Skip to main content
    • Aa
    • Aa

Meta-analyses of cognitive and motor function in youth aged 16 years and younger who subsequently develop schizophrenia

  • H. Dickson (a1), K. R. Laurens (a1) (a2) (a3), A. E. Cullen (a1) and S. Hodgins (a1) (a4) (a5)

Previous reviews have reported cognitive and motor deficits in childhood and adolescence among individuals who later develop schizophrenia. However, these reviews focused exclusively on studies of individuals with affected relatives or on population/birth cohorts, incorporated studies with estimated measures of pre-morbid intelligence, or included investigations that examined symptomatic at-risk participants or participants 18 years or older. Thus, it remains unclear whether cognitive and motor deficits constitute robust antecedents of schizophrenia. Meta-analyses were conducted on published studies that examined cognitive or motor function in youth aged 16 years or younger who later developed schizophrenia or a schizophrenia spectrum disorder (SSD) and those who did not.


Twenty-three studies fulfilled the following inclusion criteria: (1) written in English; (2) prospective investigations of birth or genetic high-risk cohorts, or follow-back investigations of population samples; (3) objective measures of cognitive or motor performance at age 16 or younger; (4) results provided for individuals who did and who did not develop schizophrenia/SSD later in life; and (5) sufficient data to calculate effect sizes. Four domains of function were examined: IQ; Motor Function; General Academic Achievement; and Mathematics Achievement.


Meta-analyses showed that, by age 16, individuals who subsequently developed schizophrenia/SSD displayed significant deficits in IQ (d=0.51) and motor function (d=0.56), but not in general academic achievement (d=0.25) or mathematics achievement (d=0.21). Subsidiary analysis indicated that the IQ deficit was present by age 13.


These results demonstrate that deficits in IQ and motor performance precede the prodrome and the onset of illness.

Corresponding author
*Address for correspondence: H. Dickson, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

GW Albee , EA Lane , JM Reuter (1964). Childhood intelligence of future schizophrenics and neighourhood peers. Journal of Psychology 58, 141144.

A Aleman , R Kahn , J Selten (2003). Sex differences in the risk of schizophrenia: evidence from meta-analysis. Archives of General Psychiatry 60, 565571.

A Ambelas (1992). Preschizophrenics: adding to the evidence, sharpening the focus. British Journal of Psychiatry 160, 401404.

GP Amminger , M Schlögelhofer , T Lehner , SL Ott , MH Friedrich , HN Aschauer (2000). Premorbid performance IQ deficits in schizophrenia. Acta Psychiatrica Scandinavica 102, 414422.

Y-G Ang , H-Y Tan (2004). Academic deterioration prior to first episode schizophrenia in young Singaporean males. Psychiatry Research 121, 303307.

E Aylward , E Walker , B Bettes (1984). Intelligence in schizophrenia: meta-analysis of the research. Schizophrenia Bulletin 10, 430459.

CB Begg , M Mazumdar (1994). Operating charactertistics of a rank correlation test for publication bias. Biometrics 50, 10881101.

RM Bilder , G Reiter , J Bates , T Lencz , P Szeszko , RS Goldman , D Robinson , JA Lieberman , JM Kane (2006). Cognitive development in schizophrenia: follow-back from the first episode. Journal of Clinical and Experimental Neuropsychology 28, 270282.

EM Bower , TA Shellhamer , JM Daily (1960). School characteristics of male adolescents who later became schizophrenic. American Journal of Orthopsychiatry 30, 712729.

WJ Brewer , SM Francey , SJ Wood , HJ Jackson , C Pantelis , LJ Phillips , AR Yung , VA Anderson , PD McGorry (2005). Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. American Journal of Psychiatry 162, 7178.

AS Brown , P Cohen , J Harkavy-Friedman , V Babulas , D Malaspina , JM Gorman , ES Susser (2001). Prenatal rubella, premorbid abnormalities, and adult schizophrenia. Biological Psychiatry 49, 473486.

M Cannon , A Caspi , TE Moffitt , H Harrington , A Taylor , RM Murray , R Poulton (2002). 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 , P Jones , MO Huttunen , A Tanskanen , T Huttunen , S Rabe-Hesketh , RM Murray (1999). School performance in Finnish children and later development of schizophrenia: a population-based longitudinal study. Archives of General Psychiatry 56, 457463.

M Cannon , T Moffitt , A Caspi , R Murray , H Harrington , R Poulton (2006). Neuropsychological performance at the age of 13 years and adult schizophreniform disorder: prospective birth cohort study. British Journal of Psychiatry 189, 463464.

TD Cannon , CE Bearden , JM Hollister , IM Rosso , LE Sanchez , T Hadley (2000). Childhood cognitive functioning in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophrenia Bulletin 26, 379393.

A Caspi , A Reichenberg , M Weiser , J Rabinowitz , Z Kaplan , H Knobler , N Davidson-Sagi , M Davidson (2003). Cognitive performance in schizophrenia patients assessed before and following the first psychotic episode. Schizophrenia Research 65, 8794.

S Chinn (2000). A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in Medicine 19, 31273131.

J Cohen (1988). Statistical Power Analysis for the Behavioral Sciences. Erlbaum: Hillsdale, NJ.

J Cohen (1992). A power primer. Psychological Bulletin 112, 155159.

TJ Crow , DJ Done , A Sacker (1995). Childhood precusors of psychosis as clues to evolutionary origins. European Archives of Psychiatry and Clinical Neuroscience 245, 6169.

R Dersimonian , N Laird (1986). Meta-analysis in clinical trials. Controlled Clinical Trials 7, 177188.

M Egger , G Davey Smith , M Schneider , C Minder (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.

L Erlenmeyer-Kimling , D Rock , SA Roberts , M Janal , C Kestenbaum , B Cornblatt , UH Adamo , II Gottesman (2000). Attention, memory, and motor skills as childhood predictors of schizophrenia-related psychoses: the New York High-Risk Project. American Journal of Psychiatry 157, 14161422.

R Fuller , P Nopoulos , S Arndt , D O'Leary , B-C Ho , NC Andreasen (2002). Longitudinal assessment of premorbid cognitive functioning in patients with schizophrenia through examination of standardized scholastic test performance. American Journal of Psychiatry 159, 11831189.

D Gunnell , G Harrison , F Rasmussen , D Fouskakis , PER Tynelius (2002). Associations between premorbid intellectual performance, early-life exposures and early-onset schizophrenia: cohort study. British Journal of Psychiatry 181, 298305.

I Helling , A Öhman , CM Hultman (2003). School achievements and schizophrenia: a case control study. Acta Psychiatrica Scandinavica 108, 381386.

I Isohanni , M-R Auml Rvelin , P Nieminen , P Jones , P Rantakallio , J Jokelainen , M Isohanni (1998). School performance as a predictor of psychiatric hospitalization in adult life. A 28-year follow-up in the Northern Finland 1966 birth cohort. Psychological Medicine 28, 967974.

I Isohanni , M Jarvelin , P Jones , J Jokelainen , M Isohanni (1999). Can excellent school performance be a precusor of schizophrenia? A 28-year follow-up in the Northern Finland 1966 birth cohort. Acta Psychiatrica Scandinavica 100, 1726.

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.

KC Koenen , TE Moffitt , AL Roberts , LT Martin , L Kubzansky , H Harrington , R Poulton , A Caspi (2009). Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. American Journal of Psychiatry 166, 5057.

WS Kremen , MJ Lyons , C Boake , H Xian , KC Jacobson , B Waterman , SA Eisen , J Goldberg , SV Faraone , MT Tsuang (2006). A discordant twin study of premorbid cognitive ability in schizophrenia. Journal of Clinical and Experimental Neuropsychology 28, 208224.

EA Lane , GW Albee (1963). Childhood intellectual development of adult schizophrenics. Journal of Abnormal and Social Psychology 67, 186189.

EA Lane , GW Albee (1968). On childhood intellectual decline of adult schizophrenics: a reassessment of an earlier study. Journal of Abnormal Psychology 73, 174177.

T Lencz , CW Smith , D McLaughlin , A Auther , E Nakayama , L Hovey , BA Cornblatt (2006). Generalized and specific neurocognitive deficits in prodromal schizophrenia. Biological Psychiatry 59, 863871.

A Lubin , CF Gieseking , HL Williams (1962). Direct measurement of cognitive deficit in schizophrenia. Journal of Consulting Psychology 26, 139143.

JH MacCabe (2008). Population-based cohort studies on premorbid cognitive function in schizophrenia. Epidemiologic Reviews 30, 7783.

J McGrath , S Saha , J Welham , O El Saadi , C MacCauley , D Chant (2004). A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2, 13.

EL Mortensen , HJ Sørensen , HH Jensen , JM Reinisch , SA Mednick (2005). IQ and mental disorder in young men. British Journal of Psychiatry 187, 407415.

RM Murray , SW Lewis (1987). Is schizophrenia a neurodevelopmental disorder? British Medical Journal 295, 681682.

LT Niemi , JM Suvisaari , A Tuulio-Henriksson , JK Lönnqvist (2003). Childhood developmental abnormalities in schizophrenia: evidence from high-risk studies. Schizophrenia Research 60, 239258.

TA Niendam , CE Bearden , IM Rosso , LE Sanchez , T Hadley , KH Nuechterlein , TD Cannon (2003). A prospective study of childhood neurocognitive functioning in schizophrenic patients and their siblings. American Journal of Psychiatry 160, 20602062.

DR Offord (1974). School performance of adult schizophrenics, their siblings and age mates. British Journal of Psychiatry 125, 1219.

M Osler , DA Lawlor , M Nordentoft (2007). Cognitive function in childhood and early adulthood and hospital admission for schizophrenia and bipolar disorders in Danish men born in 1953. Schizophrenia Research 92, 132141.

SL Ott , S Spinelli , D Rock , S Roberts , GP Amminger , L Erlenmeyer-Kimling (1998). The New York High-Risk Project: social and general intelligence in children at risk for schizophrenia. Schizophrenia Research 31, 111.

J Rabinowitz , A Reichenberg , M Weiser , M Mordechai , Z Kaplan , M Davidson (2000). Cognitive and behavioural functioning in men with schizophrenia both before and shortly after first admission to hospital: cross-sectional analysis. British Journal of Psychiatry 177, 2632.

A Reichenberg , M Weiser , J Rabinowitz , A Caspi , J Schmeidler , M Mark , Z Kaplan , M Davidson (2002). A population-based cohort study of premorbid intellectual, language, and behavioral functioning in patients with schizophrenia, schizoaffective disorder, and nonpsychotic bipolar disorder. American Journal of Psychiatry 159, 20272035.

A Reichenberg , M Weiser , MA Rapp , J Rabinowitz , A Caspi , J Schmeidler , HY Knobler , G Lubin , D Nahon , PD Harvey , M Davidson (2005). Elaboration on premorbid intellectual performance in schizophrenia: premorbid intellectual decline and risk for schizophrenia. Archives of General Psychiatry 62, 12971304.

IM Rosso , CE Bearden , JM Hollister , TL Gasperoni , LE Sanchez , T Hadley , TD Cannon (2000). Childhood neuromotor dysfunction in schizophrenia patients and their unaffected siblings: a prospective cohort study. Schizophrenia Bulletin 26, 367378.

S Ruhrmann , F Schultze-Lutter , J Klosterkötter (2010). Probably at-risk, but certainly ill – advocating the introduction of a psychosis spectrum disorder in DSM-V. Schizophrenia Research 120, 2337.

LS Schenkel , SM Silverstein (2004). Dimensions of premorbid functioning in schizophrenia: a review of neuromotor, cognitive, social, and behavioural domains. Genetic, Social, and General Psychology Monographs 130, 241270.

J Schiffman , E Walker , M Ekstrom , F Schulsinger , H Sørensen , S Mednick (2004). Childhood videotaped social and neuromotor precursors of schizophrenia: a prospective investigation. American Journal of Psychiatry 161, 20212027.

LJ Seidman , SL Buka , JM Goldstein , MT Tsuang (2006). Intellectual decline in schizophrenia: evidence from a prospective birth cohort 28 year follow-up study. Journal of Clinical and Experimental Neuropsychology 28, 225242.

HJ Sørensen , EL Mortensen , J Parnas , SA Mednick (2006). Premorbid neurocognitive functioning in schizophrenia spectrum disorder. Schizophrenia Bulletin 32, 578583.

HJ Sørensen , EL Mortensen , J Schiffman , M Ekstrøm , D Denenney , SA Mednick (2010). Premorbid IQ and adult schizophrenia spectrum disorder: Verbal Performance subtests. Psychiatry Research 178, 2326.

AJ Sutton , SJ Duval , RL Tweedie , KR Abrams , DR Jones (2000). Empirical assessment of effect of publication bias on meta-analyses. British Medical Journal 320, 15741577.

SG Thompson , JPT Higgins (2002). How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine 21, 15591573.

J Tiihonen , J Haukka , M Henriksson , M Cannon , T Kieseppa , I Laaksonen , J Sinivuo , J Lonnqvist (2005). Premorbid intellectual functioning in bipolar disorder and schizophrenia: results from a cohort study of male conscripts. American Journal of Psychiatry 162, 19041910.

J Van Os , P Jones , G Lewis , M Wadsworth , R Murray (1997). Developmental precursors of affective illness in a general population birth cohort. Archives of General Psychiatry 54, 625631.

EF Walker , T Savoie , D Davis (1994). Neuromotor precursors of schizophrenia. Schizophrenia Bulletin 20, 441451.

NP Walker , PM McConville , D Hunter , IJ Deary , LJ Whalley (2002). Childhood mental ability and lifetime psychiatric contact: a 66-year follow-up study of 1932 Scottish Mental Ability Survey. Intelligence 30, 233245.

NF Watt , AW Lubensky (1976). Childhood roots of schizophrenia. Journal of Consulting and Clinical Psychology 44, 363375.

DR Weinberger (1987). Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry 44, 660669.

J Welham , M Isohanni , P Jones , J McGrath (2009 a). The antecedents of schizophrenia: a review of birth cohort studies. Schizophrenia Bulletin 35, 603623.

J Welham , J Scott , GM Williams , JM Najman , W Bor , M O'Callaghan , J McGrath (2009 b). The antecedents of non-affective psychosis in a birth-cohort, with a focus on measures related to cognitive ability, attentional dysfunction and speech problems. Acta Psychiatrica Scandinavica 121, 273279.

M-C Whyte , C Brett , LK Harrison , M Byrne , P Miller , SM Lawrie , EC Johnstone (2006). Neuropsychological performance over time in people at high risk of developing schizophrenia and controls. Biological Psychiatry 59, 730739.

KA Woodberry , AJ Giuliano , LJ Seidman (2008). Premorbid IQ in schizophrenia: a meta-analytic review. American Journal of Psychiatry 165, 579587.

S Zammit , P Allebeck , AS David , C Dalman , T Hemmingsson , I Lundberg , G Lewis (2004). A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Archives of General Psychiatry 61, 354360.

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? *



Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 114 *
Loading metrics...

Abstract views

Total abstract views: 308 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th May 2017. This data will be updated every 24 hours.