Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5–11 Years

Abstract

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

Does behavioural parent training reduce internalising symptoms (or not) among children with externalising problems? Systematic review and meta-analysis

“…One line of research has inquired whether BPT as a standalone treatment may have clinical utility in reducing internalising problems, suggesting it represents an intervention format which benefits children with externalising and internalising problems [10,11,31]. These suggestions are based on theory emphasising the salience of transdiagnostic and contextual processes underpinning the progression of externalising and internalising problems [32][33][34][35]. The Dual Failure Model [33], for instance, proposes that children with externalising problems are more likely to experience internalizing problems, both concurrently and prospectively, due to concomitant negative family environments and social and academic difficulties.…”

Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums

“…This is particularly relevant for females with autism and ADHD + autism, who experienced the longest delays to diagnosis. In future, alternative approaches to care such as the clinical staging approach, where interventions are provided based on functional needs without the need for a diagnosis, could reduce current pressures to provide a diagnosis while still delivering appropriate interventions ( Sawrikar et al, 2022 ).…”

“…Screening for ADHD and autism symptoms in all children presenting with concerns for either disorder will be critical in helping reduce delays to diagnosis and support. The feasibility of a staged approach to clinical care with a focus on current adaptive needs rather than an immediate need for a diagnosis could also reduce pressures associated with receiving a timely diagnosis and subsequent access to intervention ( Sawrikar et al, 2022 ).…”

Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention

“…Sawrikar et al ( 2022 ) have recently described a clinical staging framework for youth at risk of developing internalising and externalising disorders. According to their model, the early stages are related to non-specific symptoms with presentation of risk factors (0), mild clinical symptoms with low risk of progression (Stage 1a) that then give way to sub-clinical syndromes that are more likely to precede to full-threshold syndromes (Stage 1b).…”