A follow-up study of childhood psychosis.

A cohort of 227 children having attended the same day treatment facility during their childhood was followed-up in adult life. A questionnaire was designed to collect data on various aspects of social and personal adjustment. The length of the follow-up period is 17 years. Information was obtained on 99 subjects whose mean age was 27-years. Of these, 55 had been admitted to the facility for childhood psychosis, and the remaining 44 subjects served as a comparison group. The results show that, in adulthood, the psychotic children fare significantly worse than the controls for employment, autonomy, marriage and the need for continuing medical care. Although non significant, a trend is found in the same direction for educational attainment and medication consumption. We then looked at the clinical and therapeutic variables in the childhood of the psychotic group which were the strongest predictors of adjustment in adulthood. We found that those children who had been admitted at a younger age, whose length of stay in the day treatment hospital had been longer, who scored lower on IQ tests and who had been discharged towards other specialised institutions, were less well adjusted. The results of this study must be interpreted with caution in light of the important attrition during the follow-up period. The discussion then focuses on case definition issues. Emphasis is placed on the need for careful diagnostic assessment and for the use of precise diagnostic assessment and for the use of precise diagnostic criteria. Further, our result on the prognostic significance of IQ level suggests that the assessment of cognitive functioning in autistic and psychotic children is key information which should be more systematically taken into account both in clinical practice and in future research projects.