In their recent article, Leask et al (Reference Leask, Done and Crow2002) reconfirm the presence of neurological soft signs as a significant childhood finding among people who later develop schizophrenia in adulthood. In some earlier work using a similar, bias-proof follow-back design we had identified developmental problems (a pragmatic equivalent of soft signs), weaknesses in speech and language and difficulties in peer relationships as the strongest childhood precursors of adult schizophrenia, indeed easily more relevant than family history of psychosis or demographic characteristics.

As interest is developing in prodromes of psychosis and its early onset, we also have a far better-defined group of children who incorporate all the above parameters and factors. In our child psychiatric clinical practice, we are seeing increasing numbers of children with soft neurological signs and disturbed peer relationships who are diagnosed with Asperger syndrome. In effect, it would appear that even though neurological signs are not a central criterion, they are universally present and in exactly the areas Leask et al identified.

Could it be that these youngsters are indeed the most primary candidates for future schizophrenia? It would logically follow; and then our notions on continuities may need revising and, perhaps more relevantly, a target population may be identified where preventive input could be crucial. I would welcome comments from readers.