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

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.

Our cohesive package of work involves four related pump-priming projects (PPP).
PPP-A: We will develop and field-test a toolkit for measuring early childhood brain markers associated with mental health outcomes, using combined EEG and eyetracking to enable a fully automated analysis pipeline suitable for large-scale deployment. The task battery will assess social brain development (e.g. videos of social dynamic scenes; face attention; dynamic gaze) and attentional control (e.g. gap-overlap attention-shifting; frontal EEG power and connectivity); tools are designed to be applicable to other domains as novel findings emerge. After development, we will assess test-retest reliability and feasibility in two contrasting rural LMIC settings.
PPP-B: To boost human capital, we will develop a new Masters program in "Developmental Neuroscience for Global Health" and submit it for accreditation. This will foster expertise, collaboration, and training between the UK and LMICs.
PPP-C: Our tools are targeted at early childhood, and critically require engagement with families. To facilitate this, we will collaborate with a Birkbeck spin-off company, BabyBrains Ltd, that provides empowering parental education (www.baby-brains.com). The CEO of BabyBrains will visit the LMIC sites to consult on how their program can be best adapted, and produce draft training materials for future work.
PPP-D: LMIC-based research requires local Centres of Excellence (CoE) that have the infrastructure, expertise and tools required to conduct large-scale studies of early development. A roadmap for creating two CoEs will be developed; West Africa (MRC-G) and India (Sangath). These CoEs will provide training for both local and UK-based researchers in applied global health research; and through a hub and spoke model enable our scientific advances at CBCD to be rapidly rolled out to the broader global community.

Our strategic vision will meet the advances outlined in the MRC Global Health Call by addressing the challenges to early brain development that affect mental health and cognition (RQ2). Our vision is to develop broadly applicable early childhood interventions to significantly alleviate the burden of poor mental health and optimise essential social and cognitive skills throughout LMICs. To do this, we will build on the expertise, infrastructure and collaborations that we have developed through our successful program of MRC-funded research into the early childhood brain systems that underlie mental health in early childhood.

We focus on understanding the mechanisms and dimensions that underlie vulnerability and resilience in mental health through a prospective longitudinal approach, which allows us to study changes in the brain that precede the later emergence of behavioral symptoms. Our work will enable a greater understanding of the epidemiology and aetiology of mental illness in LMIC settings and the health impacts of a range of external drivers by providing the tools to study the effects of a broad range of genetic and environmental risk factors on brain development in large-scale field studies. We target the following specific goals: (1) By optimizing our neurocognitive measures for use in the field, and field testing them in the Gambia and India, we will "refine .. methods and outcome measures for mental health research in LMIC settings", which will provide critical feasibility data for planned largescale grant applications focused around our key long-term questions; (2) we will "identify opportunities and assess feasibility of developing sustainable, largescale global mental health research projects" by working in partnership with LMIC academic and non-profit research institutions"(initially MRC-Gambia, Sangath); (3) by leveraging multidisciplinary expertise at CBCD and affiliated networks we will "bring together experts from different research backgrounds, including genetics, psychology, psychiatry, child health, engineering, cognitive development, maternal health, epidemiology" to enable our planned research program is fully interdisciplinary; (4) we will "provide opportunities for researchers whose work is relevant to global mental health.. particularly early career researchers" by directly involving them in our project team, and by setting up a template for our new Masters program with associated placement and mentoring opportunities to develop the next generation of global health researchers essential to our future research plans; (5) we will "produce preliminary data for future grant applications" by generating test-retest data on our battery in the UK, Gambia and India; (6) we "develop concepts for long-term investments which can be funded through more substantive funding schemes" by hosting a collaboration meeting to develop our strategic plan for future funding and (7) we will "create pathways to impact in LMICs" by creating blueprints for Centres of Excellence in West Africa and India that will provide the setting for new large-scale cohort and intervention studies. Through this route, our work will transform the life chances of infants and young children in LMIC settings.