Table 1.

Components of transdiagnostic framework to guide early dyadic interventions for NDDs

Component	Definition and Examples
Contextual Factors	Definition: Characteristics of individual dyad members and/or the dyadic relationship that may influence the experience of NDDs Examples of Demographic and Contextual factors: • Dyad members’ age, gender, and other individual characteristics • Cultural heritage/background and beliefs; comorbid health conditions • Relationship (e.g., spouse, parent-child), roles, & functioning prior to diagnosis
Illness-related factors	Definition: Characteristics of NDDs that contribute to the dyad’s adjustment Examples of Illness-related factors: • Timeliness and accuracy of diagnosis; expected progression of illness • Type, number, severity, and specificity of early symptom profile and disruptions on daily living and dyadic relationship • Availability of medical treatments to delay illness progression
External Resources	Definition: Circumstances, assets, and supports available to dyad’s that assist in navigating the NDD and related stressors Examples of External Resources: • Presence or absence of financial strain/stability • Financial resources (e.g., socioeconomic status, income, employment stability) • Health care resources (e.g., reliable information on symptoms and expected progression, relationship with providers, connection to psychosocial and practical support for NDD) • Social resources (e.g., availability of caregiving, practical, and emotional support)
Individual Appraisal	Definition: Individual ways of understanding the NDD and its impact Examples of Individual Appraisal: • Understanding of NDD and symptoms (cognitive, physical, behavioral changes), including the attribution of symptoms to NDD, causes, expected progression • Understanding of impact of NDD on daily living and future • NDD care preferences (e.g., ways of managing NDD symptoms, navigating medical visits and decision-making, desired information, and resources for NDD) • Experience of stressors (e.g., emotional reactions to NDD and related stressors) • Illness ownership (e.g., attribution of stressors as individual vs. shared)
Dyadic Appraisal	Definition: The dyad’s shared understanding the NDD and its impact Examples of Dyadic Appraisal: • Dyad’s shared understanding of NDD and symptoms (cognitive, physical, behavioral changes), including the attribution of symptoms to NDD, causes, expected progression • Dyad’s shared understanding of impact of NDD on daily living and future • Dyad’s negotiation of NDD care preferences (e.g., ways of managing NDD symptoms, navigating medical visits and decision-making, desired information, and resources) • Dyadic experience of stressors (e.g., emotional reactions to NDD and related stressors) • Illness ownership (e.g., attribution of stressors as individual vs. shared)
Individual Coping Strategies	Definition: Skills that dyad members can enact individually to effectively manage difficult emotions and cope with stressors Adaptive Individual Coping: • Internal strategies (e.g., mindfulness, acceptance, optimism, gratitude, self-efficacy) • Behavioral strategies (e.g., soliciting social support, engaging in self-care, building mastery of ways of navigating challenges and cultivating new skills)
Dyadic Coping strategies	Definition: Skills that dyad members can enact together to manage difficult emotions and cope adaptively with stressors Examples of Adaptive Dyadic Coping: • Collaborative problem solving and delegation of tasks amid individual challenges • Open communication about individual thoughts, emotions, and stressors
Dyadic Biopsychosocial Adjustment	Definition: Individual physical and mental health and relational functioning following NDD diagnosis Examples of Dyadic Adjustment: • Severity and/or chronicity of emotional distress • Individual physical health and quality of life • Dyadic relationship satisfaction, communication, and intimacy
Symptom Progression and Transition Points	Definition: Changes in stage of illness or symptoms that can impact dyad’s care needs and adjustment to NDD Examples of Symptom Progression and Transition Points: • Person with NDD’s fluctuating or declining abilities (e.g., changes in insight) • Decline in abilities leading to changes in roles and responsibilities (e.g., driving, cooking, working, and other activities of daily living)