Very Early Identification and Intervention for Infants at Risk of Neurodevelopmental Disorders: A Transdiagnostic Approach

Abstract

Neurodevelopmental disorders (NDDs) begin in the earliest months of life, but the clinical manifestations of many such disorders-including intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder, and fetal alcohol spectrum disorder-are often not seen until much later. Theoretically, very early intervention provides the best chance for optimizing outcomes for children at risk. However, opportunities for early intervention may be thwarted by a dependence on assessing overt phenotypic or behavioral symptoms that often emerge later in childhood. In this article, we examine the utility of a transdiagnostic, dimensional approach to very early identification and intervention for infants at risk of NDDs. We consider how insights from epidemiology, systems biology, and developmental neuroscience may be integrated to aid identifying at-risk infants and developing targeted, adaptive interventions. We also highlight directions for research.

Moving the dial on prenatal stress mechanisms of neurodevelopmental vulnerability to mental health problems: A personalized prevention proof of concept

“…One crucial component is targeting neurodevelopmental vulnerability to mental health problems based on probabilistic risk rather than full‐blown clinical disease. This requires developmentally specified dimensional tools, joint consideration of brain‐behavior patterns, and a transdiagnostic approach (Finlay‐Jones et al., 2019; McGorry & Nelson, 2016; Wakschlag, et al., 2019). Another vital element is extending this emphasis even earlier in development to the prenatal environment that shapes fetal neurodevelopment (Buss et al., 2012; Davis et al., 2018; Spann et al., 2018).…”

“…Our approach conceptualizes clinical phenomenology as a developmentally unfolding transdiagnostic risk spectra within a developmental origins perspective in early life, emphasizing nascent self‐regulatory structures and processes that have been robustly linked to adverse prenatal exposure (Casey et al., 2014; Graham, Pfeifer, Fisher, Carpenter, et al, 2015; Graham, Pfeifer, Fisher, Lin, et al, 2015; Wakschlag et al., 2018). This is conceptualized as probabilistic risk of subsequent mental health problems (Beauchaine & Cicchetti, 2019; Doyle & Cicchetti, 2018; Finlay‐Jones et al., 2019; Luby et al., 2019; Wakschlag, et al., 2019). Precisely assessing neurodevelopmental vulnerability to mental health problems requires a transdiagnostic approach, potentially allowing for earlier and more effective preventive intervention with population health impact (McGorry & Nelson, 2016; Smith et al., 2019; Walkup et al., 2017).…”

“…In PHBP, we focus on emotion dysregulation as the optimal neurodevelopmental phenotype for assessing vulnerability to mental health problems as it is (a) measurable beginning at birth; (b) ubiquitous across most internalizing and externalizing disorders; (c) associated with corollary prefrontal disruptions; and (d) strongly linked to prenatal stress exposure from early in life (Beauchaine & Cicchetti, 2019; Davis et al., 2018; Finlay‐Jones et al., 2019; Hartman et al., 2019; Wakschlag, et al., 2019) (see Table S1 for multi‐level measurement specifics). In particular, we have emphasized atypical expressions of irritability as our central behavioral phenotype because it is a highly salient pattern identifiable in very young infants that is a transdiagnostic risk marker (Toohey & DiGiuseppe, 2017; Wakschlag, et al., 2019).…”

“…At the same time, advances in developmentally based methods (e.g., infant imaging, dimensional phenotypes), as well as emphasis on transdiagnostic common pathways (e.g., emotion dysregulation as infant risk phenotype) now enable detection of neurodevelopmental vulnerability to subsequent mental health problems beginning at birth. Capturing this vulnerability in proximity to exposure is critical when testing plasticity of causal pathways (Beauchaine & Cicchetti, 2019; Finlay‐Jones et al., 2019; Graham, Pfeifer, Fisher, Carpenter, & Fair, 2015; Graham, Pfeifer, Fisher, Lin, et al, 2015; Hartman et al., 2019; Wakschlag, et al., 2019). Joining a burgeoning call for action (Davis et al., 2018; Doyle & Cicchetti, 2018; Gelaye & Koenen, 2018; Glover, 2014; Goodman et al., 2018; Heim et al., 2018; Shonkoff, 2016), we aim to move the translational dial on prenatal stress research from robust observational evidence to a preventive approach, with promise for improving lifecourse health.…”

Community Priority setting for Fetal Alcohol Spectrum Disorder Research in Australia

“…Given that many priorities that emerged from the current project align with those expressed regarding neurodevelopmental disorders more broadly [76], consideration may be given to trans-diagnostic or cross-syndrome approaches to research and translation. Such approaches focus on promoting healthy development and optimising functional outcomes across the spectrum of neurodevelopmental disability, as well as among those with subclinical neurodevelopmental vulnerability [77]. Because frequent co-morbidities of FASD include other neurodevelopmental disorders, physical illnesses, and mental illhealth, there is also a need for research on integrated care pathways for affected individuals and families.…”