Examining the neurodevelopmental spectrum of children and adolescents in low-resource settings - Background. Neurodevelopmental disorders (NDDs) present a major global health challenge, particularly in low-resource settings like South Africa, where traditional diagnostic frameworks and access to comprehensive evaluations are limited. This research shifts the focus from formal NDD diagnoses to neurodevelopmental difficulties—measurable impairments in cognitive, social, emotional, and behavioral functioning—offering a more adaptable, resource-efficient approach grounded in the WHO’s International Classification of Functioning, Disability and Health (ICF). Given the rising prevalence of neurodevelopmental difficulties in South Africa and the critical role of caregivers, data-driven approaches are urgently needed to identify and support affected children. This study, which will utilize data from the Asenze Cohort Study (ACS), is the first to use adapted, non- specialist-administered measures alongside data-driven methods for a comprehensive assessment of neurodevelopmental difficulties in an LMIC context. Aims. Aim 1 will cross-sectionally identify neurodevelopmental profiles of children in Asenze at ages 5, 7, and 16 using latent profile analysis to identify distinct strata of children based on patterns of neurodevelopmental difficulties at each timepoint. Aim 2 will longitudinally characterize neurodevelopmental trajectories based on latent profile changes and examine the association between trajectories and cognitive and functional impairments in adolescence. Aim 3 will evaluate caregiver mental health, alcohol and other drug use as predictors of adolescents’ cognitive and functional impairments at age 16. Approach. This study leverages data from Waves 1-3 of the ACS, a longitudinal study conducted in KwaZulu-Natal, South Africa, which followed 1,581 children and caregivers from ages 5 to 16 between 2008 and 2021. Employing Latent Profile Analysis (LPA), we will identify distinct neurodevelopmental profiles at each wave, capturing the dynamic nature and heterogeneity of child development. Subsequently, these profiles will be used to track neurodevelopmental trajectories into adolescence, enabling us to assess the associations between trajectories and cognitive and functional impairments in adolescents. Finally, we will use Marginal Structural Models to evaluate the effects of caregiver mental and behavioral health on impairments in adolescents. Training. In this F31, the PI will establish expertise in the epidemiology of child and adolescent mental, neurological, and substance use disorders in low-resource settings, while developing a deeper understanding of neurodevelopmental difficulties and their assessment within LMIC contexts. Additionally, the PI will enhance professional development through manuscript and grant preparation, conference presentations, and engagement within scientific communities. This research will inform the development of focused interventions, applicable to resource-limited US populations, aiming to improve neurodevelopmental outcomes in vulnerable children and adolescents. This F31 will equip the PI with the expertise to become an independent researcher, driving advancements in global child neurodevelopment.
