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

医疗技术的进步提高了早产儿的存活率 孕周)。然而，有越来越多的证据表明，对神经学的连锁破坏。 VPT出生后的发育。研究结果一致表明，VPT患者的神经发育不典型 在更广泛的VPT人群中有持续性心理健康问题的婴儿。具体地说，非典型白质 VPT婴儿的灰质发育可以预测自我调节的发育缺陷，这与 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 以及将VPT儿童的行为问题外部化。迫切需要创新来治疗神经病和 不断增长的VPT人群中的精神疾病。这项拟议的研究将测试一种有前景的治疗方法。 解决方案。我们之前的工作已经确定父母的反应是一个可修改的心理变量， 通过我们高效的育儿方式改善VPT儿童神经发育结果的潜力 干预。在临床环境中，有两个重大障碍限制了育儿干预措施的实施。第一, 育儿项目通常被认为是不可扩展的，因为最有效的育儿干预是 以家庭为基础，因此实施成本很高。第二，提高响应速度的潜在好处 对VPT儿童大脑发育的照顾尚不清楚，因为这种可能性从未被评估过 通过临床试验，使增加的反应性如何推动儿童结局变得未知。在一个 通过随机对照试验，拟议的研究将通过以下方式克服这些障碍： 1)测试参与可扩展的基于网络的干预以增加响应性育儿是否会导致 出生于VPT的学步儿童大脑发育更规范，自我调节能力更强。 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 是通过父母反应能力的提高来调节的。 为了实现这些目标，VPT儿童(15-28个月)的父母将被随机分配到一个网络- 基于父母教养干预或主动控制条件。在干预期间，将进行一对一指导 通过视频会议提供，以增加家长的响应行为并支持个人反思 关于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 将收集干预前和干预后的评估，以评估：1)父母的反应行为，2)VPT 使用脑电测量神经功能的儿童行为结果和3)VPT儿童神经结果 和核磁共振来测量结构的连通性。这项研究将神经成像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来确定与干预相关的 对大脑成熟和功能的影响。这项研究的发现可能会导致范式的转变，包括 将父母作为孩子发展成功的积极参与者的干预措施。

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.