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A 15-Year Longitudinal Study

Richie Poulton, PhD; Avshalom Caspi, PhD; Terrie E. Moffitt, PhD; Mary Cannon, MD; Robin Murray, MD; HonaLee Harrington, BS

Arch Gen Psychiatry. 2000;57:1053-1058.

Background  Childhood risk factors for the development of adult schizophrenia have proved to have only modest and nonspecific effects, and most seem unrelated to the adult phenotype. We report the first direct examination of the longitudinal relationship between psychotic symptoms in childhood and adulthood.

Methods  We analyzed prospective data from a birth cohort (N = 761), in which children were asked about delusional beliefs and hallucinatory experiences at age 11 years, and then followed up to age 26 years. Structured diagnostic interviews were employed at both ages and self-report of schizophreniform symptoms was augmented by other data sources at age 26 years.

Results  Self-reported psychotic symptoms at age 11 years predicted a very high risk of a schizophreniform diagnosis at age 26 years (odds ratio, 16.4; 95% confidence interval, 3.9-67.8). In terms of attributable risk, 42% of the age-26 schizophreniform cases in the cohort had reported 1 or more psychotic symptoms at age 11 years. Age-11 psychotic symptoms did not predict mania or depression at age 26 years, suggesting specificity of prediction to schizophreniform disorder. The link between child and adult psychotic symptoms was not simply the result of general childhood psychopathology.

Conclusion  These findings provide the first evidence for continuity of psychotic symptoms from childhood to adulthood.

From the Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand (Dr Poulton); Department of Psychology, University of Wisconsin, Madison (Drs Caspi and Moffitt and Ms Harrington); and the Institute of Psychiatry, University of London, London, England (Drs Caspi, Moffitt, Cannon, and Murray).

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