Approximately 1 in 10 children in the UK has a neurodevelopmental condition (including Autism Spectrum Disorder, ADHD, Intellectual Disability and specific learning and motor disabilities). Neurodevelopmental conditions often have a life-long impact on the person's (and their family's) quality of life. This includes on average lower education, greater unemployment, lack of independence, susceptibility to violence, and high rates of mental health problems. On the whole, there are few therapies available that are effective. Key factors are late diagnosis, after critical periods of brain growth are completed, and substantial differences between individuals with the same umbrella diagnosis in terms of clinical features and underlying biology, meaning that "one size does not fit all". Precision medicine aims to transform healthcare by tailoring therapies to individual brain profiles. It is based on the assumption that diagnosis can be improved if it is based on the underlying cause or mechanisms rather than merely symptoms and that atypicalities in brain development may precede some overt behavioural differences. However, applying precision medicine to young children with neurodevelopmental conditions depends on having accurate and reliable ways of measuring brain activity and behaviour. For example, to aid early identification of children with difficulties, we need ways of measuring brain activity in the home or nursery. To identify the best ways to help children, and when they need to be offered, we need tools that can adjust brain measurements as they are taken. These tools must be for all children, including those with severe intellectual or motor disability, so we need tools that measure brain activity during tasks with low motor or attentional demands, such as eye-tracking or touchscreen devices. Despite significant advances in the development of new technologies for measuring brain function in infants and young children, few instruments are used in the clinic. One challenge is making sure that such technologies are designed to permit consistent application, so readings can be reliably compared across time and across children. We also need superior computational methods for turning large amounts of multidimensional data into clinically useful information about an individual child. Hence, to make transformative changes we need to develop the right technology for the right populations for the right purposes. The goal of our network is to bring together a community of people from different backgrounds including charities and families of children with neurodevelopmental conditions, ethicists, experts in brain development, psychologists, psychiatrists, bioengineers, physicists, regulators and policy makers to develop a new generation of neurotechnology to drive forwards precision medicine for infants and young children with neurodevelopmental conditions. The scope of our network is to: (1) build an inclusive community and develop a hub that allows academics from the bioengineering and medical fields, industry and innovators, parents and people with various neurodevelopmental conditions to connect (2) identify priorities and gaps and publish our results, and (3i) carry out innovative feasibility studies to support and attract larger investments, (4) investigate ethical challenges with parents and people with lived experience to ensure that neurotechnology developments are acceptable, safe and feasible for children and parents; (5) create roadmaps to accelerate the development of new technologies for assessment, monitoring and interventions in the clinic and at home, and develop strategies for companies to invest in these technologies, to make them affordable and implement them in the UK health service, and (6) propose training programmes to train a new generation of scientists in this new interdisciplinary field.

Poverty in early years of life can have devastating effects on cognitive development and mental health. A baby's first 1000 days (from conception to two years of age) are a critical window of vulnerability to exposure to socio-economic and health challenges (i.e. poverty/undernutrition/prematurity). In the UK, it is estimated that 4 million children are raised in households in relative poverty compared with typical UK living standards. At a global level, the impact of poverty is reflected by one third of children in developing countries failing to reach their developmental milestones in cognitive and/or socio-emotional growth. This compromised development, of a core set of age-appropriate skills, has a significant impact on subsequent academic achievement, mental health and economic status. However, the impact of poverty on subsequent brain and cognitive development is rarely studied until later childhood, and into adulthood, when intervention strategies become less effective. For one such global health challenge - developmental disorders - prospective longitudinal studies using neuroscientific tools to study early brain development within high-income settings, have allowed major advances in finding early biomarkers of risk during the first year of life. These studies have recently led to the application of several promising intervention programmes. However, in order to apply this model to the study of cross-cultural global health challenges in low-income settings, we first need to make significant advances in; (i) the applicability of brain imaging for research outside of the lab to better access socially disadvantaged populations, (ii) our understanding of the impact of poverty on brain development and (iii) the development of population-tailored early intervention strategies To date, global health research has been largely limited to the use of behavioural assessments to measure the effect of exposure to early poverty. However, observable changes in behaviour are often only evident towards the second year of life - despite significantly earlier changes in brain functional and anatomical specialisation - potentially limiting our ability to effectively intervene. Assessing impairment at school age and attempting to retrospectively decode the cascading effects of early environmental insults is unlikely to reveal clear and reliable targets for intervention. It is therefore imperative that neurocognitive development is studied longitudinally, taking contemporaneous measurements of brain function in parallel with measurements of exposure to environmental challenges. The objective of this interdisciplinary fellowship is to push frontiers in the study of the impact of poverty on brain development, and to intervene in the global, cross-cultural challenges inherent in early adversity. This objective will be pursued through the study of brain and cognitive development in infants from birth, through their first months and years of life across multiple populations. My long-term goal is that, upon completion of this fellowship, I will have provided a mechanism for a shift in the focus of national and international global health projects - away from measuring outcome of poverty in later childhood and adulthood, and towards providing a pathway for protecting infants through intervention in the first days and months of life. To achieve this, I will have (i) determined appropriate low cost, population-tailored early adversity interventions for use in parallel with a widely-applicable developmental brain imaging toolkit, (ii) established a public engagement platform providing early support for parents and families, and (iii) sought opportunities to influence government policy in the area of child development in the UK and partnering sites.

Newborn infants are extremely vulnerable to brain injury. The cause and nature of newborn brain injuries varies widely, but one common factor is that infants who suffer a brain injury at birth often go on to develop cerebral palsy. Cerebral palsy is a group of permanent movement disorders that can severely limit the control of the muscles, and can have a devastating impact on quality of life. Cerebral palsy is the most common form of childhood disability in Europe and every year, approximately 1800 children in the UK are diagnosed with the condition. Cerebral palsy also has a significant impact on families and on society. It is estimated that the costs of care and support for people with cerebral palsy exceeds £1.4 Billion per year in the UK. The early diagnosis of cerebral palsy is critical. While there is no cure for the condition, there are a number of treatments that can improve an infant's long-term motor ability. During the first few weeks and months of life the brain is highly adaptable, which means it is likely to be at its most susceptible to treatment. If infants with abnormal motor development could be identified early, these treatments would have the greatest chance of success. At present, the majority of infants with cerebral palsy are not diagnosed until 1 or 2 years-of-age. By this point it is likely too late for treatment to have the best possible impact. In 2015, the government held an inquiry into issues surrounding cerebral palsy in the UK and highlighted the urgent need for more research to support the early and objective diagnosis of the condition. In healthy children and adults, the parts of the brain that control movement and receive somatosensory input (such as touch sensation) are organized like a map of the body. It has been shown that this organization is disrupted in children and adults with cerebral palsy. If we could monitor this disruption in the infant at the cot-side, it would be possible to provide an early and objective identification of infants who are developing abnormally. At present, there is no technology that can provide the precision, resolution, patient comfort or motion tolerance necessary to achieve this. The aim of this fellowship is to address these challenges and develop a new wearable functional brain imaging technology that will allow infant somatosensory and motor organization to be mapped at the cot-side. I will use flexible electronics to construct a miniaturized imaging array that will incorporate hundreds of emitters and detectors of near-infrared light to safely monitor infant brain function. This imaging array will be fixed into a soft, elastic head-cap that can be worn comfortably by a newborn baby. By designing and integrating an advanced form of motion tracking, and by developing novel signal processing approaches, I will maximize the precision and motion tolerance of this imaging technology to allow brain function to be mapped during touch stimulation and during natural movement. I will then validate this system using carefully controlled laboratory experiments and a comprehensive functional imaging study in healthy adults. Finally, I will translate this technology to the neonatal clinic and investigate the development of somatosensory and motor function in both healthy and brain-injured infants from preterm through to 6 months-of-age. In doing so, I aim to demonstrate a new approach to the objective identification and monitoring of infants with cerebral palsy.