Date Presented 3/30/2017
A sample (N = 292) of youths ages 12–25 at risk for psychosis were administered the Adolescent/Adult Sensory Profile during intake in a multisite research project. Significant differences were found for the high-risk group compared with low-risk youths and norms, findings that can inform treatment interventions.
Primary Author and Speaker: Donna Downing
Additional Authors and Speakers: Diane Parham, Sean Roush
PURPOSE: The aim of this study was to identify and compare the sensory characteristics of youths at clinical high risk (CHR) for psychosis compared with youths at clinical low risk (CLR) and normative data. Sensory differences are emerging as a potential marker for risk for psychosis. Differences in processing within and across sensory modalities are evident among people with schizophrenia. This study was conducted to inform occupational therapy practice to support and preserve functioning at an earlier stage in an emerging illness process.
DESIGN: A descriptive cohort design was used to analyze baseline data from the Adolescent/Adult Sensory Profile (AASP) collected as part of the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP), a national six-site research treatment project. Participants ages 12 to 25 were recruited through community outreach to health and school professionals in all catchment areas. Outreach focused on early identification of psychosis and how to refer early for treatment. To be considered CHR, youths met specific criteria on the Structured Interview for Prodromal Syndromes (SIPS), which was administered to all youths to determine inclusion at each EDIPPP site. CLR youths had milder symptoms and were followed as controls at each study site. This low-risk group was administered the AASP as part of the intake process.
METHOD: Baseline AASP data were gathered from CHR and CLR youths at all sites prior to initiation of intervention. Then, raw scores were analyzed for CHR and CLR youths in two age groups: 12–17 yr (N = 203) and 18–25 yr (N = 89). Analysis of variance procedures were used to determine whether differences in AASP scores existed across CLR, CHR, and normative groups by age group.
RESULTS: CHR participants differed significantly from the normative group for all four AASP scores (Low Registration, Sensory Seeking, Sensory Sensitivity, and Sensory Avoiding) in the younger and older groups. CLR participants were similar to norms for both age groups, except for Sensory Seeking scores, which were significantly lower than norms in both age ranges. Young people with CHR demonstrated active avoidance, heightened sensitivity, reduced seeking out, and reduced registration of sensations in everyday life compared with typical peers. These changes could be considered potential markers for risk for psychosis and also inform treatment interventions.
CONCLUSION: The study results highlight sensory characteristic differences for CHR and CLR youths compared to normative data. CHR youths not only experienced sensory differences from the normative sample, but certain behaviors they exhibited during an emerging illness process tended to interfere with functioning and social interactions, which impacted their daily lives. This pattern of sensory differences in CHR youths may be a valuable marker for identifying individuals who are at high risk for psychosis and may also inform interventions designed to prevent or minimize the illness process and promote functioning. The finding that CLR youths also experienced sensory changes provides evidence that brain changes may be occurring much earlier than suspected prior to the CHR state.
Occupational therapists are trained to identify, understand, and treat sensory preferences that interfere with functioning in all performance areas across all ages. Therefore, providing evidence that these sensory changes occur early in an illness process can inform occupational therapy practice, especially in schools, and foster further occupational therapy research in this area. This study also informs other areas of scientific study and supports evidence that early changes occur in multiple areas of the brain during an emerging psychotic illness process, perhaps much earlier than suspected.
References
Brown, C., & Dunn, W. (2002). Adult/adolescent sensory profile: User’s manual. San Antonio: Psychological Corporation.
Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., Schultze-Lutter, F., . . . Yung, A. (2013). The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry, 70, 107–120. https://doi.org/10.1001/jamapsychiatry.2013.269
McFarlane, W. R., Levin, B., Travis, L., Lucas, L., Lynch, S., Verdi, M., . . . Spring, E. (2014). Clinical and functional outcomes after 2 years in the Early Detection and Intervention for the Prevention of Psychosis multisite effectiveness trial. Schizophrenia Bulletin, 41, 30–43. https://doi.org/10.1093/schbul/sbu108
