A Randomized Control Trial of a Responsive Parenting Intervention to Support Healthy Brain Development and Self-regulation in Toddlers Born Preterm

医疗保健的技术进步提高了极早产儿（VPT; <32 孕周）。然而，有证据表明， 从VPT诞生开始。研究结果一致地将VPT的非典型神经发育联系起来 在更广泛的VPT人群中，有持续心理健康问题的婴儿。特别是非典型的白色物质 VPT婴儿的灰质发育预测了与自我调节相关的发育缺陷 后来出现的注意缺陷/多动障碍的精神病理学和临床内化率 和外化的行为问题。迫切需要创新来治疗神经和 精神疾病在不断增长的VPT人群中。这项拟议中的研究将测试一种有希望的治疗方法 溶液我们先前的工作已经确定父母的反应是一个可修改的心理变量， 通过我们高效的养育方式，有可能改善VPT儿童的神经发育结果 干预两个重大障碍限制了在临床环境中实施育儿干预措施。第一、 育儿计划通常被认为是不可扩展的，因为最有效的育儿干预措施是 因此实施起来昂贵。第二，提高反应速度的潜在好处 儿童期接受VPT的大脑发育尚不清楚，因为这种可能性从未被评估过。 通过临床试验，使其不知道如何增加反应性驱动儿童的结果。的上下文中 随机对照试验，拟议的研究将通过以下方式克服这些障碍： 1)测试是否参与可扩展的基于网络的干预，以增加响应式育儿的结果， 更规范的大脑发育和改善的自我调节出生VPT的幼儿。 2)测试干预是否导致任何行为和神经解剖学改变的作用机制 是通过父母反应的改善来介导的。 为了实现这些目标，VPT儿童（年龄15-28个月）的父母将被随机分配到一个网络， 基于养育干预或主动控制条件。在干预期间，一对一的指导将是 通过视频会议提供，以提高父母的响应行为，并支持个人反思 如何使新获得的反应行为适应孩子不断变化的发展水平。我们 将收集干预前后的评估，以评估：1）父母的反应行为，2）VPT 儿童行为结果和3）VPT儿童神经学结果，利用EEG测量神经功能 和核磁共振成像来测量结构连接性这项研究将神经影像学方法应用于一种新的 方法：通过利用儿童早期大脑固有的神经可塑性， 对大脑成熟和功能的影响。这项研究的结果可能会导致范式转变，包括 干预措施侧重于父母作为孩子发展成功的积极参与者。

Technological advances in medical care have increased the survival of very preterm infants (VPT; <32 gestational weeks). However, there is converging evidence of cascading disruption to neurological development resulting from VPT birth. Findings consistently link atypical neurological development in VPT infants with lasting mental health problems in the broader VPT population. Specifically, atypical white matter and grey matter development in VPT infants predict developmental deficit in self-regulation that are linked to later to emerge psychopathology of Attention-Deficit/Hyperactivity Disorder and clinical rates of internalizing and externalizing behavioral problems in VPT children. Innovation is urgently needed to treat neurological and psychiatric diseases in the growing VPT population. The proposed research will test a promising treatment solution. Our prior work has identified parental responsiveness as a modifiable psychological variable with the potential to improve VPT child neurodevelopmental outcomes through our highly effective parenting intervention. Two significant barriers limit implementation of parenting interventions in the clinical setting. First, parenting programs are often considered un-scalable because the most effective parenting interventions are home-based and thus expensive to implement. Second, the potential benefit of increased responsive caregiving to VPT childhood brain development is unclear because this possibility has never been evaluated via clinical trial, making it unknown how increasing responsiveness drives child outcome. In the context of a randomized controlled trial, the proposed study will overcome these barriers by: 1) Testing if participation in a scalable web-based intervention to increase responsive parenting results in more normative brain development and improved self-regulation in toddlers born VPT. 2) Testing if the acting mechanism of any behavioral and neuroanatomic alteration resulting from intervention is mediated by improvements in parent responsiveness. To accomplish these objectives, parents of VPT children (age 15-28-months) will be randomized to a web- based parenting intervention or an active control condition. During intervention one-on-one instruction will be provided via videoconferencing to increase parent responsiveness behaviors and support personal reflection on how to adapt newly acquired responsiveness behaviors to their child’s changing developmental level. We will collect pre- and post-intervention assessments to evaluate: 1) parental responsiveness behaviors, 2) VPT child behavioral outcomes and 3) VPT child neurological outcomes utilizing EEG to measure neural functioning and MRI to measure structural connectivity. This research applies neuroimaging methodologies in a novel way: by leveraging the inherent neuroplasticity of the brain in early childhood to identify intervention related effects on brain maturation and function. Findings from this study could result in a paradigm shift that includes interventions focusing on the parent as an active participant in their child’s developmental success.