The Coping with Unusual Experiences for Children Study (CUES): A pilot randomized controlled evaluation of the acceptability and potential clinical utility of a cognitive behavioural intervention package for young people aged 8-14 years with unusual experiences and emotional symptoms.

OBJECTIVES: Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child-specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT-UED). DESIGN: Pilot randomized controlled trial. METHODS: Participants aged 8-14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self-reported UEDs. RESULTS: Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty-nine (96%) consented to randomization to either CBT-UED (9-12 weekly sessions of 40-50 min, adjunctive to usual care, n = 24) or treatment-as-usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling 'nervous'/'scared'/'tearful'/'worried'/'sick'; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (<12 sessions) at 12 weeks, at end-of-treatment (EOT). Twenty-two CBT-UED participants (92%) attended ≥5 sessions. Forty-four participants (90%) completed 12-week assessments (CBT-UED, n = 21/24, 88%; TAU/WL, n = 23/25, 92%). Preliminary findings were encouraging for emotional symptoms and UEDs, but otherwise mixed. CONCLUSIONS: Retention, screening, and consent rates were as anticipated; recruitment took longer than planned. Trial procedures were acceptable to young people, their families, and clinicians. Therapy exceeded 12 weeks, but was well-received, with no serious adverse events attributed to participation. Further evaluation is needed. PRACTITIONER POINTS: Around half of 8- to 14-year-olds in Child and Adolescent Mental Health Services reported distressing unusual experiences. An age-adapted cognitive behavioural intervention appears feasible, and safe to deliver, with the potential to augment standard care. This is a pilot study, and further evaluation is needed. Longer term outcomes should be a focus of future evaluation.

The different faces of one's self: an fMRI study into the recognition of current and past self-facial appearances.

Mirror self-recognition is often considered as an index of self-awareness. Neuroimaging studies have identified a neural circuit specialised for the recognition of one's own current facial appearance. However, faces change considerably over a lifespan, highlighting the necessity for representations of one's face to continually be updated. We used fMRI to investigate the different neural circuits involved in the recognition of the childhood and current, adult, faces of one's self. Participants viewed images of either their own face as it currently looks morphed with the face of a familiar other or their childhood face morphed with the childhood face of the familiar other. Activity in areas which have a generalised selectivity for faces, including the inferior occipital gyrus, the superior parietal lobule and the inferior temporal gyrus, varied with the amount of current self in an image. Activity in areas involved in memory encoding and retrieval, including the hippocampus and the posterior cingulate gyrus, and areas involved in creating a sense of body ownership, including the temporo-parietal junction and the inferior parietal lobule, varied with the amount of childhood self in an image. We suggest that the recognition of one's own past or present face is underpinned by different cognitive processes in distinct neural circuits. Current self-recognition engages areas involved in perceptual face processing, whereas childhood self-recognition recruits networks involved in body ownership and memory processing.