Gur RE, Yi JJ, McDonald-McGinn DM, Tang SX, Calkins ME, Whinna D, Souders MC, Savitt A, Zackai EH, Moberg PJ, Emanuel BS, Gur RC.
Neurocognitive development in 22q11.2 deletion syndrome: comparison with youth having developmental delay and medical comorbidities. Mol Psychiatry.
2014 Jan 21
Comments on News and Primary Papers
Comment by: Philip Harvey
Submitted 25 February 2014
Posted 25 February 2014
The Gurs have done it again. First, they developed the first truly remotely deliverable cognitive assessment with any validity data that would stand the test of peer review. Now they have passed another hurdle: general population screening. For years, those of us interested in this topic have said: "Sure. Those kids look different, but can you go into the community, screen the whole group, and find the outliers who may be impaired?" So these studies are really important because they constitute a true, largely epidemiologically interesting sample of the population. Then the researchers relate psychosis and cognition and find a link. As Ruben said, it may happen that someday we can have high-throughput cognitive (or functional capacity, to give our work a plug) testing that can be administered at a routine clinical visit to a doctor. Any findings could lead to a referral. This could lead to targeted early interventions. The only weak link is the family who never goes to the doctor at all. Are they the ones really at risk? This study does not have to answer that question. The results stand on their own.
View all comments by Philip HarveyComment by: Michael F. Green, SRF Advisor
Submitted 26 February 2014
Posted 26 February 2014
The very impressive article by Gur et al. on neurocognitive growth charting was already summarized by Michele Solis, so I will just make a couple of additional comments.
As mentioned in the summary, one of the remarkable contributions of this paper is to extend the link between cognitive impairment and psychosis down to the age of eight. This is uncharted territory, and, despite some variations, the lags in complex cognition and social cognition are relatively consistent from age eight to 20. Some of us would have expected a gradually increasing gap with increasing age, but that did not happen. That is encouraging in itself.
The authors were forward thinking and included a social cognitive domain in the battery. Sometimes people assume that social cognitive tests must be more inherently complex than mundane, non-social cognitive tests (after all, they are social), but that is not always the case. Indeed, the social cognitive tests in this battery can be considered low-level tests that place minimal demands on social inference. That means they are tapping only a subset of social cognitive processes, but they are useful here because they are fully appropriate for children.
What does a 1.5-year delay in social cognition mean for the kids? At these ages—it probably means a lot. The kids with psychosis spectrum are over a year behind in identifying the emotional expressions of their classmates, siblings, and teachers. It is not hard to imagine the social and functional consequences that might accompany the delay. Fortunately, such skills can be trained. Based on this study, we may need to develop training programs for younger participants.
View all comments by Michael F. Green