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

项目总结/摘要 破坏性行为是学龄前儿童心理健康转诊的最常见原因之一 是终生精神病风险的标志此外，破坏性行为具有跨诊断的重要性， 治疗目标，是精神障碍终生风险的标志。荟萃分析研究表明， 精神药理学，以家庭为中心的治疗策略作为治疗的选择，在这个年轻的 人口然而，治疗效果的个体差异很大，需要加强 早期大脑可塑性在这一时期的影响表明，需要纳入一个机械的观点， 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验证的治疗儿童早期破坏性行为，是一个 干预，其中父母在父母期间由临床医生指导离散行为育儿技巧， 儿童互动。虽然PCIT对完成治疗的家庭有效，但高辍学率通常 报道本研究的主要假设是，父母-子女二元同步的改善，一个相互的 互动合作伙伴之间有针对性的互惠交流，是PCIT的核心基础机制 有效性我们的新方法通过检查神经同步来解释这种机制， 亲子二人组大脑激活信号之间的一致性，并将其与临床观察到的 行为同步和临床改善。在50名学龄前儿童和他们的父母的样本中，我们将 采用功能性近红外光谱（fNIRS）来测量伴随的大脑激活的关键区域， 初始评估（访视1）、PCIT中点（访视2）、PCIT完成（访视2）期间的社会认知回路 3）和1个月随访（访视4）。这项提案汇集了一个神经科学，发展， 和干预专家作为关键的第一步，将这一基本研究转化为临床应用 其最终目标是通过培训临床医生专注于二元同步的波动来优化PCIT。 我们认为，阐明双向神经发育机制将使PCIT（1）更多 有效，因为它将能够通过在特定生物靶标上的修饰直接对特定生物靶标进行操作。 临床可观察水平;（2）通过个性化治疗提高效率，使临床医生能够灵活地 从育儿技巧中选择最能立即改变个人目标的技巧，加速时间 临床改善;和（3）更普遍，因为它的双向强调将促进儿童的 阅读社会线索和适应社会伙伴的能力，这更容易在外部翻译 父母和孩子的关系这项研究将是第一个采用神经科学方法来阐明具体的 PCIT减少破坏性行为的机制，提供更直接和有效的临床靶点。 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，并减少时间承诺，从而增加患者依从性并减少损耗。

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.