Brain imaging has revolutionised how we understand mental health in children and young people. It reveals that these conditions have real biological foundations and that every child’s brain is unique. Brain scans also allow us to explore how children and young people develop, and what happens in the brain when development takes an unexpected turn for example, when a child or a young person experiences a mental health condition like anxiety or depression or has a developmental condition like attention deficit hyperactivity disorder (ADHD). 

Can we really study the brain using light?   

One particularly exciting way to study the brain is by using light. While it may sound like something from a science-fiction film, the way it works is probably more familiar to you than it might at first seem. In the same way that a fitness watch uses light to measure heart rate, scientists can use light to measure brain activity. This method is called functional near-infrared spectroscopy, or fNIRS. It allows us to observe how the brain functions while children take part in everyday activities, rather than only when they are lying still in a scanner. 

How does this light-based brain imaging actually work?  

Children simply wear a soft, comfortable hat (a bit like a swimming cap) with small sensors that shine harmless near-infrared light onto the head.  

Our brains need oxygen to do its work. Whenever we do something, like listening to music or solving a puzzle, certain brain regions work harder than others and then and use more oxygen than others. The body responds by increasing blood flow to those areas of the brain. Blood that carries a lot of oxygen absorbs light differently from blood with less oxygen and the fNIRS hat picks up on these subtle changes to map brain activity. By measuring how much of the light travels through the head and is absorbed at any given time, scientists can see which areas of the brain are active and how that activity shifts over time. 

Why can fNIRS be such a game-changer for studying the brain during development? 

fNIRS is one of the newest, most flexible brain-imaging tools available. Unlike many traditional brain-imaging methods, fNIRS is quiet, non-invasive and highly flexible. MRI scanners, for example, have greatly advanced our understanding of the (developing) brain, but they require people to lie still inside a noisy, enclosed space. This can be challenging or overwhelming for many children and young people, especially very young children, children with different sensory needs or those with neurodevelopmental conditions like ADHD. fNIRS lets children move more freely and behave more naturally. This opens the door to research that is more inclusive, allowing more children to participate in science studies.  This movement-friendly design also makes fNIRS very valuable for understanding behaviour in real-world situations. Researchers can observe children while they chat with their parents, explore toys, solve age-appropriate tasks or even play together. Or we can study two young people wearing fNIRS hats at the same time, allowing us to understand how the developing brain works in real-life communication. This kind of natural, real-time data is extremely difficult to gather using traditional brain imaging method.

How will fNIRS help us improve mental health care for young people?  

We are already using fNIRS in our research within the King’s Maudsley Partnership and will continue to grow its use when the Pears Maudsley Centre for Children and Young People opens next year. Enabling children who would have otherwise been excluded from participating in research to take part is central to ensuring our work will be more likely to benefit all children, not just the easiest to study. fNIRS is an example of how we are centering inclusion and equity in our research. 

Once our understanding of the developing brain in the real-world has improved we can then work as the King’s Maudsley Partnership, on bringing it into therapeutic settings / the clinic.  

We hope that fNIRS will become a key tool for advancing our mission to improve mental health care. For example, by helping us design interventions that are tailored to an individual child or young person’s specific strengths and challenges. Or by helping clinicians with choosing the most effective treatment plan, so that we can get care and support to families faster and more efficiently. 

We also hope that brain imaging studies can then not only take place in the dedicated clinical research facilities but also in school or community settings, and even in the comfort of your homes. Our goal is to make science work for and with every child and young person, so that they can thrive to the best of their ability.  

If you want to learn more about fNIRs and our work in this area please contact us on KMPCYP@slam.nhs.uk. Learn more about the Pears Maudsley Centre.

Learn more about Dr Louisa Gosse and her work.

Our Reaction

“Waiting lists for the assessment of both mental health conditions, ADHD, and autism have all risen exceptionally sharply in the last decade. Many people are seeking help from services that are stretched too thin, and people in need are falling through the cracks. 

“In order to confront this situation, we need to have a clear grasp as to why so many people are seeking help. The King’s Maudsley Partnership is home to the world’s largest group of researchers and clinicians dedicated to understanding and improving outcomes for children with a range of conditions, and we’re working hard to understand the underlying causes in an effort to provide the knowledge needed for more effective interventions. 

“The announcement of this review is a welcome one, and we hope our work will contribute meaningfully to it.” 

Leading experts explored what Attention Deficit Hyperactivity Disorder (ADHD) is, how it affects children and young people and what research questions are currently under investigation.

The “ADHD: New Discoveries, Better Support” webinar, held on Tuesday 4 November, brought together clinicians, researchers and experts by lived experience to reflect on the clinical academic research taking place on ADHD. The King’s Maudsley Partnership is home to the world’s largest group of researchers and clinicians dedicated to understanding and improving outcomes for children with ADHD.

Professor Philip Shaw, Director of the King’s Maudsley Partnership for Children and Young People, who’s academic work is focused on ADHD, chaired the webinar.

Increasing choice and quality of treatments 

In recent years awareness and understanding of ADHD have increased, however the treatment and support options available to support children and young people with ADHD have not kept pace. Most treatments are medication-based, and while these can be effective, many families and young people want more choices — especially non-drug alternatives.

These thoughts were echoed by Tiegan Boyens a neurodivergent lived experience consultant who joined the panel. She reflected that it took her a long time to get an ADHD diagnosis due to misconceptions around ADHD such as that it manifests primarily in physical activity and in boys. She called on researchers to do more to investigate supporting children who have ADHD alongside other comorbidities. She also said she wants to see more non-drug based treatment options to be available.

Novel brain therapies 

Professor Katya Rubia is focused on pioneering non-drug treatments for children and adults with ADHD. She spoke about some of the recent discoveries in this area. She has been investigating non-invasive brain stimulation to see if these can mimic the effects of ADHD medication by targeting the same brain regions, but without the side effects of drugs. She shared promising findings using transcranial direct current stimulation in children and adults with ADHD and new findings around Trigeminal nerve stimulation (TNS) which are due for publication in Nature Medicine in the coming weeks. She also reflected on the challenges of the placebo effect in studies involving cutting edge technology.

More information on the ATTENS (ADHD trial of external trigeminal nerve stimulation) project can be found here: ATTENS 

Tools to support children’s sleep 

Almost 75% of children with ADHD have sleep problems. Parents and carers report that poor sleep makes their children’s daytime behaviour and schoolwork worse and affects the quality of life of the whole family. However there are limited options for support and medication is the most common intervention. Professor Samuele Cortese provided insight into the DISCA (Digital Sleep Support for Children with ADHD) study. This research project aims to help parents, carers, and health professionals to manage sleep problems in children with ADHD.

More information about DISCA including information on how families can sign up to get involved in the study can be found at Home | Disca Study 

How data is guiding our work 

Professor Johnny Downs who leads the CAMHS Digital Lab shared data around children with ADHD living in south London. The data tells us that early childhood factors and demographics including ethnicity and gender make an ADHD diagnosis more likely even though this doesn’t represent true prevalence. He found that children from non-white ethnic groups are almost 50% less likely to get a diagnosis. He reflected that services need to ensure they are engaging effectively with all local communities to ensure all children who need it can access support services for ADHD.  

Professor Downs also reflected the ambitions of the CAMHS Digital Lab to continue to build digital tools to support parents and carers whose child is on the waiting list, or who has received a diagnosis, for ADHD. This follows successful outcomes from providing digital support to parents and carers on the waiting list for services via the My Health-E app. There is a virtuous circle that parents and carers receive more support and guidance whilst on the waiting list and their participation helps build a richer bank of data to underpin research into ADHD.

More information on the CAMHS Digital Lab can be found on its website Home | CAMHS Digital Lab 

The webinar came just after ADHD Awareness Month, throughout which the King’s Maudsley Partnership has been highlighting it’s work on ADHD. The King’s Maudsley Partnership’s home will be in the Pears Maudsley Centre for Children and Young People, due to open in 2026. The Centre will have a one of it’s kind research facility enabling us to revolutionise our understanding ADHD and other neurodevelopmental conditions, and mental health conditions that affect children and young people.

For more information, please contact Helen Honstvet on helen.honstvet@slam.nhs.uk or sign up to our newsletter to keep up to date with the work happening across the Partnership. You can also watch the recording of the webinar on our YouTube channel.