The High-Risk Social Challenge (HiSoC) task may be a useful tool for detecting deficits in social skills in adults at ultra-high risk (UHR) for psychosis, according to study results published in Schizophrenia Research.

The HiSoC task is currently used to assess social skills in adolescents at genetic high risk for psychosis, but has not been tested for efficacy when used to assess social skills in other UHR psychosis populations. The objective of this study was to test the efficacy and psychometric properties of the HiSoC task in adults with UHR psychosis.

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In this randomized clinical trial, researchers conducted an exploratory factor analysis to assess the factor structure of the HiSoC task in patients who fulfilled UHR psychosis criteria (n=102) vs in healthy controls (n=66). Adults with UHR psychosis were between the ages of 18 and 40 and were recruited from psychiatric facilities in Copenhagen, Denmark. Researchers examined whether the factor structure of the Danish version of the HiSoC task in UHR adults was similar to the factor structure of the American counterpart previously validated in adolescents at genetic high risk for psychosis.

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The results revealed that the 15 HiSoC items were reduced to 3 factors: “Social-Interpersonal,” “Odd Behavior and Language,” and “Affect.” The test showed high levels of interrater reliability, with the intraclass correlation coefficient ranging between 0.88 and 0.98. Researchers also found that HiSoC was unrelated to age, IQ, and level of attenuated psychotic symptoms. In terms of convergent validity, researchers found that theory of mind and global- and real-life social functioning were moderately related to the HiSoC total score and were partially related to subscale scores.

There were significant differences between the UHR group and healthy controls on the HiSoC total score, Raters Impression, and on the 3 factors (Cohen’s d range=-1.40 to -1.94, P <.001). In the healthy controls group, there were no gender differences on the HiSoC total score or subscale scores. 

This study had a few limitations. First, ratings may be biased because researchers could not maintain blinding of the assessors regarding the group status of patients, and 27% of UHR participants refused to perform the HiSoC task. Compared with the group that performed the HiSoC task, the group that did not perform the task demonstrated higher levels of negative symptoms. Second, low task tolerability may be attributed to differences between the Danish and American cultures because the Danish participants were found to be less expressive in social behavior and less comfortable performing in front of a camera. Lastly, this study may raise ethical concerns because participants were instructed to pretend to compete for a grand money prize, which may have offended those who chose not to perform the HiSoC task.

The study researchers concluded that the HiSoC task is sensitive and highly effective at detecting deficits in social skills in adults with UHR psychosis. They suggest that future studies be conducted to “extend findings by investigating the efficacy of the HiSoC task in other clinical populations such as patients with manifest psychosis and those with autism spectrum disorders.”


Glenthøj LB, Kristensen TD, Gibson CM, Jepsen JRM, Nordentoft M. Assessing social skills in individuals at ultra-high risk for psychosis: validation of the high risk social challenge task (HiSoC) [published online August 30, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.08.025