The synchrony study: A randomized controlled trial of music training for children with FASD

摘要 最近的估计表明，保守地说，在美国，多达5%的儿童有足够的 行为和认知的影响，由于产前酒精暴露，他们有资格为胎儿酒精谱 疾病（FASD）。患有FASD的儿童会经历一系列的影响，包括感觉、运动、 和执行功能，这反过来又与不良的长期结果有关。然而，很少有基于证据的 有FASD的儿童可获得干预措施，其中只有两种针对学术或认知技能。 音乐训练（MT）针对一系列复杂的技能，包括听觉和视觉感知，多感官 整合、注意力和工作记忆。这些MT目标与以下方面所经历的赤字非常吻合： 患有FASD的儿童，因此MT可能非常适合改善这些儿童的结果。在这 项目，我们假设MT通过改善预测能力来改善大脑功能和有针对性的技能。 编码预测编码框架假定大脑的主要作用是预测环境 并通过识别和纠正预测错误来优化结果。MT提供直接实践 当参与者定期产生声音（环境）并调整他们的行为时， 纠正任何错误（修复不正确的音符/计时）。我们进一步强调，这种自下而上的培训将有助于优化 感觉，运动和认知功能相对于自上而下的策略，导致更好的结果。 我们在FASD儿童中进行的MT干预试验为接受MT提供了令人兴奋的证据， 儿童和父母以及MT前/后神经和行为水平变化的发生， 患有MT的儿童与没有MT的儿童。在R61阶段，我们将进行一项随机交叉研究， 12-一周MT干预相对于音乐听（ML）控制期在更大的样本来检查 8-16岁儿童FASD中MT引起的预测编码和行为效应的神经生理学变化 岁的我们将使用脑磁图来评估大脑功能的变化， 脑电图，2）使用结构磁共振成像和扩散张量的大脑结构 影像学检查; 3）认知和行为神经心理学评估及问卷调查 分（试验前（第1周）、交叉（第13周）和试验后（第28周））。在R33阶段， 在患有FASD 8-16岁儿童中实施随机交叉设计，以：a）比较MT效应相对于 认知训练（CT）对照和B）通过比较12周与24周的干预来评估剂量效应。 我们假设，自下而上的MT方法，可以改善感觉（听觉）和运动功能， 将导致大脑连接的变化，这反过来将改善相对于顶部的认知功能， CT下行我们已经组建了一支强大的多学科团队来实施音乐培训 使用客观的神经影像学、认知和行为测量进行干预和评估结果。 未来的研究将探讨MT如何有助于FASD的基于力量的干预方法。

Abstract Recent estimates indicate that, conservatively, up to 5% of children in the United States have sufficient behavioral and cognitive effects due to prenatal alcohol exposure that they qualify for a fetal alcohol spectrum disorder (FASD). Children with an FASD experience a range of effects, including deficits in sensory, motor, and executive functions, which are in turn related to poor long-term outcomes. However, few evidence-based interventions are available for children with an FASD and, of these, only two target academic or cognitive skills. Music training (MT) targets a complex array of skills including auditory and visual perception, multisensory integration, attention, and working memory. These MT targets align well with the deficits experienced by children with FASD and, therefore, MT may be well-suited for improving outcomes for these children. In this project, we hypothesize that MT improves brain function and targeted skills via improvement in predictive coding. The predictive coding framework posits that a primary role of the brain is to predict the environment and optimize outcomes through identifying and correcting prediction errors. MT provides direct practice of predictive coding when participants regularly produce sounds (environment) and adjust their behavior to correct any errors (fix incorrect notes/timing). We further posit that this bottom-up training will help optimize sensory, motor, and cognitive function relative to top-down strategies, leading to better outcomes. Our pilot MT intervention in children with an FASD provided exciting evidence for acceptance of MT by children and parents and for the occurrence of pre-/post-MT changes at the neural and behavioral level in children with MT vs. those without MT. In the R61 phase, we will conduct a randomized cross-over study of a 12-week MT intervention relative to a music listening (ML) control period in a larger sample to examine neurophysiological changes in predictive coding and behavioral effects due to MT in FASD in children 8-16 years of age. We will assess changes in 1) brain function using magnetoencephalography and electroencephalography, 2) brain structure using structural magnetic resonance imaging and diffusion tensor imaging, and 3) cognition and behavior using neuropsychological assessment and questionnaires at three time points (pre-trial (week 1), cross-over (week 13), and post-trial (week 28)). In the R33 phase, we will again implement a randomized cross-over design in 8-16 year-olds with an FASD to: a) compare MT effects relative to a cognitive training (CT) control and b) evaluate dose effects by comparing 12- vs. 24-weeks of intervention. We hypothesize that the bottom-up approach of MT, which improves sensory (auditory) and motor functioning, will lead to changes in brain connectivity, which in turn will improve cognitive functioning relative to the top- down approach of CT. We have assembled a strong multidisciplinary team to implement a music training intervention and assess the outcomes using objective neuroimaging, cognitive, and behavioral measures. Future studies will explore how MT can contribute to a strengths-based intervention approach for FASD.