The Early Psychotic Symptoms Screening Scale (EPSy)<\/strong> is an innovative clinical and developmental psychometric instrument designed by Marie-No\u00eblle Babinet, Caroline Demily, and George A. Michael in 2023. Developed specifically to identify prodromal indicators, ultra-high-risk phenotypes, and early attenuated manifestations of psychosis<\/a> in pediatric cohorts, the instrument covers children aged 4 to 13 years while featuring an innovative dual-epoch measurement paradigm. This paradigm includes a current-age observational evaluation alongside an assessment of retrospective developmental precursors dating back to age two. The scale was established by integrating theoretical foundations and items from recognized instruments such as the Melbourne Assessment of Schizotypy in Kids<\/a> (MASK) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), combined with qualitative field interviews involving multi-disciplinary psychiatric specialists and families of pediatric patients.<\/p>\n Following iterative content validation and psychometric testing, the EPSy was refined from an initial 24-item provisional battery to a 22-item finalized screening tool. These 22 items are organized across three distinct phenomenological dimensions: Mistrust\/Paranoia Symptoms<\/em>, Perceptual Aberrations\/Hallucinations Symptoms<\/em>, and Disorganization Symptoms<\/em>. Each item is rated on a 4-point severity Likert scale ranging from 0 (absent) to 3 (present and representing a major problem). Psychometric evaluations across French-speaking validation cohorts revealed strong internal consistency, with Cronbach’s alpha<\/a> reaching 0.85 for the current-age total scale and 0.90 for the retrospective toddlerhood version. One-year test-retest reliability showed exceptional stability ($r = 0.99$<\/span>). Confirmatory factor analysis verified structural continuity across developmental periods, while robust convergent validity was established against clinical external criteria including the DSM-5 criteria, the Conners Parent Rating Scale (CPRS), and measures of childhood aggression. The EPSy represents a significant advancement in early childhood mental health, providing a reliable screening framework for early detection and targeted developmental intervention.<\/p>\n Childhood Early Psychotic Symptoms, Early Psychotic Symptoms Screening Scale, EPSy, Prodromal Psychosis, Pediatric Schizotypy, Mistrust and Paranoia, Perceptual Aberrations, Hallucinations, Disorganization Symptoms, Child Mental Health Screening, Developmental Psychopathology<\/p>\n The Early Psychotic Symptoms Screening Scale was conceptualized, constructed, and empirically validated by a multidisciplinary team of psychiatric, neurodevelopmental, and cognitive science researchers in Lyon, France:<\/p>\n Correspondence Address:<\/strong> Dr. Marie-No\u00eblle Babinet, CNRS & Universit\u00e9 Lyon 1, UMR 5229, Centre Hospitalier Le Vinatier, 95 Boulevard Pinel, 69500 Bron, France.<\/p>\n The primary clinical and scientific purpose of the Early Psychotic Symptoms Screening Scale (EPSy) is to provide an empirically grounded, developmentally sensitive screening tool capable of identifying attenuated psychotic symptoms, high-risk trajectories, and early behavioral markers of psychosis in children aged 4 to 13 years. Historically, the clinical identification of psychotic risk states has focused predominantly on late adolescence and early adulthood, utilizing standardized semi-structured interviews such as the Comprehensive Assessment of At-Risk Mental States (CAARMS<\/a>) or the Structured Interview for Psychosis-Risk Syndromes (SIPS<\/a>). However, accumulating developmental evidence indicates that subtle neurodevelopmental anomalies, social-cognitive distortions, atypical communicative patterns, and transient hallucinatory phenomena emerge substantially earlier in childhood. The EPSy addresses this gap by capturing these early signs before secondary functional impairment occurs.<\/p>\n In addition to cross-sectional evaluations of school-aged children, the EPSy features a retrospective developmental component designed to assess behavioral markers at two years of age. This retrospective assessment allows clinicians and researchers to capture early indicators of neurodevelopmental vulnerability, including gaze aversion, sensory dysregulation, atypical emotional resonance, and motor or behavioral anomalies. By establishing a bridge between early childhood indicators and middle childhood presentations, the instrument helps delineate continuous developmental trajectories toward serious mental illness.<\/p>\n In routine clinical practice, pediatric psychiatrists, clinical psychologists, school counselors, and specialized developmental clinics can administer the EPSy to identify children exhibiting clinical profiles that warrant comprehensive diagnostic workups. Early detection facilitates secondary preventive interventions, including family psychoeducation, social-cognitive rehabilitation, sensory-motor integration, and specialized therapeutic support. In developmental research, the scale provides a standardized measure for longitudinal investigations into the genetic, neurological, environmental, and behavioral determinants of psychotic disorders.<\/p>\n The overarching psychological construct assessed by the EPSy is Early Childhood Psychotic Symptoms<\/strong>, conceptualized as a multi-dimensional continuum of attenuated psychotic phenomena, schizotypal traits, and neurodevelopmental vulnerabilities observed during pediatric development. Rather than treating psychosis as a sudden categorical break, the EPSy conceptualizes it as a dynamic developmental continuum spanning three distinct, interrelated dimensions:<\/p>\n This subscale assesses emerging persecution complexes, social-evaluative paranoia, hyper-vigilance, and related social-affective deficits. Items measure beliefs that other children or adults intend harm, subjective feelings of being mocked or singled out, unprovoked interpersonal suspicion, and withdrawal from peer groups during unstructured social interactions (such as school recesses). The dimension also evaluates social-cognitive vulnerabilities, including impaired social-gaze processing, difficulty interpreting nonverbal emotional cues, problems with affective self-regulation, and heightened, unprovoked anxiety in benign everyday situations.<\/p>\n This dimension assesses anomalous sensory experiences and non-normative cognitive contents. Given the developmental frequency of imaginary companions and night terrors in young children, this subscale focuses on persistent, distressing, or atypical sensory experiences. It measures verbalized auditory and visual percepts occurring without external stimuli, unusual nocturnal perceptions, unshared multisensory hallucinations (including olfactory, gustatory, and somatic sensations), and peculiar, eccentric beliefs that deviate noticeably from cultural and age-appropriate norms.<\/p>\n This subscale captures structural disruptions in thought, speech, communication, and executive behavioral organization. Indicators include difficulty distinguishing internally generated fantasies from external reality, loose associations, tangential speech, and communicative derailment that impedes mutual understanding. In addition, the dimension tracks paralinguistic and motor disorganization, such as atypical vocal intonation (e.g., flat, monotone, or inappropriately modulated vocal pitch), erratic and purposeless motor behaviors, and conversational dysfluency characterized by intrusive interruptions and abrupt cognitive shifts.<\/p>\n The EPSy is grounded in the Neurodevelopmental Model of Schizophrenia and Psychotic Disorders<\/strong>, pioneered by researchers such as Daniel Weinberger, Robin Murray, and Elaine Walker. This paradigm posits that psychosis is not simply an adult-onset degenerative event, but the downstream manifestation of early neurodevelopmental vulnerabilities involving genetic susceptibility, disrupted synaptic pruning, perinatal neurobiological insults, and atypical neural maturation. These vulnerabilities manifest throughout early childhood as subtle cognitive, neuromotor, social-emotional, and sensory abnormalities, well before the emergence of florid delusions or hallucinations.<\/p>\n Complementing this neurodevelopmental perspective is the Schizotypy Spectrum and Quasi-Dimensional Theory<\/strong>, formulated by Paul Meehl and expanded by modern developmental psychopathologists. Schizotypy suggests that vulnerability to schizophrenia is distributed along a phenotypic continuum. At one end are subclinical personality traits, progressing through attenuated psychotic symptoms, and culminating in full psychotic episodes when combined with cumulative environmental stressors. Instruments like the Melbourne Assessment of Schizotypy in Kids (MASK) by Jones et al. demonstrated that schizotypal traits can be reliably identified in childhood. The EPSy builds on this work by combining schizotypal trait assessments with childhood emotional screening frameworks\u2014such as the Screen for Child Anxiety Related Emotional Disorders (SCARED)\u2014reflecting the clinical observation that affective dysregulation and anxiety often precede paranoid interpretations.<\/p>\n Finally, the EPSy incorporates contemporary Predictive Processing and Social-Cognitive Developmental Models<\/strong>. These models propose that early psychotic manifestations emerge from altered sensory processing and aberrant prediction error signaling. When a child’s brain cannot accurately integrate perceptual inputs with contextual expectations, ordinary environmental stimuli are experienced as confusing, threatening, or hyper-salient. Over time, these sensory aberrations foster paranoid attributions and disorganized speech patterns as the developing child attempts to make sense of altered sensory experiences.<\/p>\n The validation of the EPSy was conducted through two distinct empirical investigations in France, evaluating construct, convergent, predictive, and factorial validity:<\/p>\n Convergent validity was established by comparing the EPSy against established clinical measures. Total and subscale scores from both the current-age and retrospective 2-years-old versions demonstrated statistically significant correlations with validated instruments:<\/p>\n Predictive validity across developmental stages was confirmed through longitudinal regression models:<\/p>\n The EPSy exhibits strong internal consistency across its full-scale scores and component subscales, as well as high temporal stability across prolonged intervals:<\/p>\n Temporal stability was evaluated using a rigorous one-year test-retest interval<\/strong>:<\/p>\n The factorial architecture of the EPSy was determined through exploratory and confirmatory factor analytic procedures:<\/p>\n An initial 24-item provisional pool was subjected to Principal Component Analysis (PCA) to delineate the underlying factor structure. The analysis revealed three primary components accounting for $37.4%$<\/span> of the total cumulative variance. Two items (Item 6 and Item 14) failed to load meaningfully on any latent factor, indicating inadequate sensitivity or conceptual mismatch within the clinical construct. These two items were removed, resulting in a refined 22-item instrument.<\/p>\n To evaluate structural invariance and assess whether the three-factor model of the current-age version applied to early toddlerhood behaviors, a Confirmatory Factor Analysis (CFA) was conducted on the 2-years-old retrospective data. The analysis evaluated the 22-item, three-factor configuration:<\/p>\n These fit indices indicated an acceptable baseline structural fit for a complex developmental phenotype. The data confirmed that the three-factor structure established in middle childhood (Mistrust\/Paranoia, Perceptual Aberrations\/Hallucinations, and Disorganization) provides a coherent framework for retrospective toddlerhood evaluations as well.<\/p>\n The Early Psychotic Symptoms Screening Scale was published in 2023<\/strong> by Marie-No\u00eblle Babinet, Caroline Demily, and George A. Michael. The instrument is not a commercial product; there are no fees or licensing costs required for its administration. The scale is freely accessible for non-profit academic research, scientific investigations, and clinical training purposes under standard scholarly fair-use and attribution guidelines. Researchers and clinicians wishing to employ the scale in clinical trials, large-scale epidemiological screenings, or translational diagnostic studies should reference the original validation study published in Psychiatry Research<\/em> and direct institutional inquiries to Dr. Marie-No\u00eblle Babinet at marie-noelle.babinet@ch-le-vinatier.fr<\/a>.<\/p>\n Response Scale:<\/strong><\/p>\n Each of the 22 items is rated on a Likert scale that ranges from 0 to 3. The test can be administered electronically or via a paper-and-pencil format.<\/p>\n Note: Two items from the initial 24-item battery (Items 6 and 14) did not load on either factor during factor analysis and were dropped from the final scale.<\/em><\/p>\n2. Keywords<\/h2>\n
3. Authors<\/h2>\n
\n
4. Purpose<\/h2>\n
5. Psychological Construct<\/h2>\n
1. Mistrust and Paranoia Symptoms<\/h3>\n
2. Perceptual Aberrations and Hallucinations Symptoms<\/h3>\n
3. Disorganization Symptoms<\/h3>\n
6. Theoretical Framework<\/h2>\n
7. Validity<\/h2>\n
Convergent and Criterion Validity<\/h3>\n
\n
Predictive and Longitudinal Regression Analysis<\/h3>\n
\n
8. Reliability<\/h2>\n
Internal Consistency<\/h3>\n
\n
Test-Retest Reliability<\/h3>\n
\n
9. Factor Analysis<\/h2>\n
Exploratory Principal Component Analysis (PCA)<\/h3>\n
Confirmatory Factor Analysis (CFA)<\/h3>\n
\n
10. Instrument \/ Measurement Tool<\/h2>\n
\n
\n
\n
11. Permissions & Fee and Test Year<\/h2>\n
12. References<\/h2>\n
\n
13. Items of the Scale<\/h2>\n
\n
Mistrust\/Paranoia Symptoms (13 items)<\/h3>\n
\n
\n English:<\/strong> Feels like people around him intend to hurt him\n <\/li>\n
\n English:<\/strong> Is suspicious of others or of situations\n <\/li>\n
\n English:<\/strong> Thinks that other people are laughing at him\n <\/li>\n
\n English:<\/strong> Has a tendency to be isolated whether in the playground or outside of school\n <\/li>\n
\n English:<\/strong> Reacts inappropriately to other people’s emotions, making them think he does not understand them\n <\/li>\n
\n English:<\/strong> Has difficulty dealing with his own emotions\n <\/li>\n
\n English:<\/strong> Tends not to look people in the eye, to avoid the gaze of others\n <\/li>\n
\n English:<\/strong> Behaves inappropriately when people look at him, as if he is misinterpreting them\n <\/li>\n
\n English:<\/strong> His speech contains unusual intonations (e.g. monotonous voice, lack of rhythm in his speech, does not change the volume of his voice depending on the place or the situation)\n <\/li>\n
\n English:<\/strong> Has difficulty understanding humor, irony or innuendo\n <\/li>\n
\n English:<\/strong> Is anxious, stressed\n <\/li>\n
\n English:<\/strong> Appears scared or panicked by trivial situations\n <\/li>\n
\n English:<\/strong> Is inexplicably or unusually suspicious of events or people\n <\/li>\n<\/ol>\nPerceptual Aberrations\/Hallucinations Symptoms (4 items)<\/h3>\n
\n
\n English:<\/strong> Has ideas, beliefs that seem unusual or weird\n <\/li>\n
\n English:<\/strong> Has spoken about things he sees or hears at night\n <\/li>\n
\n English:<\/strong> Seems to see or hear things that others cannot see\n <\/li>\n
\n English:<\/strong> Talks about intensified, impaired or bizarre sounds, sights, smells or sensations\n <\/li>\n<\/ol>\nDisorganization Symptoms (5 items)<\/h3>\n
\n
\n English:<\/strong> Does not distinguish between the stories he tells and reality\n <\/li>\n
\n English:<\/strong> Has confused speech that prevents the person he is talking to from following what he is talking about and understanding him\n <\/li>\n
\n English:<\/strong> His speech contains unusual intonations (e.g. monotonous voice, lack of rhythm in his speech, does not change the volume of his voice depending on the place or the situation)\n <\/li>\n