Multimodal Profiling of Response to Pediatric Comprehensive Behavioral Intervention for Tics

项目总结 这项建议的总体目标是进行儿科综合治疗的首次机械性临床试验 抽动症的行为干预(CBIT)，以确定生物行为预测因素和反应与抽动的相关性 CBIT交付的最有力的方面。慢性抽搐在美国影响1-3%的年轻人，是一种致残性疾病 与儿童时期出现的多种精神障碍相关的神经精神症状。CBIT是当前的 一线，金标准的治疗抽搐，并专注于技能，以加强自愿抽搐抑制和 减少抽搐的触发因素。然而，大约50%的年轻人没有从CBIT中受益。目前的研究旨在使用 多模式测量以确定反应的预测因素(CBIT对谁有效？)，治疗 激活变化的过程(CBIT交付的有效方面是什么？)，以及响应的关联性 (抽动症状改善的患者会发生什么变化？)研究假设，基于文献和我们的 初步数据预测，CBIT依赖、参与并加强内部和之间的连接 支持自上而下控制运动功能的功能性大脑网络。青少年年龄10-17岁，有 慢性抽搐(N=100)将完成8个门诊疗程，每周一次的CBIT以及治疗前、治疗后和治疗后 3个月的随访评估。多模式评估将包括：1)功能的神经测量 利用fMRI和EEG研究静息和抽搐时大脑大规模功能网络的连通性 表达和抑制，2)抽动的直接观察行为测量，3)心理社会 措施，包括临床症状评估和以患者为中心的结果措施，由 初步数据和我们的患者咨询委员会。CBIT流程将通过新的基于视频的 CBIT会话的行为编码。这一项目有可能直接造福于患者 从长远来看。结果将通过告知个性化的方式对临床实践产生下游影响 治疗计划和努力精简和提高CBIT质量。结果也将有一个上游 通过确定新的神经干预靶点和治疗策略对治疗发展的影响 通过改进或辅助程序改进CBIT成果。

PROJECT SUMMARY The overall objective of this proposal is to conduct the first mechanistic clinical trial of pediatric Comprehensive Behavioral Intervention for Tics (CBIT) to identify bio-behavioral predictors and correlates of response and the most potent aspects of CBIT delivery. Chronic tics affect 1-3% of youth in the US and are a disabling neuropsychiatric symptom associated with multiple childhood-onset mental disorders. CBIT is the current first-line, gold-standard treatment for tics and focuses on skills to enhance voluntary tic suppression and reduce tic triggers. However, about 50% of youth do not benefit from CBIT. The current study aims to use multimodal measurements to identify predictors of response (for whom does CBIT work?), the therapeutic processes that activate change (what are the potent aspects of CBIT delivery?), and correlates of response (what changes occur in patients whose tics improve?). Study hypotheses, based on the literature and our preliminary data, predict that CBIT relies upon, engages, and strengthens connectivity within and between functional brain networks that support top-down control over motor functions. Youth ages 10-17 years with chronic tics (N = 100) will complete a course of 8 outpatient, weekly sessions of CBIT and pre-, post-, and 3-month follow up assessments. Multimodal assessments will include: 1) neural measures of functional connectivity among the brain's large-scale functional networks using fMRI and EEG during rest and tic expression and suppression, 2) direct-observation behavioral measurement of tics, and 3) psychosocial measures, including assessments of clinical symptoms and patient-centered outcome measures informed by preliminary data and our Patient Advisory Board. CBIT process will be assessed via a novel video-based behavioral coding of CBIT sessions. This project has the potential to directly benefit patients both immediately and in the long-term. Results will have a downstream impact on clinical practice by informing individualized treatment planning and efforts to streamline and improve CBIT quality. Results will also have an upstream impact on treatment development by identifying novel neural targets for intervention and strategies for improving CBIT outcomes via refinement or adjunctive procedures.