Transdiagnostic Profiles of Behaviour and Communication Relate to Academic and Socio-emotional Functioning and Neural White Matter Organisation

Behavioural and language difficulties co-occur in multiple neurodevelopmental conditions. Our understanding of these problems has arguably been slowed by an overreliance on case-control designs, which limit the conclusions we can draw because they fail to capture the overlap across different neurodevelopmental disorders and the heterogeneity within them. In this study, we recruited a large transdiagnostic cohort of children with complex diagnosed and undiagnosed needs (N = 805) to identify distinct subgroups of children with common profiles of behavioural and language strengths and difficulties. We then investigated whether and how these data-driven groupings could be distinguished from a comparison sample (N = 158) on academic, socio-emotional, and neural white matter characteristics. We identified three distinct subgroups of children, each with different levels of difficulties in structural language, pragmatic communication, and hot and cool executive functions. All three subgroups struggled with academic and socio-emotional skills relative to the comparison sample, potentially representing three alternative but related developmental pathways to difficulties in these areas. The children with the weakest language skills had the most widespread difficulties with learning, whereas those with more pronounced difficulties with hot executive skills experienced the most severe difficulties within the socio-emotional domain. Each data-driven subgroup could be distinguished from the comparison sample based on both shared and subgroup-unique patterns of neural white matter organisation. These findings advance our understanding of commonly co-morbid behavioural and language problems and their relationship to behavioural outcomes and neurobiological substrates.