Editorial: Can Less Be More When Measuring Psychotic Symptoms in Youth?

There is a strong tradition in child mental health of developing measures to assess both general psychopathology and specific constructs such as attention-deficit/hyperactivity disorder, autism, depression, anxiety, and obsessive-compulsive disorder. For psychosis, however, the tendency has been to use in children instruments that were developed for adults, such as the Positive and Negative Syndrome Scale (PANSS). There are general good reasons for using the same assessment tools in youth as in adults, because this facilitates comparisons across the lifespan. In the case of schizophrenia, in particular, there is evidence of continuity of psychopathology from adolescence to adulthood. There are also practical reasons why an instrument such as the PANSS, which has been widely used in research and accepted by drug regulatory agencies, has remained unchanged over time. The PANSS has consistently been shown to be able to discriminate between antipsychotic medication and placebo in adults, children, and adolescents.^1,2 Keeping the same rating instrument across studies and over time also facilitates comparisons between clinical trials and medications, allows possible time trends in treatment effect to be detected, and helps systematic reviews and meta-analyses.^1,2 The drawback of this methodological conservatism is that it provides little motivation to perfect the existing tools for measuring psychopathology, with negative impact on both research and clinical practice.