MICA: BRAINTOOLS Phase 1: Optimising neurodevelopmental outcomes for global health

伯克贝克学院的大脑和认知发展中心（CBCD）在儿童早期心理发展和心理健康的多学科研究方面享有世界领先的声誉，包括开发和应用大规模纵向研究和试验的新方法。我们的战略愿景是将这些在理论、研究设计和技术开发方面的专业知识应用于低收入人群的早期心理健康。儿童精神病学传统上侧重于对有诊断的儿童和青少年进行治疗。然而，低收入和中等收入国家的大多数患者通常无法获得昂贵的诊断后治疗（Belfer, 2008），他们通常也无法获得诊断服务（Saxena et al., 2007）。为了满足中低收入国家的需求，我们需要彻底改变我们的做法。与其将资源集中在被诊断的儿童身上，我们需要转向直接测量受婴儿期早期风险因素影响的大脑系统，然后利用这些信息开发针对这些大脑系统的低成本、可扩展和预防性治疗。为此，我们计划了一项综合的长期研究计划，以确定预测中低收入国家神经发育结果的婴儿大脑标志物；使用这些标记来测试低收入国家中哪些常见的可改变的风险因素会影响关键的大脑系统；并确定可能代表干预目标的保护因素，以在低收入和中等收入国家环境中建立恢复力。直接评估儿童早期环境风险因素的影响（而不是等待后来的神经发育结果）可以快速评估简单预防性干预措施的效果。直接测量大脑发育使我们能够尽早识别出最脆弱的儿童，从而将有限的资源集中在那些最有可能从预防方法中受益的儿童身上。综上所述，关注儿童早期的大脑发育对于彻底改变全球心理健康至关重要。我们最适合领导这一挑战，因为我们在开发长期心理健康的婴儿神经标志物方面的综合专业知识，以及我们在低资源环境下部署新技术来测量早期儿童大脑发育的经验。虽然我们的长期愿景需要广泛传播专业知识，但关键的第一步是与选定的低收入和中等收入国家密切接触，进行双向知识交流和可行性评估。因此，我们精心挑选了两个面临截然不同挑战的低收入和中等收入国家伙伴；冈比亚MRC和印度Sangath。在初步接触的基础上，我们将建立和巩固一个有四个短期目标的合作网络（推动项目）；(1)共同制定一个可行的方案来评估低收入和中等收入国家环境下的人类大脑功能发育；(2)准备一个全球健康发展神经科学硕士课程；(3)与合作伙伴SME BabyBrains一起制定一个低收入和中等收入国家环境下的父母教育和家庭参与计划；(4)对如何建立隶属于CBCD的区域卓越中心进行差距分析。总之，我们有凝聚力的一揽子计划旨在为我们将幼儿大脑发育纳入全球心理健康的长期战略奠定基础。

The Centre for Brain & Cognitive Development (CBCD) at Birkbeck has a world leading reputation for the multidisciplinary study of psychological development and mental health in early childhood, including development and application of new methodologies for large-scale longitudinal studies and trials. Our strategic vision is to bring this expertise in theory, study design, and technology development to bear on LMIC early mental health. Child psychiatry has traditionally focused on treating children and adolescents with a diagnosis. However, post-diagnostic treatments are typically expensive and inaccessible to most patients in LMICs (Belfer, 2008), who may also lack access to diagnostic services in general (Saxena et al., 2007). To meet the needs of LMICs, we need a radical shift in our approach. Rather than focus resources on children with a diagnosis, we need to shift towards direct measurement of the brain systems that are affected by early risk factors in infancy, and then use this information to develop low-cost, scalable and preventative treatments targeted towards those brain systems. To do this, we have planned an integrated long-term programme of research to identify the infant brain markers that predict neurodevelopmental outcomes in LMICs; to use these markers to test which common modifiable risk factors in LMICs affect key brain systems; and to identify protective factors that could represent targets for intervention to build resilience in LMIC settings. Directly assessing the effects of environmental risk factors in early childhood (rather than waiting for later neurodevelopmental outcome) enables rapid assessment of the efficacy of simple preventative interventions. Directly measuring brain development allows us to identify the most vulnerable children as early as possible, allowing limited resources to be focused on those most likely to benefit from preventative approaches. Taken together, focusing on brain development in early childhood is critical to revolutionising global mental health. We are optimally suited to leading this challenge because of our combined expertise in developing infant neural markers of long-term mental health and our experience in deploying novel technologies to measure early childhood brain development in low-resource settings. While our long-term vision entails widespread dissemination of expertise, a key first step is close engagement with selected LMIC sites for bi-directional knowledge exchange and feasibility assessments. Thus, we have carefully selected two LMIC partners who face contrasting challenges; MRC Gambia and Sangath India. Building on initial contacts, we will establish and consolidate a collaborative network with four short-term objectives (pump-priming projects); (1) collaboratively develop a feasible protocol for assessing human functional brain development in LMIC settings, (2) prepare a Masters course in Developmental Neuroscience for Global Health, (3) develop a plan for parent education and family engagement in LMIC settings with partner SME BabyBrains, and (4) conduct a gap analysis of how to establish regional Centres of Excellence affiliated to CBCD. Taken together, our cohesive package is designed to provide the foundation for our long-term strategy to bring early childhood brain development into global mental health.