T116. EVALUATION OF CLINICAL AND FUNCTIONAL DIFFERENCES IN CLINICAL-HIGH RISK FOR PSYCHOSIS WITH AND WITHOUT A HISTORY OF ADHD AND STIMULANT EXPOSURE: A SIX-MONTH FOLLOW-UP USING MULTILEVEL MODELING

Compared to the general population, the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) is estimated to be 2–5 times higher in those with psychosis. Individuals with both a history of ADHD and psychosis show a pattern of greater deficits/poorer prognoses over time, compared to psychosis and ADHD alone. For example, at first-episode, individuals with a history of ADHD have poorer functional trajectory over one-year follow-up in social/role functioning compared to individuals without ADHD. Furthermore, research indicates that premorbid stimulant intervention has been associated with significantly younger age of psychosis onset, particularly important as earlier onset is associated with worse course and prognosis in clinical/functional outcomes. Less is known about the relation of functioning/clinical symptoms among individuals at clinical high-risk (CHR) for psychosis with and without a history of ADHD and stimulant exposure. In the present 6-month longitudinal study, help-seeking participants aged 12–25 (n = 80, data collection ongoing) were administered the Structured Interview for Psychosis-risk Syndromes (SIPS), a diagnostic interview, and clinician-rated measures of social/role functioning (Cornblatt, CAFAS). Participants were categorized into 4 diagnostic groups (1. help-seeking control, 2. ADHD & stimulant+/CHR-, 3. CHR+/ADHD & stimulant-, 4. CHR+/ADHD & stimulant+) to assess for changes on social/role functioning and clinical symptoms over time. Data will be analyzed using multi-level modeling. Prevalence of ADHD and stimulant exposure was around half of the CHR sample; these individuals started experiencing attenuated symptom onset over 3 years earlier than those without an ADHD/stimulant history. Preliminary data suggest longitudinal effects vary by functional domain among the groups, including more difficulty for CHR+/ADHD & stimulant+ compared to CHR+ only in School and Behavior Toward Others (CAFAS subscales) and Role Functioning (Cornblatt). SIPS positive and negative symptoms indicated no worsening for either CHR group. These findings possibly indicate individuals at CHR with an ADHD/stimulant history may already be evidencing more concerns in social/role settings as compared with ADHD or CHR alone. Similar to the FEP literature, a comparable pattern may exist with earlier attenuated symptom onset among the two CHR groups, such that it may be associated with poorer functioning over time. These data offer implications for identifying specific targets for early intervention and highlighting the importance of measure development in assessing these domains, as the functioning measures utilized in this study assessed slightly differing aspects of each domain (i.e., quality or quantity of interactions; impact of behavior/executive skills or quality/independence in school work). Additionally, differing clinical symptom presentations of the 2 CHR groups may not yet be apparent in the earliest course of psychosis in comparison to the FEP literature, thus longer prospective follow-up may be needed for these disparities to develop. A few limitations include attrition over six-months impacting sample size, unconfirmed self-reported medication data, inconsistent assessment of onset of attenuated symptoms, need for analyses with covariates, and SIPS high false-positive rate. Future investigation may focus on a longer prospective follow-up period to assess for conversion, in addition to other factors that delineate CHR groups with(out) an ADHD/stimulant history, including cognitive functioning, and more accurate assessment of past medication report via pharmacy records.