Neurocognitive profiles in early childhood in relation to clinical and functional outcomes in middle childhood in offspring at familial high‐risk of schizophrenia or bipolar disorder: The Danish High‐Risk and Resilience Study

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Background Widespread neurocognitive impairments exist in children at familial high‐risk of schizophrenia (FHR‐SZ), whereas evidence is mixed in children at FHR of bipolar disorder (FHR‐BP). Neurocognitive heterogeneity is well‐established, but associations with longitudinal clinical and functional outcomes remain unexplored. Methods In this prospective cohort study, 274 children (FHR‐SZ, n = 170, FHR‐BP, n = 104, 46.7% female, mean age 12.0 years, SD 0.25) provided neurocognitive data at baseline and clinical data at 4‐year follow‐up. The assessed neurocognitive functions included intelligence, processing speed, attention, memory, and executive functions. Axis I mental disorders, psychotic experiences, and functioning were ascertained through child and caregiver interviews. Dimensional psychopathology was reported by the caregiver. Three baseline neurocognitive subgroups (mildly impaired, typical, and above‐average) derived from hierarchical cluster analysis across FHR‐groups constituted categorical predictors with clinical and functional measures at follow‐up as outcomes. Results Compared with children in the typical subgroup and after accounting for sex, outcome of interest and Any Axis I disorder at baseline, and FHR‐group, children in the mildly impaired subgroup at baseline had a threefold increased risk of any externalizing mental disorder (OR 2.9, 95% CI 1.3–6.5, p = .007) and a twofold increased risk of psychotic experiences (OR 2.0, 95% CI 1.0–3.8, p = .04) during middle childhood. Additionally, they had significantly higher dimensional symptom severity (Cohen's d range 0.27–0.43, p < .05) and poorer global functioning (Cohen's d = 0.48, p < .001) at follow‐up. Neurocognitive subgroup membership was non‐differentially associated with clinical and functional outcomes across FHR‐groups. Conclusions A significantly impaired neurocognitive profile in early childhood confers risk for detrimental clinical and functional outcomes in middle childhood beyond that which can be attributed to pre‐existing clinical and functional states and constitutes a cross‐diagnostic, neurodevelopmental risk marker in these FHR‐groups. Early neurocognitive profiling is warranted, and future studies should investigate long‐term associations with mental disorders.