Neurocognition and Social Cognition as Risk Markers in Adolescents: A Comparative Study of Asymptomatic Siblings of Early-Onset Schizophrenia and Bipolar Disorder

Neurocognition and Social Cognition as Risk Markers in Adolescents: A Comparative Study of Asymptomatic Siblings of Early-Onset Schizophrenia and Bipolar Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neurocognition and Social Cognition as Risk Markers in Adolescents: A Comparative Study of Asymptomatic Siblings of Early-Onset Schizophrenia and Bipolar Disorder Safak Eray Camli, Seymanur Bukru, Aylin Bandirma, Caner Mutlu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8966245/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Early-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) share overlapping clinical and genetic features. This study aims to compare the neuro-social cognitive profiles of healthy siblings of adolescents with EOS (EOS-Sib) and BD (BD-Sib) to identify potential endophenotypes and evaluate the impact of environmental stressors, such as childhood trauma, on these profiles. The study included 164 participants: 36 EOS-Sib, 40 BD-Sib, and 88 healthy controls (HC) aged 11–23. All subjects underwent a rigorous screening process using the semi structured interview ( K-SADS-PL) to exclude any psychopathology. Cognitive performance was assessed using the University of Pennsylvania Computerized Neurocognitive Battery. Also Childhood Trauma Questionnaire and Children’s Depression Rating Scale are used for the clinical evaluation. A composite 'G-score' was derived to represent global neurocognitive performance. Both EOS-Sib and BD-Sib groups exhibited significant deficits in executive functions, working memory, and emotion recognition (ER) compared to HC (p < .001). No significant differences were found between the two sibling groups in G-score. ANCOVA results revealed that while childhood trauma impaired ER performance independent of diagnosis (p=.013), it did not affect general neurocognition. ROC analysis demonstrated that the G-score had high discriminative power (AUC = .805) in distinguishing risk carriers from controls, with an optimal cut-off of 0.35 (sensitivity: 73%, specificity: 74%). The EOS-Sib and BD-Sib share a common neurocognitive endophenotype characterized by global impairment. The G-score serves as a robust objective marker for familial risk screening. Furthermore, the findings highlight that environmental stressors like trauma specifically exacerbate social cognitive deficits, suggesting that early intervention strategies should integrate both cognitive remediation and trauma-focused psychosocial support. Early-Onset Schizophrenia Bipolar Disorder Endophenotype Neurocognition Social Cognition Siblings Figures Figure 1 Figure 2 Figure 3 Introduction Early-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) are neurodevelopmental disorders that typically emerge during adolescence, have a chronic course, and significantly impair an individual's social, academic, and occupational functioning [ 1 , 2 , 3 ]. While the global prevalence of schizophrenia is approximately 1% [ 4 ], the prevalence of BD ranges from 1% to 3% [ 5 ]. The early onset of both disorders is associated with a more severe clinical Picture [ 6 , 7 ]. The diagnostic boundaries of these diseases are often blurred, particularly due to overlapping symptoms (such as psychotic features or mood swings) during adolescence[ 8 ]. To overcome this complexity and understand the biological manifestations of genetic risk, the concept of ‘endophenotype’ has come to the fore. Cognitive dysfunction is considered a key candidate endophenotype for both EOS and BD; this makes the study of healthy siblings who have not yet developed clinical symptoms but carry genetic risk a critical area of research [ 9 , 10 ]. The literature describes distinct cognitive profiles for both risk groups. Studies on healthy siblings of individuals with BD (BD-Sib) show that, despite being clinically healthy, these individuals exhibit moderate deficits compared to healthy controls, particularly in executive functions, verbal memory, and attention [ 10 ]. Healthy siblings of individuals with EOS (EOS-Sib), on the other hand, are generally characterized by more widespread and profound neurocognitive deficits; impairments in working memory, sensorimotor speed, and social cognition are particularly striking in this group [ 12 ]. However, a common finding for both groups is impairments in social cognition and, in particular, emotion recognition (ER) processes [ 12 , 13 ]. A key point of debate is how much of this cognitive weakness is due to genetic ‘endophenotype’ characteristics and how much is shaped by environmental factors such as childhood trauma or chronic stress within the family experienced by the siblings. This distinction is a critical threshold for understanding the etiology of both disorders [ 9 , 14 ]. Although there are numerous independent studies on siblings with EOS and BD in the current literature, the number of studies directly comparing both risk groups within the same methodological framework and simultaneously is quite limited. This situation makes it difficult to evaluate the neurocognitive similarities and differences between the two disorders from a comprehensive perspective [ 15 , 16 ]. Furthermore, insufficient attention has been paid to the cut-off points required for the cognitive impairments observed in sibling groups to be used as a ‘risk marker’ in clinical practice, and to the diagnostic accuracy (sensitivity and specificity) of these cut-off points [ 17 ]. Although the value of neurocognitive performance as an endophenotype is frequently emphasized, concrete data on which cognitive score can most accurately distinguish an individual as a ‘genetic risk carrier’ from healthy controls is lacking [ 18 ]. This gap hinders both the development of early intervention strategies and the objective assessment of familial transmission risk [ 17 ]. The primary aim of this study is to compare healthy siblings (BD-Sib and EOS-Sib) of adolescents diagnosed with BD and EOS with healthy controls (HC) using the University of Pennsylvania Computerized Neurocognitive Battery (Penn CNB). By incorporating assessments of childhood trauma and depressive symptoms, we specifically aimed to evaluate these risk groups while controlling for potential confounding factors that may influence cognitive outcomes. We also aimed to determine the strongest ‘G-score’ and ER threshold scores that could distinguish these risk groups from healthy controls, thereby assessing the value of cognitive performance as a risk marker. Our hypotheses are: (1) Both sibling groups will show significantly lower performance than healthy controls, particularly in executive functions and social cognition; (2) The neurocognitive and social cognitive profile of the EOS-Sib group will show more widespread impairment compared to the BD-Sib group; (3) Childhood traumas or depressive symptoms will have a decisive effect on neurocognition and social cognition scores; (4) The neurocognitive G-score will be a powerful parameter that can distinguish both risk groups from the healthy population with high sensitivity. Participants and Study Design The study sample was recruited from the Child and Adolescent Psychiatry outpatient and inpatient units at XXXXXXX University Faculty of Medicine. The final cohort comprised 164 adolescents aged 11 to 23 years, categorized into three distinct groups: BD-Sib (n = 40) : Asymptomatic siblings of patients with Bipolar Disorder. EOS-Sib (n = 36) : Asymptomatic siblings of patients with Early-Onset Schizophrenia. Healthy Controls (HC, n = 88) : Individuals with no personal or familial history of psychiatric illness. To ensure environmental and sociocultural consistency, the HC group was selected from the same residential areas as the clinical groups. All subjects underwent a rigorous screening process using the K-SADS-PL [ 19 , 20 ] to exclude any current or lifetime psychopathology. Additional exclusion criteria included intellectual disability as determined by clinical examination and chronic medical conditions. Power Analysis To determine the required sample size for detecting differences between groups, an a-priori power analysis was conducted using G*Power (v3.1.9.7). Assuming a medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.80 for a one-way ANOVA, the minimum total sample size required for three groups was calculated to be 159. To account for potential data loss or incomplete responses, we recruited a total of 164 participants [ 21 ]. Assessment Tools: The following instruments were utilized to collect data and evaluate the clinical profiles of the participants: Clinical Scales: Sociodemographic Data Form : A custom-designed form was used to record the baseline characteristics of the participants, including their age, gender, and socio-economic status. K-SADS-PL (Present and Lifetime Version) : To establish comprehensive current and past psychiatric diagnoses, the School-Aged Children’s Mood Disorders and Schizophrenia Interview Schedule was administered [ 18 ]. Ünal et al. (2016) confirmed the Turkish validity and reliability of this semi-structured interview [ 19 ]. Child Depression Rating Scale-Revised (CDRS-R) : Depression severity was quantified using the CDRS-R, an instrument adapted from the Hamilton Depression Rating Scale by Mayes et al. [ 22 ], and the psychometric properties of the Turkish version were validated by Güney et al. [ 23 ]. Childhood Trauma Questionnaire (CTQ-33) : A retrospective assessment of childhood neglect and abuse was conducted using the CTQ-33 [ 24 ]. This study used the Turkish cultural adaptation conducted by Vedat Şar et al. in 2021 [ 25 ]. Neurocognitive Assessment: Cognitive and social cognitive performance was evaluated using the University of Pennsylvania Computerized Neurocognitive Battery (Penn CNB) [ 26 , 27 ]. The battery assessed four primary domains: Executive Functions : PCET, LNB2, and Penn Continuous Performance Test. Episodic Memory : CPF, CPFD, and SVOLT. Sensorimotor Speed : Motor Praxis and Finger Tapping tests. Social Cognition : The ER40 (Emotion Recognition Task) served as the primary measure for objective social cognition. Composite Scoring : Following the protocol by Moore et al. (2015), an overall 'G score' was derived by standardizing individual test accuracies into Z-scores and calculating their aggregate mean [ 28 ]. Procedure and Ethics Ethical approval was granted by the xxxxx University Ethics Committee (No: 2026/63/3–7), and the study adhered to the Declaration of Helsinki. After obtaining written informed consent from participants and their guardians, clinical assessments were conducted. Following a 10-minute resting period, the 50-minute Penn CNB was administered in a single session without interruptions. Data from participants unable to complete the full battery were excluded to ensure consistency. Statistical Analysis All statistical analyses were performed using SPSS version 28. Normality was assessed using the Shapiro-Wilk test. Due to the non-parametric distribution of several variables, the Kruskal-Wallis H test was employed for intergroup comparisons of neurocognitive and clinical scores. Post-hoc pairwise comparisons were conducted with Bonferroni correction to control for Type I error. To evaluate the independent effect of group status on neurocognition and social cognition while controlling for confounding variables (maternal/paternal education, depression, and childhood trauma), Analysis of Covariance (ANCOVA) was performed. Effect sizes were reported as partial eta squared (ηp 2 ) for ANCOVA and epsilon squared (ϵ 2 ) for Kruskal-Wallis tests. Furthermore, Receiver Operating Characteristic (ROC) curve analysis was conducted to determine the discriminative power of the Neurocognitive G-score and Emotion Recognition in identifying individuals at genetic risk (Bipolar and EOS siblings) versus healthy controls. The optimal cut-off points were determined using the Youden Index (Sensitivity + Specificity − 1). Results 1.Demographic Characteristics No statistically significant difference was found between the Sibling of Bipolar (14.95 ± 2.16), Sibling of EOS (15.36 ± 2.74), and Healthy Control (15.70 ± 2.37) groups in terms of age. Similarly, gender distribution did not differ significantly across the groups (p = .61). The groups were well-matched in terms of both age and gender. Gender distribution was compared across the three groups, and no statistically significant difference was found (p=.61). The Bipolar sibling group consisted of an equal number of participants (n = 20 female, n = 20 male). The Healthy Control group included 39 females (44.3%) and 49 males (55.7%), while the Sibling of EOS group was comprised of 19 females (52.8%) and 17 males (47.2%). These results indicate that the groups were well-matched in terms of gender. Table 1 Comparison of Sociodemographic variables of groups Variables Sibling of Bipolar (n = 40) Healthy Control (n = 88) Sibling of EOS (n = 36) Test Statistic p Age (Years) (Mean ± SD) 14.95 ± 2.16 15.70 ± 2.37 15.36 ± 2.74 F = 1.34 .265 Gender , n (%) χ² = 0.98 .610 Female 20 (50.0%) 39 (44.3%) 19 (52.8%) Male 20 (50.0%) 49 (55.7%) 17 (47.2%) Family Income Level* , n (%) χ² = 2.06 .357 Low 0 (0.0%) 3 (3.4%) 2 (5.6%) Medium/High 40 (100.0%) 85 (96.6%) 34 (94.4%) Maternal Education , n (%) χ² = 28.23 < .001 * Primary/Secondary (Low) 22 (55.0%) 18 (20.5%) 20 (55.6%) (Fisher) High School (Medium) 8 (20.0%) 11 (12.5%) 5 (13.9%) University (High) 10 (25.0%) 59 (67.0%) 11 (30.6%) Paternal Education , n (%) χ² = 14.34 .005 * Primary/Secondary (Low) 9 (22.5%) 10 (11.4%) 15 (41.7%) (Fisher) High School (Medium) 4 (10.0%) 7 (8.0%) 3 (8.3%) University (High) 27 (67.5%) 71 (80.7%) 18 (50.0%) * Family income was categorized based on the minimum wage 2.Neurocognitive Performance and Social Cognition (PennCNB) Social Cognition A significant group effect was found in ER (p = .003), where healthy controls performed significantly better than both sibling groups. Sensorimotor Speed & Memory For Motor Praxis Speed, healthy controls were significantly faster than both risk groups (p < .001). In episodic memory tasks, while Visual Object Learning (immediate) showed no significant difference (p = .057), the Delayed Visual Object Learning scores were significantly lower in both sibling groups compared to controls (p = .014). Executive Control Significant deficits were observed in the sibling groups for the Conditional Exclusion Task (p < .001) and working memory tasks, including Letter N-Back (p .05). Overall Performance Consequently, the Total Neurocognitive Score (G Score) showed a highly significant difference (p < .001), indicating global cognitive impairment in both BD and EOS sibling groups compared to healthy controls. The comparison of neurocognitive and social cognition performance across groups is presented in Table 2 and Fig. 1 – 2 Table 2 Comparison of the Social Cognition and Neurocognition Subtests of the Groups Domain / Measure Sibling of Bipolar (n = 40) Sibling of EOS (n = 36) Healthy Control (n = 88) Test Statistic p-value Effect Size PENNCNB Median (Min-Max) Median (Min-Max) Median (Min-Max) χ2 (df = 2) Sig. ϵ2 Social Cognition Emotion Recognition 32.0 (22.0–37.0) a 31.0 (14.0–37.0) a 34.0 (23.0–39.0) b 11.536 .003 0.071 (Medium) Sensorimotor Motor Praxis Test Speed 708.0 (447–1344) a 804.0 (492–1999) a 619.5 (386–1372) b 30.638 < .001 0.188 (Large) Episodic Memory Visual Object Learning Task-Correct Response 15.0 (7.0–19.0) 15.0 (9.0–19.0) 16.0 (11.0–20.0) 5.727 .057 0.035 (Small) Visual Object Learning Task Delayed-Correct Response 14.0 (7.0–19.0) a 14.0 (9.0–19.0) a 16.0 (9.0–19.0) b 8.528 .014 0.052 (Small) Executive Functions Conditional Exclusion Task Accuracy 1.43 (0.04–3.37) a 2.23 (0.25–3.43) a 2.94 (0.04–3.64) b 35.250 < .001 0.216 (Large) Continuous Performance Number True Positive 25.0 (3.0–30.0) 24.0 (1.0–30.0) 25.0 (1.0–30.0) 5.862 .053 0.036 (Small) Continuous Performance Letter True Positive 24.0 (12.0–29.0) 23.0 (1.0–30.0) 26.0 (1.0–30.0) 4.205 .122 0.026 (Small) Letter- and- Back 2 Task correct response 12.0 (6.0–15.0) a 12.0 (2.0–15.0) a 14.0 (4.0–15.0) b 13.918 .001 0.085 (Medium) Global Cognition Total Nörocognitive Score (G Score)** 0.05 (-1.6–1.2) a -0.82 (-2.5–1.4) a 0.67 (-1.3–1.8) b 35.845 < .001 0.220 (Large) * Kruskal Wallis analysis was applied. Data are presented as Median (Minimum-Maximum). Statistical analysis performed using Kruskal-Wallis H test. Bold values indicate statistical significance (p 0.14 (large). a,b The group from which the difference originates. 3.Trauma History and Depression Levels When childhood trauma histories were examined using the CTQ-33, no significant differences were found between the groups in terms of emotional abuse, sexual abuse, emotional neglect, or overprotection/overcontrol (p > .05). However, significant differences were detected in physical abuse (p = .044), physical neglect (p < .001), and total CTQ scores (p = .035). Specifically, the Sibling of EOS group reported significantly higher levels of physical neglect and total trauma scores compared to healthy controls. Regarding depression levels, the CDRS scores differed significantly among all three groups (p < .001), with the risk groups exhibiting higher depression scores than the control group. The comparison of the PTSD - CDRS –RCADS Scores of the Groups are given in Table 3 . Table 3 Comparison of the PTSD - CDRS –RCADS Scores of the Groups Measure / Scale Sibling of Bipolar (n = 40) Sibling of EOS (n = 36) Healthy Control (n = 88) Test Statistic p-value Effect Size Median (Min-Max) Median (Min-Max) Median (Min-Max) χ2 (df = 2) Sig. ϵ2 Childhood Trauma (CTQ) Emotional Abuse 5.0 (5.0–18.0) 7.0 (5.0–15.0) 6.0 (5.0–20.0) 4.568 .102 0.028 (Small) Physical Abuse 5.0 (5.0–10.0) a 5.0 (5.0–10.0) b 5.0 (5.0–10.0) a 6.257 .044 0.038 (Small) Sexual Abuse 5.0 (5.0–10.0) 5.0 (5.0–8.0) 5.0 (5.0–17.0) 4.127 .127 0.025 (Small) Emotional Neglect 9.0 (5.0–23.0) 11.0 (5.0–20.0) 9.0 (5.0–20.0) 5.438 .066 0.033 (Small) Physical Neglect 6.0 (5.0–13.0) a 7.0 (5.0–17.0) a 5.0 (5.0–14.0) b 18.067 < .001 0.111 (Medium) Overprotection 8.0 (5.0–25.0) 10.0 (5.0–23.0) 8.0 (5.0–17.0) 2.408 .300 0.015 (Small) CTQ Total Score 39.0 (30–94) a 49.0 (30–84) b 40.0 (30–74) c 6.696 .035 0.041 (Small) Clinical Scores Depression (CDRS) 25.0 (17–44) a 30.0 (19–44) b 20.0 (17–31) 33.421 < .001 0.205 (Large) RCADS_Total 40.0 (2.0–88) 30.0 (6.0–110) 32.0 (5.0–74) 0.923 .630 0.006 (Negligible) RCADS-Anxiety 30.0 (2.0–74.0) 22.0 (4.0–91.0) 26.0 (5.0–63.0) 0.394 .821 0.002 (Negligible) RCADS-Depression 7.0 (0.0–26.0) 7.0 (0.0–21.0) 7.0 (0.0–20.0) 0.535 .765 0.003 (Negligible) * Kruskal Wallis analysis was applied. a,b,c The group from which the difference originates. * Kruskal Wallis analysis was applied. Data are presented as Median (Minimum-Maximum). Statistical analysis performed using Kruskal-Wallis H test. Bold values indicate statistical significance (p 0.14 (large). 4.1. Intergroup Neurocognitive Performance and the Effect of Confounding Factors The ANCOVA model, which included parental education, depression, and trauma as covariates, significantly predicted the Neurocognitive G Score (F(6,151) = 7.78,p<.001). The model explained 23.6% of the variance in neurocognitive performance (R2=.236, Adjusted R2=.206). Although the groups were initially matched for age and gender, significant differences were observed in parental education levels. To ensure that the observed neurocognitive deficits were not driven by these socioeconomic differences, maternal and paternal education levels were included in the model. The results indicated that neither maternal (p=.355) nor paternal education (p=.216) had a statistically significant effect on the Neurocognitive G Score. Similarly, depression and trauma scores were not significant predictors. Even after controlling for these potential confounders, the main effect of Group remained highly significant (F(2,151) = 12.11,p<.001). The partial eta squared (ηp2​) was .138, indicating a large effect size. Post-hoc analyses confirmed that the Healthy Control group performed significantly better than both the BD-Sib and EOS-Sib groups, with no significant difference observed between the two risk groups. 4.2. The Specific Effect of Trauma on Emotion Recognition The generated ANCOVA model for Emotion Recognition was statistically significant (F(6,151) = 4.83,p<.001) and accounted for 16.1% of the total variance in emotion recognition scores (R2=.161, Adjusted R2=.128). Since the data did not exhibit a normal distribution, the analysis was reinforced using Bootstrapping (1000 samples, BCa 95% Confidence Interval). The results revealed a distinct pattern compared to general neurocognition. While parental education levels and depression severity did not significantly predict emotion recognition performance (p>.05), childhood trauma (CTQ) emerged as a significant covariate (p=.013). Specifically, higher levels of childhood trauma were associated with lower emotion recognition accuracy (B = -0.072) , independent of the diagnosis. Crucially, even after controlling for the significant effect of trauma, the main effect of Group remained statistically significant (F(2,151) = 6.37,p=.002,ηp2​=.078). This finding suggests that while social cognition deficits are partly influenced by environmental stress factors like trauma, the diagnostic risk status exerts a significant independent effect. ANCOVA Results for Neurocognitive and Social Cognition Measures Controlling for Confounders are given in Table 4 . Table 4 ANCOVA Results for Neurocognitive and Social Cognition Measures Controlling for Confounders Dependent Variable Source df F p ηp2​ Pairwise Comparisons (Bonferroni) Neurocognitive G Score Corrected Model 6 7.78 < .001 .236 Maternal Education 1 0.86 .355 .006 Paternal Education 1 1.54 .216 .010 Depression (CDRS) 1 2.66 .105 .017 Trauma (CTQ) 1 0.33 .570 .002 Group (Main Effect) 2 12.11 BP-Sib; HC > EOS-Sib Emotion Recognition Corrected Model 6 4.83 < .001 .161 Maternal Education 1 0.01 .933 .000 Paternal Education 1 0.65 .420 .004 Depression (CDRS) 1 1.82 .180 .012 Trauma (CTQ) 1 6.28 .013 * .040 (Negative Correlation) Group (Main Effect) 2 6.37 .002 * .078 HC > BP-Sib; HC > EOS-Sib Note: HC: Healthy Control, BP-Sib: Sibling of Bipolar Disorder, EOS-Sib: Sibling of Early Onset Schizophrenia. Significant values are bolded (p < .05).For Emotion Recognition, bootstrapping (1000 samples) was applied. The effect of Trauma (CTQ) was confirmed significant (p = .026 with bootstrap), while parental education remained non-significant. The diagnostic accuracy of neurocognitive and social cognitive measures in distinguishing siblings (Bipolar and EOS) from healthy controls was evaluated using ROC curve analysis. The Neurocognitive G Score demonstrated a high discriminative power with an AUC of .805 (95% CI: .733–.876, p < .001). At a cut-off value of 0.35, the G Score yielded a sensitivity of 73% and a specificity of 74%. Emotion Recognition also showed significant discriminative ability with an AUC of .691 (95% CI: .599–.782, p < .001). These findings suggest that global neurocognitive impairment serves as a more robust marker for familial risk than social cognition alone. ROC curve analysis of Neurocognitive G Score and Emotion Recognition are given in Table 5 and Fig. 3 . Table 5 ROC curve analysis of Neurocognitive G Score and Emotion Recognition Test Variable AUC 95% Confidence Interval SE p-value Optimal Cut-off Sensitivity Specificity Neurocognitive G Score .805 [.733, .876] .036 < .001 0.35 73% 74% Emotion Recognition .691 [.599, .782] .047 < .001 33.5 74% 55% AUC : Area Under the Curve. SE : Standard Error. Optimal Cut-off : Calculated using the Youden Index (Sensitivity + Specificity – 1). Risk Groups : Combined Sibling of Bipolar Disorder and Sibling of Early Onset Schizophrenia (EOS). Discussion This study directly compares the neurocognitive and social cognitive profiles of adolescents diagnosed with Early-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) with those of their healthy siblings, and examines the diagnostic specificity of these profiles. Our key findings indicate that both risk groups exhibit global cognitive impairment compared to healthy controls, and that the composite neurocognitive score, defined as the ‘G-score’, can distinguish these groups from the healthy population with high accuracy. Furthermore, it was found that childhood traumas have a specific disruptive effect on social cognition (ER) rather than general cognitive performance, and that this effect operates independently of genetic risk. Our findings support the ‘cognitive endophenotype’ hypothesis in the literature, as both sibling groups exhibit deficits in areas such as executive functions, working memory, and motor speed [ 29 ]. Interestingly, no statistically significant difference was found between EOS and Bipolar siblings in terms of global cognitive performance; this may indicate that both disorders share a common familial predisposition at the cognitive level [ 30 ]. One of the most original contributions of our study, the ROC analysis results, revealed that the G-score with a threshold value of 0.35 could distinguish genetic risk carriers with 73% sensitivity and 74% specificity. This high AUC value (.805) demonstrates that neurocognitive batteries can be used as a concrete marker in early-stage risk screening in clinical practice [ 31 ]. In the field of social cognition, the fact that both risk groups performed worse than healthy controls on ER tests confirms that this domain is also an important candidate endophenotype [ 32 , 33 ]. However, one of the most striking findings of this study is that childhood trauma subscales, particularly levels of physical neglect, were found to be significantly higher in the EOS-sibling (psychosis risk) group than in all other groups. This can be explained by the neglect of healthy siblings (failures in meeting social and physical needs) as a result of resources and attention within the family being channeled to the individual with a chronic and severe illness [ 34 ]. On the other hand, our statistical analyses revealed that while the history of trauma did not affect general neurocognitive performance, it had an independent disruptive effect on emotion recognition ability. In conclusion, although social cognition is impaired as a genetic predisposition in both risk groups, the deepened pattern of physical neglect in the psychosis risk group may further fragilize social cognitive development as an environmental burden superimposed on genetic risk [ 35 , 36 ].This finding suggests that environmental stressors are a critical variable in social cognitive development that interacts with genetic predisposition and, in some cases, independently lowers performance. This indicates that interventions in at-risk groups should include not only cognitive rehabilitation but also trauma-focused psychosocial support processes [ 37 ]. Despite the significant contributions of this research, several limitations must be acknowledged. First, although our sample size meets the requirements for statistical power analysis, studies involving larger cohorts would further enhance the generalizability of these findings. Second, while including only asymptomatic siblings without comorbidities allowed for the observation of a "pure" cognitive profile, this specific sub-group may not fully reflect the more complex, multi-morbid presentations typically encountered in clinical practice. Furthermore, our cross-sectional design makes it difficult to draw definitive conclusions regarding the longitudinal trajectory of these cognitive impairments or the risk of progression to a formal disorder. Future studies should utilize longitudinal designs to test the predictive value of cognitive threshold scores in these sibling groups. A further limitation concerns the assessment of social cognition, which was evaluated primarily through ER tasks; the use of in vivo assessment tools in future research may yield more reliable results that better reflect real-world social functioning. Additionally, as the K-SADS was used to exclude clinical diagnoses for study inclusion, the CDRS-R scores observed in our sample represent subthreshold depressive symptoms. Consequently, this study does not capture the cognitive impacts of full-scale clinical depression or clinical Post-Traumatic Stress Disorder which may limit the scope of the findings regarding more severe psychiatric phenotypes. In conclusion, this study has demonstrated that siblings with EOS and BD share similar neurocognitive profiles, and that this performance deficit strongly reflects genetic risk. In particular, the high discriminatory power of the neurocognitive G-score provides an objective criterion for screening at-risk individuals. The effect of trauma on social cognition is critical for understanding how biological risk is modulated by environmental factors. These data will contribute to the identification of cognitive and environmental targets for early intervention programs to be developed for high-risk individuals during adolescence. Declarations Author Contribution SEC designed the study, performed the statistical analyses, and wrote the primary manuscript. AB and SB were responsible for data collection, participant recruitment, and clinical assessments. CM and ST contributed to the critical revision of the manuscript for important intellectual content and provided senior supervision throughout the research process. All authors have read and approved the final version of the manuscript. 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Schizophr Res 210:21–29 Kaufman J et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988 Ünal F et al (2019) Reliability and validity of the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version, DSM-5 November 2016-Turkish adaptation (K-SADS-PL-DSM-5-T). Turkish J Psychiatry, 30(1) Sağdıç M et al (2024) Face and emotion recognition in individuals diagnosed with schizophrenia, ultra-high risk for psychosis, unaffected siblings, and healthy controls in a sample from Turkey. Schizophrenia Research: Cognition 36:100301 Mayes TL et al (2010) Psychometric properties of the Children's Depression Rating Scale–Revised in adolescents. J Child Adolesc Psychopharmacol 20(6):513–516 Guney SA, Baykara HB, Emiroglu NI (2018) Psychometric properties of the Turkish adaptation of the Children's Depression Rating Scale: revised in Turkish adolescents/Cocuklar icin Depresyon Degerlendirme Olcegi Revize Formunun Turk populasyonundaki ergenlerde psikometrik ozellikleri. Anadolu Psikiyatri Dergisi 19(S1):41–49 Bernstein DP et al (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151(8):1132–1136 Şar V et al (2021) A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation 22(1):35–51 Gur RC et al (2010) A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. J Neurosci Methods 187(2):254–262 Izgi B et al (2022) Test–retest reliability of the Turkish translation of the Penn Computerized Neurocognitive Battery. Appl Neuropsychology: Adult 29(5):1258–1267 Moore TM et al (2015) Psychometric properties of the penn computerized neurocognitive battery. Neuropsychology 29(2):235 Kravariti E et al (2026) Transdiagnostic Neurocognitive Endophenotypes for Schizophrenia, Bipolar I Disorder and a Broad Psychosis/Bipolar I Disorder Phenotype: A Mega-Analysis of Twin and Sibling Data. Schizophr Bull 52(1):sbaf050 Cardno AG, Owen MJ (2014) Genetic relationships between schizophrenia, bipolar disorder, and schizoaffective disorder. Schizophr Bull 40(3):504–515 Kantor JR et al (2022) Comparison of two cognitive screening measures in a longitudinal sample of youth at-risk for psychosis. Schizophr Res 246:216–224 Fakra E et al (2012) Les endophénotypes émotionnels dans les troubles bipolaires et la schizophrénie. L'Encéphale 38:S93–S97 Eack SM et al (2010) Social cognition deficits among individuals at familial high risk for schizophrenia. Schizophr Bull 36(6):1081–1088 Izon E, Radez J, Knight MTD (2024) The psychosocial stressors of siblings of people with experiences of psychosis (SOPEP): A systematic narrative review across cultures. Clin Psychol Psychother 31(1):e2921 Mansueto G et al (2019) Childhood adversities and psychotic symptoms: the potential mediating or moderating role of neurocognition and social cognition. Schizophr Res 206:183–193 Rokita KI et al (2020) Childhood trauma, brain structure and emotion recognition in patients with schizophrenia and healthy participants. Soc Cognit Affect Neurosci 15(12):1325–1339 Bortolato B et al (2015) Cognitive dysfunction in bipolar disorder and schizophrenia: a systematic review of meta-analyses. Neuropsychiatric disease and treatment, : pp. 3111–3125 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8966245","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631554285,"identity":"3325f7b3-d827-4267-a679-eea85ac94ff3","order_by":0,"name":"Safak Eray Camli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYFACxgeMDSCavYHxAAMbWMiAgBZmA4gWngMMSFoSiNEikUCkFvn2w4wfZ1Tckze4+cbgME+ZnV0De/M2CcYf93BqMTiTzCy54Uyx4YbbOUAt55KTG3iOlUkwJBTj1sKQf0DyYVsCI1gLbxtzMoNEjhlQC26Xyfc/Zv758F+C/YabZ0Ba6pMZ5N/g18JwI5lNcmNDQuKGGzwgLYftGCR48GsxuPGYzXLGsYTkmWfSCg7OOXc8gY0nrdgiIQ2fw5KZb/bUJNj2HT+88cGbsmp7fvbDG298sMHjMBhQOAChE9tAJBEagNY1QGh7YhSPglEwCkbByAIAU49YqNlgjCIAAAAASUVORK5CYII=","orcid":"","institution":"Bursa Uludağ University","correspondingAuthor":true,"prefix":"","firstName":"Safak","middleName":"Eray","lastName":"Camli","suffix":""},{"id":631554286,"identity":"292b6d83-6768-431e-b706-8f3071559933","order_by":1,"name":"Seymanur Bukru","email":"","orcid":"","institution":"Bursa Uludağ University","correspondingAuthor":false,"prefix":"","firstName":"Seymanur","middleName":"","lastName":"Bukru","suffix":""},{"id":631554287,"identity":"2b094a84-f732-44b2-97c4-d175b12f77b2","order_by":2,"name":"Aylin Bandirma","email":"","orcid":"","institution":"Ministry of Health Eskisehir City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aylin","middleName":"","lastName":"Bandirma","suffix":""},{"id":631554288,"identity":"263ffed6-4c4b-42e7-b557-93efa758aef4","order_by":3,"name":"Caner Mutlu","email":"","orcid":"","institution":"Bursa Uludağ University","correspondingAuthor":false,"prefix":"","firstName":"Caner","middleName":"","lastName":"Mutlu","suffix":""},{"id":631554289,"identity":"4d198cb9-17b5-4421-ab06-347f9d923ebb","order_by":4,"name":"Serkan Turan","email":"","orcid":"","institution":"Bursa Uludağ University","correspondingAuthor":false,"prefix":"","firstName":"Serkan","middleName":"","lastName":"Turan","suffix":""}],"badges":[],"createdAt":"2026-02-25 09:56:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8966245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8966245/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108941582,"identity":"364bb3ca-8dee-46d1-82b8-c9e7819b31a2","added_by":"auto","created_at":"2026-05-11 05:36:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46870,"visible":true,"origin":"","legend":"\u003cp\u003eNeurocognition scores of groups\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8966245/v1/22ea9143cfbf763b3646424d.png"},{"id":108941583,"identity":"f093a976-848e-4fa0-b095-07ab16431828","added_by":"auto","created_at":"2026-05-11 05:36:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41844,"visible":true,"origin":"","legend":"\u003cp\u003eEmotion Recognotion scores of groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8966245/v1/a07d6ddfb31eae49f4c47f1c.png"},{"id":108941584,"identity":"f8542b24-2a68-4b43-ac20-873f75fdcaa3","added_by":"auto","created_at":"2026-05-11 05:36:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":73108,"visible":true,"origin":"","legend":"\u003cp\u003eROC Curve for ER and G score\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8966245/v1/55b687d5b677e3fd2ce2605b.png"},{"id":109067879,"identity":"8abb287c-c510-4acc-9ce4-422698aa0bdb","added_by":"auto","created_at":"2026-05-12 10:02:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653750,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8966245/v1/0e3d24d9-5e1e-4601-a15c-e33cad1c4547.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neurocognition and Social Cognition as Risk Markers in Adolescents: A Comparative Study of Asymptomatic Siblings of Early-Onset Schizophrenia and Bipolar Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEarly-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) are neurodevelopmental disorders that typically emerge during adolescence, have a chronic course, and significantly impair an individual's social, academic, and occupational functioning [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While the global prevalence of schizophrenia is approximately 1% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], the prevalence of BD ranges from 1% to 3% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The early onset of both disorders is associated with a more severe clinical Picture [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The diagnostic boundaries of these diseases are often blurred, particularly due to overlapping symptoms (such as psychotic features or mood swings) during adolescence[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. To overcome this complexity and understand the biological manifestations of genetic risk, the concept of \u0026lsquo;endophenotype\u0026rsquo; has come to the fore. Cognitive dysfunction is considered a key candidate endophenotype for both EOS and BD; this makes the study of healthy siblings who have not yet developed clinical symptoms but carry genetic risk a critical area of research [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe literature describes distinct cognitive profiles for both risk groups. Studies on healthy siblings of individuals with BD (BD-Sib) show that, despite being clinically healthy, these individuals exhibit moderate deficits compared to healthy controls, particularly in executive functions, verbal memory, and attention [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Healthy siblings of individuals with EOS (EOS-Sib), on the other hand, are generally characterized by more widespread and profound neurocognitive deficits; impairments in working memory, sensorimotor speed, and social cognition are particularly striking in this group [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, a common finding for both groups is impairments in social cognition and, in particular, emotion recognition (ER) processes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A key point of debate is how much of this cognitive weakness is due to genetic \u0026lsquo;endophenotype\u0026rsquo; characteristics and how much is shaped by environmental factors such as childhood trauma or chronic stress within the family experienced by the siblings. This distinction is a critical threshold for understanding the etiology of both disorders [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough there are numerous independent studies on siblings with EOS and BD in the current literature, the number of studies directly comparing both risk groups within the same methodological framework and simultaneously is quite limited. This situation makes it difficult to evaluate the neurocognitive similarities and differences between the two disorders from a comprehensive perspective [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Furthermore, insufficient attention has been paid to the cut-off points required for the cognitive impairments observed in sibling groups to be used as a \u0026lsquo;risk marker\u0026rsquo; in clinical practice, and to the diagnostic accuracy (sensitivity and specificity) of these cut-off points [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although the value of neurocognitive performance as an endophenotype is frequently emphasized, concrete data on which cognitive score can most accurately distinguish an individual as a \u0026lsquo;genetic risk carrier\u0026rsquo; from healthy controls is lacking [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This gap hinders both the development of early intervention strategies and the objective assessment of familial transmission risk [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary aim of this study is to compare healthy siblings (BD-Sib and EOS-Sib) of adolescents diagnosed with BD and EOS with healthy controls (HC) using the University of Pennsylvania Computerized Neurocognitive Battery (Penn CNB). By incorporating assessments of childhood trauma and depressive symptoms, we specifically aimed to evaluate these risk groups while controlling for potential confounding factors that may influence cognitive outcomes. We also aimed to determine the strongest \u0026lsquo;G-score\u0026rsquo; and ER threshold scores that could distinguish these risk groups from healthy controls, thereby assessing the value of cognitive performance as a risk marker. Our hypotheses are:\u003c/p\u003e \u003cp\u003e(1) Both sibling groups will show significantly lower performance than healthy controls, particularly in executive functions and social cognition;\u003c/p\u003e \u003cp\u003e(2) The neurocognitive and social cognitive profile of the EOS-Sib group will show more widespread impairment compared to the BD-Sib group;\u003c/p\u003e \u003cp\u003e(3) Childhood traumas or depressive symptoms will have a decisive effect on neurocognition and social cognition scores;\u003c/p\u003e \u003cp\u003e(4) The neurocognitive G-score will be a powerful parameter that can distinguish both risk groups from the healthy population with high sensitivity.\u003c/p\u003e"},{"header":"Participants and Study Design","content":"\u003cp\u003eThe study sample was recruited from the Child and Adolescent Psychiatry outpatient and inpatient units at XXXXXXX University Faculty of Medicine. The final cohort comprised 164 adolescents aged 11 to 23 years, categorized into three distinct groups:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBD-Sib (n\u0026thinsp;=\u0026thinsp;40)\u003c/b\u003e: Asymptomatic siblings of patients with Bipolar Disorder.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEOS-Sib (n\u0026thinsp;=\u0026thinsp;36)\u003c/b\u003e: Asymptomatic siblings of patients with Early-Onset Schizophrenia.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eHealthy Controls (HC, n\u0026thinsp;=\u0026thinsp;88)\u003c/b\u003e: Individuals with no personal or familial history of psychiatric illness.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eTo ensure environmental and sociocultural consistency, the HC group was selected from the same residential areas as the clinical groups. All subjects underwent a rigorous screening process using the K-SADS-PL [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] to exclude any current or lifetime psychopathology. Additional exclusion criteria included intellectual disability as determined by clinical examination and chronic medical conditions.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePower Analysis\u003c/h2\u003e \u003cp\u003eTo determine the required sample size for detecting differences between groups, an a-priori power analysis was conducted using G*Power (v3.1.9.7). Assuming a medium effect size (f\u0026thinsp;=\u0026thinsp;0.25), an alpha level of 0.05, and a power of 0.80 for a one-way ANOVA, the minimum total sample size required for three groups was calculated to be 159. To account for potential data loss or incomplete responses, we recruited a total of 164 participants [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment Tools:\u003c/h3\u003e\n\u003cp\u003eThe following instruments were utilized to collect data and evaluate the clinical profiles of the participants:\u003c/p\u003e\n\u003ch3\u003eClinical Scales:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSociodemographic Data Form\u003c/b\u003e: A custom-designed form was used to record the baseline characteristics of the participants, including their age, gender, and socio-economic status.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eK-SADS-PL (Present and Lifetime Version)\u003c/b\u003e: To establish comprehensive current and past psychiatric diagnoses, the School-Aged Children\u0026rsquo;s Mood Disorders and Schizophrenia Interview Schedule was administered [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. \u0026Uuml;nal et al. (2016) confirmed the Turkish validity and reliability of this semi-structured interview [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eChild Depression Rating Scale-Revised (CDRS-R)\u003c/b\u003e: Depression severity was quantified using the CDRS-R, an instrument adapted from the Hamilton Depression Rating Scale by Mayes et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and the psychometric properties of the Turkish version were validated by G\u0026uuml;ney et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eChildhood Trauma Questionnaire (CTQ-33)\u003c/b\u003e: A retrospective assessment of childhood neglect and abuse was conducted using the CTQ-33 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This study used the Turkish cultural adaptation conducted by Vedat Şar et al. in 2021 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eNeurocognitive Assessment:\u003c/h3\u003e\n\u003cp\u003eCognitive and social cognitive performance was evaluated using the University of Pennsylvania Computerized Neurocognitive Battery (Penn CNB) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The battery assessed four primary domains:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExecutive Functions\u003c/b\u003e: PCET, LNB2, and Penn Continuous Performance Test.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eEpisodic Memory\u003c/b\u003e: CPF, CPFD, and SVOLT.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSensorimotor Speed\u003c/b\u003e: Motor Praxis and Finger Tapping tests.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSocial Cognition\u003c/b\u003e: The \u003cb\u003eER40 (Emotion Recognition Task)\u003c/b\u003e served as the primary measure for objective social cognition.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eComposite Scoring\u003c/b\u003e: Following the protocol by Moore et al. (2015), an overall \u003cb\u003e'G score'\u003c/b\u003e was derived by standardizing individual test accuracies into Z-scores and calculating their aggregate mean [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eProcedure and Ethics\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was granted by the xxxxx University Ethics Committee (No: 2026/63/3\u0026ndash;7), and the study adhered to the Declaration of Helsinki. After obtaining written informed consent from participants and their guardians, clinical assessments were conducted. Following a 10-minute resting period, the 50-minute Penn CNB was administered in a single session without interruptions. Data from participants unable to complete the full battery were excluded to ensure consistency.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using SPSS version 28. Normality was assessed using the Shapiro-Wilk test. Due to the non-parametric distribution of several variables, the Kruskal-Wallis H test was employed for intergroup comparisons of neurocognitive and clinical scores. Post-hoc pairwise comparisons were conducted with Bonferroni correction to control for Type I error. To evaluate the independent effect of group status on neurocognition and social cognition while controlling for confounding variables (maternal/paternal education, depression, and childhood trauma), Analysis of Covariance (ANCOVA) was performed. Effect sizes were reported as partial eta squared (ηp\u003csup\u003e2\u003c/sup\u003e) for ANCOVA and epsilon squared (ϵ\u003csup\u003e2\u003c/sup\u003e) for Kruskal-Wallis tests. Furthermore, Receiver Operating Characteristic (ROC) curve analysis was conducted to determine the discriminative power of the Neurocognitive G-score and Emotion Recognition in identifying individuals at genetic risk (Bipolar and EOS siblings) versus healthy controls. The optimal cut-off points were determined using the Youden Index (Sensitivity\u0026thinsp;+\u0026thinsp;Specificity\u0026thinsp;\u0026minus;\u0026thinsp;1).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e1.Demographic Characteristics\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNo statistically significant difference was found between the Sibling of Bipolar (14.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16), Sibling of EOS (15.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74), and Healthy Control (15.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37) groups in terms of age. Similarly, gender distribution did not differ significantly across the groups (p = .61). The groups were well-matched in terms of both age and gender. Gender distribution was compared across the three groups, and no statistically significant difference was found (p=.61). The Bipolar sibling group consisted of an equal number of participants (n\u0026thinsp;=\u0026thinsp;20 female, n\u0026thinsp;=\u0026thinsp;20 male). The Healthy Control group included 39 females (44.3%) and 49 males (55.7%), while the Sibling of EOS group was comprised of 19 females (52.8%) and 17 males (47.2%). These results indicate that the groups were well-matched in terms of gender.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Sociodemographic variables of groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSibling of Bipolar (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealthy Control (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSibling of EOS (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (44.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (52.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (55.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily Income Level*\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium/High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal Education\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 28.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary/Secondary (Low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(Fisher)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School (Medium)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity (High)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (67.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePaternal Education\u003c/b\u003e, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 14.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.005\u003c/b\u003e*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary/Secondary (Low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e(Fisher)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School (Medium)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity (High)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (80.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Family income was \u003cb\u003ecategorized based on\u003c/b\u003e the minimum wage\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003e2.Neurocognitive Performance and Social Cognition (PennCNB)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocial Cognition\u003c/strong\u003e \u003cp\u003eA significant group effect was found in ER (p = .003), where healthy controls performed significantly better than both sibling groups.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSensorimotor Speed \u0026amp; Memory\u003c/strong\u003e \u003cp\u003eFor Motor Praxis Speed, healthy controls were significantly faster than both risk groups (p \u0026lt; .001). In episodic memory tasks, while Visual Object Learning (immediate) showed no significant difference (p = .057), the Delayed Visual Object Learning scores were significantly lower in both sibling groups compared to controls (p = .014).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExecutive Control\u003c/strong\u003e \u003cp\u003eSignificant deficits were observed in the sibling groups for the Conditional Exclusion Task (p \u0026lt; .001) and working memory tasks, including Letter N-Back (p \u0026lt; .001) and Letter N-Back 2 (p = .001). However, no significant differences were found in attention-related tasks (Continuous Performance Number and Letter True Positives, p \u0026gt; .05).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOverall Performance\u003c/strong\u003e \u003cp\u003eConsequently, the Total Neurocognitive Score (G Score) showed a highly significant difference (p \u0026lt; .001), indicating global cognitive impairment in both BD and EOS sibling groups compared to healthy controls.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe comparison of neurocognitive and social cognition performance across groups is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the Social Cognition and Neurocognition Subtests of the Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain / Measure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSibling of Bipolar (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSibling of EOS (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealthy Control (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePENNCNB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMedian (Min-Max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMedian (Min-Max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMedian (Min-Max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eχ2 (df\u0026thinsp;=\u0026thinsp;2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eϵ2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Cognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotion Recognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003cp\u003e(22.0\u0026ndash;37.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003cp\u003e(14.0\u0026ndash;37.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003cp\u003e(23.0\u0026ndash;39.0)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003cp\u003e(Medium)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSensorimotor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotor Praxis Test Speed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e708.0\u003c/p\u003e \u003cp\u003e(447\u0026ndash;1344)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e804.0\u003c/p\u003e \u003cp\u003e(492\u0026ndash;1999) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e619.5\u003c/p\u003e \u003cp\u003e(386\u0026ndash;1372) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.638\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.188\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Large)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEpisodic Memory\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual Object Learning Task-Correct Response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003cp\u003e(7.0\u0026ndash;19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u003c/p\u003e \u003cp\u003e(9.0\u0026ndash;19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003cp\u003e(11.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisual Object Learning Task Delayed-Correct Response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003cp\u003e(7.0\u0026ndash;19.0) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003cp\u003e(9.0\u0026ndash;19.0) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003cp\u003e(9.0\u0026ndash;19.0) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExecutive Functions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditional Exclusion Task Accuracy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003cp\u003e(0.04\u0026ndash;3.37) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003cp\u003e(0.25\u0026ndash;3.43) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003cp\u003e(0.04\u0026ndash;3.64) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.216\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Large)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous Performance Number True Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003cp\u003e(3.0\u0026ndash;30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003cp\u003e(1.0\u0026ndash;30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003cp\u003e(1.0\u0026ndash;30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinuous Performance Letter True Positive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003cp\u003e(12.0\u0026ndash;29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003cp\u003e(1.0\u0026ndash;30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003cp\u003e(1.0\u0026ndash;30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLetter- and- Back 2 Task correct response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003cp\u003e(6.0\u0026ndash;15.0) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003cp\u003e(2.0\u0026ndash;15.0) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003cp\u003e(4.0\u0026ndash;15.0) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003cp\u003e(Medium)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGlobal Cognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal N\u0026ouml;rocognitive Score\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(G Score)**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-1.6\u0026ndash;1.2)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.82\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-2.5\u0026ndash;1.4)\u003c/b\u003e \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(-1.3\u0026ndash;1.8)\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e35.845\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.220\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Large)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003e Kruskal Wallis analysis was applied. Data are presented as Median (Minimum-Maximum). Statistical analysis performed using Kruskal-Wallis H test. Bold values indicate statistical significance (p \u0026lt; .05). Effect size (ϵ2) interpretation: 0.01\u0026ndash;0.06 (small), 0.06\u0026ndash;0.14 (moderate), \u0026gt;\u0026thinsp;0.14 (large).\u003csup\u003ea,b\u003c/sup\u003e The group from which the difference originates.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.Trauma History and Depression Levels\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWhen childhood trauma histories were examined using the CTQ-33, no significant differences were found between the groups in terms of emotional abuse, sexual abuse, emotional neglect, or overprotection/overcontrol (p \u0026gt; .05). However, significant differences were detected in physical abuse (p = .044), physical neglect (p \u0026lt; .001), and total CTQ scores (p = .035). Specifically, the Sibling of EOS group reported significantly higher levels of physical neglect and total trauma scores compared to healthy controls. Regarding depression levels, the CDRS scores differed significantly among all three groups (p \u0026lt; .001), with the risk groups exhibiting higher depression scores than the control group. The comparison of the PTSD - CDRS \u0026ndash;RCADS Scores of the Groups are given in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the PTSD - CDRS \u0026ndash;RCADS Scores of the Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMeasure / Scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSibling of Bipolar (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSibling of EOS (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHealthy Control (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ2 (df\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eϵ2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildhood Trauma (CTQ)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;10.0) \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;10.0)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;10.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual Abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Neglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical Neglect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e6.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(5.0\u0026ndash;13.0)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(5.0\u0026ndash;17.0)\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e5.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(5.0\u0026ndash;14.0)\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e18.067\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.111\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Medium)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverprotection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCTQ Total Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e39.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(30\u0026ndash;94)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e49.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(30\u0026ndash;84)\u003c/b\u003e \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e40.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(30\u0026ndash;74)\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6.696\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003cp\u003e(Small)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression (CDRS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e25.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(17\u0026ndash;44)\u003c/b\u003e \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e30.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(19\u0026ndash;44)\u003c/b\u003e \u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20.0\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(17\u0026ndash;31)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e33.421\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.205\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Large)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRCADS_Total\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003cp\u003e(2.0\u0026ndash;88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003cp\u003e(6.0\u0026ndash;110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003cp\u003e(Negligible)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRCADS-Anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003cp\u003e(2.0\u0026ndash;74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003cp\u003e(4.0\u0026ndash;91.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003cp\u003e(5.0\u0026ndash;63.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003cp\u003e(Negligible)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRCADS-Depression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003cp\u003e(0.0\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003cp\u003e(0.0\u0026ndash;21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003cp\u003e(0.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003cp\u003e(Negligible)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003e Kruskal Wallis analysis was applied. \u003csup\u003ea,b,c\u003c/sup\u003e The group from which the difference originates.\u003c/p\u003e \u003cp\u003e \u003csup\u003e*\u003c/sup\u003e Kruskal Wallis analysis was applied. Data are presented as Median (Minimum-Maximum). Statistical analysis performed using Kruskal-Wallis H test. Bold values indicate statistical significance (p \u0026lt; .05). Effect size (ϵ2) interpretation: 0.01\u0026ndash;0.06 (small), 0.06\u0026ndash;0.14 (moderate), \u0026gt;\u0026thinsp;0.14 (large).\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.1. Intergroup Neurocognitive Performance and the Effect of Confounding Factors\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe ANCOVA model, which included parental education, depression, and trauma as covariates, significantly predicted the Neurocognitive G Score (F(6,151)\u0026thinsp;=\u0026thinsp;7.78,p\u0026lt;.001). The model explained \u003cb\u003e23.6%\u003c/b\u003e of the variance in neurocognitive performance (R2=.236, Adjusted R2=.206).\u003c/p\u003e \u003cp\u003eAlthough the groups were initially matched for age and gender, significant differences were observed in parental education levels. To ensure that the observed neurocognitive deficits were not driven by these socioeconomic differences, maternal and paternal education levels were included in the model. The results indicated that neither maternal (p=.355) nor paternal education (p=.216) had a statistically significant effect on the Neurocognitive G Score. Similarly, depression and trauma scores were not significant predictors.\u003c/p\u003e \u003cp\u003eEven after controlling for these potential confounders, the main effect of \u003cb\u003eGroup\u003c/b\u003e remained highly significant (F(2,151)\u0026thinsp;=\u0026thinsp;12.11,p\u0026lt;.001). The partial eta squared (ηp2​) was .138, indicating a large effect size. Post-hoc analyses confirmed that the Healthy Control group performed significantly better than both the BD-Sib and EOS-Sib groups, with no significant difference observed between the two risk groups.\u003c/p\u003e \u003cp\u003e \u003cb\u003e4.2. The Specific Effect of Trauma on Emotion Recognition\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe generated ANCOVA model for Emotion Recognition was statistically significant (F(6,151)\u0026thinsp;=\u0026thinsp;4.83,p\u0026lt;.001) and accounted for \u003cb\u003e16.1%\u003c/b\u003e of the total variance in emotion recognition scores (R2=.161, Adjusted R2=.128). Since the data did not exhibit a normal distribution, the analysis was reinforced using \u003cb\u003eBootstrapping\u003c/b\u003e (1000 samples, BCa 95% Confidence Interval).\u003c/p\u003e \u003cp\u003eThe results revealed a distinct pattern compared to general neurocognition. While parental education levels and depression severity did not significantly predict emotion recognition performance (p\u0026gt;.05), \u003cb\u003echildhood trauma (CTQ)\u003c/b\u003eemerged as a significant covariate (p=.013). Specifically, higher levels of childhood trauma were associated with lower emotion recognition accuracy \u003cb\u003e(B = -0.072)\u003c/b\u003e, independent of the diagnosis.\u003c/p\u003e \u003cp\u003eCrucially, even after controlling for the significant effect of trauma, the main effect of \u003cb\u003eGroup\u003c/b\u003e remained statistically significant (F(2,151)\u0026thinsp;=\u0026thinsp;6.37,p=.002,ηp2​=.078). This finding suggests that while social cognition deficits are partly influenced by environmental stress factors like trauma, the diagnostic risk status exerts a significant independent effect. ANCOVA Results for Neurocognitive and Social Cognition Measures Controlling for Confounders are given in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eANCOVA Results for Neurocognitive and Social Cognition Measures Controlling for Confounders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eηp2​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePairwise Comparisons (Bonferroni)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeurocognitive G Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrected Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression (CDRS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma (CTQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup (Main Effect)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e12.11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.138\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eHC\u0026thinsp;\u0026gt;\u0026thinsp;BP-Sib; HC\u0026thinsp;\u0026gt;\u0026thinsp;EOS-Sib\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotion Recognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrected Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaternal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression (CDRS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTrauma (CTQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.013\u003c/b\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e(Negative Correlation)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGroup (Main Effect)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6.37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.002\u003c/b\u003e*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e.078\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eHC\u0026thinsp;\u0026gt;\u0026thinsp;BP-Sib; HC\u0026thinsp;\u0026gt;\u0026thinsp;EOS-Sib\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: HC: Healthy Control, BP-Sib: Sibling of Bipolar Disorder, EOS-Sib: Sibling of Early Onset Schizophrenia. Significant values are bolded (p \u0026lt; .05).For Emotion Recognition, bootstrapping (1000 samples) was applied. The effect of Trauma (CTQ) was confirmed significant (p = .026 with bootstrap), while parental education remained non-significant.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe diagnostic accuracy of neurocognitive and social cognitive measures in distinguishing siblings (Bipolar and EOS) from healthy controls was evaluated using ROC curve analysis. The Neurocognitive G Score demonstrated a high discriminative power with an AUC of .805 (95% CI: .733\u0026ndash;.876, p \u0026lt; .001). At a cut-off value of 0.35, the G Score yielded a sensitivity of 73% and a specificity of 74%. Emotion Recognition also showed significant discriminative ability with an AUC of .691 (95% CI: .599\u0026ndash;.782, p \u0026lt; .001). These findings suggest that global neurocognitive impairment serves as a more robust marker for familial risk than social cognition alone. ROC curve analysis of Neurocognitive G Score and Emotion Recognition are given in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eROC curve analysis of Neurocognitive G Score and Emotion Recognition\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOptimal Cut-off\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeurocognitive G Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[.733, .876]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmotion Recognition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[.599, .782]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAUC\u003c/b\u003e: Area Under the Curve. \u003cb\u003eSE\u003c/b\u003e: Standard Error. \u003cb\u003eOptimal Cut-off\u003c/b\u003e: Calculated using the Youden Index (Sensitivity\u0026thinsp;+\u0026thinsp;Specificity \u0026ndash; 1).\u003cb\u003eRisk Groups\u003c/b\u003e: Combined Sibling of Bipolar Disorder and Sibling of Early Onset Schizophrenia (EOS).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study directly compares the neurocognitive and social cognitive profiles of adolescents diagnosed with Early-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) with those of their healthy siblings, and examines the diagnostic specificity of these profiles. Our key findings indicate that both risk groups exhibit global cognitive impairment compared to healthy controls, and that the composite neurocognitive score, defined as the \u0026lsquo;G-score\u0026rsquo;, can distinguish these groups from the healthy population with high accuracy. Furthermore, it was found that childhood traumas have a specific disruptive effect on social cognition (ER) rather than general cognitive performance, and that this effect operates independently of genetic risk.\u003c/p\u003e \u003cp\u003eOur findings support the \u0026lsquo;cognitive endophenotype\u0026rsquo; hypothesis in the literature, as both sibling groups exhibit deficits in areas such as executive functions, working memory, and motor speed [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Interestingly, no statistically significant difference was found between EOS and Bipolar siblings in terms of global cognitive performance; this may indicate that both disorders share a common familial predisposition at the cognitive level [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. One of the most original contributions of our study, the ROC analysis results, revealed that the G-score with a threshold value of 0.35 could distinguish genetic risk carriers with 73% sensitivity and 74% specificity. This high AUC value (.805) demonstrates that neurocognitive batteries can be used as a concrete marker in early-stage risk screening in clinical practice [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the field of social cognition, the fact that both risk groups performed worse than healthy controls on ER tests confirms that this domain is also an important candidate endophenotype [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, one of the most striking findings of this study is that childhood trauma subscales, particularly levels of physical neglect, were found to be significantly higher in the EOS-sibling (psychosis risk) group than in all other groups. This can be explained by the neglect of healthy siblings (failures in meeting social and physical needs) as a result of resources and attention within the family being channeled to the individual with a chronic and severe illness [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. On the other hand, our statistical analyses revealed that while the history of trauma did not affect general neurocognitive performance, it had an independent disruptive effect on emotion recognition ability. In conclusion, although social cognition is impaired as a genetic predisposition in both risk groups, the deepened pattern of physical neglect in the psychosis risk group may further fragilize social cognitive development as an environmental burden superimposed on genetic risk [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].This finding suggests that environmental stressors are a critical variable in social cognitive development that interacts with genetic predisposition and, in some cases, independently lowers performance. This indicates that interventions in at-risk groups should include not only cognitive rehabilitation but also trauma-focused psychosocial support processes [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the significant contributions of this research, several limitations must be acknowledged. First, although our sample size meets the requirements for statistical power analysis, studies involving larger cohorts would further enhance the generalizability of these findings. Second, while including only asymptomatic siblings without comorbidities allowed for the observation of a \"pure\" cognitive profile, this specific sub-group may not fully reflect the more complex, multi-morbid presentations typically encountered in clinical practice. Furthermore, our cross-sectional design makes it difficult to draw definitive conclusions regarding the longitudinal trajectory of these cognitive impairments or the risk of progression to a formal disorder. Future studies should utilize longitudinal designs to test the predictive value of cognitive threshold scores in these sibling groups.\u003c/p\u003e \u003cp\u003eA further limitation concerns the assessment of social cognition, which was evaluated primarily through ER tasks; the use of in vivo assessment tools in future research may yield more reliable results that better reflect real-world social functioning. Additionally, as the K-SADS was used to exclude clinical diagnoses for study inclusion, the CDRS-R scores observed in our sample represent subthreshold depressive symptoms. Consequently, this study does not capture the cognitive impacts of full-scale clinical depression or clinical Post-Traumatic Stress Disorder which may limit the scope of the findings regarding more severe psychiatric phenotypes.\u003c/p\u003e \u003cp\u003eIn conclusion, this study has demonstrated that siblings with EOS and BD share similar neurocognitive profiles, and that this performance deficit strongly reflects genetic risk. In particular, the high discriminatory power of the neurocognitive G-score provides an objective criterion for screening at-risk individuals. The effect of trauma on social cognition is critical for understanding how biological risk is modulated by environmental factors. These data will contribute to the identification of cognitive and environmental targets for early intervention programs to be developed for high-risk individuals during adolescence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSEC designed the study, performed the statistical analyses, and wrote the primary manuscript. AB and SB were responsible for data collection, participant recruitment, and clinical assessments. CM and ST contributed to the critical revision of the manuscript for important intellectual content and provided senior supervision throughout the research process. All authors have read and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCoulon N et al (2020) Early and very early-onset schizophrenia compared with adult‐onset schizophrenia: French FACE‐SZ database. 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Schizophrenia Research: Cognition 36:100301\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMayes TL et al (2010) Psychometric properties of the Children's Depression Rating Scale\u0026ndash;Revised in adolescents. J Child Adolesc Psychopharmacol 20(6):513\u0026ndash;516\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuney SA, Baykara HB, Emiroglu NI (2018) Psychometric properties of the Turkish adaptation of the Children's Depression Rating Scale: revised in Turkish adolescents/Cocuklar icin Depresyon Degerlendirme Olcegi Revize Formunun Turk populasyonundaki ergenlerde psikometrik ozellikleri. Anadolu Psikiyatri Dergisi 19(S1):41\u0026ndash;49\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernstein DP et al (1994) Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151(8):1132\u0026ndash;1136\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŞar V et al (2021) A revised and expanded version of the Turkish Childhood Trauma Questionnaire (CTQ-33): Overprotection-overcontrol as additional factor. J Trauma Dissociation 22(1):35\u0026ndash;51\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGur RC et al (2010) A cognitive neuroscience-based computerized battery for efficient measurement of individual differences: standardization and initial construct validation. J Neurosci Methods 187(2):254\u0026ndash;262\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzgi B et al (2022) Test\u0026ndash;retest reliability of the Turkish translation of the Penn Computerized Neurocognitive Battery. Appl Neuropsychology: Adult 29(5):1258\u0026ndash;1267\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore TM et al (2015) Psychometric properties of the penn computerized neurocognitive battery. 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Soc Cognit Affect Neurosci 15(12):1325\u0026ndash;1339\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBortolato B et al (2015) \u003cem\u003eCognitive dysfunction in bipolar disorder and schizophrenia: a systematic review of meta-analyses.\u003c/em\u003e Neuropsychiatric disease and treatment, : pp. 3111\u0026ndash;3125\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early-Onset Schizophrenia, Bipolar Disorder, Endophenotype, Neurocognition, Social Cognition, Siblings","lastPublishedDoi":"10.21203/rs.3.rs-8966245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8966245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEarly-Onset Schizophrenia (EOS) and Bipolar Disorder (BD) share overlapping clinical and genetic features. This study aims to compare the neuro-social cognitive profiles of healthy siblings of adolescents with EOS (EOS-Sib) and BD (BD-Sib) to identify potential endophenotypes and evaluate the impact of environmental stressors, such as childhood trauma, on these profiles.\u003c/p\u003e \u003cp\u003eThe study included 164 participants: 36 EOS-Sib, 40 BD-Sib, and 88 healthy controls (HC) aged 11\u0026ndash;23. All subjects underwent a rigorous screening process using the semi structured interview ( K-SADS-PL) to exclude any psychopathology. Cognitive performance was assessed using the University of Pennsylvania Computerized Neurocognitive Battery. Also Childhood Trauma Questionnaire and Children\u0026rsquo;s Depression Rating Scale are used for the clinical evaluation. A composite 'G-score' was derived to represent global neurocognitive performance.\u003c/p\u003e \u003cp\u003eBoth EOS-Sib and BD-Sib groups exhibited significant deficits in executive functions, working memory, and emotion recognition (ER) compared to HC (p \u0026lt; .001). No significant differences were found between the two sibling groups in G-score. ANCOVA results revealed that while childhood trauma impaired ER performance independent of diagnosis (p=.013), it did not affect general neurocognition. ROC analysis demonstrated that the G-score had high discriminative power (AUC = .805) in distinguishing risk carriers from controls, with an optimal cut-off of 0.35 (sensitivity: 73%, specificity: 74%).\u003c/p\u003e \u003cp\u003eThe EOS-Sib and BD-Sib share a common neurocognitive endophenotype characterized by global impairment. The G-score serves as a robust objective marker for familial risk screening. Furthermore, the findings highlight that environmental stressors like trauma specifically exacerbate social cognitive deficits, suggesting that early intervention strategies should integrate both cognitive remediation and trauma-focused psychosocial support.\u003c/p\u003e","manuscriptTitle":"Neurocognition and Social Cognition as Risk Markers in Adolescents: A Comparative Study of Asymptomatic Siblings of Early-Onset Schizophrenia and Bipolar Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 05:36:02","doi":"10.21203/rs.3.rs-8966245/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40694f78-fb1c-4b5a-969e-061b06f27498","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T11:25:22+00:00","index":35,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T11:04:44+00:00","index":34,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T05:36:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 05:36:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8966245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8966245","identity":"rs-8966245","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}