Neurally targeted group intervention to reduce early childhood anxiety

20%的学龄前儿童受到临床严重焦虑的影响，并可能成为慢性焦虑症，导致抑郁， 滥用药物，辍学，甚至自杀。减少焦虑，防止其后遗症，临床上 受影响的儿童必须及早得到有效治疗。为临床焦虑的学龄前儿童提供的干预措施 对某些儿童有效，但不是所有儿童，多达50%的4-7岁儿童继续符合 治疗后的焦虑症。为了解决这个问题，我们利用理论模型和经验 研究表明，努力控制能力不足(EC)可能是焦虑最早的根源 各阶段。EC容量不足反映了额叶脑区(例如，背外侧前额叶)的功能障碍 皮质/dlPFC和前扣带回/ACC)，以自适应地调节威胁回路并维持任务 行为。EC的这些神经底物可以使用神经生理学指标进行索引，这与错误相关 负性(ERN)和时频通道间相位同步(ICPS)。来自我们的调查结果 实验室和其他人的工作表明，ERN和ICPS的减少与EC和 增强的威胁反应性，类似于临床焦虑儿童的记录。作为回应，我们的团队 开发了一个儿童友好的EC培训小组(“Camp Kidpower”)，旨在增加ERN、ICPS和相关的 幼儿焦虑症状缓解服务中的EC行为。我们的初步研究结果表明 这种短暂的认知训练方法吸引了预期的EC神经和行为目标，并减少了 焦虑症状。在这项试点工作的基础上，目前的项目旨在将这些发现复制和推广到 使用随机对照设计的更大样本。这项研究的参与者是4至6岁的儿童。 (n=90)有临床显著症状的患者将被随机分为EC培训干预组(n=45)或 游戏组控制组(n=45)。结果将在每种情况之前和之后进行评估，使用多个级别 一种方法，包括EC的神经生理和行为指标，以及临床医生评级和父母- 报告儿童焦虑症状(类型和严重程度)。我们的目标是：1)确认参与我们的 EC培训增加ERN和ICPS，并改善EC行为，2)测试这些因素是否参与 大脑行为EC目标对应于焦虑症状的减少，并探索焦虑 EC培训的减少量受到基线威胁反应措施的影响，以及3)确定 更大剂量的EC训练与更多的神经行为目标参与度和 减少焦虑症状。通过评估神经科学衍生目标的变化如何与 焦虑症状的变化，这项工作是对NIMH对实验疗法和 解决了设计干预措施以减少幼儿焦虑的迫切需要。

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.