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

• 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
• 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

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 生活在压力环境中的儿童恢复能力的重要来源（例如，Graham & Easterbrooks， 2000），有助于儿童的身心健康（Shonkoff，2016）。相反，研究表明 不安全的依恋是导致儿童行为问题的一个重要危险因素 和生理失调（例如，Luijk et al., 2010；参见 Fearon et al., 2010 和 Groh et al., 2012，了解元- 分析结果）。因此，努力防止不安全依恋对于儿童的健康发展至关重要。 尽管有一些有希望的方法可以防止不安全依恋、生理失调和 儿童行为问题已经出现（见 Berlin et al., 2016），但没有一个问题得到广泛普及 执行。迫切需要的是基于理论和研究的综合评价 干预方案可在儿童患病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。 拟议研究的目标是进行安全圈 - 养育（COS-P）的随机对照试验 有证据表明早期启蒙 (EHS) 儿童和家庭正在接受早期启蒙 (EHS) 计划的干预 以因素为特征（例如，低收入、父母抑郁、遭受暴力/创伤；USDHHS、 2006a）这使他们面临不安全依恋和行为问题的风险增加。项目 解决了 NICHD CDBB 的优先事项，即促进高危儿童的心理社会调整和 了解在高风险环境下仍可能发生的积极成果的贡献者。而且， 该项目解决了在努力降低负面结果风险方面取得进展的一个关键障碍 通过测试与家庭和儿童合作设计的干预措施的有效性，对高危儿童进行评估 来自将要实施该计划的现实世界环境的工作人员。主要目的是检查是否 在常规 EHS 服务中添加这种基于依恋的简短干预措施将 (1) 减少儿童的不安全感 依恋、生理失调和行为问题； (2) 促进父母敏感的反应 给孩子带来困扰。其他目标是 (3) 检查干预效果的潜在调节因素以及 (4) 测试父母对儿童痛苦反应的变化是否是一种积极改变的机制。 我们选择 HS/EHS 作为强大的服务交付机制，因为它是一种广泛可用的资源 在许多社区，拥有基础设施并致力于儿童的心理健康。 HS/EHS 该计划在某些领域取得了积极成果，但有证据表明，不安全依恋的风险降低了 缺乏（Spieker et al., 2005）。我们采取的方法值得注意，因为我们考虑了更广泛的公众 我们的以依恋为导向的预防方案可以在健康环境中得到广泛实施。 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 项目的 249 名亲子二人组。