Introducing Prof Eva Loth

What is your role and the role of your institution/group within the CANDY project?

I am the leader of WP 4: Developing a European Clinical Research Platform for Neurodevelopmental Conditions. Central to this workpackage is our Preschool Brain Imaging and Behaviour Project (PIP), which is co-funded by CANDY and AIMS-2-TRIALS. PIP is the first European longitudinal multi-centre and multi-disciplinary project that follows nearly 500 autistic children, children with ADHD, ID, epilepsy or without a clinical condition from 3 to 6 years. We comprehensively assess each child in terms of their clinical features, adaptive behaviour, quality of life, cognitive profile, brain development and function, immune markers, microbiome, genomics and environmental factors. Our goal is to identify markers and mechanisms that help us to predict a child’s natural development as well as their support needs.

We also harmonise datasets from existing large scale cohort studies to identify mechanisms that are shared vs. distinct across a range of neurodevelopmental conditions. Often times we acquire a lot of data but do not have capacity to analyse them in real-time. In CANDY we draw on significant analytics expertise to identify subpopulations within or between diagnostic categories (ie., autism, ADHD, ID, conduct disorder etc) with similar cognitive or neurobiological characteristics.

What is your long-term vision for CANDY? What is special about the CANDY project?

One aspect of CANDY that I am particularly excited about is that it moves beyond the typical case-control designs, in which we tend to compare people with one clinical condition to a typically developing or neurotypical comparison group. Evidently, this design does not enable us to ascertain what may be truly specific for a particular condition (or a subpopulation within that) because similarities or differences with other conditions just aren’t tested on the same measures. Moreover, it has become increasingly evident that there is tremendous overlap in clinical features between neurodevelopmental and mental health conditions. CANDY helps us to move out of our silos by adopting a transdiagnostic approach, while using existing categorical conditions as a reference point.

What are the key-findings of your group  gained within the CANDY project so far?

I’ve learnt that longitudinal studies require a lot of patience! We are just about to complete the first assessment wave of PIP across all sites (while follow-up waves are in parallel in progress). As this is the first large-scale preschool MRI study in Europe, our teams have acquired and shared a lot of tricks ‘on the job’ of how to make a sleep scan in our MRI sleep tent most enjoyable for children and their parents. I’ve also learnt that our work is better and more meaningful when we involve autistic and neurodivergent people with lived experience – ideally from the outset. There is no going back from that.

Your reading suggestion?

“Does the current state of biomarker discovery in autism reflect the limits of reductionism in precision medicine? Suggestions for an integrative approach that considers dynamic mechanisms between brain, body and the social environment” Loth, E. (2023) https://pubmed.ncbi.nlm.nih.gov/36911126/

I recently wrote a perspective paper on the progress, challenges and future avenues for precision support for neurodevelopmental conditions. One key argument I am trying to make is that it may not be enough to only focus on a child’s biology or conversely only focus on social factors, but we need to integrate both to get a fuller understanding of a person’s strengths and difficulties in particular social contexts. Precision support may then entail both tailored support for particular features  and changes in the environment (the family, school, and society at large).