Characteristics and long term outcomes of youth with early onset schizophrenia/psychotic disorder
MetadataShow full item record
Research on children and adolescents (youth) with early onset schizophrenia/psychotic disorders (EOS) has shown the presence of clinical complexities in this rare population (Schimmelmann, Conus, Cotton, McGorry, & Lambert, 2007; Vourdas, Pipe, Corrigall, & Frangou, 2003). However, specific school outcomes for youth with EOS have remained understudied. An Individualized Educational Program (IEP) is mandated under the requirement of the Individuals with Disabilities Education Act to provide free and appropriate public education to student age from 3 through 21 in the least restrictive environment. However, there are a lack of studies providing knowledge on whether youth with EOS receive an IEP and whether those with an IEP perform better in schools than those without an IEP. Additionally, adults diagnosed with schizophrenia have high rates of substance use, and in particular often begin smoking early (Kotov, Guey, Bromet, & Schwartz, 2010). Therefore, the role of cigarette smoking in this population is another area where additional knowledge is needed to help understand what effects nicotine has on youth with psychotic symptoms. The goals of this study are a) to augment the current literature by providing a broader understanding of the characteristics of youth with EOS; b) to examine the impact of IEP over time on school outcomes, including school performance, discipline, and dropout, and psychological functioning; and c) to examine the association between cigarette smoking and changes in school outcomes and psychological functioning over time. This exploratory study used the data from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHS Program). A subset of data from the descriptive study and the longitudinal outcome study, collected from 1998 to 2006, was used for this study with a specific focus on youth with EOS. Mixed models and logistic regressions were used to test long term effects of two predictors (i.e., IEP and cigarette smoking) on school outcome and psychological functioning. Results presented an unsettling and disturbing picture of the challenges these youth face. More than 70% lived in poverty, more than 70% had multiple psychiatric diagnoses, more than half had trauma histories, and 39% had severe behavioral problems resulting in disciplinary actions against them. Results from 140 youth in the longitudinal outcome study showed that 82% of youth had received an IEP. Academic performances were generally poor in both reading and math subscales, absenteeism rates were high, and many dropped out of school. An IEP tended to predict less fluctuation of anxiety even though among youth with EOS anxiety levels remained close to clinical cut point. IEPs failed to predict lower depression scores, or reduce negative behaviors, or improve overall school outcomes. More than a quarter of youth smoked cigarettes in the past six months. Smoking tended to predict comorbid depression and anxiety. Youth who smoked cigarettes had higher state of anxiety and depression throughout study time points with a less fluctuation in the pattern. Smoking did not, however, predict school outcomes or serious negative behaviors at school including dropout or discipline. Further, cigarette smoking was an indicator of high level of initial and sustained anxiety and depression in this population.