Pediatric Anxiety Disorders Clinical Trial
Official title:
Fear Conditioning, Extinction and Its Recall in Anxious Youth: Identifying Neuro- Cognitive Abnormalities and Their Relation to Pediatric Anxiety Treatment Outcomes
The proposed research aims to isolate brain-based information-processing mechanisms
implicated in perturbed fear learning and extinction characteristic of pediatric anxiety.
The study will focus on the therapeutic relevance of dysfunction in fear learning and
extinction for treatment by examining the associations between brain functioning and
response to exposure intervention in anxious children.
Anxiety disorders are the most common form of pediatric psychopathology, affecting 5 - 20%
of children and adolescents. Despite therapeutic advances, treatment-resistance remains
high, and progress towards early detection of at-risk populations and more effective
treatments has stalled. Although some anxiety disorders are transient, recent studies
suggest that pediatric anxiety disorders commonly persist into adulthood. Because anxiety
disorders are costly and debilitating conditions that are very often associated with other
severe psychopathology such as substance abuse, depression and suicidality, there is an
imperative need to identify risk and resilience factors that moderate pediatric anxiety and
improve treatment.
Fear conditioning and resistance to extinction are two domains that have been implicated in
the etiology and maintenance of anxiety disorders. Indeed, one of the most effective
treatment for pediatric and adult anxiety disorders, exposure therapy, relies profoundly on
extinction learning. The proposed research plan will investigate the neural correlates of
aberrant fear conditioning and extinction processes in children and adolescents with anxiety
disorders.
The proposed research aims to isolate brain-based information-processing mechanisms
implicated in perturbed fear learning and extinction characteristic of pediatric anxiety. A
fMRI study using a novel age-appropriate fear conditioning-extinction paradigm are proposed.
The study will delineate perturbed psychological and psychophysiological response to fear
conditioning and isolate neuro-cognitive mechanisms mediating extinction recall in anxious
and non-anxious children. Three weeks after completing fear conditioning and extinction task
in the psychophysiology lab, participants will return to complete an fMRI extinction-recall
task quantifying responses to extinguished CS blends. Two major hypotheses will be examined:
a) anxious children will exhibit perturbations during extinction as measured by
psychophysiology indexes and self-reported fear compared to non-anxious children; b) less
activation in ventromedial prefrontal cortex (vmPFC) is expected in anxious, relative to
healthy, children during extinction-recall. Furthermore, the study will focus on the
therapeutic relevance of dysfunction in fear learning and extinction for treatment by
examining the associations between vmPFC function and response to exposure intervention in
anxious children. Lower levels of vmPFC activation prior to exposure therapy and larger
pre-to-post-treatment changes in vmPFC activity are expected to be associated with better
response to exposure therapy.
;
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label