Dyadic Synchrony as a Mechanism of Parent-Child Interaction Therapy (PCIT): A Neuroscience-Based Approach

二元同步作为亲子互动治疗（PCIT）的机制：一种基于神经科学的方法

基本信息

批准号：
9614022
负责人：
Susan B Perlman
金额：
$ 24.37万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-13 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9614022
关键词：
Accounting Adult Advisory Committees Aftercare Age Anxiety Attention deficit hyperactivity disorder Behavior Behavioral Biological Brain Child Child Rearing Childhood Clinical Clinical Treatment Code Cues Custom Data Development Dropout Early treatment Effectiveness Enrollment Family Frustration Future Goals Health Personnel Individual Individual Differences Intervention Laboratories Lead Link Longevity Measurable Measurement Measures Mental Depression Mental Health Mental disorders Methods Minority Modification Near-Infrared Spectroscopy Neurosciences Nursery Schools Outcome Parent-Child Relations Parents Population Preschool Child Process Psychopathology Reporting Research Research Design Research Personnel Risk Role Sampling Science Series Signal Transduction Specific qualifier value Speed Symptoms Techniques Testing Therapeutic Therapeutic Intervention Therapeutic Uses Time Traction Training Translating Translations Treatment Effectiveness Treatment Efficacy Visit autism spectrum disorder barrier to care base behavior measurement behavior observation clinical application clinical translation compliance behavior contingency management early childhood flexibility follow-up individualized medicine innovation lifetime risk multilevel analysis novel novel strategies personalized medicine prevent primary caregiver programs relating to nervous system response satisfaction skills social social cognition symptom treatment symptomatic improvement symptomatology teacher therapy outcome treatment adherence treatment choice treatment effect treatment response treatment strategy working group

项目摘要

PROJECT SUMMARY/ABSTRACT Disruptive behavior is one of the most common reasons for mental health referral of preschool age children and is a marker of lifetime psychiatric risk. In addition, disruptive behavior has transdiagnostic import, is often a treatment target, and is a marker of lifetime risk for mental disorder. Meta-analytic studies indicate non- psychopharmacological, family-focused therapeutic strategies as the treatment of choice in this young population. However, substantial individual differences in treatment effectiveness and the need to enhance impact during this period of early brain plasticity suggest the need for incorporating a mechanistic perspective into treatment approaches for early childhood disruptive behavior. Parent-Child Interaction Therapy (PCIT), among the most widely used empirically validated treatments for early childhood disruptive behavior, is an intervention in which a parent in coached by a clinician on discrete behavioral parenting skills during parent- child interaction. While PCIT is effective for families who complete treatment, high drop-out rates are typically reported. The primary hypothesis of this study is that improvement in parent-child dyadic synchrony, a mutually focused and reciprocated exchange between interactional partners, is a core basic mechanism for PCIT effectiveness. Our novel approach explicates this mechanism by examining neural synchrony, which assesses coherence between the signals of brain activation of parent-child dyads, and links it to the clinically-observable behavioral synchrony and clinical improvement. In a sample of 50 preschool children and their parents, we will employ functional near infrared spectroscopy (fNIRS) to measure concomitant brain activation in key regions of social cognition circuitry during an initial assessment (Visit 1), PCIT midpoint (Visit 2), PCIT completion (Visit 3), and one month follow-up (Visit 4). This proposal brings together a team of neuroscientific, developmental and intervention experts as the critical first step in translating this basic line of research to clinical application with the ultimate goals of optimizing PCIT by training clinicians to focus upon fluctuations in dyadic synchrony. We theorize that explicating bidirectional neurodevelopmental mechanisms would make PCIT (1) more effective because it would enable operating directly on a specified biological target through modification at the clinically observable level; (2) more efficient by personalizing treatment, allowing clinicians the flexibility to select from the parenting skills that most immediately alter the target on the individual level, accelerating time to clinical improvement; and (3) more generalizable as its bidirectional emphasis would facilitate the child’s capacity to read social cues and respond adaptively to social partners, which more readily translates outside the parent-child context. This study will be the first to employ neuroscientific methods to elucidate the specific mechanisms by which PCIT reduces disruptive behavior, providing a more direct and efficient clinical target. Clinical translation of findings could serve as the basis for concentrating PCIT sessions, speed the time to improvement, and reduce time commitment, thus increasing patient compliance and decreasing attrition.

项目概要/摘要破坏性行为是学龄前儿童心理健康转介的最常见原因之一此外，破坏性的终生行为通常具有跨诊断的意义。治疗目标，并且是终生精神障碍风险的标志。荟萃分析研究表明，非- 精神药理学、以家庭为中心的治疗策略作为该年轻人的治疗选择但治疗效果个体差异较大，需要加强。早期大脑可塑性时期的影响表明需要纳入机械观点儿童早期破坏性行为的治疗方法（PCIT），针对幼儿破坏性行为，最广泛使用的经经验验证的治疗方法之一是干预中，临床医生对父母进行离散行为养育技能的指导虽然 PCIT 对完成治疗的家庭有效，但通常辍学率很高。报道称，这项研究的主要假设是亲子二元同步性的改善，即相互的。互动伙伴之间专注、互惠的交流，是PCIT的核心基础机制我们的新颖方法通过检查评估神经同步性来解释这种机制。亲子二人组大脑激活信号之间的一致性，并将其与临床可观察到的联系起来在 50 名学龄前儿童及其父母的样本中，我们将进行行为同步和临床改善。采用功能性近红外光谱 (fNIRS) 来测量关键区域的伴随大脑激活初始评估期间的社会认知回路（访问 1）、PCIT 中点（访问 2）、PCIT 完成（访问 3），以及一个月的随访（访问 4）。该提案汇集了一个神经科学、发育学团队。和干预专家是将这一基本研究方向转化为临床应用的关键的第一步最终目标是通过培训参议员关注二元同步的波动来优化 PCIT。我们推测，解释双向神经发育机制将使 PCIT (1) 更加有效，因为它可以通过修改直接对特定的生物目标进行操作临床可观察的水平；（2）通过个性化治疗更有效，允许灵活性从最能立即改变个人目标的育儿技巧中进行选择，加快时间临床改善；（3）更普遍，因为它的双向重点将促进儿童的解读社交线索并对社交伙伴做出适应性反应的能力，这更容易转化为外界的信息这项研究将是第一个采用神经科学方法来阐明具体情况的研究。 PCIT 减少破坏性行为的机制，提供更直接、更有效的临床目标。结果的临床转化可以作为集中 PCIT 会议的基础，加快改善并减少时间投入，从而提高患者的依从性并减少人员流失。