Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Predictors of treatment response and drop out in the Treatment of Early- Onset Schizophrenia Spectrum Disorders (TEOSS) study ☆ Daniel Gabriel a, ⁎ , Ewgeni Jakubovski a,1 , Jerome H. Taylor a,b , Bekir B. Artukoglu a , Michael H. Bloch a,b a Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA b Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA ARTICLE INFO Keywords: Psychotic disorders Clinical trial Children Response Schizophrenia Schizoaffective disorder Pediatric ABSTRACT The Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) compared the efficacy of risperidone, olanzapine, and molindone over 8 weeks in 119 youths age 8–19 years with early-onset schizophrenia or schizoaffective disorder. From this large dataset, we examined predictors of treatment response and drop out using stepwise regression and receiver operating characteristics curve (ROC) analysis. Treatment response was defined as having both a ≥ 20% improvement in Positive and Negative Syndrome Scale (PANSS) score and a Clinical Global Impression-Improvement (CGI-I) score < 3. More severe baseline symptoms, having a history of being in an early education program, and previous prescription of a mood stabilizer increased the likelihood of responding to treatment. Anhedonia and poor community functioning predicted a reduction in symptom severity on the PANSS. Random assignment to different antipsychotic treatment was not predictive of outcome. Parental report of aggressive behaviors at baseline and being African American were associated with a greater likelihood of drop out. Our results suggest youth with more severe psychotic symptoms are most likely to benefit from treatment with antipsychotics and that aggressive youth may require additional support to improve treatment adherence. Further investigation is needed to understand potentially modifiable predictors of response like early education programs. 1. Introduction Antipsychotic medications are the first-line treatment for schizo- phrenia in both adults and children having demonstrated efficacy across a plethora of placebo-controlled trials (McClellan and Stock, 2013). Roughly half of children and adults with schizophrenia respond to antipsychotic medications (Stentebjerg-Olesen et al., 2013; Verma et al., 2012). These medications have a medium-to-large effect size compared to placebo for improving psychotic symptoms in patients with schizophrenia across the lifespan (Leucht et al., 2013). Although antipsychotics are effective for schizophrenia, a sizable proportion of patients do not respond (Levine et al., 2012). Identifying predictors of treatment response to antipsychotics in schizophrenia is important for providing the most accurate prognostic information to patients. Previous antipsychotic trials in adults with chronic schizophrenia have suggested that factors like better cognitive functioning, higher self-perception of well-being, positive attitude about treatment, female sex, more severe baseline symptoms, and early improvement are associated with an improved likelihood of response to antipsychotics (Heres et al., 2014; Jakubovski et al., 2015; O'Gorman et al., 2011). Information regarding predictors of antipsychotic response in pe- diatric schizophrenia spectrum disorders is sparse compared to adults (Vernal et al., 2015). However, there are a number of trials examining predictors of antipsychotic response in first-episode psychosis patients (Crespo-Facorro et al., 2007; Perkins et al., 2004). At baseline, high premorbid functioning during adolescence, severe positive symptoms, and short duration of untreated psychosis were positively correlated with short-term response to antipsychotics (Crespo-Facorro et al., 2013). There is also substantial evidence to suggest that early positive response to antipsychotic treatment is predictive of better long-term outcome in both first-episode psychosis and adults with schizophrenia (Levine and Rabinowitz, 2010; O'Gorman et al., 2011). We investigated predictors of early response in early-onset schizophrenia spectrum http://dx.doi.org/10.1016/j.psychres.2017.05.038 Received 8 June 2016; Received in revised form 19 January 2017; Accepted 19 May 2017 ☆ Clinical Trials Registration: NCT00053703 ⁎ Corresponding author. 1 Present address: Department of Psychiatry, Social Psychiatry, and Psychotherapy at Hannover Medical School, Germany. E-mail address: gabridc0@sewanee.edu (D. Gabriel). Psychiatry Research 255 (2017) 248–255 Available online 30 May 2017 0165-1781/ © 2017 Elsevier B.V. All rights reserved. MARK