This R34 pilot proposal, entitled """"""""Intensive Brain Training in Early Onset Schizophrenia &Schizoaffective Disorder"""""""" is submitted in response to RFA-MH-09-020 Novel Interventions for Neurodevelopmental Disorders. The overarching goal of this pilot study is to determine whether an intensive computerized intervention targeted on improving central auditory and visual processing as well as executive functioning improves neurocognition and overall functioning in youth with Early Onset Schizophrenia and Schizoaffective Disorders (EOSS), defined by onset prior to 18 years. Youth with EOSS have more pronounced neurocognitive deficits and generally poorer prognosis than individuals with adult onset schizophrenia. Since severity of neurocognitive deficits have been more strongly linked to functional outcome than severity of positive psychotic symptoms, interventions that improve neurocognition may be especially potent in reducing long term disability. Functional neurocognitive studies have demonstrated that individuals with schizophrenia tend to process information less efficiently than those without schizophrenia. Developmental neuroscientists have demonstrated that repeated exposure to synchronized and meaningful stimuli can led to structural changes in the brain that improve its processing efficiency. Although such plastic changes are possible even in adults, younger individuals generally have greater capacity to respond to such environmental training. This pilot study will randomly assign 40 youth (ages 10-18 years) to participate in a 90 hour Intensive neuroadaptive computerized Cognitive Training program conducted over 20 weeks (ICT group) or to spend the same amount of time engaged in commercially available computer games (EOSS control group). Changes in neurocognition (primary outcome measure), global functioning, psychiatric symptoms and Brain Derived Neurotrophic Factor (BDNF) will be assessed prior to beginning the interventions, at completion of the intervention (20 weeks) and 8 and 12 months following baseline. The same assessments will be performed in a group of 20 nonpsychiatrically ill youth matched for age, gender and race at the same time points to allow comparison of neurocognitive data and assess the typical extent of variability over time in neurocognitive functioning and BDNF levels. The results of this pilot study will allow refinement of the ICT program and inform the design of a more definitive test of neurocognitive interventions for youth with EOSS.
Children and adolescents with early onset schizophrenia and schizoaffective disorder (EOSS) often have profound neurocognitive disturbances that are strongly related to their abilities to function socially and vocationally as adults. This pilot study will evaluate a focused intensive computerized intervention designed to improve cognitive functioning of youth with EOSS. If feasible and effective, such an intervention might reduce long-term disability in youth with schizophrenia and schizoaffective disorder.
