6907 Clinical benefits of formal definition of subthreshold diagnosis for neurodevelopmental, emotional, behavioural and intellectual disorders (NDEBID)

Objectives Neurodevelopmental Disorders (NDD) often co-exist with a wider range of emotional, behavioural, and intellectual disorders, collectively grouped together as NDEBID. The commonest NDD are Autism spectrum disorder (ASD), Attention deficit/hyperactivity disorder (ADHD), Tic disorders, Developmental Language, Coordination and Intellectual Disabilities. There is evidence of wide discrepancies between prevalence of NDEBID among epidemiological and clinical samples, suggesting that many more children and Young People (CYP) have with NDEBID are not diagnosed clinically. The over-reliance on only discrete diagnosis alone by Practitioners would inevitably exclude many CYP with subthreshold diagnosis who continue to experience high levels of functional impairment in several areas of daily living. This observation underlies the importance of better recognition of CYP who not only meet the full criteria for specific diagnosis, but also those with subthreshold symptoms, who equally require optimal psychosocial supportive interventions. Aims and Objectives We aimed to appraise the published literature about common themes regarding subthreshold NDEBID and to discuss practical benefits of their wider recognition and documentation in clinical practice. Methods A search of the published literature was carried out from electronic databases including PMC, Pubmed, CINAHL, and the Cochrane Database of Systematic reviews, and various other online resources using various combinations of keywords including: 'Subthreshold', 'neurobehavioural disorders', 'neurodevelopmental', 'childhood', 'ADHD', 'ASD', 'emotional' and 'psychiatric disorders'. Results Some of the themes identified include Definition, Prevalence, Assessment tools, Management, Raising Public Awareness, and future research direction. Subthreshold symptoms or traits refer to a spectrum of characteristics which do not reach the full criteria for an individual NDEBID diagnosis. They are also considered as peculiar traits or Neurological Soft signs (NSS) of varying degrees of intensity among the general population which does not reach the threshold for a clinical NDEBID diagnosis. The exact prevalence of subthreshold diagnosis of the commonest NDEBID including ASD and ADHD is unknown due to limited research studies. Some studies have reported up to 18% prevalence of subthreshold Neurobehavioural and emotional problems in children and young people (CYP). Many subthreshold symptoms often progress to full adult psychopathology including major depression, bipolar, anxiety disorders, alcohol use, substance use, conduct disorder and ADHD. They also lead to significant lifetime impairment in several domains. Early recognition and optimal psychosocial interventions could lead to significant mitigation of the long-term poor psychiatric outcomes and social functional impairments. Conclusion Subthreshold symptoms of NDEBID are quite common in the general population. Autistic traits are particularly common among extraordinarily talented people and ADHD traits are common among successful sports and athletics people. Subthreshold NDEBID are not benign and are associated with higher risk of several behavioural and psychopathological disorders including anxiety, depression and suicidality. They therefore require earlier recognition through comprehensive screening assessments and ongoing psychosocial support and monitoring for potential future psychopathology. We argue that subthreshold diagnosis of NDEBID should be included in future editions of the Diagnostic classification manuals as well as wider clinical recognition and documentation to ensure optimal care and support for the vulnerable groups of CYP affected.