Targeting Processing Speed Deficits to Improve Social Functioning and Lower Psychosis Risk (SCORES)

Targeting Processing Speed Deficits to Improve Social Functioning and Lower Psychosis Risk in Adolescents at Clinical High Risk for Psychosis

This 10 week intervention, Specific Cognitive Remediation with Surround (or SCORES), is designed to target processing speed, a cognitive domain related directly to social functioning, which in turn, represents a vulnerability factor for psychosis. This remotely-delivered intervention combining targeted cognitive training exercises and group support was developed to directly impact processing speed, and at the same time, boost motivation and engagement in adolescents at risk for schizophrenia and other psychotic disorders.

This study evaluates the effectiveness of a cognitive remediation (CR) program plus group coaching and support designed to improve processing speed and, in turn, social functioning and attenuated positive symptoms in individual considered Clinical High Risk for psychosis. The SCORES (Specific COgnitive REmediation with Support) intervention is a novel Cognitive Remediation program combined with group coaching, performance-based rewards, game-like tasks, and educational elements to increase engagement and retention. The study is funded by a R61/R33 award. In the current active R61 phase, presented here, all participants will complete 40 hours of Cognitive Remediation or brain training (4 hours per week/10 weeks) with a mid-point assessment (at 5 weeks) to determine the training dose needed to impact processing speed as measured by the Matrics Cognitive Consensus Battery. Employing the optimal dose of SCORES (20 or 40 hours) found in the R61, we will apply for the R33 (Phase 2) to allow for a replication and assessment of specificity of the targeted intervention.

Clinical High Risk (CHR), Processing Speed, Social Functioning, Social Impairment, Social Skills, Adolescents, Cognitive Remediation

The study will utilize a Single Group intervention model. All participants will participate in cognitive training with small group support.

All participants will complete 40 hours of Cognitive Remediation with a mid-point assessment (20 hours/5 weeks) to determine the level of training needed to impact processing speed.

This study evaluates the effectiveness of a 10-week cognitive remediation program plus group coaching and therapy to improve processing speed and, in turn, social functioning and attenuated positive symptoms in CHR subjects. The SCORES (Specific COgnitive Remediation with Support) intervention is a novel CR program combined with group coaching, performance-based rewards, game-like tasks, and therapy elements to increase engagement and retention. In the 2 year, R61 phase, all participants will complete 40 hours of CR (4 hrs per week) with a mid-point assessment (20 hours of CR at 5 weeks) to determine the impact of CR on processing speed as measured by the MCCB. The results will inform a potential second study (R33) employing the optimal dose of SCORES (20 or 40 hours) found in the R61. The second future study will allow for a replication and assessment of specificity of the targeted intervention.

Change in GF:Social score from baseline to follow up timepoints. The GF:Social scale scores range from 1 to 10 with higher scores representing better social functioning.

Change in Total Positive Symptom score from baseline to follow up timepoints. Each of the 5 positive symptoms on the SOPS range from 0-6 (6 indicating a psychotic symptom).

Inclusion Criteria: Meet Clinical High Risk (CHR) criteria on the Structured Interview for Psychosis Risk Syndromes, defined by the presence of at least one attenuated positive symptom at a moderate to severe level A score representing 0.5 SD below the mean on Animal Naming, Trails A or BACS: Symbol Coding from the MATRICS Consensus Cognitive Battery (MCCB). Exclusion Criteria: Any DSM 5 Schizophrenia-Spectrum diagnosis Non-English speaking Past or current history of a clinically significant central nervous system disorder (e.g., seizure disorder) Estimated IQ<70 Significant head injury Significant substance abuse Significant visual or auditory impairment.

We plan to make all data collected available as a national resource to the broader scientific community for investigators wishing to pursue their own analyses. Consistent with the NIH policy regarding data sharing, we will share data no later than following acceptance for publication of the main findings from the final dataset, which is expected to occur at the end of year 5. We request that we maintain exclusive access to these data until the end of year 5 to ensure an adequate amount of time for the PIs to conduct analyses and prepare manuscripts for publication. All de-identified data resulting from this NIH-funded award will be submitted to the NIMH Data Archive (NDA) according to this timeline, along with appropriate supporting documentation to enable efficient use of the data by other researchers not involved in the study. Data derived from the proposed study will also be shared through presentation at research conferences and through publication in peer-reviewed journals.

Data will be shared with researchers upon request. Other researchers across the world can then request the pseudo-anonymized study data for other research from the NDA. Every researcher (and institutions to which they belong) who requests the pseudo-anonymized study data must promise to keep the data safe. Experts at the NIH will review each request carefully to reduce risks to participant privacy.