Attention Training for Underserved Youth With Anxiety
Condition: Anxiety
MeSH terms: Anxiety Disorders
Study type: Interventional

Summary: 
      This study aims to test the efficacy and feasibility of administering a computerized
      attention training program targeting clinical levels of anxiety in Latino youth between the
      ages of 8-17. 52 youth from Imperial County, a rural and predominantly Latino region, will be
      randomized to receive either 1) a 12-session attention modification program (AMP) or 2) an
      attention condition program (non-active treatment). Clinical assessment of symptom severity
      will be conducted before, during, and after treatment. We hypothesize that at the end of
      treatment, children who receive the active intervention (AMP) will show (1) decreased
      attention bias to anxiety-related triggers using an independent measure of attention bias to
      assess change and (b) reduced anxiety severity. We also hypothesize that this study will be
      feasible, tolerable, acceptable, and safe in this underserved sample of Latino youth. This
      study is an initial step towards demonstrating the feasibility of implementing a novel
      computerized attention training program in anxiety in underserved community samples.
    

Detailed description: 
      The main aim of this pilot study is to examine the feasibility, tolerability, and
      acceptability of a computerized attention training program for children who have clinically
      elevated anxiety. Youth from a rural Latino community, with significant anxiety symptoms (N =
      52) will be randomized to an active attention bias modification program (AMP) for four weeks
      or to an attention control condition (nonactive) for four weeks. Families will be assessed at
      baseline, mistreatment, post-treatment and 3 month followup. AMP responders will be
      determined by reduction on a self-report measure of anxiety and a clinician administered
      assessment. Community health workers (promotoras) will be trained to administer the program
      to youth. Data will be gathered to examine the feasibility, tolerability, and acceptability
      of this type of treatment and this mode of service delivery. It is hypothesized that the AMP
      will be feasible, tolerable, and acceptable to this underserved community sample of ethnic
      minority youth.

      Study Design: Following ascertainment of study eligibility and completion of baseline
      assessment, youth will be assigned to four weeks of AMP or ACC (attention control condition).
      All youngsters and their families will undergo a comprehensive baseline assessment and be
      reassessed at mistreatment, treatment endpoint (week 4) and 3 month followup.

      Screening: Youth will be recruited through various mechanisms.

        1. Flyers will be posted in primary care clinics in Imperial Valley and Los Angeles County.
           Clinicas de Salud del Pueblo is a private, non-profit corporation providing primary care
           services throughout Imperial County. Flyers will be posted in the 10 primary care
           clinics, located in Imperial County.

        2. The second method for recruiting subjects will be through physician referral from
           providers within the primary care systems. Prior to the study start, all
           pediatricians/providers will receive information about the study, symptoms of child
           anxiety, and the use of a short screening measure to assist in detecting child anxiety.
           If a provider at one of the clinics identifies a child with anxiety or a parent reports
           that child has symptoms consistent with anxiety (fears, worries, nervousness,
           unexplained somatic complaints, etc.), the provider will have the option to explain the
           study to the parent and give them the study brochures. Alternatively, providers, if
           able, can also ask parents to sign a consent to contact form, giving the research team
           permission to contact them directly to discuss the study.

        3. Providers may also chose to refer the patient to the study promotora who will assist
           will explaining the study to the participant, screening, and consenting the
           participants.

        4. Flyers will also be posted at Sun Valley Behavioral Medical Center, a private medical
           clinic that serves the medical and mental health needs of children, adolescents and
           adults in Imperial County. In this case, parents will be expected to call our research
           team for more information.

        5. The co-PI on this study, Dr. Denise Chavira has an ongoing school based study being
           conducted with high school students in Imperial Valley. Given that this study covers a
           range of ages (8-17), we will also recruit from high schools. As part of the existing
           consent form (for protocol 14-000663), students are asked to check the box if they are
           interested in participating in future research studies. We will contact those students
           who have indicated interest in future studies to discuss the current project.

      In all of these methods, the community health worker/promotora/e will contact the parent to
      conduct an initial screen. Thereafter the promotora and/or research coordinator will arrange
      an in person meeting with the parent and youth to review the consent with the parent and
      assent form with the youth and administer the eligibility measures. The initial eligibility
      assessments will not be conducted until all consent/assent forms have been signed and
      returned to the research team.

      At the end of the eligibility visits, the PIs (Chavira and Chang) will review the
      questionnaires to determine final eligibility. Those who are eligible will process to the
      baseline visit where they will receive the AMP or ACC program as well as other measures. We
      have included a table of these measures as well as the assessment schedule in 10.1 section
      1.0.

      Attention Modification Program: AMP is a modified version of the dot-probe paradigm similar
      to the original task used by MacLeod, Mathews, and Tata. Each trial begins with a fixation
      cross presented in the center of the computer screen for 500 ms. The cross is then replaced
      by a pair of faces presented in the center of the screen for 500 ms. The face pair disappears
      and a probe (i.e., the letter "E" or "F") appears immediately in the location of one of the
      two faces. Participants will be instructed to decide whether the letter is an E or an F and
      press the corresponding mouse button. The letter probe will remain on the screen until the
      participant responds. Response latencies to identify the probe will be recorded from the
      onset of the presentation of the letter probe to the button press. A total of 288 training
      trials will be delivered each session. This paradigm has been modified to facilitate an
      attention bias away from threatening material. In this case, the probe always replaces the
      neutral face. Thus, although there will be no specific instruction to direct attention away
      from the threatening face, on all trials, the position of the neutral face will indicate the
      position of the probe.

      Attention Control Condition: Like AMP, the attention control condition is a dot-probe task
      that begins with a fixation cross presented in the computer screen for 500ms, is followed by
      a pair of faces (one neutral, one threatening) for 500ms, and then a trial is completed when
      the face pair disappears and a probe (letter "E" or "F") appears in the location of one of
      the two faces. Participants will be instructed to decide whether the letter is an E or an F
      and press the corresponding mouse button. The letter probe will remain on the screen until
      the participant responds. Response latencies to identify the probe will be recorded from the
      onset of the presentation of the letter probe to the button press. A total of 288 training
      trials will be delivered each session. However, in this case, the probe replaces both the
      neutral and threat face 50% of the time.

      Assessment. All parents and children enrolled in the study will complete assessments at
      baseline, mid-treatment, post-treatment and 3 month followup. Assessments will focus on
      feasibility outcomes and clinical outcome measures. Further, measures of moderating factors
      will be included in order to better understand variables (e.g., poverty, attention control,
      acculturation) that may suggest trends in differential treatment response within the two
      conditions.
    

Intervention name(s): Attention Modification Program; Attention Control Condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Each trial begins with a fixation cross at the center of the computer screen for 500 ms. The cross is then replaced by a face pair presented in the center of the screen. The face pair disappears and a probe (letter "E" or "F") appears immediately in the location of one of the two previous stimuli. Youth will be instructed to decide whether the letter is an E or an F and press the corresponding mouse button. This paradigm has been modified to facilitate an attention bias away from threat material. In this case, the probe always replaces the neutral stimuli. Thus, although there will be no specific instruction to direct attention away from the threat stimuli, on all trials, the position of the neutral stimulus will indicate the position of the probe.; Each trial begins with a fixation cross presented in the center of the computer screen. The cross is then replaced by a face pair presented in the center of the screen. The face pair disappears and a probe (letter "E" or "F") appears immediately in the location of one of the two previous stimuli. Youth will be instructed to decide whether the letter is an E or an F and press the corresponding mouse button. This paradigm is not intended to facilitate an attention bias away from threat material. In this case, the probe randomly replaces the threat or neutral stimulus.
Other intervention name(s): ABM, attention bias modification, attention training; ACC
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: attention training, youth, latino