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The development in rating-based executive functions in children at familial high risk of schizophrenia or bipolar disorder from age 7 to age 11: the Danish high risk and resilience study

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Abstract

Executive functions (EF) deficits are well documented in children at familial high risk of schizophrenia (FHR-SZ), and to a lesser degree in children at familial high risk of bipolar disorder (FHR-BP). The aim of this study was to assess EF development in preadolescent children at FHR-SZ, FHR-BP and population-based controls (PBC) using a multi-informant rating scale. A total of 519 children (FHR-SZ, n = 201; FHR-BP, n = 119; PBC, n = 199) participated at age 7, at age 11 or at both time points. Caregivers and teachers completed the Behavior Rating Inventory of Executive Functions (BRIEF). The developmental pattern from age 7 to age 11, did not differ between groups. At age 11, caregivers and teachers rated children at FHR-SZ as having widespread EF deficits. A higher proportion of children at FHR-SZ had clinically significant scores on the General executive composite (GEC) and all BRIEF indices compared to PBC. According to the caregivers, children at FHR-BP had significantly more EF deficits than PBC on 9 out of 13 BRIEF scales, whereas according to teachers, they only had significantly more deficits on one subdomain (Initiate). Likewise, caregivers rated a significantly higher proportion of children at FHR-BP above the clinical cut-off on the GEC and Metacognition index, compared to PBC, whereas there were no significant differences according to teachers. This study highlights the relevance of including multi-informant rating scales in the assessment of EF in children at FHR-SZ and FHR-BP. The results imply a need to identify children at high risk who would benefit from targeted intervention.

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Acknowledgements

This research was funded by the Lundbeck Initiative for Integrative Psychiatric Research (iPSYCH), Trygfonden, the Innovation Fund Denmark, the Mental Health Services of the Capital Region of Denmark, Aarhus University, the Independent Research Fund Denmark, and the Beatrice Surovell Haskell Fund for Child Mental Health Research of Copenhagen. We wish to express our gratitude towards the children, caregivers and teachers taking their time to participate in our study, as well as A.F. Bundgaard, A.M. Bundsgaard, H.B Stadsgaard, L. Carmichael, M. Birk, M. Melau, M. Wilms, N. L. Steffensen, S. B. Rohd, Å.K. Prøsch, D.L. Gantriis, D.V. Ellersgaard, and C.J. Christiani, who have contributed to the data collection, and A.H. Carlsen for statistical guidance. The authors have no relevant conflict of interests.

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Authors and Affiliations

  1. Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark

    Anna Krogh Andreassen, Aja Greve, Christina Bruun Knudsen, Lotte Veddum, Merete Birk, Ole Mors & Vibeke Fuglsang Bliksted

  2. The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark

    Anna Krogh Andreassen, Aja Greve, Nicoline Hemager, Christina Bruun Knudsen, Lotte Veddum, Anne Søndergaard, Julie Marie Brandt, Maja Gregersen, Mette Falkenberg-Krantz, Katrine Søborg Spang, Jessica Ohland, Jens Richardt Møllegaard Jepsen, Anne Amalie Elgaard Thorup, Merete Nordentoft, Ole Mors & Vibeke Fuglsang Bliksted

  3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Anna Krogh Andreassen, Christina Bruun Knudsen, Lotte Veddum & Vibeke Fuglsang Bliksted

  4. Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark

    Rikke Lambek

  5. CORE – Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark

    Nicoline Hemager, Anne Søndergaard, Julie Marie Brandt, Maja Gregersen, Mette Falkenberg-Krantz, Katrine Søborg Spang, Jessica Ohland, Jens Richardt Møllegaard Jepsen & Merete Nordentoft

  6. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Anne Søndergaard, Julie Marie Brandt, Maja Gregersen, Birgitte Klee Burton, Anne Amalie Elgaard Thorup & Merete Nordentoft

  7. Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark

    Nicoline Hemager, Mette Falkenberg-Krantz, Katrine Søborg Spang, Birgitte Klee Burton, Jens Richardt Møllegaard Jepsen & Anne Amalie Elgaard Thorup

  8. Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark

    Jens Richardt Møllegaard Jepsen

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  1. Anna Krogh Andreassen
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Correspondence to Anna Krogh Andreassen.

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The Danish High Risk and Resilience Study was performed according to the principles of the Declaration of Helsinki. It was approved by the Danish Data Protection Agency and the National Committee on Health Research Ethics (Ref: H-16043683).

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Andreassen, A.K., Lambek, R., Greve, A. et al. The development in rating-based executive functions in children at familial high risk of schizophrenia or bipolar disorder from age 7 to age 11: the Danish high risk and resilience study. Eur Child Adolesc Psychiatry 33, 549–560 (2024). https://doi.org/10.1007/s00787-023-02177-w

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