Rethinking childhood-onset schizophrenia: neurodevelopmental comorbidities shape the psychopathological profile
- 1Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- 2Department of Neuroscience, Catholic University, Rome, Italy
- 3Life Sciences and Public Health Department, Catholic University, Rome, Italy
Abstract
Objectives: Childhood-onset schizophrenia (COS), defined by the onset of psychotic symptoms before the age of 13 years, is a rare and severe form of schizophrenia. Despite growing interest, little is known about how neurodevelopmental comorbidities shape its clinical presentation. This study aimed to examine whether COS with comorbid neurodevelopmental disorders differs in psychopathological profile from COS with psychiatric comorbidities and from COS without comorbidities.
Methods: Sixty-one children diagnosed with COS and evaluated at symptom onset in a specialized early psychosis service were included and classified into three subgroups: COS with neurodevelopmental comorbidities, COS with psychiatric comorbidities, and COS without comorbidities. Psychopathological dimensions were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children – Present and Lifetime Version and the Structured Interview for Psychosis-Risk Syndromes and the Scale of Prodromal Symptoms (SIPS/SOPS). Group differences were examined using MANOVA and mixed-design repeated-measures ANOVA, repeated with IQ as a covariate, with False Discovery Rate correction across all SIPS measures. A secondary analysis separated intellectual disability from autism spectrum disorder and/or attention-deficit/hyperactivity disorder.
Results: Children with COS and neurodevelopmental comorbidities showed an earlier age at onset, lower IQ, greater bizarre thinking and less social anhedonia. In contrast, COS with psychiatric comorbidity and COS without comorbidities exhibited largely overlapping profiles, marked by greater severity of negative symptoms and more organized thought processes. Within the neurodevelopmental group, the symptom pattern did not appear to be driven by specific diagnoses.
Conclusions: These preliminary findings are consistent with variation in the configuration of psychopathological features within COS along a continuum, and highlight the relevance of neurodevelopmental trajectories in shaping symptom expression. Accounting for neurodevelopmental comorbidities may be crucial for improving early diagnostic characterization and informing targeted therapeutic strategies in pediatric schizophrenia.
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BibTeX
@article{luzio2026rethinking,
title = {{Rethinking childhood-onset schizophrenia: neurodevelopmental comorbidities shape the psychopathological profile}},
author = {Michelangelo Di Luzio and Maria Pontillo and Barbara D’Aiello and Giulia D’Amario and Ilaria Bertoncini and Roberto Averna and Milena Labonia and Stefano Vicari},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1918377},
url = {https://doi.org/10.3389/fpsyt.2026.1918377},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rethinking childhood-onset schizophrenia: neurodevelopmental comorbidities shape the psychopathological profile
AU - Michelangelo Di Luzio
AU - Maria Pontillo
AU - Barbara D’Aiello
AU - Giulia D’Amario
AU - Ilaria Bertoncini
AU - Roberto Averna
AU - Milena Labonia
AU - Stefano Vicari
PY - 2026
DA - 2026/10/12
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1918377
UR - https://doi.org/10.3389/fpsyt.2026.1918377
AB - Objectives: Childhood-onset schizophrenia (COS), defined by the onset of psychotic symptoms before the age of 13 years, is a rare and severe form of schizophrenia. Despite growing interest, little is known about how neurodevelopmental comorbidities shape its clinical presentation. This study aimed to examine whether COS with comorbid neurodevelopmental disorders differs in psychopathological profile from COS with psychiatric comorbidities and from COS without comorbidities. Methods: Sixty-one children diagnosed with COS and evaluated at symptom onset in a specialized early psychosis service were included and classified into three subgroups: COS with neurodevelopmental comorbidities, COS with psychiatric comorbidities, and COS without comorbidities. Psychopathological dimensions were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children – Present and Lifetime Version and the Structured Interview for Psychosis-Risk Syndromes and the Scale of Prodromal Symptoms (SIPS/SOPS). Group differences were examined using MANOVA and mixed-design repeated-measures ANOVA, repeated with IQ as a covariate, with False Discovery Rate correction across all SIPS measures. A secondary analysis separated intellectual disability from autism spectrum disorder and/or attention-deficit/hyperactivity disorder. Results: Children with COS and neurodevelopmental comorbidities showed an earlier age at onset, lower IQ, greater bizarre thinking and less social anhedonia. In contrast, COS with psychiatric comorbidity and COS without comorbidities exhibited largely overlapping profiles, marked by greater severity of negative symptoms and more organized thought processes. Within the neurodevelopmental group, the symptom pattern did not appear to be driven by specific diagnoses. Conclusions: These preliminary findings are consistent with variation in the configuration of psychopathological features within COS along a continuum, and highlight the relevance of neurodevelopmental trajectories in shaping symptom expression. Accounting for neurodevelopmental comorbidities may be crucial for improving early diagnostic characterization and informing targeted therapeutic strategies in pediatric schizophrenia.
SN - 1664-0640
ER -