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获益。 这项R61/R33申请旨在测试一种新的完全基于父母的心理社会干预是否适用于儿童。 儿童期焦虑症使杏仁核-内侧前额叶皮层（mPFC）神经回路参与儿童的 大脑，与儿童依赖父母减少杏仁核反应和焦虑有关; 治疗后目标回路的变化与儿童焦虑的减少有关。 R61研究将90名患有原发性焦虑症的儿童（年龄7- 10岁）随机分配到两个 干预措施：1）支持性育儿焦虑的儿童情绪（空间），一个新的完全父母- 没有直接的儿童参与的基础治疗，通过减少父母的焦虑来减少儿童的焦虑。 适应他们的孩子的症状;或2）家长教育支持（PES），一个可信的比较 干预也完全基于父母，并控制治疗持续时间和父母-治疗师接触， 但不包括对父母行为的任何主动改变。治疗前后，功能 磁共振成像（fMRI）将用于检查儿童对父母参与目标的依赖 通过比较儿童在母亲在场时杏仁核反应性和mPFC连接性的电路 在母亲不在的情况下我们希望空间减少儿童对父母存在的依赖，以减少 杏仁核反应性，明显高于PES。如果该假设得到支持，则将执行R33。的 R33将136名患有原发性焦虑症的儿童（7- 10岁）随机分配到两种干预措施之一：1） 父母参与SPACE;或2）儿童接受认知行为治疗（CBT），这是一种标准护理 已知疗效的治疗。我们将使用之前和之后的功能磁共振成像和多信息源/多模态儿童焦虑 评价。我们希望SPACE能减少儿童对父母存在的依赖，以减少杏仁核的反应， 显著高于CBT;我们预计SPACE中的目标参与与儿童焦虑相关 症状减轻;我们希望SPACE能够切实可行，并为儿童和家长所接受。 这项研究在几个方面都是创新的，有可能产生巨大的临床和科学影响。是 这是第一项研究，旨在研究心理社会干预对儿童神经回路的影响， 焦虑症，以及第一项研究，以检查一个专门的父母只有干预的影响，没有 儿童治疗师的接触，在儿童脑回路上。它将为儿童的神经生物学提供深入的了解。 依赖依恋数字来减少焦虑，这是一个导致损害的过程， 与儿童焦虑症相关的费用。由于许多儿童无法或不愿参加 治疗，结果支持空间的承诺，作为一种有效的方式，以减少儿童焦虑将有助于 来解决一个常见的治疗障碍。这项研究的有希望的结果将为 更大规模的R 01临床试验，以研究SPACE的疗效及其作用的介导剂和调节剂。

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.