Annual Research Review: The transdiagnostic revolution in neurodevelopmental disorders

Abstract

Practitioners frequently use diagnostic criteria to identify children with neurodevelopmental disorders and to guide intervention decisions. These criteria also provide the organising framework for much of the research focussing on these disorders. Study design, recruitment, analysis and theory are largely built on the assumption that diagnostic criteria reflect an underlying reality. However, there is growing concern that this assumption may not be a valid and that an alternative transdiagnostic approach may better serve our understanding of this large heterogeneous population of young people. This review draws on important developments over the past decade that have set the stage for much-needed breakthroughs in understanding neurodevelopmental disorders. We evaluate contemporary approaches to study design and recruitment, review the use of data-driven methods to characterise cognition, behaviour and neurobiology, and consider what alternative transdiagnostic models could mean for children and families. This review concludes that an overreliance on ill-fitting diagnostic criteria is impeding progress towards identifying the barriers that children encounter, understanding underpinning mechanisms and finding the best route to supporting them.

Capturing developmental dynamics within a transdiagnostic framework: Challenges and promises

“…Our understanding of the difficulties individuals encounter during development is currently constrained by diagnostic frameworks that chart a list of symptoms and assign individuals to one or more discrete categories at a particular point in time. Existing diagnostic classification systems, such as the DSM-5 (American Psychiatric Association ,2013)) or ICD-11 (World Health Organization, 2019) have been widely critiqued (Astle et al, 2021;Astle & Fletcher-Watson, 2020;Happé et al, 2006;Pennington, 2006), with many scholars and practitioners questioning whether they are fit for purpose, in both research and practice. The purpose of this review is not to provide a detailed overview of the conceptual and methodological shortcomings of the diagnostic orthodoxy; this has already been done (Astle et al, 2021).…”

“…Existing diagnostic classification systems, such as the DSM-5 (American Psychiatric Association ,2013)) or ICD-11 (World Health Organization, 2019) have been widely critiqued (Astle et al, 2021;Astle & Fletcher-Watson, 2020;Happé et al, 2006;Pennington, 2006), with many scholars and practitioners questioning whether they are fit for purpose, in both research and practice. The purpose of this review is not to provide a detailed overview of the conceptual and methodological shortcomings of the diagnostic orthodoxy; this has already been done (Astle et al, 2021). To summarise the case against existing diagnostic systems briefly: these frameworks are thought to be ill equipped to accommodate the high degree of symptom overlap across diagnoses, incorporate variability within diagnoses, or capture the needs of those with difficulties that do not conform to a diagnostic standard.…”

Cognitive and academic skills in two developmental cohorts of different ability level: A mutualistic network perspective.

“…Overstating the “purity” of learning problems at the point of recruitment biases outcomes towards core-deficit accounts. To avoid such biases, learning-related problems are increasingly studied using transdiagnostic approaches (Astle et al, 2021; Casey et al, 2014; Holmes et al, 2019; Mareva & Holmes, 2019). These approaches aim to understand the processes and causes of difficulties that occur across individuals irrespective of diagnosis or group membership.…”

Neurodevelopmental disorders in the international classification of diseases, 11th edition (ICD-11): An overview

“…Značajno je naglasiti da iako postoji duga tradicija u prepoznavanju i konceptualizaciji neurorazvojnih poremećaja [2,7] , Američka psihijatrijska asocijacija je tek 2013. godine prvi put uvrstila neurorazvojne poremećaje kao posebnu dijagnostičku grupu u poslednjoj reviziji Dijagnostičkog i statističkog priručnika za mentalne poremećaje (eng. Diagnostic and statistical manual of mental disorders, 5th ed, [DSM-5]) [8] .…”