Cognitive bias and unusual experiences in childhood

Abstract

Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associated with distress or impairment (UEDs; UK National Institute for Health and Care Excellence, 2013 [1]). Accurate models of the psychological underpinnings of childhood UEDs are required to effectively target therapies. Cognitive biases, such as the jumping to conclusions data-gathering bias (JTC), are implicated in the development and maintenance of psychosis in adults. In this study, we aimed to establish the suitability for children of a task developed to assess JTC in adults. Eighty-six participants (aged 5-14 years) were recruited from Child and Adolescent Mental Health Service (CAMHS) and community (school) settings, and completed the probabilistic reasoning ('Beads') task, alongside measures of intellectual functioning, general psychopathology, and UEDs. Self-reported reasoning strategy was coded as 'probabilistic' or 'other'. Younger children (5-10 years) were more likely than older children (11-14 years) to JTC (OR = 2.7, 95 % CI = 1.1-6.5, p = 0.03); and to use non-probabilistic reasoning strategies (OR = 9.4, 95 % CI = 1.7-48.8, p = 0.008). Both UED presence (OR = 5.1, 95 % CI = 1.2-21.9, p = 0.03) and lower IQ (OR = 0.9, 95 % CI = 0.9-1.0, p = 0.02) were significantly and independently associated with JTC, irrespective of age and task comprehension. Findings replicate research in adults, indicating that the 'Beads' task can be reliably employed in children to assess cognitive biases. Psychological treatments for children with distressing unusual experiences might usefully incorporate reasoning interventions.

Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

“…In recent studies, the psychosocial factors implicated in the onset, severity, and maintenance of adult psychosis have been found to also predict the occurrence and severity of childhood UEs [28][29][30][31][32][33][34]. Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30].…”

“…Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30]. We have also shown that reasoning [31] and negative schematic beliefs [32] can both be assessed in children in a similar fashion to adults with psychosis, and could both form useful foci for intervention. However, it remains unclear whether childhood UEs share characteristics of dimension, and content or type, with adult symptoms of psychosis, and, if so, whether there is similar variation in associated psychosocial processes to support the development of targeted interventions.…”

“…The current study was designed to build on our earlier findings supporting the general applicability of CBTp, implicating reasoning, emotional problems and negative life events in overall UE severity [30][31][32], by investigating whether the influence of these cognitive, emotional and social processes differed according to particular characteristics of childhood UEs. We studied a sample of clinically referred 8-14 year olds, some of whom were also participants in our earlier research [30][31][32], and considered similar dimensional attributes and content/type characteristics of childhood UEs to those linked with particular psychosocial processes in studies of adult psychotic symptoms.…”

“…We studied a sample of clinically referred 8-14 year olds, some of whom were also participants in our earlier research [30][31][32], and considered similar dimensional attributes and content/type characteristics of childhood UEs to those linked with particular psychosocial processes in studies of adult psychotic symptoms.…”

“…These theoretical advances have informed the development of targeted CBTp interventions that focus on changing a particular cognitive or emotional process, in the context of a particular symptom presentation. Larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic, undifferentiated CBTp protocols with heterogeneous therapy foci [23][24][25][26][27].In recent studies, the psychosocial factors implicated in the onset, severity, and maintenance of adult psychosis have been found to also predict the occurrence and severity of childhood UEs [28][29][30][31][32][33][34]. Our research has shown that cognitive, emotional and social factors each make independent contributions to overall UE severity, supporting the general applicability of CBTp to this group [30].…”