Abstract
BACKGROUND: Social functioning difficulties in adolescents and young adults at clinical high risk for psychosis (CHR-P) are among the strongest risk factors for psychosis onset. Recent research in patients with schizophrenia has demonstrated complex relationships between early auditory processing deficits as measured by the mismatch negativity (MMN) response of the auditory event-related potential, neurocognition, social cognition, negative symptoms, and social functioning. However, the interrelationships of these variables and associations with social functioning impairments prior to the onset of the illness are unclear. The present study used a structural equation modeling (SEM) approach to integrate these factors to determine the specific determinants that lead to poor social functioning in CHR-P youth. METHODS: A total of 518 CHR-P individuals from the NAPLS2 (North American Prodrome Longitudinal Study) were used to evaluate SEMs with pathways starting from MMN to social functioning. The intervening variables included processing speed, social cognition, and negative symptoms. RESULTS: A final trimmed model revealed that early auditory processing (MMN) had a direct effect on processing speed, and both processing speed and negative symptoms had direct effects on social functioning. The direct effect from social cognition to social functioning was not significant. CONCLUSIONS: Our findings suggest that neurophysiological deficits are associated with social functioning by way of processing speed impairments, which fully accounted for the relationship in CHR-P youths prior to psychosis onset. These results may have implications for early intervention strategies that target early information-processing deficits with the aim of improving social trajectories and limiting psychosis onset in young CHR-P individuals.