Child Study Center, The Pennsylvania State University, University Park, State College.
Child Study Center, The Pennsylvania State University, University Park, State College.
J Am Acad Child Adolesc Psychiatry. 2018 Feb;57(2):103-110. doi: 10.1016/j.jaac.2017.11.016. Epub 2017 Nov 28.
Children with behavioral inhibition, a temperament characterized by biologically based hypervigilance to novelty and social withdrawal, are at high risk for developing anxiety. This study examined the effect of a novel attention training protocol, attention bias modification (ABM), on symptomatic, behavioral, and neural risk markers in children with behavioral inhibition.
Nine- to 12-year-old typically developing children identified as having behavioral inhibition (N = 84) were assigned to a 4-session active ABM training (n = 43) or placebo protocol (n = 41) using a double-blinded, randomized, controlled trial approach. Anxiety symptoms (Diagnostic Interview Schedule for Children-Fourth Edition), attention bias (AB; measured by a dot-probe task; AB = incongruent reaction time - congruent reaction time), and AB-related neural activation (measured by functional magnetic resonance imaging activation for the incongruent > congruent contrast in the dot-probe task) were assessed before and after the training sessions.
Results showed that active ABM (n = 40) significantly alleviated participants' symptoms of separation anxiety, but not social anxiety, compared with the placebo task (n = 40); ABM did not modify behavioral AB scores in the dot-probe task; and at the neural level, active ABM (n = 15) significantly decreased amygdala and insula activation and increased activation in the ventrolateral prefrontal cortex compared with placebo (n = 19).
These findings provide important evidence for ABM as a potentially effective protective tool for temperamentally at-risk children in a developmental window before the emergence of clinical disorder and open to prevention and intervention. Clinical trial registration information-Attention and Social Behavior in Children (BRAINS); http://clinicaltrials.gov/; NCT02401282.
具有行为抑制特征的儿童，其特点是对新奇事物和社会回避具有基于生物学的高度警惕性，他们患焦虑症的风险很高。本研究探讨了一种新的注意训练方案，即注意偏向修正（ABM），对具有行为抑制的儿童的症状、行为和神经风险标志物的影响。
采用双盲、随机、对照试验方法，将 9 至 12 岁被确定为具有行为抑制（N=84）的典型发育儿童分为 4 个疗程的主动 ABM 训练（n=43）或安慰剂方案（n=41）。使用儿童诊断访谈表第四版（Diagnostic Interview Schedule for Children-Fourth Edition）评估焦虑症状，使用点探测任务（AB=不一致反应时间-一致反应时间）评估注意偏向（AB），使用功能磁共振成像（fMRI）在点探测任务中评估不一致>一致的对比激活来评估 AB 相关的神经激活。
结果表明，与安慰剂任务（n=40）相比，主动 ABM（n=40）显著减轻了参与者的分离焦虑症状，但不能减轻社交焦虑症状；ABM 没有改变点探测任务中的行为 AB 评分；在神经水平上，主动 ABM（n=15）与安慰剂（n=19）相比，显著降低了杏仁核和岛叶的激活，增加了腹外侧前额叶的激活。
这些发现为 ABM 作为一种潜在有效的保护工具提供了重要证据，适用于在出现临床障碍之前的发育窗口期具有气质风险的儿童，并为预防和干预提供了可能。临床试验注册信息-儿童注意和社会行为（BRAINS）；http://clinicaltrials.gov/；NCT02401282。
