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2.61 Understanding How Established Risk Factors Associate With Emergence and Persistence of Psychotic Experiences in Adolescence
Abstract   Peer reviewed

2.61 Understanding How Established Risk Factors Associate With Emergence and Persistence of Psychotic Experiences in Adolescence

Debbie CL Burdinski, Jacqueline Alexandra Clauss, Satrajit S. Ghosh and Jodi M. Gilman
Journal of the American Academy of Child and Adolescent Psychiatry, Vol.64(10 Supplement), pp.S212-S213
10/2025
DOI: 10.1016/j.jaac.2025.08.181

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Abstract

Objectives Persistence of psychotic experiences (PEs) in adolescence has been associated with worse psychiatric outcomes in adulthood, suggesting that markers of symptom persistence may also predict adverse long-term outcomes. This study investigates how established risk factors for PEs are associated with symptom emergence and persistence. Methods Yearly self-reports of PEs were obtained from the first 5 years of the ABCD study, which follows approximately 12,000 children starting at ages 9-10. Prodromal Questionnaire-Brief Child Version severity scores were divided, based on prior literature, into 3 symptom states: low, medium, and high. To estimate year-to-year transition probabilities between symptom states, multinomial logistic regression was used to model current state as a function of prior state. Sex and established risk factors for PEs were included as potential moderators of symptom emergence and persistence following the previous symptom state. Results The model was fit separately in 2 sociodemographically matched cohorts (n = 4429 and n = 4645), yielding consistent findings. Participants with low symptom severity were highly likely to remain in the low state (probability: 0.921; 95% CI, 0.916-0.926), while those with high severity less often de-escalated to low (probability: 0.461; 95% CI, 0.415-0.506). A Wald test of the contrast was highly significant (adjusted p < .001). Female sex, childhood adversity, bullying, and past-year adverse events were associated with both symptom emergence and persistence. Alcohol experimentation was only associated with symptom escalation from a previously low state, whereas perinatal adversity was only associated with symptom persistence from a previously high state. Conclusions Female sex and certain established risk factors (childhood adversity, bullying, and past-year adverse events) for PEs not only increase the likelihood of emergence, but also of persistence of these symptoms, and may thereby help identify adolescents most at risk for future psychopathology.

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