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

位于伯克贝克的脑与认知发展中心(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，包括为大规模纵向研究和试验开发和应用新方法。我们的战略愿景是将这些理论、研究设计和技术开发方面的专业知识应用于LMIC的早期心理健康。儿童精神病学传统上专注于用诊断来治疗儿童和青少年。然而，诊断后治疗通常是昂贵的，而且LMICs中的大多数患者无法获得(Belfer，2008)，他们一般也可能无法获得诊断服务(Saxena等人，2007年)。为了满足LMIC的需求，我们需要彻底改变我们的做法。与其将资源集中在有诊断的儿童身上，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，然后利用这些信息来开发针对这些大脑系统的低成本、可扩展和预防性的治疗方法。为此，我们计划了一项综合的长期研究计划，以确定预测LMIC神经发育结果的婴儿大脑标记物；使用这些标记物来测试LMIC中哪些常见的可改变的风险因素影响关键大脑系统；以及确定可能代表LMIC环境中建立复原力的干预目标的保护性因素。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)能够快速评估简单预防性干预的效果。直接测量大脑发育使我们能够尽早识别最脆弱的儿童，使有限的资源集中在那些最有可能从预防性方法中受益的人身上。总而言之，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精神健康的婴儿神经标记物方面的专业知识，以及在低资源环境下部署新技术测量儿童早期大脑发育方面的经验。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LMIC地点密切接触，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不同挑战的LMIC合作伙伴：MRC冈比亚和Sangath India。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协作网络(泵启动项目)；(1)合作制定一项可行的方案，以评估LMIC环境中人类功能大脑的发育，(2)准备一门全球健康发展神经科学硕士课程，(3)与合作伙伴中小企业BabyBrains共同制定LMIC环境中的家长教育和家庭参与计划，以及(4)就如何建立CBCD附属的地区英才中心进行差距分析。综上所述，我们的凝聚力一揽子计划旨在为我们将儿童早期大脑发育纳入全球心理健康的长期战略提供基础。

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.