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

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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.