Precision pathways for young children at risk of neurodevelopmental disorders

Precision pathways for young children at risk of neurodevelopmental disorders: Early identification and adaptive intervention starting from the prenatal period

Neurodevelopmental disorders (NDDs) can include:

• Autism Spectrum Disorder (ASD)
• Fetal Alcohol Spectrum Disorder (FASD)
• Intellectual Disability (ID)
• Cerebral Palsy (CP)
• Attention Deficit Hyperactivity Disorder (ADHD) 
• Developmental Language Disorder (DLD)

These disorders affect approximately 15% of children.

Children with NDDs can experience marked and lifelong difficulties across a number of functional domains, including language and speech, motor skills, behaviour, memory, learning, or other neurological functions. As a result, the individual, family, and societal burden associated with NDDs is immense.

While some NDDs are associated with specific environmental or genetic causative factor, others have a more heterogeneous aetiology. Moreover, the way different risk and protective factors interact to predict type and severity of impairment across the neurodevelopmental spectrum is not well understood.

The identification of early markers and risk profiles pathognomonic of NDDs requires systematic, prospective approaches to chart normal and abnormal developmental trajectories across different domains. Understanding the causal pathways driving neurodevelopmental impairments will enable creation of a new generation of screening and diagnostic tools as well as inform the development of targeted intervention approaches.

Current guidance on the management of individual NDDs is contingent on diagnosis, which often relies on accurate identification of behavioural symptoms that typically emerge after 2-3 years of age. As a result, current models of care may fail to engage at-risk children, or may engage them later than is optimal.

Ideally, intervention for NDDs would take place in the first two years after birth, when neuroplasticity is maximal. To address this our proposed program integrates the development and evaluation of very early intervention that is responsive to type and severity of neurodevelopmental risk across early development. This transdiagnostic and dimensional model allows clinical management of at-risk children to shift from ‘wait and see’ to ‘identify and act’. Through the very early application of precision medicine principles, this project aims to optimise trajectories from the antenatal period onward.

Our research aims to improve the identification and treatment of children at risk of NDDs. We aim to identify early (birth - 2 years) markers and risk profiles for neurodevelopmental impairment, and to develop and evaluate very early treatments that are personalized to individual strengths and difficulties. By doing this, we hope to promote positive developmental outcomes across the lifespan. Together with strategies that aim to engage optimally with at-risk families and translate screening and intervention principles into policy and practice, this program has the very real potential to revolutionize the clinical management of children at heightened risk of NDDs.

There is a large Stakeholder Reference Group for this project that has representatives from several Western Australian government departments and non government organisations.

Funder of this Project

FASD Research Australia from the National Health and Medical Research Council (NHMRC) Centres of Research Excellence grant.

Read more information about the Think Big Neurodevelopmental Disorders Group