Parent–adolescent agreement on psychosis risk symptoms Emily Kline a , Elizabeth Thompson a , Caroline Schimunek a , Gloria Reeves b , Kristin Bussell b , Steven C. Pitts a , Jason Schiffman a, ⁎ a University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD, 21250, USA b University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD, 21201, USA abstract article info Article history: Received 18 January 2013 Received in revised form 5 March 2013 Accepted 11 March 2013 Available online 6 April 2013 Keywords: Adolescents Attenuated psychosis syndrome Caregivers Prodrome Schizophrenia Screening Despite practice guidelines recommending caregiver inclusion for assessment of mental health problems in adolescents, clinical high-risk (CHR) assessment tools that target attenuated psychosis symptoms rely solely on self-report. As many individuals in the clinical high-risk phase are expected to be adolescents, and programs of CHR research routinely recruit participants as young as twelve, parent input regarding adolescents' symptoms and functioning may help to inform clinical conceptualizations. No assessment tool targeting CHR symptoms has been developed for this purpose. We created a caregiver-report version of the 12-item Prime Screen-Revised and administered the measure to caregivers of 52 youth ages 12–19 referred by mental health providers for CHR study participation. Youth completed the Prime Screen-Revised as well as the Structured Interview for Psychosis Risk Syndromes (SIPS). Caregiver responses demonstrated poor agreement with youth ratings on Prime Screen-Revised (r = .09), but moderate agreement with clinician ratings (r = .41). The addition of caregiver screening data to youth self-report scores significantly improved a linear regression predicting clinician ratings. Using a threshold of four or more endorsements, the combined use of parent and adolescent responses accurately classified 75% of respondents with regard to SIPS-determined CHR status. Findings suggest that involving care- givers may help to improve the specificity of CHR screening and assessment procedures. © 2013 Elsevier B.V. All rights reserved. 1. Introduction The codification of a set of risk markers referred to as a “clinical high risk” state (CHR) or “attenuated psychosis syndrome” (APS) has advanced the possibility of developing targeted treatment to delay or prevent the onset of psychosis among individuals prodromal to schizophrenia and other psychotic spectrum disorders (Fusar-Poli et al., 2012). The inclusion of APS in section three of DSM-5 highlights the need to expand knowledge and practice for individuals thought to be most vulnerable to psychosis. Current research is focused on the goals of refining the CHR construct to limit the number of individuals falsely identified as being clinically high risk for psychosis, under- standing the mechanisms governing the origins and progression of psychotic symptoms, and establishing interventions that are safe and effective for reducing both current distress and likelihood of future illness (Fusar-Poli et al., 2012). The Structured Interview for Psychosis Risk Syndromes (SIPS; Miller et al., 1999) is the most widely used assessment tool used in North American efforts to identify CHR populations. Similar to its Australian predecessor, the Comprehensive Assessment of At-Risk Mental States (CAARMS; Yung et al., 2005), the SIPS emphasizes the appearance and worsening of attenuated positive symptoms (e.g., brief hallucinations, or unusual ideas), in addition to genetic risk and functional impair- ments, in its conceptualization of the CHR category. CHR criteria as defined by the SIPS form the basis of inclusion criteria for most pro- grams of high-risk recruitment. Unfortunately, the interview requires considerable training and administration time. Thus, though considered the current gold standard as a highly specialized assessment tool for CHR status, the SIPS is impractical as a “first step” screener for symptoms that may indicate elevated clinical risk. A few self-report measures have emerged as brief and low-cost methods for screening and monitoring psychosis risk symptoms (e.g., Heinimaa et al., 2003; Miller et al., 2004; Ord et al., 2004; Loewy et al., 2011). These tools have demonstrated good reliability and validity within validation samples. In a naturalistic clinical sample of help-seeking adolescents and young adults, three such tools demon- strated strong continuous agreement with the SIPS and adequate performance as screening tools for detecting potentially high-risk indi- viduals (Kline et al., 2012a,b). Moreover, a few of these screening tools have been used for ‘real-world’ applications, for example in screening newly incarcerated men for mental health needs (Jarrett et al., 2012) and as a first-step online assessment in a high-risk recruitment protocol (Ising et al., 2012; Rietdijk et al., 2012). Given that median age of psychosis onset occurs around 22 years (Kessler et al., 2007) and that as many as 20% of first-episode patients may be eighteen or younger (Schimmelmann et al., 2007), the onset of CHR symptoms for many individuals on a trajectory toward Schizophrenia Research 147 (2013) 147–152 ⁎ Corresponding author. Tel.: +1 410 455 1535; fax: +1 410 455 1055. E-mail address: schiffma@umbc.edu (J. Schiffman). 0920-9964/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.schres.2013.03.007 Contents lists available at SciVerse ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres