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Psychotic-like experiences in a community sample of 8000 children aged 9 to 11 years: an item response theory analysis

  • K. R. Laurens (a1) (a2) (a3), M. J. Hobbs (a4), M. Sunderland (a4), M. J. Green (a1) (a2) and G. L. Mould (a3)...

Psychotic-like experiences (PLEs) in the general population are common, particularly in childhood, and may constitute part of a spectrum of normative development. Nevertheless, these experiences confer increased risk for later psychotic disorder, and are associated with poorer health and quality of life.


This study used factor analytic methods to determine the latent structure underlying PLEs, problem behaviours and personal competencies in the general child population, and used item response theory (IRT) to assess the psychometric properties of nine PLE items to determine which items best represented a latent psychotic-like construct (PSY). A total of 7966 children aged 9–11 years, constituting 95% of eligible children, completed self-report questionnaires.


Almost two-thirds of the children endorsed at least one PLE item. Structural analyses identified a unidimensional construct representing psychotic-like severity in the population, the full range of which was well sampled by the nine items. This construct was discriminable from (though correlated with) latent dimensions representing internalizing and externalizing problems. Items assessing visual and auditory hallucination-like experiences provided the most information about PSY; delusion-like experiences identified children at more severe levels of the construct.


Assessing PLEs during middle childhood is feasible and supplements information concerning internalizing and externalizing problems presented by children. The hallucination-like experiences constitute appropriate items to screen the population to identify children who may require further clinical assessment or monitoring. Longitudinal follow-up of the children is required to determine sensitivity and specificity of the PLE items for later psychotic illness.

Corresponding author
*Address for correspondence: Dr K. R. Laurens, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:
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Arango, C (2011). Attenuated psychotic symptoms syndrome: how it may affect child and adolescent psychiatry. European Child and Adolescent Psychiatry 20, 6770.
Armando, M, Nelson, B, Yung, AR, Ross, M, Birchwood, M, Girardi, P, Fiori Nastro, P (2010). Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophrenia Research 119, 258265.
Bak, M, Delespaul, P, Hanssen, M, de Graaf, R, Vollebergh, W, van Os, J (2003). How false are ‘false’ positive psychotic symptoms? Schizophrenia Research 62, 187189.
Barragan, M, Laurens, KR, Navarro, JB, Obiols, JE (2011). Psychotic-like experiences and depressive symptoms in a community sample of adolescents. European Psychiatry 26, 396401.
Bentler, PM (1990). Comparative fit indexes in structural models. Psychological Bulletin 107, 238246.
Bradshaw, J, Bloor, K, Huby, M, Rhodes, D, Sinclair, I, Gibbs, I (2009). Local Index of Child Well-Being: Summary Report. Department for Communities and Local Government: London, UK.
Costello, A, Edelbrock, C, Kalas, R, Kessler, M, Klaric, S (1982). Diagnostic Interview Schedule for Children: Child Version. National Institute of Mental Health: Rockville, MD.
Cullen, AE, Dickson, H, West, SA, Morris, RG, Mould, GL, Hodgins, S, Murray, RM, Laurens, KR (2010). Neurocognitive performance in children aged 9–12 years who present putative antecedents of schizophrenia. Schizophrenia Research 121, 1523.
David, AS (2010). Why we need more debate on whether psychotic symptoms lie on a continuum with normality. Psychological Medicine 40, 19351942.
De Loore, E, Gunther, N, Drukker, M, Feron, F, Sabbe, B, Deboutte, D, van Os, J, Myin-Germeys, I (2011). Persistence and outcome of auditory hallucinations in adolescence: a longitudinal general population study of 1800 individuals. Schizophrenia Research 127, 252256.
Dhossche, D, Ferdinand, R, Van der Ende, J, Hofstra, MB, Verhulst, F (2002). Diagnostic outcome of self-reported hallucinations in a community sample of adolescents. Psychological Medicine 32, 619627.
Embretson, S, Reise, S (2000). Item Response Theory for Psychologists. Lawrence Erlbaum Associates, Inc.: Mahwah, NJ.
Goodman, A, Lamping, DL, Ploubidis, GB (2010). When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. Journal of Abnormal Child Psychology 38, 11791191.
Goodman, R (1997). The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry 38, 581586.
Goodman, R (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry 40, 13371345.
Hu, L, Bentler, PM (1998). Fit indices in covariance structure modeling: sensitivity to underparamterized model misspecification. Psychological Methods 3, 424453.
Jennrich, RI, Sampson, PF (1966). Rotation for simple loadings. Psychometrika 31, 313323.
Kaymaz, N, van Os, J (2010). Extended psychosis phenotype – yes: single continuum – unlikely. Psychological Medicine 40, 19631966.
Kelleher, I, Cannon, M (2011). Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychological Medicine 41, 16.
Kelleher, I, Harley, M, Murtagh, A, Cannon, M (2011). Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophrenia Bulletin 37, 352361.
Keshavan, MS, Delisi, LE, Seidman, LJ (2011). Early and broadly defined psychosis risk mental states. Schizophrenia Research 126, 110.
Kessler, RC, Ormel, J, Petukhova, M, McLaughlin, KA, Green, JG, Russo, LJ, Stein, DJ, Zaslavsky, AM, Aguilar-Gaxiola, S, Alonso, J, Andrade, L, Benjet, C, de Girolamo, G, de Graaf, R, Demyttenaere, K, Fayyad, J, Haro, JM, Hu, C, Karam, A, Lee, S, Lepine, JP, Matchsinger, H, Mihaescu-Pintia, C, Posada-Villa, J, Sagar, R, Ustun, TB (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 68, 90–100.
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Murray, RM, Jones, PB (2007). Neighbourhood variation in the incidence of psychotic disorders in Southeast London. Social Psychiatry and Psychiatric Epidemiology 42, 438445.
Krabbendam, L, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Nolen, WA, Iedema, J, Van Os, J (2004). Dimensions of depression, mania and psychosis in the general population. Psychological Medicine 34, 11771186.
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921926.
Lahey, BB, Van Hulle, CA, Singh, AL, Waldman, ID, Rathouz, PJ (2011). Higher-order genetic and environmental structure of prevalent forms of child and adolescent psychopathology. Archives of General Psychiatry 68, 181189.
Laurens, KR, Hodgins, S, Maughan, B, Murray, RM, Rutter, ML, Taylor, EA (2007). Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years. Schizophrenia Research 90, 130146.
Laurens, KR, Hodgins, S, Mould, GL, West, SA, Schoenberg, PL, Murray, RM, Taylor, EA (2010). Error-related processing dysfunction in children aged 9 to 12 years presenting putative antecedents of schizophrenia. Biological Psychiatry 67, 238245.
Laurens, KR, Hodgins, S, Taylor, EA, Murray, RM (2011). Is earlier intervention for schizophrenia possible? Identifying antecedents of schizophrenia in children aged 9–12 years. In Schizophrenia: The Final Frontier – A Festscrift for Robin M. Murrary (ed. David, A. S., McGuffin, P. and Kapur, S.), pp. 1932. Psychology Press: London.
Laurens, KR, West, SA, Murray, RM, Hodgins, S (2008). Psychotic-like experiences and other antecedents of schizophrenia in children aged 9–12 years: a comparison of ethnic and migrant groups in the United Kingdom. Psychological Medicine 38, 11031111.
Lawrie, SM, Hall, J, McIntosh, AM, Owens, DG, Johnstone, EC (2010). The ‘continuum of psychosis’: scientifically unproven and clinically impractical. British Journal of Psychiatry 197, 423425.
Linscott, RJ, van Os, J (2010). Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology 6, 391419.
Mackie, CJ, Castellanos-Ryan, N, Conrod, PJ (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
MacManus, D, Laurens, KR, Walker, EF, Brasfield, JL, Riaz, M, Hodgins, S (2011). Movement abnormalities and psychotic-like experiences in childhood: markers of developing schizophrenia? Psychological Medicine. Published online 11 July 2011. doi:10.1017/S0033291711001085.
Markon, KE (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine 40, 273288.
Morgan, C, Fisher, H, Hutchinson, G, Kirkbride, J, Craig, TK, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2009). Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatrica Scandinavica 119, 226235.
Muris, P, Meesters, C, Eijkelenboom, A, Vincken, M (2004). The self-report version of the Strengths and Difficulties Questionnaire: its psychometric properties in 8- to 13-year-old non-clinical children. British Journal of Clinical Psychology 43, 437448.
Muthén, L, Muthén, B (1998–2010). Mplus User's Guide. Muthén & Muthén: Los Angeles, CA.
Noble, M, McLennan, D, Wilkinson, K, Whitworth, A, Barnes, H, Dibben, C (2008). The English Indices of Deprivation 2007. Department for Communities and Local Government: London, UK.
Nuevo, R, Chatterji, S, Verdes, E, Naidoo, N, Arango, C, Ayuso-Mateos, JL (2010). The continuum of psychotic symptoms in the general population: a cross-national study. Schizophrenia Bulletin. Published online 13 September 2010. doi:10.1093/schbul/sbq099.
Perala, J, Suvisaari, J, Saarni, SI, Kuoppasalmi, K, Isometsa, E, Pirkola, S, Partonen, T, Tuulio-Henriksson, A, Hintikka, J, Kieseppa, T, Harkanen, T, Koskinen, S, Lonnqvist, J (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry 64, 1928.
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Samejima, F (1969). Estimation of Latent Ability Using a Response Patter of Graded Scores. Psychometric Monograph No. 17. Psychometric Society: Richmond, VA.
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347358.
Steiger, JH (1990). Structural model evaluation and modification: an internal estimation approach. Multivariate Behavioral Research 25, 173180.
Stone, LL, Otten, R, Engels, RC, Vermulst, AA, Janssens, JM (2010). Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4- to 12-year-olds: a review. Clinical Child and Family Psychology Review 13, 254274.
Streiner, DL (2010). Measure for measure: new developments in measurement and item response theory. Canadian Journal of Psychiatry 55, 180186.
Thissen, D, Chen, W-H, Bock, RD (2003). Multilog (Version 7). Scientific Software International: Lincolnwood, IL.
Tucker, LR, Lewis, C (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38, 110.
van Os, J, Hanssen, M, Bijl, RV, Ravelli, A (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 1120.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
Welham, J, Scott, J, Williams, G, Najman, J, Bor, W, O'Callaghan, M, McGrath, J (2009). Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychological Medicine 39, 625634.
Wigman, JT, Lin, A, Vollebergh, WA, van Os, J, Raaijmakers, QA, Nelson, B, Baksheev, G, Yung, AR (2011). Subclinical psychosis and depression: co-occurring phenomena that do not predict each other over time. Schizophrenia Research 130, 277281.
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