Indeed, the conclusions about preschizophrenic cognitive decline in the study by Dr. Fuller et al. (1) could be stronger if information were available to exclude other confounders of academic functioning, such as comorbid conduct, substance use, or other psychiatric disorders, as well as the contribution of other prodromal symptoms. While the contribution of prodromal symptoms was dismissed on the basis of finding of no correlation between age at illness onset and test scores, there may not be simple relationships between them. For example, test scores at grade 11 could be confounded by earlier scores, premorbid intelligence, and psychiatric comorbidities. Previous studies of prodromal symptoms of first-episode psychosis point to the presence of a variety of emotional and attenuated negative symptoms (3, 4), all of which also could contribute to the academic decline observed. Nevertheless, these appeared less likely, since despite limitations of recall in these retrospective studies, it appeared from detailed interviews with patients and informants that cognitive disturbances (disturbances in attention, concentration, or memory and deterioration in school results), rather than neurotic symptoms, were more specific to the psychotic prodrome and that cognitive symptoms appeared to be the first manifestation (4).