Diagnosis of developmental disorders such as autism and attention deficit hyperactivity disorder (ADHD) rarely occurs prior to 3 years. Thus, there is very little known about the emergence of these disorders during infancy. It is important to identify the earliest symptoms of these conditions for three reasons: (1) as it allows us to see symptoms in their original "pure" form before a child's difficulties becomes compounded by years of atypical development, (2) it enables us to discover early risk signs suggesting the infant's development needs close monitoring, and (3) it allows us to potentially intervene in the course of development before the onset of the full syndrome - a strategy that some believe may be more effective than waiting until a disorder is fully established. This grant addresses these issues in three parts. In the first Part (A) we will expand on our current studies of infants at-risk for a later diagnosis of autism to also include infants at-risk for ADHD (by virtue of being the younger brother or sister of an older child already diagnosed with ADHD). We will compare the development of brain and cognitive functions in typical (low-risk) infants, and those at-risk for autism and ADHD, using a variety of baby-friendly methods such as MRI (Magnetic Resonance Imaging) while in natural sleep, EEG (electroencephalography), eye-tracking, and parent-infant interaction. We have chosen to compare autism and ADHD risk for several reasons. One of these is to determine how specific the early warning signs are for particular later outcomes. Another reason is that we know that there is some shared genetic risk between these disorders, and that they quite commonly co-occur in the same children. Part A is embedded within national and international collaborative networks in order to increase the number of babies studied on some key measures, and correspondingly increase our ability to detect effects. While in Part A we search for the earliest appearing markers and symptoms, in Part B we will initiate work on potential early interventions. Specifically, we will build on our recent study on improving attention skills in typical (low-risk) infants by engaging them in eye-tracker controlled "games" in which they track moving objects on a screen. We will extend this work in several ways to make the training programme more suitable as a potential intervention for infants at-risk for ADHD, e.g. by greatly extending the period of training, and by taking advantage of new technology to allow for some training sessions to take place in the infant's home. In Part C we plan a new line of basic research that can also be extended to infants at-risk in the future. While we know much about the early development of vision and auditory processing, very little research has been done on the sense of touch. Touch is important to study for many reasons, including that it is a primary mode of sensory interaction with parents. We will use several imaging methods to learn about the development of brain regions important for basic aspects of touch, social touch, and the infants emerging multi-sensory perception of its own body.

Currently in the UK, it is estimated that over 2.5 million of neurodiverse adults have not received a diagnosis and therefore struggle to access care. The most common neurodevelopmental conditions, attention deficit hyperactivity disorder (ADHD) and autism (ASD), affect 5% and 1% of children and adults in the UK - on average one child per classroom. Nowadays, the understanding of autism and ADHD has greatly increase. However, a lot of adults and children have not received a diagnosis. Within the UK healthcare system, without a diagnosis, these patients cannot access the care they need. Having ADHD or autism often negatively impacts many aspects of life such as employment, relationship, or school. Studies have shown that adults with undiagnosed and untreated ASD/ADHD are more likely to have educational problems, mental health issues, depression and anxiety, are more likely to commit crimes and abuse substances, are more likely to divorce, be unemployed or commit suicide. These aspects are worse when ASD/ADHD is not diagnosed but can be reduced with early identification and effective support. Diagnosing ASD/ADHD as early as possible is of utmost importance in reducing some of these long terms risks for adults living with these conditions. Recent governmental reports have highlighted the importance of having access to diagnosis and care for these conditions. In order to successfully address these priorities, it is important that research first identifies the costs of living with undiagnosed ASD/ADHD. Previous studies which have looked into the cost and impact of undiagnosed mental health on the individuals, society and economy have shown that the cost of not diagnosing and treating mental health issues was higher than the cost of running services for these issues. This led to the creation of a national NHS service (IAPT), a service helping adults with mental health issues. No research to date has been done on the cost of undiagnosed ASD/ADHD. This new study will highlight the economic and societal cost of undiagnosed ASD/ADHD in order to give policy makers and healthcare providers the necessary information to justify funding appropriate services. Most specifically, the project will answer two questions: 1. What are the long-term risks and impacts (for instance: higher rate of divorce, substance abuse, unemployment) associated with undiagnosed ASD/ADHD? 2. What are the individual, societal and economic costs of these associated risks? To answer these questions, first a literature review of published science articles will summarise the studies which looked into the risks associated with undiagnosed ASD/ADHD. Then I will conduct questionnaires and interviews with adults with ASD/ADHD to see whether the risks highlighted in the literature review reflect real life struggles. These two studies will create a comprehensive summary of the risks associated with undiagnosed ASD/ADHD. Once this summary is completed, an economic evaluation of the costs of these risks will be conducted with undiagnosed adults. In order to understand what these costs mean, they will be compared to three groups, one groups of adults diagnosed with ASD/ADHD in childhood, one group of adults diagnosed in childhood and one group of adults diagnosed in adulthood. This will allow us to establish the true cost of the impact of receiving a diagnosis as early as possible. A group of adults with ASD/ADHD will feedback on all the different tasks of this project to ensure it represents real-life experiences. Many people argue that having conditions such as ASD/ADHD cost a lot more to society than neurotypical individuals (for example, extra support in class). However, this study argues that the cost of not identifying individuals with such difficulties, is likely to cost more in the long term (for example while extra support in class has a cost, school underachievement and unemployment will cost much more to an individual and society in the long run).

As many as 1 in 54 people are autistic (CDC, 2020). Autism is a lifelong developmental disability diagnosed based on difficulties in social communication and interaction, as well as restricted and repetitive behaviours and interests (which includes sensory sensitivities). Autistic people may be seven times more likely to become involved with the Criminal Justice System (CJS) as a victim/witness or a suspect/defendant. Our previous research has shown that autistic people are among the most vulnerable entering the CJS, their experiences are largely negative, and police interviewing techniques need to be adapted to support differences in how autistic people remember and report events. Yet there is very little research on autistic people's experiences at court, despite there being several reasons to suspect that courtroom proceedings may be especially challenging for this group (e.g., the adversarial nature of cross-examination, and stress and sensory sensitivities that may be triggered in courtroom environments). To enable fair access to justice, it is important to understand the impact of standard courtroom proceedings, including cross-examination, on autistic people and their ability to provide their best evidence. It is also important to test how useful and effective 'Special Measures' (SMs) are in supporting autistic people in court. This may include the assistance of a trained professional called a Registered Intermediary to support communication, and the use of video technology to allow evidence to be provided remotely, by pre-recording or both. SMs can be expensive and time consuming, yet we know relatively little about how helpful they are for autistic people. In our research, we will work with the autistic and legal communities in a series of innovative work packages (WPs) collecting both quantitative and qualitative data. We will identify key issues that autistic individuals experience at court, test the utility of SMs, and co-create training and guidance for legal professionals to enable them to better support autistic people at court. In WP1, we will explore the lived experiences, views and perceptions of autistic people who have been through the court system, via surveys, interviews and focus groups, as well as a 'participative walkthrough' of a simulated trial. Findings will be used to refine our experimental work in WP2 to provide the first empirical test of the impact of cross-examination (with and without SMs) in autistic adults. Our focus will be on the quality, accuracy, relevance, and perceived credibility of autistic adults' accounts, as well as on their overall experiences (including state anxiety and emotional regulation). Informed by findings from WPs 1 and 2, in WP3 we will develop, evaluate, and refine an interactive training package for legal professionals and a resource of autistic people, in collaboration with these user groups. Many of the adaptations that are effective for autistic people will likely be beneficial for everyone. Findings will have implications for the autistic community (as well as those with other conditions such as ADHD, intellectual disability, and anxiety disorders), legal professionals, the family courts, social workers, and policy makers. Findings will also have implications internationally (e.g., the Witness Intermediary Scheme has been used as a model for similar initiatives in Northern Ireland and Australia, with further interest from Canada, New Zealand, and South Africa); and for the family courts, where SMs are incorporated into hearings. An extensive program of academic and non-academic collaboration and dissemination has been developed to maximise the research impact with a broad range of key users, with input from the National Autistic Society, Autistica, the MoJ, and Judiciary, as well as members of the autistic community, police, solicitors, barristers, judges, intermediaries, and family and criminal court representatives (see letters of support).

Digital games have extraordinary economic, social and cultural impact. The industry is one of the fastest-growing in the world, larger than film or music, with revenues expected to increase from $138 billion in 2018 to $180 billion by 2021. 2.6 billion people worldwide play digital games (21 million in the UK), with an average age of 35 and equal numbers of females and males. The Wellcome Trust-sponsored game Senua's Sacrifice, made in the UK, won 5 Baftas for its interactive and educational portrayal of psychosis. The UK games industry is a global leader - UK game sales are valued at £4.3bn with 12,000 people directly employed. The games industry is innovative and hungry for innovation - recent research breakthroughs in Artificial Intelligence (AI) and Machine Learning (ML) have arisen through games research undertaken at Google DeepMind in the UK. Rolls Royce makes better jet engines using 3D technology pioneered in games. Games are leading the "data and AI revolution" of HM Government's 2017 Industrial Strategy. Games have become a massive lever for social good through applied games for health, education, and science. The mobile game Pokémon Go added 144 billion steps to physical activity in the US alone. The Alzheimer's Research-funded Sea Hero Quest game collected data equivalent to 9,400 years of dementia lab data within 6 months. The EPSRC Centre for Doctoral Training in Intelligent Games and Game Intelligence (IGGI) first received funding in 2014, and has since been a huge success: raising the level of research innovation in games, with the highest-possible ratings in our EPSRC mid-term review. The next phase of IGGI will inject 60+ PhD-qualified research leaders and state of the art research advances into the UK games industry. The two core themes of IGGI are: (1) Intelligent Games: increasing the flow of research into games. IGGI PhD research in topics such as AI, data science, and design will empower the UK games industry to create more innovative and entertaining games. IGGI research has already enhanced the experience for millions of game players. IGGI will create engaging AI agents that are enjoyable to interact with, tackling fundamental challenges for the future of work and society that go beyond games. IGGI will spearhead new AI techniques that augment human creativity by automatically 'filling in the details' of human sketches. (2) Game Intelligence: increasing the use of intelligence from games to achieve scientific and social goals. Every action in a digital game can be logged, creating huge data sets for behavioural science. For example, current IGGI students have assessed traits such as IQ, agreeableness, or attention from large game datasets. IGGI students will investigate more intelligent, adaptive games for education and to improve mental health. IGGI will maximize the enormous opportunity for scientific and social impact from games by laying the research groundwork for further data-driven applied games for health, science, and education. IGGI will massively advance these research themes, and train 60+ PhD students to be future research leaders. To accomplish this, our updated training programme and 60+ research supervisors will provide students with rigorous training and hands-on experience in AI, programming, game design, research methods, and data science, with end user and industry engagement from day one. Recruiting and empowering a diverse student cohort to promote equality, diversity, and inclusion through games, IGGI will drive positive culture change in industry and academia. Students will work with leading UK experts to co-create and disseminate standards for responsible games innovation. Directly working with the UK games industry through placements, workshops, game development challenges, and an annual conference, they will advance research knowledge and translate it into social, cultural and economic impact.