Prevention of Attachment Insecurity, Physiological Dysregulation, and Child Behavior Problems

越来越多的科学证据表明，安全的依恋和敏感的照顾是 对于生活在压力环境中的儿童来说，重要的复原力来源(例如，Graham&Easterbrooks， 2000)，有助于儿童的身心健康(Shonkoff，2016)。相反，研究表明 这种不安全的依恋是儿童行为问题发展的一个重要风险因素 和生理失调(例如，Luijk等人，2010；见Fearon等人，2010，和Groh等人，2012，元- 分析结果)。因此，努力防止不安全的依恋对儿童的健康发展至关重要。 尽管有一些有希望的方法来防止不安全的依恋、生理失调和 儿童行为问题已经出现(见柏林等人，2016)，没有一个取得广泛的进展 实施。当务之急是对一个以理论和研究为基础的全面评估 干预方案，可在儿童患高血压风险较高的家庭中广泛实施 发展或维持不安全的依恋、生理失调和行为问题。 这项拟议研究的目标是进行安全圈-育儿圈(COS-P)的RCT 早期学前教育(EHS)计划内的干预，鉴于有证据表明EHS儿童和家庭 以各种因素为特征(例如，低收入、父母抑郁、遭受暴力/创伤；USDHHS、 2006a)，这使他们面临更大的不安全依恋和行为问题的风险。该项目 处理NICHD CDBB的优先事项，促进高危儿童的心理社会适应 了解在高风险环境下仍能取得积极成果的因素。此外， 该项目解决了在以下方面努力降低负面结果风险方面取得进展的一个关键障碍 通过与家庭和家庭合作设计的干预措施的有效性来测试高危儿童 工作人员从将实施它的现实世界背景中脱颖而出。主要目标是检查是否 在常规的EHS服务中增加这种基于依恋的短暂干预将(1)减少儿童的不安全感 依恋、生理失调和行为问题；以及(2)促进父母敏感的反应 孩子们的痛苦。其他目标是(3)检查干预有效性的潜在主持人和(4) 测试父母对儿童痛苦反应的变化是否起到积极变化的作用。 我们选择HS/EHS作为强大的服务提供机制，因为它是一种广泛可用的资源 在许多社区，有基础设施，并致力于儿童的心理健康。HS/EHS 该计划在某些领域显示了积极的结果，但有证据表明，降低了不安全依恋的风险 是缺乏的(Spieker等人，2005年)。我们采取的方法值得注意，因为我们考虑到更广泛的公众 我们面向依恋的预防协议可以在其中广泛实施的健康环境。 RCT包括来自宾夕法尼亚州哈里斯堡和宾夕法尼亚州利哈伊谷EHS计划的249名亲子二人组。

A growing body of scientific evidence demonstrates that secure attachment and sensitive caregiving are important sources of resilience for children living in stressful environments (e.g., Graham & Easterbrooks, 2000), contributing to children’s mental and physical health (Shonkoff, 2016). Conversely, research indicates that insecure attachment is an important risk factor for the development of both childhood behavior problems and physiological dysregulation (e.g., Luijk et al., 2010; see Fearon et al., 2010, and Groh et al., 2012, for meta- analytic findings). Thus, efforts to prevent insecure attachment are crucial for children’s healthy development. Although a few promising approaches to preventing insecure attachment, physiological dysregulation, and childhood behavior problems have emerged (see Berlin et al., 2016), none has achieved widespread implementation. What is urgently needed is evaluation of a comprehensive theory- and research-based intervention protocol that can be widely implemented among families whose children are at elevated risk for developing or maintaining insecure attachments, physiological dysregulation, and behavior problems. The goal of the proposed study is to conduct an RCT of the Circle of Security – Parenting (COS-P) intervention within Early Head Start (EHS) programs, in light of evidence that EHS children and families are characterized by factors (e.g., low income, parental depression, exposure to violence/trauma; USDHHS, 2006a) that leave them at increased risk for insecure attachment and behavior problems. The project addresses the NICHD CDBB priority of promoting psychosocial adjustment for at-risk children and of understanding contributors to positive outcomes that can occur despite high-risk environments. Moreover, the project addresses a critical barrier to progress in the attempt to reduce the risk of negative outcomes among at-risk children by testing the efficacy of an intervention that was designed in collaboration with families and staff from the real-world contexts in which it will be implemented. Principal aims are to examine whether the addition of this brief attachment-based intervention to regular EHS services will (1) reduce child insecure attachment, physiological dysregulation, and behavior problems; and (2) promote sensitive parental responses to child distress. Additional aims are (3) to examine potential moderators of intervention effectiveness and (4) to test whether changes in parental response to child distress act as a mechanism of positive change. We have chosen HS/EHS as a strong service delivery mechanism because it is a widely available resource in many communities, with an infrastructure and a commitment to the mental health of children. The HS/EHS program has shown positive outcomes in some areas, yet evidence of reducing the risk of insecure attachment is lacking (Spieker et al., 2005). The approach we take is noteworthy in that we consider the broader public health context in which our attachment-oriented prevention protocol can be widely implemented. The RCT includes 249 parent-child dyads from the Harrisburg, PA and Lehigh Valley, PA EHS programs.