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

越来越多的科学证据表明，安全型依恋和敏感型依恋 生活在压力环境中的儿童的复原力的重要来源（例如，格雷厄姆和伊斯特布鲁克， 2000），有助于儿童的心理和身体健康（Shonkoff，2016）。相反，研究表明， 不安全的依恋是儿童行为问题发展的一个重要危险因素， 和生理失调（例如，Luijk等人，2010;参见Fearon等人，2010年，和Groh等人，2012年，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。 虽然有一些有希望的方法来防止不安全的依恋，生理失调， 已经出现了儿童行为问题（参见柏林等人，2016年，没有一个人获得广泛的 实施.目前迫切需要的是一个全面的理论和研究为基础的评价 干预协议，可以广泛实施的家庭，其子女在高风险的， 发展或维持不安全的依恋、生理失调和行为问题。 这项研究的目的是进行一项关于安全圈-养育（COS-P）的RCT。 早期开端（EHS）计划中的干预，鉴于有证据表明EHS儿童和家庭 其特征在于因素（例如，低收入，父母抑郁，暴露于暴力/创伤; USDHHS， 2006年a），使他们在不安全的依恋和行为问题的风险增加。项目 解决NICHD CDBB促进高危儿童心理社会调整和 了解在高风险环境下可能产生的积极成果的贡献者。此外，委员会认为， 该项目解决了进展的一个关键障碍，试图减少在以下方面产生负面结果的风险： 通过测试与家庭合作设计的干预措施的有效性， 工作人员从现实世界的背景下，它将被实施。主要目的是研究 在常规的EHS服务中增加这种基于依恋的简短干预将（1）减少儿童的不安全感 依恋、生理失调和行为问题;（2）促进敏感的父母反应 孩子的苦恼。其他目的是（3）检查干预有效性的潜在调节因素和（4） 测试父母对儿童痛苦反应的变化是否是积极变化的机制。 我们选择HS/EHS作为强大的服务交付机制，因为它是一个广泛可用的资源 在许多社区，有基础设施和对儿童心理健康的承诺。HS/EHS 该计划在某些领域取得了积极成果，但有证据表明， 缺乏（斯皮克尔等人，2005年）的报告。我们采取的方法值得注意，因为我们认为更广泛的公众 我们以依恋为导向的预防方案可以广泛实施的健康背景。 随机对照试验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项目的249对亲子配对。

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.