Knowledge on risk and protective factors for the long-term outcome of children and adolescents diagnosed with psychosis before age 18 (Early-Onset Psychosis, EOP) is essential to improve the outcomes in this patient group. Being in employment is a particular important outcome for individuals living with psychosis and for reducing the societal cost of illness. Identification of predictive markers for long-term occupational functioning can guide clinical practice and tailor treatment interventions to target modifiable predictors as well as strengthen the interventions for the patients at highest risk of poor outcomes.

To describe the long-term sociodemographic, functional, and clinical outcomes of EOP and healthy control (HC) participants, and explore predictors of occupational functioning.

The study sample consists of 205 participants with EOP and 199 HCs aged between 10 and 17 at baseline. Clinical baseline data were linked to register-based outcome data from the Danish National Registers a mean of 11 years (range 4.5 to 23.5 years) after baseline assessment. At baseline, parental socioeconomic status, psychosis symptoms, neurocognitive functioning, social functioning, and drug use were assessed. At follow-up, register-data on employment status, marital status, income, educational level, supported housing, psychiatric hospitalizations, somatic hospitalizations and deaths were retrieved, and compared for EOP and HC participants. Predictors of competitive employment were explored using univariable and multivariable logistic regression.

At follow-up participants were between 18 and 41 years of age. Register-based outcomes showed markedly poorer sociodemographic, functional, and clinical outcomes for individuals with EOP compared to HCs. At follow-up 47% of EOP and 94% of HC participants were in competitive employment. Being in competitive employment at follow-up was in univariable analyses predicted by higher household income and better neurocognitive functioning (estimated IQ; verbal fluency; and attention and information processing speed) at baseline. These baseline measures did not remain significantly associated with competitive employment in multivariate analyses.

The finding that almost half of individuals with EOP was in employment at follow-up is encouraging compared to previous literature. The study nonetheless emphasizes the importance in continuous efforts to improve outcomes in early-onset psychosis, as outcomes across sociodemographic, functional, and clinical outcomes remains significantly poorer than controls. The study points to neurocognitive functioning as a potential modifiable treatment target to improve occupational functioning.

None Declared

Few studies have explored associations between adaptive functioning and cognition in adolescents with early-onset schizophrenia spectrum disorders (EOS).

Adaptive functioning, cognition, positive, negative, and general symptoms were characterized in adolescents with EOS and healthy controls. A modified scale of negative, respectively, general symptoms was used. Bivariate analyses identified correlates of adaptive functioning to be included in multivariate analysis.

Adolescents with EOS showed significant impairments of social- and neurocognitive functions (−0.86 < Cohen´s ds < −0.58) and adaptive functioning (Cohen´s d = −2.23). Visual memory, verbal working memory, processing speed, reaction time, social cognition, and modified negative and general symptoms correlated significantly with adaptive functioning. The multiple regression analysis revealed only verbal working memory as uniquely associated with adaptive functioning (explaining 22.7 % of its variance). Verbal working memory also associated significantly with adaptive functioning in the context of the nonsignificant modified negative and the significant modified general symptoms dimension.

Adolescents with first-episode EOS had large impairments in adaptive functioning and moderate to large cognitive deficits. Verbal working memory was an important associate to concurrent adaptive functioning and may be a treatment target for trials to improve cognitive and adaptive functioning in adolescents with EOS.

Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are developmental disorders with shared clinical characteristics such as cognitive impairments and impulsivity. Impulsivity is a core feature of ADHD and an important factor in aggression, violence, and substance use in schizophrenia. Based on the hypothesis that schizophrenia and ADHD represent a continuum of neurodevelopmental impairments, the aim was to identify overlapping and disease specific forms of impulsivity.

Adolescents between 12 and 17 years of age were assessed with the Schedule for Affective Disorders and Schizophrenia for School-aged Children – Present and Lifetime Version. Subjects with early-onset, first-episode schizophrenia spectrum disorders (EOS) (N = 29) or ADHD (N = 29) and healthy controls (N = 45) were compared on two performance measures (Information Sampling Task, Stop Signal Task) and a subjective personality trait measure of impulsivity (Barratt Impulsiveness Scale, Version 11 (BIS-11)).

Significantly increased reflection impulsivity was observed in ADHD but not in the EOS group. No significant response inhibition deficits (stop signal reaction time) were found in the two clinical groups. The ADHD and the EOS group showed significantly increased motor, attentional, and non-planning subtraits of impulsivity.

Impaired pre-decisional information gathering appeared to be specific for ADHD while the information gathering was not significantly reduced in subjects with EOS. Neither the ADHD nor EOS group showed impaired response inhibition but shared increased personality subtraits of attentional, non-planning, and motor impulsivity although the latter was significantly more pronounced in ADHD. These increased subtraits of impulsivity may reflect diagnostic non-specific neurodevelopmental impairments in ADHD and EOS in adolescence.

Deficient mismatch negativity (MMN) has been proposed as a candidate biomarker in schizophrenia and may therefore be potentially useful in early identification and intervention in early onset psychosis. In this study we explored whether deficits in the automatic orienting and reorienting responses, measured as MMN and P3a amplitude, are present in young adolescents with first-episode psychosis (FEP) and whether findings are specific to psychosis compared to young adolescents with attention deficit hyperactivity disorder (ADHD).

MMN and P3a amplitude were assessed in young adolescents (age 12–17 years) with either FEP (N = 27) or ADHD (N = 28) and age- and gender-matched healthy controls (N = 43). The MMN paradigm consisted of a four-tone auditory oddball task with deviant stimuli based on frequency, duration and their combination.

Significantly less MMN was found in patients with psychosis compared to healthy controls in response to frequency and duration deviants. MMN amplitudes in the group of patients with ADHD were not significantly different from patients with psychosis or healthy controls. No significant group differences were found on P3a amplitude.

Young adolescents with FEP showed impaired MMN compared to healthy controls while intermediate and overlapping levels of MMN were observed in adolescents with ADHD. The findings suggest that young FEP patients already exhibit pre-attentive deficits that are characteristic of schizophrenia albeit expressed on a continuum shared with other neuropsychiatric disorders.