Propelling Equitable, Early-Life Identification and Prevention of Mental Health Risk

Lauren Wakschlag, PhD, is a professor of Medical Social Sciences, of Pediatrics and of Psychiatry and Behavioral Sciences. She is also a founding director of the Institute for Innovations in Developmental Sciences (DevSci) at Northwestern and vice chair for Scientific and Faculty Development in the Department of Medical Social Sciences.  

Wakschlag’s research pinpoints early developmental markers of mental health risk, which includes characterizing the phenotype of emergent mental health problems in early childhood and elucidating prenatal origins of these disease pathways. The overarching goal of her research is to accelerate the implementation of early mental health prevention by providing well-characterized neurodevelopmental phenotypes of disease susceptibility that serve as core prevention targets.  

What are your research interests? 

The organizing theme of my research can best be conceptualized within the framework I have developed, “the science of when to worry and when to act,” for young children’s mental health in the first five years of life. This includes a focus on methods for detecting the earliest signs of atypical social-emotional development that are markers of mental health risk, tied to corollary preventive interventions. These early clinical red flags for mental health risk largely center on atypicalities in brain and behavioral processes that subserve young children’s self-regulation (i.e., adaptive management of emotions, cognition and behavior). The measurement toolkit we have developed has centrally focused on phenotypic characterization of irritability; a red flag measurable from birth that can be identified via simple screening which we have begun to implement for toddlers in routine primary care in collaboration with Lurie Children’s. We are also developing and testing novel preventions targeting these risk pathways as early as possible at the beginning of development — even before birth — to “right” these developmental pathways before disease occurs.   

What is the ultimate goal of your research? 

The ultimate goal of my research is to generate innovative methods and a compelling evidence base to propel equitable early-life identification and prevention of mental health risk at the population level. Harnessing developmental science to improve the life outlooks of diverse young children and families is the science-to-impact quest that drives me as a clinical investigator. This is well aligned with DevSci’s “healthier, earlier” mission.    

How did you become interested in this area of research? 

My passion has always been early childhood research. Scientifically, I am drawn to the “energy and struggle” of this age period — rapid developmental change with transient perturbations which provide an optimal opportunity to promote social-emotional health and wellbeing. I love that early child social-emotional health sets the stage for the study of fragile life course outlooks. What an opportunity!  

Although one of my major contributions to the field has been creating novel methods for early detection of mental health risk prior to disease onset, I did not set out to be a measurement expert or methodologist. I unwittingly backed into that area of science due to my interest in identifying how early we can tell that a child is at mental health risk, and then discovering that there were no empirical tools that we could use to tell us.   

As a result, my research occurs at the boundaries of developmental and mental health research. My doctoral studies were in human development and mental health research, so unlike many traditionally trained clinical psychologists, I was well grounded in not only the clinical side but also what is normative in early childhood. This was foundational to my ability to advance detection of when these normative developmental processes go awry. When I entered the clinical research field in the 1990s, the prevailing idea was that toddlers and preschoolers were too young to develop mental health problems because it was all the “wild west of the terrible twos.” So, even though there was a great deal of evidence that early childhood is the most rapid and plastic period of neurodevelopment that establishes the developmental origins of life course health and disease, clinicians were routinely telling families whose young children had early social-emotional struggles to wait until their children turned six to seek help. This clinical mindset was inconsistent with the robust evidence base demonstrating great regularity and order in the unfolding of social emotional development in early life, enabling meaningful detection of atypical patterns.    

My recognition of this scientific-clinical disconnect was an awakening that has driven much of my research career. I set my sights on creating a scientific path to do something about this massive research-to-practice gap. It was an uphill climb, but I have been determined to bring these disparate areas of research together so that we can capitalize on the tremendous malleability of the brain and behavior during this formative life period to reduce early risk and promote resilience.  

What types of collaborations are you engaged in across campus (and beyond)? 

Collaboration is my oxygen. I am so fortunate at Northwestern to be embedded in two units that share the signature mission of building collaborative bridges to advance the most impactful science, the Department of Medical Social Sciences at Feinberg, and the University-wide Institute for Innovations in Developmental Sciences (DevSci), of which I am a founding director. Indeed, a major impetus for founding DevSci was to coalesce a broad and deep developmental sciences collaborative community at Northwestern. My most central collaborations span the translational spectrum, ranging from developmental neuroscience to implementation science to pediatrics, because their key purpose is to specify developmental mechanisms and leverage this knowledge to make developmental science matter in the real world. At Northwestern, this reflects central partnerships within Feinberg, across to the Evanston campus and to Lurie Children’s Hospital.  

How is your research funded? 

My work has been continuously funded by the National Institutes of Health. The majority of my methodologic work has been supported by the National Institutes of Mental Health. I have also built a substantial portfolio funded by the National Institute of Drug Abuse, which has funded my work on adverse prenatal exposures as mechanisms of early-life mental health risk.   

Who inspires you? Or who are your mentors? 

I am most inspired by pediatricians and allied health professionals who are “in the trenches” in promoting developmental health and resilience in young children. They give heart and soul day in and day out to optimize each child’s developmental potential. I feel that we as scientists owe it to this dedicated clinical and early intervention workforce to ensure that our science is useful in the real world so we can be partners in ensuring that diverse children with varied lived experience have the strongest possible foundation from which to develop and thrive.