Evaluating Innovative Treatment Formats for Difficult-to-Treat Child Populations

项目摘要/摘要 该应用程序将促进专注于杠杆的独立研究事业的发展 针对难以治疗和难以接触的儿童群体的创新治疗模式和技术。 PI将获得必要的技能和研究培训，以从 针对存在独特护理障碍的青年人口的实验性治疗框架，例如 复杂的症状表现和/或缺乏获得优质护理的机会。 选择性缄默症(SM)是一种如此复杂的儿童障碍，需要专门的护理，而不是 大多数有需要的年轻人都可以随时获得。SM是一种焦虑症，其特征是无法说话 某些社交场合，尽管有能力在熟悉的场合说话。尽管患病率很低，但SM导致 严重损害儿童的社会和学习功能；因为大多数受影响的儿童不能说话 在学校，他们经常得不到适当的学术服务的充分评价，而且得不到日常生活-- 白天的需要在教室里得到满足。作为一种低基准率的疾病，对SM的专家护理并不广泛，并且 绝大多数受影响的儿童没有得到适当的服务。解决访问的问题 对于许多低基准率疾病的优质护理，专家提供者正在越来越多地提供强化治疗 选项，个人从世界各地旅行，进行短暂(例如，1周)的全天会议 在患者所在的社区，没有提供或没有提供类似质量和能力的治疗。 尽管在开发团体强化行为治疗模式方面取得了巨大的临床进展，但 SM的治疗，到目前为止，研究还没有在对照试验中评估SM的强化治疗。 作为NRSA培训拨款中心的项目需要一项试点等待名单对照试验，以评估 在不同人群中进行为期一周的集体强化行为治疗，儿童SM(N=30)通过 夏天。青少年将随机接受即刻SM强化团体行为疗法(IGBT)或 等待列表控制(WL)。目标1将通过以下方式检查该计划的可行性和家长的满意度 辍学率和每日就诊率、标准化消费者满意度和参与治疗的障碍 措施，以及因参加该计划而产生的费用。目标2将检查SM的削减 一周后和潜在的两种情况下的症状(以及总体焦虑和功能) 治疗反应的预测指标。目标3将通过评估来检查治疗反应的维持情况 强化小组治疗计划是否改善了儿童的SM症状(以及总体 焦虑和学习功能)在课堂上进行了8周后进入以下学校 年。最后，探索性目标4将考察与文化和文化相关的治疗反应的个体差异。 社会人口因素。

PROJECT SUMMARY/ABSTRACT This application will foster the development of an independent research career focused on leveraging innovative treatment formats and techniques to target difficult-to-treat and difficult-to-reach child populations. The PI will gain the necessary skills and research training to conduct rigorous clinical evaluations from an experimental therapeutics framework for youth populations that present with unique obstacles to care, such as complex symptom presentations and/or lack of accessibility to quality care. Selective mutism (SM) is one such complex child disorder that requires specialized care that is not readily available for most youth in need. SM is an anxiety disorder characterized by an inability to speak in certain social situations, despite ability to speak in familiar situations. Despite its low prevalence, SM results in severe impairment in children's social and academic functioning; because most affected children fail to speak in school, they are often insufficiently evaluated for appropriate academic services, and do not get their day-to- day needs met in the classroom. As a low base-rate disorder, expert care for SM is not broadly accessible, and the vast majority of affected children do not receive appropriate services. To address problems of access to quality care for many low base rate disorders, expert providers are increasingly offering intensive treatment options, in which individuals travel from across the world for brief (e.g., 1 week) periods of all-day sessions in treatments not offered, or not offered with similar quality and competency, in the patient's local community. Despite tremendous clinical advances in the development of group intensive behavior therapy formats for the treatment of SM, to date research has not evaluated intensive treatments for SM in a controlled trial. The project at the center of this NRSA training grant entails a pilot waitlist controlled trial evaluating a one-week group intensive behavior therapy in a diverse population of children SM (N=30) delivered over the summer. Youth will be randomized to either immediate SM intensive group behavior therapy (IGBT), or to a waitlist control (WL). Aim 1 will examine feasibility of and parental satisfaction with the program by examining dropout and daily attendance rates, standardized consumer satisfaction and barriers to treatment participation measures, and costs incurred as a result of participation in the program. Aim 2 will examine reductions in SM symptoms (as well as overall anxiety and functioning) across the two conditions after one week and potential predictors of treatment response. Aim 3 will examine maintenance of treatment response by evaluating whether or not the intensive group treatment program improves children's SM symptoms (as well as overall anxiety and academic functioning) across the two groups in the classroom 8 weeks into the following school year. Finally exploratory Aim 4 will examine individual differences in treatment response related to cultural and sociodemographic factors.