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

预防依恋不安全感、生理失调和儿童行为问题

基本信息

批准号：
10440666
负责人：
JUDE A CASSIDY
金额：
$ 66.65万
依托单位：
UNIV OF MARYLAND, COLLEGE PARK
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10440666
关键词：
Adaptive Behaviors Address Adverse effects Area Behavioral Berlin Biological Buffers Child Child Behavior Child Development Child Mental Health Child Rearing Childhood Collaborations Communities Development Distress Effectiveness of Interventions Emotional Emotions Empathy Enrollment Environment Evaluation Exposure to Family Fostering Foundations Goals Head Start Program Health Infrastructure Intervention Learning Level of Evidence Light Link Low income Maternal Behavior Mediating Mediation Mental Depression Meta-Analysis National Institute of Child Health and Human Development Neighborhoods Outcome Parent-Child Relations Parents Physiological Prevention Prevention Protocols Problem behavior Protocols documentation Psychopathology Public Health Randomized Controlled Trials Recovery Regulation Research Resources Risk Risk Behaviors Risk Factors Sampling Secure Security Services Source Stress Temperament Testing Trauma Treatment Efficacy Work base caregiving depressive symptoms design early life stress efficacy testing efficacy trial experience follow-up foster child group intervention high risk hypothalamic-pituitary-adrenal axis implementation efforts innovation intervention effect intervention program physical conditioning post intervention prevent psychosocial adjustment resilience response service delivery social stressor theories therapy design violence exposure

项目摘要

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.

越来越多的科学证据表明，安全的依恋和敏感的照顾是对生活在压力大的环境中的儿童的重要弹性来源（例如，格雷厄姆和伊斯特布鲁克， 2000年），促进儿童的身心健康（Shonkoff，2016年）。相反，研究表明这种不安全的依恋是发展两个儿童行为问题的重要风险因素和身体失调（例如，Luijk等，2010；参见Fearon等，2010，以及Groh等，2012 分析结果）。这对于防止不安全依恋的努力对于儿童的健康发展至关重要。尽管采用了一些有前途的方法来防止不安全的依恋，身体失调和出现了儿童行为问题（参见Berlin等，2016），没有一个没有实现宽度执行。迫切需要的是评估全面的理论和基于研究的理论干预方案可以在孩子处于较高风险的家庭中广泛实施发展或维持不安全的附件，身体失调和行为问题。拟议的研究的目的是进行安全圈的RCT - 育儿（COS-P）鉴于EHS儿童和家庭是较早的开始（EHS）计划的干预（EHS）计划以因素为特征（例如，低收入，父母抑郁，暴露于暴力/创伤； 2006a），使他们面临着不安全依恋和行为问题的风险。项目针对NICHD CDBB的优先级，以促进高危儿童的社会心理调整和了解可能发生高危环境的积极成果的贡献者。而且，该项目解决了进步的关键障碍，以减少降低负面结果的风险高危儿童通过测试与家庭合作设计的干预效率的效率从现实世界中实施的工作人员中的工作人员。主要目的是检查是否在常规EHS服务中增加此简短的基于依恋的干预将（1）减少儿童不安全依恋，身体失调和行为问题；（2）促进敏感父母的反应到儿童困扰。其他目的是（3）检查干预效率的潜在主持人和（4）测试父母对儿童痛苦的反应的变化是否是积极变化的机制。我们选择了HS/EHS作为强大的服务交付机制，因为它是广泛可用的资源在许多社区中，具有基础设施和对儿童心理健康的承诺。 HS/EHS 计划在某些领域表现出积极的结果，但证据降低了不安全依恋的风险缺乏（Spieker等，2005）。我们采取的方法值得注意，因为我们认为更广泛的公众可以广泛实施以依恋为导向的预防方案的健康环境。 RCT包括来自宾夕法尼亚州哈里斯堡和宾夕法尼亚州列海谷的249个亲子二元组。