Skip to main content

Childhood adversity and cognitive function in schizophrenia spectrum disorders and healthy controls: evidence for an association between neglect and social cognition

  • S Kilian (a1), L Asmal (a1), B Chiliza (a2), MR Olivier (a1), L Phahladira (a1), F Scheffler (a1), S Seedat (a1), SR Marder (a3) (a4), MF Green (a3) (a4) and R Emsley (a1)...

Childhood adversity is associated with cognitive impairments in schizophrenia. However, findings to date are inconsistent and little is known about the relationship between social cognition and childhood trauma. We investigated the relationship between childhood abuse and neglect and cognitive function in patients with a first-episode of schizophrenia or schizophreniform disorder (n = 56) and matched healthy controls (n = 52). To the best of our knowledge, this is the first study assessing this relationship in patients and controls exposed to similarly high levels of trauma.


Pearson correlational coefficients were used to assess correlations between Childhood Trauma Questionnaire abuse and neglect scores and cognition. For the MCCB domains displaying significant (p < 0.05) correlations, within group hierarchical linear regression, was done to assess whether abuse and neglect were significant predictors of cognition after controlling for the effect of education.


Patients and controls reported similarly high levels of abuse and neglect. Cognitive performance was poorer for patients compared with controls for all cognitive domains except working memory and social cognition. After controlling for education, exposure to childhood neglect remained a significant predictor of impairment in social cognition in both patients and controls. Neglect was also a significant predictor of poorer verbal learning in patients and of attention/vigilance in controls. However, childhood abuse did not significantly predict cognitive impairments in either patients or controls.


These findings are cross sectional and do not infer causality. Nonetheless, they indicate that associations between one type of childhood adversity (i.e. neglect) and social cognition are present and are not illness-specific.

Corresponding author
Author for correspondence: S Kilian, E-mail:
Hide All
Aas, M, Dazzan, P, Fisher, HL, Morgan, C, Morgan, K, Reichenberg, A et al. (2011) Childhood trauma and cognitive function in first-episode affective and non-affective psychosis. Schizophrenia Research 129, 1219.
Aas, M, Steen, NE, Agartz, I, Aminoff, SR, Lorentzen, S, Sundet, K et al. (2012) Is cognitive impairment following early life stress in severe mental disorders based on specific or general cognitive functioning? Psychiatry Research 198, 495500.
Addington, D, Addington, J and Maticka-Tyndale, E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry Supplement 163, 3944.
Alameda, L, Ferrari, C, Baumann, PS, Gholam-Rezaee, M, Do, KQ and Conus, P (2015) Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients. Psychological Medicine 45, 27272736.
Alemany, S, Arias, B, Aguilera, M, Villa, H, Moya, J, Ibanez, MI, Vossen, H, Gasto, C, Ortet, G and Fananas, L (2011) Childhood abuse, the BDNF-Val66Met polymorphism and adult psychotic-like experiences. British Journal of Psychiatry 199, 3842.
Bernstein, DP, Fink, L, Handelsman, L, Foote, J, Lovejoy, M, Wenzel, K et al. (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry 151, 11321136.
Bernstein, DP and Fink, LA (1998) CTQ: Childhood Trauma Questionnaire: A Retrospective Self-Report. San Antonio, TX: Psychological Corporation.
Berstein, DP, Stein, JA, Newcom, MD, Walker, E, Pogge, D, Ahluvalia, T et al. (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect 27, 169190.
Danese, A, Moffitt, TE, Arseneault, L, Bleiberg, BA, Dinardo, PB, Gandelman, SB et al. (2017) The origins of cognitive deficits in victimized children: implications for neuroscientists and clinicians. The American Journal of Psychiatry 174, 349361.
Diamond, LM and Aspinwall, LG (2003) Emotion regulation across the life span: an integrative perspective emphasizing self-regulation, positive affect, and dyadic processes. Motivation and Emotion 27, 125156.
Fett, AK, Viechtbauer, W, Dominguez, MD, Penn, DL, van Os, J and Krabbendam, L (2011) The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience and Biobehavioral Reviews 35, 573588.
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition. (SCID-I/NP). New York: New York State Psychiatric Institute, Biometrics Research.
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J et al. (2011) Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546553.
Frajo-Apor, B, Pardeller, S, Kemmler, G, Welte, AS and Hofer, A (2016) Emotional intelligence deficits in schizophrenia: the impact of non-social cognition. Schizophrenia Research 172, 131136.
Garcia, M, Montalvo, I, Creus, M, Cabezas, A, Sole, M, Algora, MJ et al. (2016) Sex differences in the effect of childhood trauma on the clinical expression of early psychosis. Comprehensive Psychiatry 68, 8696.
Geoffroy, MC, Pinto, PS, Li, L and Power, C (2016) Child neglect and maltreatment and childhood-to-adulthood cognition and mental health in a prospective birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry 55, 3340.
Green, MF, Horan, WP and Lee, J (2015) Social cognition in schizophrenia. Nature Reviews Neuroscience 16, 620631.
Healey, KM, Bartholomeusz, CF and Penn, DL (2016) Deficits in social cognition in first episode psychosis: a review of the literature. Clinical Psychology Review 50, 108137.
Heins, M, Simons, C, Lataster, T, Pfeifer, S, Versmissen, D, Lardinois, M et al. (2011) Childhood trauma and psychosis: a case-control and case-sibling comparison across different levels of genetic liability, psychopathology, and type of trauma. American Journal of Psychiatry 168, 12861294.
Hellemann, GS, Green, MF, Kern, RS, Sitarenios, G and Nuechterlein, KH (in press) Developing an international scoring system for a consensus-based social cognition measure: MSCEIT-Managing Emotions. Psychological Medicine. doi: 10.1017/S0033291717001052.
Jones, L, Bellis, MA, Wood, S, Hughes, K, McCoy, E, Eckley, L et al. (2012) Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies. Lancet 380, 899907.
Kahn, RS and Keefe, RS (2013) Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 70, 11071112.
Kay, SR, Fiszbein, A and Opler, LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Lysaker, PH, Meyer, P, Evans, JD and Marks, KA (2001) Neurocognitive and symptom correlates of self-reported childhood sexual abuse in schizophrenia spectrum disorders. Annals of Clinical Psychiatry 13, 8992.
McCabe, KL, Maloney, EA, Stain, HJ, Loughland, CM and Carr, VJ (2012) Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research 46, 600607.
Myin-Germeys, I and van Os, J (2007) Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.
Nuechterlein, KH and Green, MF (2006) MATRICS Consensus Battery Manual. Los Angeles: MATRICS Assessment Inc.
Olivier, MR, Killian, S, Chiliza, B, Asmal, L, Schoeman, R, Oosthuizen, PP et al. (2015) Cognitive performance during the first year of treatment in first-episode schizophrenia: a case-control study. Psychological Medicine 45, 28732883.
Perez, CM and Widom, CS (1994) Childhood victimization and long-term intellectual and academic outcomes. Child Abuse and Neglect 18, 617633.
Sapolsky, RM (1996) Why stress is bad for your brain. Science 273, 749750.
Schenkel, LS, Spaulding, WD, DiLillo, D and Silverstein, SM (2005) Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research 76, 273286.
Shannon, C, Douse, K, McCusker, C, Feeney, L, Barrett, S and Mulholland, C (2011) The association between childhood trauma and memory functioning in schizophrenia. Schizophrenia Bulletin 37, 531537.
Shipman, K, Edwards, A, Brown, A, Swisher, L and Jennings, E (2005) Managing emotion in a maltreating context: A pilot study examining child neglect. Child Abuse and Neglect 29, 10151029.
Sideli, L, Fisher, HL, Russo, M, Murray, RM, Stilo, SA, Wiffen, BD et al. (2014) Failure to find association between childhood abuse and cognition in first-episode psychosis patients. European Psychiatry 29, 3235.
van Dam, DS, van Nierop, M, Viechtbauer, W, Velthorst, E, van Winkel, R, Genetic Risk and Outcome of Psychosis (GROUP) Bruggeman, R et al. (2015) Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology. Psychological Medicine 45, 13631377.
van Os, J, Marsman, A, van Dam, D and Simons, CJ (2017) Evidence that the impact of childhood trauma on IQ is substantial in controls, moderate in siblings, and absent in patients with psychotic disorder. Schizophrenia Bulletin 43, 316324.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W et al. (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Kilian et al. supplementary material
Figure S2-S8

 Word (189 KB)
189 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed