Basic science and treatment innovation

Abstract

The idea of trans‐diagnostic and modular treatments highlighted in this Editorial points the way beyond self‐contained ‘branded’ therapies to a more flexible intervention science responsive to advances in basic science and relevant also to personalisation of therapies. For such approaches to be rigorous, there need to be empirically identified trans‐diagnostic target mechanisms. The Editorial reviews two studies of potential mechanisms of this kind in the developmental neurobiology of stress response in children at risk from prenatal maternal stress and post natal neglect and maltreatment. A number of treatment trials are also reviewed illustrating the common method of digitally‐aided therapy; a common theme is the difficult in sustaining adherence to such treatment delivery methods. Finally it reviews a useful independent investigation of a commonly used autism screening instrument, suggesting improvements for greater specificity.

Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention

“…New molecular genetic data are quite clear in confirming results from epidemiologic studies indicating substantial overlap among psychiatric disorders as regards causal genomic loci (Smoller et al., ). Likewise, others have suggested that shared mechanisms among disorders should be key treatment targets (Green, ; Marchette & Weisz, ).…”

Mediation of 6‐year mid‐childhood follow‐up outcomes after pre‐school social communication (PACT) therapy for autistic children: randomised controlled trial

“…But the mechanistic analysis has further value in suggesting that other intervention models that succeed in increasing child communication initiations as we measure them here (an important caveat since apparently similar constructs measured differently may not be equivalent), could also have similar longer‐term outcome effects to PACT. This is an example of the generally important potential benefit of mechanistic analyses in clinical trials to identify ‘active processes’ of this kind and thus promote treatment evolution and innovation (Green, 2017 ; Marchette & Weisz, 2017 ).…”

Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation

“…They derive from applied behavior analysis and social communication models of ASD etiology, applying parent-mediated enrichment of the social interactive environment, and demonstrate preliminary positive outcomes on parent-infant interactions. In particular, evaluation of these early interventions suggest that undemanding synchronous parent behavior, which notices and responds to the child’s focus without suggesting a new action, is associated with stronger joint attention and language skills throughout childhood (Steiner, 2013; Rogers et al, 2014; Baker et al, 2015; Baranek et al, 2015; Bradshaw et al, 2015; Green, 2017; Petinou and Minaidou, 2017; French and Kennedy, 2018; Green and Garg, 2018; Wan et al, 2018; Whitehouse et al, 2019).…”