A Study of Preschool Irritability: Brain Imaging in the Clinic Setting

学龄前儿童焦虑症的临床研究

SUSAN PERLMAN (2014-02-17 to 2016-01-31) $406,550

Project ID: R21MH100189 (NIMH)

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Abstract

The goal of this research is to use functional Near Infrared Spectroscopy (fNIRS) to study the neural basis of irritability in a sample of preschool children (ages 3-5) who are being clinically treated for early onset psychopathology. Irritability exists on a dimension in every member of the population, however, it is also a significant mental health concern that is present in nearly every form of psychopathology. A new diagnostic category in the DSM-V revision has even been added in order to secure the research and clinical services that this symptom requires. The proposed study will be the first to examine brain mechanisms for frustration and inhibitory control, which signify key behavioral deficits, in young, highly irritable children. Obtaining these measures of functional abnormalities in the neural systems supporting frustration and inhibitory control in preschool children presenting with varying levels of irritability will first help us to identify which children show greater levels of dysfunction within these neural systems. It is also a first step toward the longer term goal of examining the extent to which these neural system abnormalities, identified at the age at which irritability first presents, may represent biological markers that can help distinguish relevant developmental trajectories of psychopathology, so that different treatments can be applied at this early stage of symptomatology. Children will be tested in the clinic setting using fNIRS, an optical imaging technique that is painless, non-restrictive, transportable, and allows for subject/experimenter interaction. Well-validated experimental paradigms will be employed. Primary analyses will probe the neural activity within specific regions related to frustration and inhibitory control, using state-of-the-art analysis techniques, in order to define brain deficits tat correlate with this symptom. Exploratory analyses will examine the extent to which these neural system abnormalities may predict symptom severity and clinical diagnosis by correlating activity in these neural systems with diagnostic report. Finally, long term plans for this research include a future proposal to complete a longitudinal R01 study, combining fNIRS and functional magnetic resonance imaging (fMRI). A large community sample of preschool children, across the range of irritability levels, will participate in yearly fNIRS measurement of neural systems fo frustration and inhibitory control using age appropriate tasks. In the later years of the project, when children have entered middle childhood, they will be scanned, using simultaneous fNIRS and fMRI to increase our understanding of the neural and clinical trajectories of this symptom. Our transdisciplinary research team unites developmental psychologists, neuroscientists, and child psychiatrists who are experts in their respective fields, but share a common interest in understanding the neural mechanisms for irritability as a predictor of child mental health outcomes.

本研究的目的是使用功能性近红外光谱（fNIRS）来研究临床上接受早期精神病理学治疗的学龄前儿童（3-5岁）样本的易激惹的神经基础。在每个人群中存在一定程度的易怒，然而，它也是一种重要的心理健康问题，几乎存在于每种形式的精神病理学中。甚至还添加了DSM-V修订版中的新诊断类别，以确保该症状所需的研究和临床服务。拟议的研究将首次检查挫折和抑制控制的大脑机制，这表明年轻，高度易激惹儿童的关键行为缺陷。在支持沮丧和抑制控制的神经系统中获得这些功能异常的测量结果将首先帮助我们确定哪些儿童在这些神经系统中表现出更高水平的功能障碍。这也是迈向长期目标的第一步，这个目标是检查这些神经系统异常的程度，这些异常在易激惹首次出现的年龄确定，可能代表生物标志物，可以帮助区分相关的精神病理学发展轨迹，以便不同的治疗方法可以应用于症状学的早期阶段。儿童将在临床环境中使用fNIRS进行测试，fNIRS是一种无痛，非限制性，可移动的光学成像技术，并允许受试者/实验者互动。将采用经过充分验证的实验范例。初步分析将使用最先进的分析技术探测与挫折和抑制控制相关的特定区域内的神经活动，以定义与此症状相关的脑缺陷。探索性分析将通过将这些神经系统中的活动与诊断报告相关联来检查这些神经系统异常可以预测症状严重程度和临床诊断的程度。最后，这项研究的长期计划包括完成纵向R01研究的未来提案，结合fNIRS和功能磁共振成像（fMRI）。大范围的学龄前儿童样本，在烦躁程度范围内，将参与年度fNIRS测量神经系统的挫折和抑制控制使用适合年龄的任务。在该项目的后期，当儿童进入儿童中期时，他们将使用同时fNIRS和fMRI进行扫描，以增加我们对这种症状的神经和临床轨迹的理解。我们的跨学科研究团队将发展心理学家，神经科学家和儿童精神病学家联合起来，他们是各自领域的专家，但在理解作为儿童心理健康结果预测因素的烦躁神经机制方面有着共同的兴趣。