Can systems science provide an answer to the complexity of childhood-onset neurodisability?

 Systems Science is an inter/transdisciplinary field that studies the complexity of systems in nature, social or any other scientific field which in the last 30 years has come to the fore as a way of dealing with complexity in many spheres of life, including healthcare, and has recently been applied to CON (Kenzie et al 2020, Gough & Shortland 2022, Mayston et al 2024). The advantage of systems science is that it facilitates understanding of the interactions of all the factors within the system and between the various systems in both a linear and a non-linear way and allows exploration and identification of patterns of complexity to arrive at feasible solutions. This seems to offer a relevant approach to research and intervention planning in CP.

Child development is complex, and accordingly any childhood-onset neurodisability (CON) will also be complex. Complexity in CON arises from the variety of epidemiology, pathophysiology, comorbidities, families and communities, social and cultural contexts, all of which interact and combine to result in varied capacity for participation in life for every individual. These factors also impact on provision of intervention and outcomes.

Research to determine which interventions might offer optimal outcomes have to date mostly used RCTs, most often of a single intervention. However, it is increasingly recognized that because of complexity, one size does not fit all, thus these trials have limitations largely because they do not address the individual: context of family, type of CP, available resources, individual preferences to name a few. In systems science terms, RCTs apply a reductionist way of thinking and investigate intervention in a linear way, a challenge which is becoming recognized (Thomas et al 2024; Mayston et al 2024 )

True holism is enabled using a systems science approach and shifts research thinking to adaptive trials where the multiple interactions can be explored and considered. This requires a shift in thinking in clinical reasoning to a systems science-based approach which factors in all elements of the ICF, with a particular focus on the interactions between the different components and how these together determine the child’s lived experience.