Brain Response Associated With Parent-based Treatment for Childhood Anxiety Disorders

Specific Aims: Anxiety disorders impact up to one-third of children, cause tremendous suffering, increase risk for psychiatric and medical morbidity, impair school and social functioning, and cost billions of dollars each year. Data consistently show that child anxiety is characterized by amygdala hyperactivity and deficits in prefrontal control of the amygdala. Emerging data link these disruptions to anxious children's over-reliance on parents for amygdala-medial prefrontal cortex (mPFC) engagement and anxiety reduction.

In the first phase of this study we aim to demonstrate that an entirely parent-based psychosocial treatment with no child involvement, Supportive Parenting for Anxious Childhood Emotions (SPACE), engages an amygdala-mPFC target in anxious children, lessening child reliance on parents to reduce amygdala reactivity.

Cross-species neurobiological evidence indicates that parental presence reduces amygdala reactivity and activates the mPFC to reduce offspring anxiety. In humans we recently demonstrated parental presence increases functional connectivity between their child's mPFC and amygdala, reducing the child's amygdala reactivity and anxiety. In a healthy sample, parental engagement of child amygdala-mPFC connectivity was linked to the child's reliance on parents for help with anxiety. Data from clinically anxious children likewise show parental presence engages child mPFC, and data we collected since our previous submission demonstrate that parental presence reduces amygdala reactivity in clinically anxious children.

Offspring's natural reliance on parents for anxiety reduction is magnified in clinically anxious children. Parents become deeply enmeshed in their child's symptoms through the process of family accommodation, defined as change in parents' behavior to help the child avoid or alleviate anxiety. In clinically anxious children, 90% report depending on parents to reduce their anxiety, and 97% of parents report accommodating their anxious child's symptoms. These cross-generational patterns of parental entanglement in their child's anxiety symptoms contribute to the immense burden, distress, and costs of pediatric anxiety (e.g., parents missing work to be with their anxious child). Anxious children's reliance on parents for anxiety reduction may disrupt the child's ability to independently reduce amygdala reactivity and anxiety.

We developed SPACE to translate these neurobiological and clinical research findings into a manualized parent-based treatment focused on reducing family accommodation in parents of anxious children. Preliminary data from a randomized clinical trial show that after 12 weeks of parents receiving SPACE (N=29), with no therapist-child contact, family accommodation and child anxiety were significantly reduced. We propose that SPACE engages anxious children's amygdala-mPFC circuitry, lessening their reliance on parents to reduce amygdala reactivity.