Abstract
The London Child Health and Development Study (CHADS) is a prospective, longitudinal investigation of children, sampled from the general community aged 9–11 years and assessed biennially, who present premorbid risk markers for schizophrenia. The study aims to characterise developmental trajectories of psychological, cognitive, and biological functioning in at-risk children and identify potential targets for early preventative intervention. This review summarises CHADS findings, discusses these in the context of recent theory regarding aetiology and prevention of schizophrenia, and highlights challenges to be addressed with future research. We review (1) epidemiological information on the prevalence and correlates of developmental antecedents of schizophrenia in the general child population, (2) evidence of psychosocial, cognitive, and biological dysfunctions in at-risk children presenting multiple antecedents of schizophrenia and at-risk children with a family history of schizophrenia, and (3) related findings from an associated sample of help-seeking children receiving intervention. Community-based screening of 9–11-year olds identified ~9 % with a triad of antecedents of schizophrenia [including psychotic-like experiences (PLEs)] who are putatively at-risk of psychosis; these children reported greater exposure and responsivity to stressors, impairments in general intelligence and specific cognitive functions, brain structure and function abnormalities, and neuromotor dysfunction. Preliminary evidence suggests distressing PLEs are a viable target for cognitive-behavioural intervention in at-risk children. Intervention in early, premorbid phases of illness might alleviate current difficulties and avert future schizophrenia using benign treatments. The CHADS programme has identified several markers that may index early pathophysiology and constitute potential targets for preventative intervention.
Highlights
Over the past two decades, considerable research and clinical effort has been invested in devising methods of early detection and intervention for psychosis, with the aims of delaying, ameliorating, and preventing, illness onset [1]
Building on the work of early prospective longitudinal studies of both general population and familial high-risk cohorts, we have identified several neurobiological markers that may index early, premorbid pathophysiology on a developmental trajectory to spectrum disorders (SSD)
By means of our large, unselected sample, we have contributed epidemiological findings demonstrating that the prevalence of the triad of schizophrenia antecedents is elevated among males and specific ethnic groups, and that psychotic-like experiences (PLEs) in particular can be distressing and persistent for some children, depending on co-occurrence of internalising and externalising symptoms or other antecedents of schizophrenia
Summary
Over the past two decades, considerable research and clinical effort has been invested in devising methods of early detection and intervention for psychosis, with the aims of delaying, ameliorating, and preventing, illness onset [1]. Within 2–3 years of presentation, a third of these ‘‘clinically high risk (CHR)1’’ individuals transition to psychotic illness [2]; a substantial proportion continue to experience persistent psychopathology, marked psychosocial impairment, and compromised quality of life; and only a third experience clinical remission [3]. This trajectory of persisting or worsening functional disability for the majority underscores a need for earlier intervention. The primary goal of the study was to characterise developmental trajectories of at-risk individuals through adolescence and into young adulthood, with the aim of determining markers of evolving disease that, in the longer term, might be targeted with early, preventative interventions
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