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Hearing and speech impairment at age 4 and risk of later non-affective psychosis

  • A. Fors (a1), K. M. Abel (a2), S. Wicks (a1) (a3), C. Magnusson (a1) (a3) and C. Dalman (a1) (a3)...

Schizophrenia often becomes manifest in late adolescence and young adulthood but deviations in physical and behavioural development may already be present in childhood. We investigated the relationship between hearing impairment (measured with audiometry) and speech impairment (broadly defined) at age 4 years and adult risk of non-affective psychosis.


We performed a population-based, case–control study in Sweden with 105 cases of schizophrenia or other non-affective psychoses and 213 controls matched for sex, date and place of birth. Information on hearing and speech impairment at age 4, along with potential confounding factors, was retrieved from Well Baby Clinic (WBC) records.


Hearing impairment [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.6–23.2] and speech impairment (OR 2.6, 95% CI 1.4–4.9) at age 4 were associated with an increased risk of non-affective psychotic illness. These associations were mutually independent and not explained by parental psychiatric history, occupational class or obstetric complications.


These results support the hypothesis that psychosis has a developmental aspect with presentation of antecedent markers early in childhood, long before the disease becomes manifest. Our findings add to the growing evidence that early hearing impairment and speech impairment are risk indicators for later non-affective psychosis and possibly represent aetiological clues and potentially modifiable risk factors. Notably, speech impairment and language impairment are both detectable with inexpensive, easily accessible screening.

Corresponding author
*Address for correspondence: Dr A. Fors, Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet Norrbacka, 7th floor, SE-171 76 Stockholm, Sweden. (Email:
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KM Abel , S Wicks , ES Susser , C Dalman , MG Pedersen , PB Mortensen , RT Webb (2010). Birth weight, schizophrenia, and adult mental disorder: is risk confined to the smallest babies? Archives of General Psychiatry 67, 923930.

KM Abel (2004). Foetal origins of schizophrenia: testable hypotheses of genetic and environmental influences. British Journal of Psychiatry 184, 383385.

I Arias , A Sorlozano , E Villegas , JD Luna , K McKenney , J Cervilla , B Gutierrez , J Gutierrez (2012). Infectious agents associated with schizophrenia: a meta-analysis. Schizophrenia Research 136, 128136.

I Augustsson , I Engstrand (2006). Hearing loss as a sequel of secretory and acute otitis media as reflected by audiometric screening of Swedish conscripts. International Journal of Pediatric Otorhinolaryngology 70, 703710.

O Axelsson (2003). The Swedish medical birth register. Acta Obstetricia et Gynecologica Scandinavica 82, 491492.

KD Baker , DH Skuse (2005). Adolescents and young adults with 22q11 deletion syndrome: psychopathology in an at-risk group. British Journal of Psychiatry 186, 115120.

CE Bearden , IM Rosso , JM Hollister , LE Sanchez , T Hadley , TD Cannon (2000). A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia. Schizophrenia Bulletin 26, 395410.

BE Bennedsen , PB Mortensen , AV Olesen , TB Henriksen (2001). Congenital malformations, stillbirths, and infant deaths among children of women with schizophrenia. Archives of General Psychiatry 58, 674679.

I Bergman , RP Hirsch , TJ Fria , SM Shapiro , I Holzman , MJ Painter (1985). Cause of hearing loss in the high-risk premature infant. Journal of Pediatrics 106, 95101.

JM Best (2007). Rubella. Seminars in Fetal and Neonatal Medicine 12, 182192.

MM Blanchard , S Jacobson , MC Clarke , D Connor , I Kelleher , H Garavan , M Harley , M Cannon (2010). Language, motor and speed of processing deficits in adolescents with subclinical psychotic symptoms. Schizophrenia Research 123, 7176.

EB Bromfield , BA Dworetzky , DF Wyszynski , CR Smith , EJ Baldwin , LB Holmes (2008). Valproate teratogenicity and epilepsy syndrome. Epilepsia 49, 21222124.

V Burden , CM Stott , J Forge , I Goodyer (1996). The Cambridge Language and Speech Project (CLASP). I. Detection of language difficulties at 36 to 39 months. Developmental Medicine and Child Neurology 38, 613631.

M Cannon , A Caspi , TE Moffitt , H Harrington , A Taylor , RM Murray , R Poulton (2002 a). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449456.

M Cannon , PB Jones , RM Murray (2002 b). Obstetric complications and schizophrenia: historical and meta-analytic review. American Journal of Psychiatry 159, 10801092.

SK Chadha , AK Agarwal , A Gulati , A Garg (2006). A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status. Journal of Laryngology and Otology 120, 1619.

J Clegg , C Hollis , L Mawhood , M Rutter (2005). Developmental language disorders – a follow-up in later adult life. Cognitive, language and psychosocial outcomes. Journal of Child Psychology and Psychiatry 46, 128149.

C Dalman , J Broms , J Cullberg , P Allebeck (2002). Young cases of schizophrenia identified in a national inpatient register – are the diagnoses valid? Social Psychiatry and Psychiatric Epidemiology 37, 527531.

N Darin , P Hanner , K Thiringer (1997). Changes in prevalence, aetiology, age at detection, and associated disabilities in preschool children with hearing impairment born in Goteborg. Developmental Medicine and Child Neurology 39, 797802.

A David , A Malmberg , G Lewis , L Brandt , P Allebeck (1995). Are there neurological and sensory risk factors for schizophrenia? Schizophrenia Bulletin 14, 247251.

J Davidson , ML Hyde , PW Alberti (1989). Epidemiologic patterns in childhood hearing loss: a review. International Journal of Pediatriic Otorhinolaryngology 17, 239266.

B Ekholm , A Ekholm , R Adolfsson , M Vares , U Osby , GC Sedvall , EG Jonsson (2005). Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nordic Journal of Psychiatry 59, 457464.

H Fortnum , A Summerfield , D Marshall , A Davis , J Bamford (2001). Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study. British Medical Journal 323, 536540.

C Gibson , D Penn , M Prinstein , D Perkins , A Belger (2010). Social skill and social cognition in adolescents at genetic risk for psychosis. Schizophrenia Bulletin 122, 179184.

TD Griffiths , T Sigmundsson , N Takei , D Rowe , RM Murray (1998). Neurological abnormalities in familial and sporadic schizophrenia. Brain 121, 191203.

J Hassan , J Connell (2007). Translational mini-review series on infectious disease: congenital cytomegalovirus infection: 50 years on. Clinical and Experimental Immunology 149, 205210.

M Isohanni , PB Jones , K Moilanen , P Rantakallio , J Veijola , H Oja , M Koiranen , J Jokelainen , T Croudace , M Jarvelin (2001). Early developmental milestones in adult schizophrenia and other psychoses. A 31-year follow-up of the Northern Finland 1966 Birth Cohort. Schizophrenia Bulletin 52, 119.

P Jones , B Rodgers , R Murray , M Marmot (1994). Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344, 13981402.

L Jorgensen , A Ahlbom , P Allebeck , C Dalman (2010). The Stockholm Non-Affective Psychoses Study (SNAPS): the importance of including out-patient data in incidence studies. Acta Psychiatrica Scandinavica 121, 389392.

AM Korver , S Konings , FW Dekker , M Beers , CC Wever , JH Frijns , AM Oudesluys-Murphy ; DECIBEL Collaborative Study Group (2010). Newborn hearing screening vs later hearing screening and developmental outcomes in children with permanent childhood hearing impairment. Journal of the American Medical Association 304, 17011708.

P Mason , M Rimmer , A Richman , G Garg , J Johnson , PG Mottram (2008). Middle-ear disease and schizophrenia: case-control study. British Journal of Psychiatry 193, 192196.

PR Mason , FE Winton (1995). Ear disease and schizophrenia: a case-control study. Acta Psychiatrica Scandinavica 91, 217221.

R McLeod , K Boyer , T Karrison , K Kasza , C Swisher , N Roizen , J Jalbrzikowski , J Remington , P Heydemann , AG Noble , M Mets , E Holfels , S Withers , P Latkany , P Meier (2006). Outcome of treatment for congenital toxoplasmosis, 1981-2004: the National Collaborative Chicago-Based, Congenital Toxoplasmosis Study. Clinical Infectious Diseases 42, 13831394.

P Mortensen , B Nørgaard-Pedersen , B Waltoft , T Sørensen , D Hougaard , E Torrey , RH Yolken (2007). Toxoplasma gondii as a risk factor for early-onset schizophrenia: analysis of filter paper blood samples obtained at birth. Biological Psychiatry 61, 688693.

SE Mouridsen , KM Hauschild (2008). A longitudinal study of schizophrenia- and affective spectrum disorders in individuals diagnosed with a developmental language disorder as children. Journal of Neural Transmission 115, 15911597.

M Reis , B Kallen (2008). Maternal use of antipsychotics in early pregnancy and delivery outcome. Journal of Clinical Psychopharmacology 28, 279288.

NJ Roizen (2003). Nongenetic causes of hearing loss. Mental Retardation and Developmental Disabilities Research Reviews 9, 120127.

EB Samren , CM van Duijn , S Koch , VK Hiilesmaa , H Klepel , AH Bardy , GB Mannagetta , AW Deichl , E Gaily , ML Granstrom , H Meinardi , DE Grobbee , A Hofman , D Janz , D Lindhout (1997). Maternal use of antiepileptic drugs and the risk of major congenital malformations: a joint European prospective study of human teratogenesis associated with maternal epilepsy. Epilepsia 38, 981990.

A Schreier , D Wolke , K Thomas , J Horwood , C Hollis , D Gunnell , G Lewis , A Thompson , S Zammit , L Duffy , G Salvi , G Harrison (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.

SS Shergill , MJ Brammer , SCR Williams , RM Murray , PK McGuire (2000 a). Mapping auditory hallucinations in schizophrenia using functional magnetic resonance imaging. Archives of General Psychiatry 57, 10331038.

SS Shergill , E Bullmore , A Simmons , R Murray , P McGuire (2000 b). Functional anatomy of auditory verbal imagery in schizophrenic patients with auditory hallucinations. American Journal of Psychiatry 157, 16911693.

N Stefanis , V Thewissen , C Bakoula , J van Os , I Myin-Germeys (2006). Hearing impairment and psychosis: a replication in a cohort of young adults. Schizophrenia Research 85, 266272.

H Sweeting , P West (2001). Being different: correlates of the experience of teasing and bullying at age 11. Research Papers in Education 16, 225246.

M van der Werf , M van Boxtel , F Verhey , J Jolles , V Thewissen , J van Os (2007). Mild hearing impairment and psychotic experiences in a normal aging population. Schizophrenia Research 94, 180186.

J van Os , G Kenis , BPF Rutten (2010). The environment and schizophrenia. Nature 468, 203212.

E Vartiainen , P Kemppinen , S Karjalainen (1997). Prevalence and etiology of bilateral sensorineural hearing impairment in a Finnish childhood population. International Journal of Pediatric Otorhinolaryngology 41, 175185.

RT Webb , AR Pickles , SA King-Hele , L Appleby , PB Mortensen , KM Abel (2008). Parental mental illness and fatal birth defects in a national birth cohort. Psychological Medicine 38, 14951503.

N Werbeloff , M Drukker , BP Dohrenwend , I Levav , R Yoffe , J van Os , M Davidson , M Weiser (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 69, 467475.

S Wicks , A Hjern , D Gunnell , G Lewis , C Dalman (2005). Social adversity in childhood and the risk of developing psychosis: a national cohort study. American Journal of Psychiatry 162, 16521657.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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