A – 39 Psychotic-Like Experiences vs Early-Onset Schizophrenia: A Pediatric Case Study on Potential Neurocognitive Prodromal Symptoms

Abstract Objective Distinguishing between prodromal symptoms of emerging early-onset schizophrenia (EOS) and non-schizophrenic childhood psychotic-like experiences (PLE) can be particularly challenging. While existing literature suggests diagnostic considerations should primarily rely on a detailed clinical interview inclusive of alternative psychiatric/psychosocial/medical etiologies and developmental considerations, studies on potential prodromal neurocognitive symptoms are less robust. This case aims to expand upon the existing literature by identifying neurocognitive deficits that may potentially serve to differentiate between PLE and EOS and assist early diagnostic identification. Method Ms. Doe is a 12-year-old African American female referred for neuropsychological evaluation in a setting of severe depression and anxiety. Mood symptoms first started at age 9 and are somewhat responsive to SSRI pharmacotherapy and psychotherapy. She reports onset of visual and auditory hallucinations in the past 6-12 months which are non-responsive to current treatment. Medical/developmental history is unremarkable. Family psychiatric history is unremarkable. Results Evaluation found impairments in auditory attention, vigilance and letter fluency. Performance across tasks of psychomotor speed, expressive/receptive language, and inhibitory control were within normal limits with overall intelligence falling in the above average range. Collateral rating scales revealed socially withdrawn behavior, reduced emotional expression and general suspiciousness of others. Conclusion Poly-etiologic factors including ADHD and comorbid mood disorders should be considered when interpreting attention deficits among children suffering from PLE. Difficulties with letter fluency may provide early insight into emerging language disorganization characteristic in EOS. Collateral report scales may assist with differential diagnoses by elucidating the underpinnings of social dysfunction across settings.