Neurally targeted group intervention to reduce early childhood anxiety

神经靶向群体干预减少儿童早期焦虑

基本信息

批准号：
10320446
负责人：
Kate Dimond Fitzgerald
金额：
--
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-01 至 2022-01-02
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10320446
关键词：
6 year old 7 year old Address Adult Affect Aftercare Anterior Anxiety Anxiety Disorders Behavior Behavior Control Behavior Therapy Behavioral Brain region Child Chronic Clinical Clinical Trials Custom Disease remission Dorsal Dose Early Intervention Educational Intervention Elderly Empirical Research Equilibrium Exercise Failure Frequencies Fright Home Individual Intervention Interview Investigational Therapies Life Link Literature Longevity Measurement Measures Mental Depression National Institute of Mental Health Neurosciences Nursery Schools Outcome Parents Participant Phase Pilot Projects Play Prefrontal Cortex Public Health Randomized Randomized Clinical Trials Reporting Research Risk Sampling School Drop-Outs Services Severities Signal Transduction Specific qualifier value Structure Student Dropouts Substance abuse problem Suicide Symptoms Testing Theoretical model Time Training Work aged anxiety reduction anxiety symptoms anxiety treatment anxious base behavior measurement brain behavior childhood anxiety cingulate cortex clinically significant cognitive training design dosage early childhood functional disability group intervention improved indexing neurobehavioral neurophysiology neuroregulation prevent randomized controlled design randomized trial relating to nervous system response selective attention skills targeted treatment theories therapy design transmission process

项目摘要

Clinically significant anxiety affects 20% of preschoolers and can become chronic, leading to depression, substance abuse, school-drop out and even suicide. To reduce anxiety and prevent its sequelae, clinically affected children must be effectively treated early. Available interventions for clinically anxious preschoolers are effective for some, but not all children, with as many as 50% of 4-7 year olds continuing to meet criteria for an anxiety disorder after treatment. To address this problem, we leverage theoretical models and empirical research suggesting that insufficient capacity for Effortful Control (EC) may underlie anxiety from its earliest stages. Insufficient capacity for EC reflects failures of frontal brain regions (e.g., dorsolateral prefrontal cortex/dlPFC and anterior cingulate cortex/ACC) to adaptively regulate threat circuits and maintain on-task behavior. These neural substrates for EC can be indexed using neurophysiological measures, the error-related negativity (ERN) and time frequency interchannel phase synchrony (ICPS), respectively. Findings from our labs and the work of others have shown that reduced ERN and ICPS relate to behavioral deficits in EC and enhanced threat reactivity similar to that documented in clinically anxious children. In response, our team developed a child-friendly group EC training (“Camp Kidpower”) designed to increase ERN, ICPS and related EC behaviors in the service of decreasing anxiety symptoms in preschoolers. Results of our pilot study indicate that this brief cognitive training approach engaged the intended EC neural and behavioral targets and reduced anxiety symptoms. Building on this pilot work, the current project aims to replicate and extend these findings in a larger sample using a randomized controlled design. Participants in this study will be 4- to 6-year-old children (n=90) with clinically significant symptoms who will be randomized into the EC training intervention (n=45) or a playgroup control (n=45). Outcomes will be assessed before and after each condition, using a multi-level approach that includes neurophysiological and behavioral indices of EC, as well as clinician-rated and parent- report on child anxiety symptoms (type and severity). Our aims are to: 1) confirm that participation in our EC training increases ERN and ICPS and improves EC behavior, 2) test whether engagement of these brain-behavior EC targets correspond to reductions in anxiety symptoms and explore whether anxiety reduction by EC training is moderated by baseline threat reactivity measures, and 3) identify whether greater dosage of EC training is associated with greater neuro-behavioral target engagement and reduction of anxiety symptoms. By evaluating how changes in neuroscience-derived targets relate to changes in anxiety symptoms, this work is responsive to the NIMH call for experimental therapeutics and addresses an urgent need for the design of interventions to reduce anxiety in young children.

临床上意义上的焦虑会影响20％的学龄前儿童，并可能变得慢性，导致抑郁症，滥用药物，淘汰甚至自杀。为了减轻焦虑并预防其后遗症，在临床上受影响的儿童必须有效治疗。临床上焦虑学龄前儿童的可用干预措施对于某些儿童而言，有效有效，有多达50％的4-7岁儿童继续符合标准治疗后发生焦虑症。为了解决这个问题，我们利用理论模型和经验研究表明，有效控制能力不足（EC）可能是最早的动画的基础阶段。 EC的能力不足反映了额脑区域的故障（例如，背质额叶皮层/DLPFC和前扣带回皮层/ACC）适应威胁电路并保持在任务中行为。这些用于EC的神经元底物可以使用神经生理学措施（与误差有关）索引负性（ERN）和时间频率频际相位同步（ICP）。我们的发现实验室和其他人的工作表明，降低的ERN和ICP与EC和EC中的行为定义有关增强的威胁反应性类似于临床上焦虑的儿童中所记录的反应性。作为回应，我们的团队开发了一种旨在增加ERN，ICP和相关的儿童友好团体EC培训（“ CAMP Kidpower”） EC为减少学龄前儿童动画症状的行为。我们的试点研究的结果表明这种简短的认知训练方法涉及预期的EC神经和行为目标，并减少了焦虑符号。在此试点工作的基础上，当前的项目旨在复制和扩展这些发现使用随机控制设计的较大样本。这项研究的参与者将是4至6岁的孩子（n = 90）具有临床意义的症状，将随机分为EC训练干预（n = 45）或 PlayGroup控件（n = 45）。在每个条件之前和之后，将使用多级别的结果进行评估方法包括EC的神经生理和行为指数，以及临床评级和父母报告儿童焦虑症状（类型和严重程度）。我们的目标是：1）确认参与我们 EC培训增加了ERN和ICP并改善EC行为，2）测试是否参与这些脑行为EC目标对应于动画症状的减少，并探索动画是否存在通过基线威胁反应性措施来减少EC培训的减少，3）确定是否确定是否是否 EC培训的更大剂量与更大的神经行为目标参与和减轻动画症状。通过评估神经科学衍生目标的变化与焦虑症状的变化，这项工作对NIMH呼吁进行实验疗法和迫切需要设计干预措施，以减轻幼儿的焦虑。