Reducing Maternal Delay Discounting as a Target Mechanism to Decrease Harsh Parenting and Improve Child Mental Health Outcomes in a Traditionally Underserved Community

摘要 严厉的育儿方式与青少年中严重且代价高昂的心理健康问题有关，包括 药物使用、情绪障碍、自杀念头和行为。值得关注的是，这些育儿做法 最常见的是来自贫困社区的家庭；然而，许多基于行为的育儿方式 干预措施没有考虑到将环境劣势与育儿联系起来的独特机制 接近了。虽然严厉养育子女的原因复杂多样，但其中一种机制可能是 父母倾向于优先考虑立即的奖励(例如通过身体上的行为来阻止孩子的不当行为 惩罚)相对于较大但延迟的奖励(包括改善亲子关系 关系质量)。这种行为倾向被称为延迟折扣和最近的研究结果 研究小组表示，延迟打折的比率预示着父母会使用严厉的身体管教。现有 研究还表明，暴露在不利环境和发展之间有很强的联系 延迟打折。具体地说，不稳定和低资源的社区可能会加强机会主义选择 行为，如暴露在这些环境中的个人表现出夸张的倾向 降低延迟收到的奖励的价值。因此，延迟折扣可能是一个重要的联系途径 恶劣的环境和严苛的育儿方式。利用实验性治疗学框架，当前 该项目旨在采用间歇性的未来思维(EFT)干预措施，以减少与育儿相关的 延迟折扣。本申请拟对初步实施情况和效果进行评估 使用混合型I型研究设计的结果。遵循以部署为重点的模式，我们将进行 反复进行小病例系列试验，并从社区合作伙伴那里收集有关必要干预的数据 剂量和关键实施结果(包括可接受性、耐受性和安全性)。由此产生的结果 AIM将通知手动适应。然后，我们将招募72名5岁至10岁儿童的母亲 来自密歇根州弗林特市资源匮乏、少数族裔占多数的社区服务组织。 参与者将被随机接受EFT或以记忆为重点的比较干预。结果将会 评估EFT在减少母亲延迟折扣和严厉养育以及改善儿童方面的效果 临床结果。探索性分析还将考虑适应性干预的效用，以改善 对父母行为训练技巧的参与和理解。这项研究的结果将被用于计划 一项大规模(R01)的混合型II型干预试验，并将为改善公共卫生方法提供信息 弱势社区的青少年心理健康。

Abstract Harsh parenting is associated with serious and costly mental health problems among youth, including substance use, mood disorders, and suicidal ideation and behaviors. Of concern, these parenting practices are most common among families from impoverished communities; however, many behaviorally-based parenting interventions do not take into account the unique mechanisms linking environmental disadvantage to parenting approaches. While the causes of harsh parenting are complex and varied, one such mechanism may be parents' tendencies to prioritize immediate rewards (such as stopping a child's misbehavior via physical punishment like spanking and hitting) relative to larger, but delayed rewards (including improved parent-child relationship quality). This behavioral tendency is known as delay discounting and recent findings from this study team suggest that rates of delay discounting predict parents' use of harsh physical discipline. Existing research also indicates a strong link between exposure to disadvantaged environments and the development of delay discounting. Specifically, unstable and low-resource communities may reinforce opportunistic choice behaviors, such that individuals exposed to these environments demonstrate an exaggerated tendency to devalue rewards that are delayed in their receipt. Thus, delay discounting may be an important pathway linking impoverished environments and harsh parenting. Utilizing an experimental therapeutics framework, the current project aims to adapt an episodic future thinking (EFT) intervention to target the reduction of parenting-related delay discounting. This application proposes to evaluate preliminary implementation and effectiveness outcomes using a Hybrid Type I research design. Following a deployment-focused model, we will conduct iterative small case-series trials and collect data from community-partners regarding necessary intervention dosage and critical implementation outcomes (including acceptability, tolerability, and safety). Results from this aim will inform manual adaptation. We will then recruit 72 mothers of children between the ages of 5 and 10 from community-serving organizations in the low resource, majority-minority, city of Flint, Michigan. Participants will be randomized to receive EFT or a memory-focused comparison intervention. Outcomes will evaluate the effect of EFT on reducing maternal delay discounting and harsh parenting, and improving child clinical outcomes. Exploratory analyses will also consider the utility of the adapted intervention for improving engagement and uptake of behavioral parent training techniques. Findings from this study will be used to plan a large-scale (R01), Hybrid Type II intervention trial and will inform public health approaches for improving youth mental health in vulnerable communities.