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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.

项目总结/文摘