Back to the future: Linking early psychiatric symptoms to transdiagnostic cognitive functioning in at-risk youth from...

Cognitive impairment (problems in thinking, learning, remembering, judging, and decision-making) is central to many psychiatric disorders and may often appear well before the symptom onset. Given the moderate heritability of psychiatric disorders, children with first-degree relatives affected by severe mental illness are at higher risk and may show early psychiatric symptoms. Our study explored the potential association between cognitive functioning and early subsyndromal transdiagnostic psychiatric symptoms in at-risk youth. We compared 924 at-risk youth (aged nine to ten) with 924 matched controls from the Adolescent Brain Cognitive Development (ABCD) study. At-risk youth performed worse than controls in episodic memory, executive function, and working memory and exhibited more psychiatric symptoms (i.e., emotional dysfunction, psychosis and externalizing symptoms) than controls. Multivariate partial least squares in at-risk youth revealed a pattern linking heightened psychiatric symptoms with reduced cognitive performance across all domains except executive function, driven primarily by memory and language abilities, suggesting the well-established link between cognitive dysfunction and psychiatric symptoms is already present in at-risk youth, even prior to manifestation of clinically meaningful levels of cognitive impairment or psychiatric symptoms. Such an association could potentially guide prediction, prevention and early intervention for children who are at risk of developing mental illness later in life.