(PS3-20) Neural Predictors of Response to SPACE for Childhood Anxiety

Abstract Text: SPACE (Supportive Parenting of Anxious Childhood Emotions) is a parent-based treatment that reduces child anxiety by directly targeting parental accommodation. SPACE has been shown to be efficacious and noninferior to cognitive behavioral therapy. Given vast heterogeneity in childhood anxiety, identifying predictors of treatment response may contribute to our ability to parse distinct pathways underlying individual differences in treatment outcomes and advance the goal of personalized treatment. Here we examined whether baseline variation in parental modulation of their child’s neural regulation of fear relates to treatment response in SPACE.

Children ages 6-12 (N=95; Mage=8.75, SD=1.86) with primary anxiety disorders completed an event-related fMRI task measuring neural reactivity to threat while alone in the scanner room (“Parent-Absent condition”) and while their parent was physically present holding their hand (“Parent-Present condition”). The parents then completed 12 weeks of SPACE. Parents reported on accommodation (Family Accommodation Scale—Anxiety) and child anxiety (Screen for Child Anxiety Related Emotional Disorders - Parent Version) before and after treatment.

Across the sample, parents reported reduced child anxiety, b=0.54, SE=0.07, p<.001, and parental accommodation, b=0.42, SE=0.07, p<.001, following treatment. Pre-treatment left amygdala-right hippocampus connectivity in the Parent-Present versus Parent-Absent conditions was positively associated with post-treatment parent-reported accommodation (controlling for pre-treatment accommodation), b=0.77, SE=0.37, p=.038, and post-treatment child anxiety (controlling for pre-treatment anxiety), b=1.47, SE=0.62, p=.020.

These results indicate that baseline parental modulation of specific neural threat circuitry relates to children’s anxiety symptoms and parental accommodation, a key treatment target, following SPACE. While child anxiety and parental accommodation decreased following treatment across the sample, children who showed greater parental modulation of functional connectivity between the amygdala and hippocampus prior to treatment experienced more lingering anxiety symptoms and parental accommodation following treatment. Taken together, these results highlight potential family-level biomarkers of response to parent-focused treatment for childhood anxiety disorders.