Attention Deviance and Other Cognitive Markers

Attention deficits have been shown to be highly characteristic of schizophrenic patients and their relatives. According to data gathered from the New York High-risk Project, attention deviance can be reliably detected in preschizophrenic children, and these deficits are stable and enduring over time [43]. In a 1992 review of attentional findings from the New York High-risk Project [42], the authors indicate that by at least the age of 7 more than a quarter of the high-risk sample had attention deficits. Similar attention deficits were also observed in low-risk children, but these problems persisted beyond childhood only in high-risk subjects [42]. Similar findings emerged from the NIMH Israeli High-risk Project, with adult schizophrenia spectrum cases showing greater attention difficulties at age 11 as compared to control groups [37]. Using samples of patients from Ireland, Israel and Washington, DC, Mirsky [91] found that schizophrenic patients performed most poorly on measures of attention, control subjects performed best, and relatives of ill patients, whether or not they had a psychiatric diagnosis, performed at an intermediate level. The ability to focus on environmental cues and respond appropriately, as well as the ability to sustain or maintain one's attention, were the most powerful discriminators of impaired attention in schizophrenic patients [91].

In addition to attention deficits, memory and neuromotor functioning seem to be particularly promising biobehavioural markers. Using a series of neuropsychological tests, Erlenmeyer-Kimling et al. [44] found that sensitivity for predicting schizophrenia spectrum disorders in high-risk children was 83% for verbal memory and 75% for gross motor skills. Attention deviance had a sensitivity of 58%, a specificity of 82% and an overall accuracy of 78%. Using all three variables (attention deviance, memory and gross motor skills) yielded a sensitivity of 50%, specificity of almost 90%, a 10% false positive rate, 46% positive predictive power, 90% negative predictive power, and an overall accuracy rate of 83% [44]. These findings offer particular promise with respect to developing useful screening batteries for high-risk children.

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