Table of Contents
Abstract
The Early Psychotic Symptoms Screening Scale (EPSy) is a specialized screening instrument developed in 2023 by Marie-Noëlle Babinet, Caroline Demily, and George A. Michael. Its primary function is to evaluate the prodromal signs of psychotic symptoms in children ranging from 4 to 13 years of age. The scale is notable for its dual structure, featuring two distinct versions: one designed for assessing the child’s current behavior (current-age version) and a retrospective version focusing on behavior at age two.
Item generation for the EPSy was comprehensive, integrating insights from established measures that assess schizotypal characteristics in children, such as the Melbourne Assessment Schizotypy in Kids (MASK), and tools for assessing child anxiety, like the Screen for Child Anxiety Related Emotional Disorders (SCARED). Furthermore, the scale’s clinical relevance was assured through extensive interviews with expert professionals, including psychiatrists, child psychiatrists, and psychologists, as well as the families of patients.
This meticulous process initially produced 24 items, which were subsequently refined to a final 22-item scale across three dimensions following rigorous factor analysis using data collected from French-speaking children. The research underlying the EPSy reports comprehensive results regarding its reliability and validity, supporting its use as an early detection tool.
Keywords
Childhood Early Psychotic Symptoms, Disorganization Symptoms, Mistrust/Paranoia Symptoms, Perceptual Aberrations/Hallucinations Symptoms, Symptom Screening, Child Psychopathology, Early Childhood Development, Mental Health Screening, Thought Disorders.
Authors
Babinet, Marie-Noëlle, Demily, Caroline, Michael, George A.
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Purpose
The fundamental purpose of the EPSy scale is to provide an efficient and structured method for assessing the prodromes of psychotic symptoms in children between the ages of 4 and 13. By including a retrospective measure for age two, the EPSy aims to capture developmental trajectory and early indicators of risk.
Construct
The primary psychological construct measured by the EPSy instrument is Early Psychotic Symptoms. These symptoms are operationalized across three core dimensions identified through factor analysis: Mistrust/Paranoia, Perceptual Aberrations/Hallucinations, and Disorganization.
Validity
The EPSy scale demonstrates satisfactory convergent validity. This evidence stems from significant correlations observed between both versions of the scale (current-age and 2-years-old) and several relevant external measures. These external validation tools included the Melbourne Assessment Schizotypy in Kids (MASK), assessments of aggression behavior, the Conners Parent Rating Scale-48 items (CPRS), and criteria from the DSM-V. All reported correlation coefficients were statistically significant (p < .05), exceeding 0.127.
Further robust evidence of validity was provided by regression analysis. Specifically, the total score on the retrospective 2-years-old version significantly predicted the total score on the current-age version of the scale (F(2237) = 197.4, p < .001, R2 = 0.63). Age showed no significant effect in this prediction model. Additionally, the mistrust/paranoia factor at age two was a strong predictor of the corresponding mistrust/paranoia factor in the current-age measure (F(2237) = 152.4, p < .001, R2 = 0.56).
Reliability
Internal Consistency: The scale exhibits high internal consistency across both versions. For the retrospective (2-years-old) version, the total EPSy score yielded a robust Cronbach’s alpha coefficient of 0.90, with factor alphas ranging from 0.65 to 0.84. The current-age version showed comparable reliability, with a total Cronbach’s alpha of 0.85, and factor coefficients ranging from 0.65 to 0.85.
Test-Retest Reliability: Exceptional stability was demonstrated using a one-year test-retest interval. For the 2-years-old version, the Pearson correlation coefficient for the total score was 0.99, with all three factors (mistrust/paranoia, perceptual aberrations/hallucinations, and disorganization) also reporting coefficients of 0.98 or 0.99 (all p-values < .001). The current-age version maintained this high standard, reporting a one-year test-retest Pearson correlation of 0.99 (CI95%: 0.98 to 0.99, p < .001), with factor coefficients between 0.97 and 0.99.
Factor Analysis
The scale development utilized both exploratory and confirmatory factor analysis techniques. An initial Principal Component Analysis (PCA) identified a compelling three-factor structure, which collectively accounted for 37.4% of the total variance. During this exploratory phase, two items (Item 6 and Item 14) were removed due to failure to load significantly onto any factor, resulting in the final 22-item structure.
A subsequent Confirmatory Factor Analysis (CFA) was performed on the 2-years-old version to determine if the 3-factor structure identified in the current-age version was longitudinally applicable. The analysis suggested that the 3-factor model provided a reasonably good fit for the retrospective data. Key fit indices included: χ2(206) = 1171, χ2/df = 5.68, CFI = 0.66, TLI = 0.62, RMSEA = 0.14, SRMR = 0.11, AIC = 5142, GFI = 0.68, and MFI = 0.13.
Instrument
Test Type: Original instrument functioning as a Screener.
Format: The scale consists of 22 items, each rated on a 4-point Likert scale ranging from 0 to 3. The test can be administered electronically or using a paper-and-pencil format.
Language Available: The instrument is available in French for use, with source materials provided in both English and French.
Population Group: Humans (males and females).
Age Group: The primary target group for evaluation is children aged 4 to 13 years, spanning Preschool Age (2-5 yrs) through early Adolescence (13-17 yrs).
Population Details: Validation studies were conducted in France using samples of French-speaking children between the ages of 4 and 13.
Test Methodology: The validation process encompassed Test Validity, Convergent Validity, Test Reliability, Internal Consistency, Test-Retest Reliability, Factor Analysis, Confirmatory Factor Analysis, Exploratory Factor Analysis, and Principal Component Analysis.
Keywords
Early Psychotic Symptoms, Child Development, Schizotypy, Mental Health, Screening Instrument, Disorganization, Paranoia, Hallucinations.
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Authors
Author ORCID Identifier: Marie-Noëlle Babinet: http://orcid.org/0000-0001-7784-8489. George A. Michael: http://orcid.org/0000-0001-9071-4303.
Affiliation Email addresses: Marie-Noëlle Babinet: [email protected].
Correspondence Address: Marie-Noëlle Babinet: CNRS & Université Lyon 1, UMR 5229, Centre Hospitalier Le Vinatier, Centre d’excellence Autisme iMIND, Centre de Référence Maladies Rares Troubles du Comportement d’Origine Génétique (GénoPsy Lyon), 95 Boulevard Pinel, Bron, France, 69500, [email protected].
Permissions & Fee and Test Year
The Early Psychotic Symptoms Screening Scale (EPSy) was developed in 2023. It is explicitly stated as a non-commercial product, and there is no fee associated with its use. The scale is available for Research/Teaching purposes.
Reference’s
Babinet, M.-N., Demily, C., & Michael, G. A. (2023). A new scale for the screening of childhood early psychotic symptoms. Psychiatry Research, 327, 1–12. https://doi.org/10.1016/j.psychres.2023.115418
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Items of the Early Psychotic Symptoms Screening Scale (EPSy)
This is a 22-item measure. The complete list of test items is available in the source publication, specifically in Table 3 on pages 6-7 of the referenced article. The items are grouped into three factors or subscales:
Mistrust/Paranoia symptoms
Perceptual aberrations/Hallucinations symptoms
Disorganization symptoms
Mistrust/paranoia symptoms
| French version | English version |
| A l’impression que les gens autour de lui ont l’intention de lui faire du mal | Feels like people around him intend to hurt him |
| Est méfiant envers les autres ou face à des situations | Is suspicious of others or of situations |
| A l’impression que les autres se moquent de lui | Thinks that other people are laughing at him |
| A une tendance é l’isolement que ce soit dans la cour de récréation ou bien en dehors de l’école | Has a tendency to be isolated whether in the playground or outside of school |
| Se comporte de façon inadaptée face aux émotions des autres faisant penser qu’il ne les comprend pas | Reacts inappropriately to other people’s emotions, making them think he does not understand them |
| A des difficultés pour gérer ses propres émotions | Has difficulty dealing with his own emotions |
| A tendance à ne pas regarder les gens dans les yeux, à fuir le regard des autres | Tends not to look people in the eye, to avoid the gaze of others |
| Se comporte de façon inadaptée lorsqu’un regard est dirigée vers lui comme s’il l’interprétait mal | Behaves inappropriately when people look at him, as if he is misinterpreting them |
| His speech contains unusual intonations (e.g. monotonous voice, lack of rhythm in his speech, does not change the volume of his voice depending on the place or the situation) | Has difficulty understanding humor, irony or innuendo |
| Est anxieux, stressé | Is anxious, stressed |
| Semble effrayé ou paniqué dans des situations anodines | Appears scared or panicked by trivial situations |
| Se montre méfiant de manière inexpliquée ou inhabituelle é l’égard d’événements ou de personnes | Is inexplicably or unusually suspicious of events or people |
Perceptual aberrations/Hallucinations symptoms
| French version | English version |
| A des idées, des croyances qui semblent inhabituelles ou bizarres | Has ideas, beliefs that seem unusual or weird |
| A déjà parlé de choses qu’il voit ou entend dans la nuit | Has spoken about things he sees or hears at night |
| Semble voir ou entendre des choses que les autres ne voient pas | Seems to see or hear things that others cannot see |
| Parle de sons, de visions, d’odeurs ou de sensations exacerbés, altérés ou bizarres | Talks about intensified, impaired or bizarre sounds, sights, smells or sensations |
Disorganization symptoms
| French version | English version |
| Ne distingue pas les histoires qu’il raconte et la réalité | Does not distinguish between the stories he tells and reality |
| A un discours confus qui empêche son interlocuteur de suivre le fil conducteur et de comprendre le récit | Has confused speech that prevents the person he is talking to from following what he is talking about and understanding him |
| Sa voix présente des intonations inhabituelles (ex. voix monotone, absence de rythme dans son discours, ne modifie pas le volume de sa voix en fonction de l’endroit ou de la situation) | His speech contains unusual intonations (e.g. monotonous voice, lack of rhythm in his speech, does not change the volume of his voice depending on the place or the situation) |
| Est désorganisé dans son comportement | Is disorganized in his behavior |
| Coupe la parole, suit son idée, fait des digressions donnant l’impression qu’il ne s’intéresse pas à son interlocuteur | Interrupts others when they are talking, pursues his own thoughts, digresses, giving the impression that he is not interested in the person he is talking to |
Note: Each item is rated on a Likert scale (0: This behavior is absent; 1: This behavior is present and it is not at all a problem; 2: This behavior is present and it is a minor problem; 3: This behavior is present and it is a major problem). Two initial items (Items 6 and 14) were removed during factor analysis due to insufficient loading.
Cite this article
Mohammed looti (2025). Early Psychotic Symptoms Screening Scale (EPSy). Psychological Scales & Instruments Database. Retrieved from https://db.arabpsychology.com/scales/early-psychotic-symptoms-screening-scale-epsy/
Mohammed looti. "Early Psychotic Symptoms Screening Scale (EPSy)." Psychological Scales & Instruments Database, 31 Oct. 2025, https://db.arabpsychology.com/scales/early-psychotic-symptoms-screening-scale-epsy/.
Mohammed looti. "Early Psychotic Symptoms Screening Scale (EPSy)." Psychological Scales & Instruments Database, 2025. https://db.arabpsychology.com/scales/early-psychotic-symptoms-screening-scale-epsy/.
Mohammed looti (2025) 'Early Psychotic Symptoms Screening Scale (EPSy)', Psychological Scales & Instruments Database. Available at: https://db.arabpsychology.com/scales/early-psychotic-symptoms-screening-scale-epsy/.
[1] Mohammed looti, "Early Psychotic Symptoms Screening Scale (EPSy)," Psychological Scales & Instruments Database, vol. X, no. Y, ص Z-Z, October, 2025.
Mohammed looti. Early Psychotic Symptoms Screening Scale (EPSy). Psychological Scales & Instruments Database. 2025;vol(issue):pages.