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

项目摘要/摘要 破坏性行为是学龄前儿童心理健康转诊最常见的原因之一 是终生精神疾病风险的标志。此外，破坏性行为具有跨诊断的重要性，通常是 是治疗的目标，也是精神障碍终身风险的标志。元分析研究表明， 精神药理学，以家庭为中心的治疗策略作为这一年轻患者的首选治疗 人口。然而，治疗效果的个体差异很大，需要加强 在这一早期大脑可塑性时期的影响表明，需要结合机械论的观点 儿童早期破坏性行为的治疗方法。亲子互动疗法(PCIT)， 在最广泛使用的经验证的儿童早期破坏性行为治疗方法中，有一种 在干预中，父母由临床医生指导离散的行为养育技能- 儿童互动。虽然PCIT对于完成治疗的家庭是有效的，但高辍学率通常是 据报道。这项研究的主要假设是亲子二元同步性的改善，这是相互的 互动伙伴之间的集中和互惠交流，是PCIT的核心基本机制 有效性。我们的新方法通过检查神经同步性来解释这一机制，这评估了 亲子二联体的大脑激活信号之间的一致性，并将其与临床可观察到的 行为同步性和临床改善。在50名学龄前儿童及其父母的样本中，我们将 使用功能近红外光谱(FNIRS)测量伴随脑激活的关键区域 初步评估期间的社会认知回路(访问1)、PCIT中间点(访问2)、PCIT完成(访问 3)、1个月随访(访4)。这项提议汇集了一支神经科学、发展性 和干预专家作为将这一基本研究转化为临床应用的关键第一步 最终目标是通过培训临床医生专注于二进同步的波动来优化PCIT。 我们的理论是，阐明双向神经发育机制将使PCIT(1) 有效，因为它可以通过在 临床可观察水平；(2)通过个性化治疗更有效，允许临床医生灵活地 从最直接改变个人目标、加快时间的育儿技能中进行选择 对临床的改善；以及(3)更具普遍性，因为它的双向强调将有助于儿童的 阅读社交线索并对社交伙伴做出适应性反应的能力，这更容易转化为外部 父子上下文。这项研究将是第一次使用神经科学方法来阐明 PCIT减少破坏性行为的机制，提供了更直接和更有效的临床靶点。 研究结果的临床翻译可以作为集中PCIT会议的基础，加快时间 改善，减少时间投入，从而提高患者的依从性并减少磨损。

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.