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1 Supplementary Online Content Vorstman JAS, Breetvelt EJ, Duijff SN, et al; International Consortium on Brain and Behavior in 22q11.2 Deletion Syndrome. Cognitive decline preceding the onset of psychosis in patients with 22q11.2 deletion syndrome. JAMA Psychiatry. Published online February 25, doi: /jamapsychiatry etable 1. Participating sites and total sample sizes of subjects with 22q11.2DS with IQ data in this study etable 2. Sample demographics & assessment methods for 411 subjects with 22q11DS aged 8-24 years with IQ and psychiatric data etable 3. Number and type of Wechsler IQ scales used per site in n = 411 subjects with 22q11DS efigure 1. 22q11DS-specific IQ trajectories (n=829) efigure 2. Histogram of VIQ percentile changes from one time point to the next in in 326 subjects with 22q11DS This supplementary material has been provided by the authors to give readers additional information about their work.

2 etable 1. Participating sites and total sample sizes of subjects with 22q11.2DS with IQ data in this study Office Médico Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland Site n subjects 72 Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA 25 Child Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children s Hospital, Rome, Italy Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham 86 NC, USA Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada 178 Division of Human Genetics, The Children s Hospital of Philadelphia and the Perelman School of Medicine, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, 17 USA Centre for Human Genetics, University Hospital Gasthuisberg, Department of Human Genetics, University of Leuven, Leuven, Belgium The Behavioral Neurogenetics Center, Edmond & Lili Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Psychiatry, Brain Center Rudolf Magnus, and Department of Pediatric Psychology, Wilhelmina Children s Hospital, University Medical Center, Utrecht, The Netherlands Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York, USA Department of Psychiatry, U.C. Davis Medical School, Sacramento, California, USA 23 Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA 29 Total

3 etable 2. Sample demographics & assessment methods for 411 subjects with 22q11DS aged 8 24 years with IQ and psychiatric data Site Recruitment; setting n Gender (M:F) University of Geneva Switzerland University of California, Los Angeles, United The Children Hospital Bambino Gesù, Italy Duke University, United University of Toronto, Canada. Children s Hospital of Philadelphia, United. Center for Human Genetics, University Hospital Gasthuisberg Leuven Tel Aviv University, Israel University Medical Center Utrecht, the Netherlands SUNY Upstate Medical University, Syracuse, United Recruitment through family associations; academic psychiatry outpatient clinic Recruitment through foundation websites and regional Genetics and Craniofacial clinics; Research study. Recruitment via referral and through family associations; academic child & adolescent psychiatry outpatient clinic Recruitment through hospital case registry; academic psychiatry outpatient clinic Recruitment through genetic clinics; academic psychiatry outpatient clinic Recruitment via targeted research study; multidisciplinary 22q11.2DS Center. Recruitment through hospital, via referral and through family associations; academic clinical genetic clinic. Recruitment via referral and through family associations and pediatric clinics. Recruitment via referral and through family associations; academic child & adolescent psychiatry outpatient clinic. Recruitment via referral, family associations, and the Center for the Diagnosis, Treatment and Study of Velo cardio facial Syndrome. Age at last psychiatric assessment Mean ± stdev Median (range) 71 30: ± ( ) 25 14: ± ( ) Psychiatric assessment methods 1 n with psychotic disorder DICA 2 and 16 K SADS 3 (psychosis suppl.) C DISC 4 and SCID : and 21.0 K SADS : ± ( ) 7 3:4 15,6 ± ( ) 5 3: ± ( ) 52 25: ± ( ) 70 37: ± ( ) 52 17: ± ( ) 82 41: ± ( ) C DISC 4 2 K SADS 3 and SCID 5 1 K SADS 3 and SIPS 6 : modified DSM IV based clinical interview. 1 4 K SADS 3 12 K SADS 3 ; (psychosis & mood suppl.) 10 K SADS 3 7 Total : ± ( ) 1. In all sites phenotyping included assessment by an expert clinician with diagnostic classification according to the DSM IV. 2. DICA: Diagnostic interview for children and adolescents (Reich W. Diagnostic interview for children and adolescents (DICA). J Am Acad Child Adolesc Psychiatry. 2000;39(1):59 66). 3. K SADS: the Schedule for Affective Disorders and Schizophrenia for School Age Children (Chambers WJ, Puig Antich J, Hirsch M, Paez P, Ambrosini PJ, Tabrizi MA, Davies M. The assessment of affective disorders in children and adolescents by semistructured interview. Test retest reliability of the schedule for affective disorders and schizophrenia for school age children, present episode version. Arch Gen Psychiatry. 1985;42(7): ). In some studies only selected sections (psychosis, mood) were used. 4. C DISC Computerized Diagnostic Interview Schedule for Children (Shaffer D, Schwab Stone M, Fisher P, Cohen P, Piacentini J, Davies M, Conners CK, Regier D. The Diagnostic Interview Schedule for Children Revised Version (DISC R): I. Preparation, field testing, interrater reliability, and acceptability. J Am Acad Child Adolesc Psychiatry. 1993;32(3): ).

4 5. SCID: Structured Interview for DSM IV (Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM III R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992;49(8): ). 6. SIPS: structured interview for prodromal syndromes (Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW. Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull. 2003;29(4): ). Note that the listed studies included both subjects with low mental ages as well as subjects of adult age. In those instances either the formulation of questions was adapted to the cognitive level and age of each subject or the adult version of the questionnaire was used, as per the manual of these schedules. etable 3. Number and type of Wechsler IQ scales used per site in n = 411 subjects with 22q11DS WPSSI 1 WISC 2 WAIS 3 WASI 4 Total Wechsler cognitive tests per site University of Geneva Switzerland University of California, Los Angeles, United The Children Hospital Bambino Gesù, Italy Duke University, United University of Toronto, Canada. Children s Hospital of Philadelphia, United. Center for Human Genetics, University Hospital Gasthuisberg Leuven Tel Aviv University, Israel University Medical Center Utrecht, the Netherlands SUNY Upstate Medical University, Syracuse, United Wechsler Preschool and Primary Scale of Intelligence; including WPPSI III and WPPSI R 2 Wechsler intelligence scale for children; including WISC R, WISC III and WISC IV 3 Wechsler Adult Intelligence Scale; including WAIS R, WAIS III and WAIS IV 4 Wechsler Abbreviated Scale of Intelligence

5 efigure 1. 22q11DS specific IQ trajectories (n=829) A. 22q11DS specific full scale IQ chart B. 22q11DS specific verbal IQ chart

6 C. 22q11DS specific performance IQ chart

7 efigure 2. Histogram of VIQ percentile changes from one time point to the next in in 326 subjects with 22q11DS A histogram showing the distribution of changes in percentile between two sequential VIQ measurements. Note that the top of the curve is in the negative range of percentile change, consistent with a slight overall decline observed in the 22q11DS population. The grey shaded area represents the subset of 45 subjects with 22q11DS with a psychotic disorder.