Social impairment and social language deficits in children and adolescents with and at risk for psychosis Eugene J. D'Angelo a,b, ⁎, Nicholas Morelli a , Sarah Hope Lincoln b,c , Kelsey Graber a , Sahil Tembulkar a , Alyssa Gaudet a , Joseph Gonzalez-Heydrich a,b a Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA b Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA c McLean Hospital, Department of Psychiatry, 115 Mill Street, Belmont, MA 02478, USA abstract article info Article history: Received 28 February 2018 Received in revised form 12 July 2018 Accepted 14 July 2018 Available online xxxx Intro: One of the more debilitating functional outcomes of schizophrenia-spectrum disorders is social impair- ment. Previous studies have identified impaired social functioning both in the prodromal phase of psychosis and after acute symptoms abate, suggesting that social impairment represents a core deficit in psychosis not di- rectly linked to psychotic episodes or symptom severity. To date, research in this area has focused primarily on adult populations rather than children, and has not directly assessed social language in individuals across the psy- chosis continuum. Methods: 81 youth ages 7–18 (N = 24 Typically Developing [TD], N = 36 Clinical High Risk [CHR], N = 21 Psy- chotic Disorder [PD]) were recruited. Youth participants were administered the Social Language Development Test (SLDT), and parent(s)/guardian(s) completed the Social Responsiveness Scale-II (SRS-II). Results: Social language ability was not associated with social impairment. PD participants performed signifi- cantly worse on the SLDT than TD participants. CHR and PD participants were both rated as having experienced significantly greater social impairment than TD participants on every subscale of the SRS-II. Discussion: Deficits in social language ability and social functioning are strong candidates for phenotypic markers of psychosis, and may be evident earlier in development than previous work has demonstrated. Additionally, the severity of social impairment did not differ between CHR and PD participants, further supporting that social cog- nitive deficits and social impairment, while related to symptom severity, are discrete deficits in individuals with and at risk for psychosis. These results highlight the importance of addressing social skills for individuals present- ing in clinical settings with psychotic symptoms, including children. © 2018 Published by Elsevier B.V. Keywords: Schizophrenia Social impairment Language High risk Children 1. Introduction Schizophrenia-spectrum disorders are marked by a decline in func- tional outcome, including occupational impairment (Marwaha and Johnson, 2004), poor academic achievement (MacCabe et al., 2008), and social isolation (Michalska Da Rocha et al., 2018). In the last two de- cades, research has focused on identifying to what degree these impair- ments are present in the prodromal phase of psychosis. Individuals at clinical high risk (CHR; also known as “ultra-high risk” and “at risk men- tal state” [Yung et al., 1996]) are defined as a group experiencing psychotic-like symptoms, below diagnostic threshold, but at high risk for converting to psychosis due to positive psychotic-like symptoms (Miller et al., 2002). Mounting evidence indicates that CHR individuals experience impairments similar to those observed in individuals with psychotic disorders (PD), particularly in areas of social cognition and so- cial functioning (Lincoln et al., 2017). Social cognition is the psychological process involved in perceiving, encoding, retrieving, and regulating of information about other people (Green et al., 2008). Deficits in social cognition have been demonstrated extensively in individuals with schizophrenia-spectrum disorders (Savla et al., 2013), and more recently, in CHR individuals. A meta- analysis of over 1200 CHR participants identified deficits across multiple domains of social cognition, including theory of mind, social perception, attributional bias, and emotion processing, with the largest effect size for attributional bias (Lee et al., 2015). A recent review found similarly diminished social cognitive abilities among CHR individuals, but concluded that these deficits may be specific to more complex social cognitive tasks that require higher-order theory of mind processing Schizophrenia Research xxx (2018) xxx–xxx ⁎ Corresponding author at: Boston Children's Hospital, Department of Psychiatry, 300 Longwood Avenue, Boston, MA 02115, USA. E-mail addresses: eugene.dangelo@childrens.harvard.edu (E.J. D'Angelo), nicholas.morelli@childrens.harvard.edu (N. Morelli), slincoln@fas.harvard.edu (S.H. Lincoln), kelsey.graber@childrens.harvard.edu (K. Graber), sahil.tembulkar@childrens.harvard.edu (S. Tembulkar), alyssa.gaudet@childrens.harvard.edu (A. Gaudet), joseph.gonzalez-heydrich@childrens.harvard.edu (J. Gonzalez-Heydrich). SCHRES-07978; No of Pages 7 https://doi.org/10.1016/j.schres.2018.07.028 0920-9964/© 2018 Published by Elsevier B.V. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Please cite this article as: D'Angelo, E.J., et al., Social impairment and social language deficits in children and adolescents with and at risk for psychosis, Schizophr. Res. (2018), https://doi.org/10.1016/j.schres.2018.07.028