neuroscience research to determine the pathogenesis of schizophrenia. For clinicians, the findings indicate that psychotic symptoms in childhood are often a marker of an impaired developmental process and should be actively assessed.