Towards a better diagnosis for all!

#Globallab: Dr. Georgia Lockwood-Estrin on her career as a global mental health researcher.

I am a neuroscientist by training, having a BSc in Neuroscience, and an MSc in clinical neuroscience from UCL. My PhD was in neurodevelopment and neuroimaging from Imperial College London, which I finished in 2015 – for this project I was looking at the development of the fetal and neonatal brain and looking how MRI measures differ in babies born prematurely (who are at high risk of developmental disorders) compared to those born at term.

During my PhD, I became more and more interested in global health and wanted to marry my interest in neuroscience, mental health, and global health. So I, therefore, started to pursue this following my PhD. I began working as a research fellow at LSHTM in global mental health to follow this path, where I met Prof Vikram Patel – one of the sponsors of my current Sir Henry Wellcome Post-doc fellowship. Under his guidance, I co-created a small group of neuroscientists and psychologists working in the field of public health, from India and the UK. Together we expanded this “translational neuroscience network” which now includes Professor Mark Johnson, Professor Emily Jones, and Dr Teea Gliga from BBK, as well as many others from the UK, USA, Malawi, and India.

I also spent a really exciting and interesting year working with Louise Howard at KCL, in the Section of Women’s Mental Health – where I expanded my interests to focusing on mental health disorders of young women, which has broadened my research focus. I then began my Sir Henry Wellcome Post-doc research fellow position at BBK. As part of this, I am spending approximately 8 months in Delhi to conduct fieldwork with an aim of establishing measures to identify autism symptoms in children using eye-tracking in low-income settings, specifically in Delhi, India. I am particularly interested that these measures are acceptable to parents and feasible for use in community settings.

What is the one thing you have learned in your studies that no parent should ignore? Not to ignore their worries and concerns about their child’s development. I am currently working on a systematic review of barriers to ASD diagnosis in women and girls, and one overriding feature of this literature shows that parents worries and concerns occur a long time before seeking health care – and often it is a struggle to even get clinicians to understand concerns, let alone friends/family/teachers (esp for disorders which may have a sex bias like ASD). I also see the same in the field settings here in India where I work, where parents might worry about their child’s development but do not feel empowered to seek the help they need for it. I would urge parents not to ignore their own concerns and to push forward as soon as they can with seeking help (even if it ends up not being a problem), which may lead to better and smoother longer-term outcomes for their child and their family well-being.

Can you tell us a little bit more about your own research field? What are the hot topics you are dealing with? As mentioned above, I’m part of a “translational neuroscience network” here in Delhi, which aims to bring neuroscience into global health/public health – we are a group of neuroscientists, clinicians, computer scientists, public health researchers, and others, and we have a couple of projects on the ground at the moment. The current focus of work is on using portable technologies to assess child cognitive development and to identify probable cases of Autism Spectrum Disorders (ASD). In the long term, we envision that this platform will establish programmes of applied research to translate neuroscientific findings into scalable tools for detection and intervention for a range of brain disorders in low-resource settings. My project is called EIRA (Eye-trackIng assessment for children with Autism), and aims to establish objective measures for identifying children with Autism Spectrum Disorders, using portable eye-tracking technology. The secondary aim is to assess the acceptability and feasibility of using this technology within community settings in Delhi, India. Therefore we are hoping to discover a novel, acceptable, feasible and objective way to measure symptoms of autism in low resource community settings in Delhi, India. I am also working on BRAINTOOLS here in Delhi, which is a similar study, but this time investigating the reliability of using EEG in community settings to evaluation sensory processing and social attention in 3-5-year-old typically developing children. Some background to the problem: Autism Spectrum Disorders (ASD) is characterised by deficits of social communication and restrictive behaviours, and its diagnosis currently relies on highly skilled mental health professionals measuring these deficits. South Asia has the largest number of children with ASD in the world, with India alone accounting for over 2 million children with ASD. However, although parents may notice symptoms as early as 24 months, large detection gaps mean that most children are belatedly or never diagnosed mainly due to the paucity of mental health specialists, hence critical years for interventions are missed. Task-shifting detection to a non-specialist health care is one solution. However, because current diagnostic assessments for ASD are complex, high-cost and require extensive training, objective measures of ASD are needed for detection. Cognitive markers of ASD have been identified using eye-tracking technology when tested in controlled lab-based settings in high-income countries. These markers have been associated with specific ASD symptoms when tested in childhood. EIRA, therefore, aims to establish markers using portable eye-tracking technology that are acceptable and feasible for use in identifying children with ASD in low resource settings in Delhi. These methods can improve detection, and enable a greater number of children to benefit from early interventions.

What is your most exciting finding so far? (How is that relevant to parents?)  I'm still in the data collecting phase at the moment, so no findings yet on this. But data collection is looking promising, and acceptable for use in the community settings in which we are working. We have had a number of challenges which we have had to climb over, for example, problems with electricity shortages (frequent power outages, or limited power supply meaning our equipment won’t run). Other difficulties have included very loud noise levels here in Delhi, and children not being used to watching screens, so sitting in front of the screen for a long time is challenging. It is also challenging bringing all the equipment we have with us to small houses, along with tiny and bumpy roads.

What is your favorite method? What does it tell us about what goes on in those little heads?  I think eye-tracking as a method. For EIRA we are using eye-tracking in the following way: A child sits in front of a screen watching videos of cartoons and people interacting (amongst other things); whilst the child watches these videos, we track where they are looking on the screen using a small portable eye-tracker. There is considerable evidence that eye-gaze patterns in children and people with autism differ compared to their typically developing peers when looking at these specific tasks/scenes. However, this research has been almost exclusively conducted in highly controlled lab-based settings in high-income countries – this is the first study to bring this technology into a community setting in a low and middle-income country, in order to understand whether these same differences can be seen in a much less well-controlled environment. It is simple to use and self-explanatory, without requiring anything of the child other than to watch a screen.

Is there a parenting book or website you would recommend? I am afraid I don’t really know of any to recommend – ask me again in a few years!

Can you sing the Babybrains song? (no pressure)

haha i dont think so?

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