Brain response associated with parent-based treatment for childhood anxiety disorders

目前，50%的儿童没有从儿童焦虑症的循证治疗中受益。 这个R61/R33应用程序建议测试一种全新的完全基于父母的心理社会干预 儿童焦虑症与儿童杏仁核-内侧前额叶皮质(MPFC)神经回路有关 大脑，与儿童依赖父母减少他们的杏仁核反应性和焦虑有关；以及 治疗后靶点回路的变化与儿童焦虑的减少有关。 R61研究将90名患有原发焦虑症的儿童(7-10岁)随机分配到两组中的一组 干预：1)支持儿童焦虑情绪的育儿(SPACE)，一种新颖的完全父母-- 没有儿童直接参与的基础治疗，通过减少父母的焦虑来减少儿童的焦虑 适应孩子的症状；或2)父母教育支持(PES)，一个可信的比较者 干预也完全基于父母，并对治疗持续时间和父母与治疗师的接触进行控制， 但不包括对父母行为的任何主动改变。治疗前后，功能 将使用磁共振成像(FMRI)来检查儿童对父母参与目标的依赖程度 在母亲在场的情况下比较儿童杏仁核反应性和mPFC连接的回路 在他们母亲不在的情况下。我们预计空间将减少儿童对父母在场的依赖 杏仁核反应性明显高于PES。如果这一假设得到支持，则将执行R33。这个 R33将随机将136名患有原发焦虑症的儿童(7-10岁)随机分配到以下两种干预措施之一：1) 父母参与太空活动；或2)孩子接受认知行为疗法(CBT)，这是一种护理标准 已知疗效的治疗。我们将在治疗前后使用功能磁共振成像和多信息者/多模式儿童焦虑症 评估。我们希望空间能够减少儿童对父母在场的依赖，从而减少杏仁核的反应性， 显著高于CBT；我们预计太空中的目标参与与儿童焦虑有关 减轻症状；我们预计空间将是可行的，并为儿童和父母所接受。 这项研究在几个方面都是创新的，并有可能产生巨大的临床和科学影响。它是 这是第一项研究心理社会干预对儿童神经回路的影响 焦虑症，这是第一项研究，考察了只由父母干预而不加NO的效果。 儿童心理治疗师的联系，关于儿童大脑回路。它将为儿童的神经生物学提供洞察力 依赖依恋数字来减少焦虑，这一过程有助于损害和 与儿童焦虑症相关的成本。因为许多孩子不能或不愿意参与 治疗，结果支持空间作为减少儿童焦虑的有效方式的承诺将会有所帮助 以解决治疗的一个共同障碍。这项研究的令人振奋的结果将为 较大规模的R01临床试验，考察空间效应及其调节因子和调节剂的作用。

Currently, 50% of children do not benefit from evidence-based treatments for childhood anxiety disorders. This R61/R33 application proposes to test whether a novel entirely parent-based psychosocial intervention for childhood anxiety disorders engages amygdala-medial prefrontal cortex (mPFC) neural circuitry in the child's brain, implicated in children's reliance on parents to reduce their amygdala reactivity and anxiety; and whether changes in the target circuitry after treatment are associated with reductions in child anxiety. The R61 study will randomly assign 90 children (ages 7-10yrs) with primary anxiety disorders to one of two interventions: 1) Supportive Parenting for Anxious Childhood Emotions (SPACE), a novel completely parent- based treatment with no direct child involvement, that reduces children's anxiety by reducing parents' accommodation of their child's symptoms; or 2) Parent Educational Support (PES), a credible comparator intervention that is also entirely parent-based and controls for treatment duration and parent-therapist contact, but does not include any active modification of parental behavior. Before and after treatment, functional magnetic resonance imaging (fMRI) will be used examine children's reliance on parents to engage the target circuitry by comparing children's amygdala reactivity and mPFC connectivity in the presence of their mother and in the absence of their mother. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than PES. If this hypothesis is supported the R33 will be performed. The R33 will randomly assign 136 children (7-10yrs) with primary anxiety disorders to one of two interventions: 1) Parents participate in SPACE; or 2) Children receive cognitive-behavioral therapy (CBT), a standard of care treatment of known efficacy. We will use before and after fMRI and multi-informant/multi-modal child anxiety evaluations. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than CBT; We expect target engagement in SPACE to be associated with child anxiety symptom reduction; We expect SPACE will be feasible to deliver and acceptable to children and parents. This study is innovative in several ways and has the potential for large clinical and scientific impact. It is the first study to examine the impact of a psychosocial intervention on the neural circuitry of children with anxiety disorders, and the first study to examine the effects of an exclusively parent-only intervention with no child-therapist contact, on child brain circuitry. It will provide insight into the neurobiology of children's dependence on attachment figures for anxiety reduction, a process that contributes to the impairment and costs associated with childhood anxiety disorders. As many children are unable or unwilling to participate in therapy, results supporting the promise of SPACE as an effective way to reduce childhood anxiety would help to address a common barrier to treatment. Promising results from this study would provide the basis for a larger scale R01 clinical trial, to investigate the efficacy of SPACE and mediators and moderators of its effects.