Dyadic Synchrony as a Mechanism of Parent-Child Interaction Therapy (PCIT): A Neuroscience-Based Approach

二元同步作为亲子互动疗法（PCIT）的机制：基于神经科学的方法

SUSAN PERLMAN (2018-08-13 to 2020-06-30) $446,012

Project ID: R21MH115088 (NIMH)

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Abstract

Disruptive behavior is one of the most common reasons for mental health referral of preschool age children and is a marker of lifetime psychiatric risk. In addition, disruptive behavior has transdiagnostic import, is often a treatment target, and is a marker of lifetime risk for mental disorder. Meta-analytic studies indicate non- psychopharmacological, family-focused therapeutic strategies as the treatment of choice in this young population. However, substantial individual differences in treatment effectiveness and the need to enhance impact during this period of early brain plasticity suggest the need for incorporating a mechanistic perspective into treatment approaches for early childhood disruptive behavior. Parent-Child Interaction Therapy (PCIT), among the most widely used empirically validated treatments for early childhood disruptive behavior, is an intervention in which a parent in coached by a clinician on discrete behavioral parenting skills during parent- child interaction. While PCIT is effective for families who complete treatment, high drop-out rates are typically reported. The primary hypothesis of this study is that improvement in parent-child dyadic synchrony, a mutually focused and reciprocated exchange between interactional partners, is a core basic mechanism for PCIT effectiveness. Our novel approach explicates this mechanism by examining neural synchrony, which assesses coherence between the signals of brain activation of parent-child dyads, and links it to the clinically-observable behavioral synchrony and clinical improvement. In a sample of 50 preschool children and their parents, we will employ functional near infrared spectroscopy (fNIRS) to measure concomitant brain activation in key regions of social cognition circuitry during an initial assessment (Visit 1), PCIT midpoint (Visit 2), PCIT completion (Visit 3), and one month follow-up (Visit 4). This proposal brings together a team of neuroscientific, developmental and intervention experts as the critical first step in translating this basic line of research to clinical application with the ultimate goals of optimizing PCIT by training clinicians to focus upon fluctuations in dyadic synchrony. We theorize that explicating bidirectional neurodevelopmental mechanisms would make PCIT (1) more effective because it would enable operating directly on a specified biological target through modification at the clinically observable level; (2) more efficient by personalizing treatment, allowing clinicians the flexibility to select from the parenting skills that most immediately alter the target on the individual level, accelerating time to clinical improvement; and (3) more generalizable as its bidirectional emphasis would facilitate the child?s capacity to read social cues and respond adaptively to social partners, which more readily translates outside the parent-child context. This study will be the first to employ neuroscientific methods to elucidate the specific mechanisms by which PCIT reduces disruptive behavior, providing a more direct and efficient clinical target. Clinical translation of findings could serve as the basis for concentrating PCIT sessions, speed the time to improvement, and reduce time commitment, thus increasing patient compliance and decreasing attrition.

破坏性行为是学龄前儿童心理健康转诊的最常见原因之一，也是终生精神疾病风险的标志。此外，破坏性行为具有转移诊断意义，通常是治疗目标，并且是精神障碍终身风险的标志。 Meta分析研究表明，非精神药理学，以家庭为中心的治疗策略是这一年轻人群的治疗选择。然而，在早期大脑可塑性期间，治疗效果的显着个体差异和增强影响的需要表明需要将机械观点纳入早期儿童破坏行为的治疗方法中。亲子互动疗法（PCIT）是最广泛使用的经验验证的早期儿童破坏行为治疗方法，是一种干预，其中父母由临床医生在父母 - 子女互动期间执行离散的行为育儿技巧。虽然PCIT对完成治疗的家庭有效，但通常会报告高辍学率。这项研究的主要假设是，改善亲子二元同步，互动伙伴之间相互集中和互惠的交流，是PCIT有效性的核心基本机制。我们的新方法通过检查神经同步来阐明这种机制，神经同步评估亲子对偶的大脑激活信号之间的一致性，并将其与临床可观察的行为同步和临床改善联系起来。在50名学龄前儿童及其父母的样本中，我们将采用功能性近红外光谱（fNIRS）来测量初始评估（访问1），PCIT中点（访问2），PCIT期间社会认知电路关键区域的伴随脑激活完成（访问3），以及一个月的随访（访问4）。该提案汇集了神经科学，发育和干预专家团队，作为将这一基本研究线转化为临床应用的关键第一步，其最终目标是通过培训临床医生来关注二元同步的波动来优化PCIT。我们推测，阐明双向神经发育机制将使PCIT（1）更有效，因为它可以通过临床可观察水平的修改直接在特定的生物学靶标上进行操作; （2）通过个性化治疗提高效率，使临床医生能够灵活地选择最能立即改变个体目标的育儿技能，加快临床改进的时间; （3）更加普遍化，因为其双向强调将有助于儿童阅读社交线索并适应社交伙伴的能力，这更容易在父母 - 子女背景之外进行翻译。这项研究将首次采用神经科学方法来阐明PCIT减少破坏性行为的具体机制，从而提供更直接，更有效的临床目标。结果的临床翻译可以作为集中PCIT会议的基础，加快改进时间，减少时间承诺，从而提高患者的依从性并减少减员。