Development and Pilot Evaluation of an Executive Functioning and Emotion Regulation Intervention for Preadolescent Self-Injurious Thoughts and Behaviors

University Of Colorado Denver, Aurora CO

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Self-injurious thoughts and behaviors (SITBs) are a growing and underrecognized problem in preadolescents. About 15% of preadolescents report having some experience with suicidal thoughts; 10% have engaged in self-injury; and 1 in 100 report a suicide attempt. Youth who experience SITBs at a younger age are more likely to progress to more frequent and dangerous forms of self-injury and be hospitalized. Despite the importance of early intervention, there are currently no outpatient, research-supported treatments designed for preadolescents with SITBs. Developing and testing treatments specifically for preadolescents is crucially important, as risk factors differ in this age group. Treatment must also be developmentally appropriate and incorporate caregivers in ways that address the unique needs of preadolescents and their families. Emotion dysregulation and executive functioning (EF) are modifiable, transdiagnostic processes that underlie risk factors for SITBs in preadolescents, are sensitive to treatment change, and have been identified as key targets in recent calls for increased focus on prevention and early intervention of preadolescent SITBs. Dr. Sarah Kennedy (PI) and Dr. Laura Anthony (Co-I) have co-developed and evaluated transdiagnostic interventions targeting these key risk factors. The goal of the proposed R34 is to integrate and adapt these existing interventions to develop SURE-Kids, the first outpatient treatment specifically for preadolescents with SITBs to address emotion dysregulation and EF within the family context. The aims of this project are to: 1) iteratively develop a transdiagnostic intervention for preadolescent SITBs addressing emotion dysregulation and EF, with guidance from experts and end users to maximize implementation potential; 2) evaluate engagement (primary outcome), feasibility, acceptability, and implementation outcomes, using a pilot randomized controlled trial design with a treatment as usual (TAU) comparison condition; and 3) collect preliminary evidence to explore superiority of SURE-Kids to TAU in reducing SITBs and engaging target mechanisms. Trial participants (N = 52) will be recruited from preadolescents ages 7-12 admitted to the emergency department at a large pediatric hospital in Colorado for SITB-related concerns. Participants will complete assessments at baseline, 6, 12, and 24-weeks post- randomization. Engagement will be measured by evaluating whether SURE-Kids participants attend more sessions than TAU participants. Predetermined benchmarks will be used to evaluate feasibility and acceptability, and implementation outcomes will be evaluated both quantitatively and qualitatively. Based on pilot trial results, adaptations to the intervention will be finalized with guidance from an Adaptation and Implementation Team. The end-product will be an iteratively adapted intervention for preadolescent SITBs and refined study procedures, which will be used in a larger, fully-powered, hybrid type I effectiveness- implementation trial.