Prenatal and infancy origins of biological and social-cognitive processes in disruptive behaviour problems in children aged 7 - 9 years.

经常打人、不遵守规则和在社会和学校环境中捣乱的幼儿，比其他儿童更有可能在成年后继续表现出行为问题，包括犯罪、关系不稳定、工作记录差、抑郁、酗酒和吸毒问题。他们更有可能使自己的孩子遭受虐待。这些问题产生于遗传和环境影响的复杂组合，其中关键因素可能包括产前压力，早期婴儿情绪化，以及作为风险的严厉或虐待性父母，以及作为保护因素的温暖父母。预防需要从怀孕和婴儿期开始，治疗需要从幼儿期开始，有明显的迹象表明，有攻击性和破坏性行为问题的儿童之间存在着重要的差异。有些人的行为主要是由愤怒、冲动、对他人行为的反应驱动的，有些人缺乏情绪反应和对他人感受的移情反应是关键。我们预测，那些情绪化的婴儿，特别是那些对挫折反应强烈的婴儿，以及那些对压力表现出更高的荷尔蒙和神经系统反应的婴儿，以及那些暴露在家庭逆境中的婴儿，更有可能在以后将他人的行为视为威胁，并做出愤怒和攻击性的反应。相比之下，我们认为没有同理心的孩子在婴儿时期与他人接触较少，对普通的压力源缺乏恐惧，这将导致他们对他人缺乏情感反应，因此对他人的痛苦漠不关心。我们认为，在早期环境中持续的威胁水平将有助于第三种途径的攻击性和破坏性行为，在这种情况下，幼儿最初表现出高反应性，但随后通过发展低反应性来适应，从而导致对他人的痛苦缺乏反应。必须确定这些差异，以此为基础制定针对妊娠期和婴儿期的具体干预措施，以及针对幼儿期的治疗措施。 这将是第一项跟踪从怀孕到9岁的儿童的研究，将测试三种拟议的途径。在前两次MRC赠款的资助下，我们从怀孕开始，第一次母亲及其子女在怀孕的两个时间点以及出生后5周和9周进行评估，然后是7个月，14个月，2.5年，3.5年和4.5年，现在计划在7年和9年进行评估。我们最初招募了1286名首次怀孕的妇女，她们代表了一般人群。其中，1 233名母亲可与婴儿一起接受产后随访。我们使用问卷调查，健康访问报告和家庭评估对他们从出生到4.5岁进行了研究。在怀孕期间，我们邀请了少数女性（316名），其中许多人报告了高关系压力，组成一个高风险群体，随着时间的推移进行更深入的评估。我们定期采访母亲，了解她们自己的心理健康和社会支持，并评估她们的孩子与母亲的互动，以及作为个人，直到4.5岁。在7岁时，我们将对大约300名儿童及其父母进行全面的评估，其中许多措施，如计划和抑制不当反应，我们以前使用过。特别令人感兴趣的措施将是儿童对社会排斥游戏的行为和生理反应，情绪激动的图片，以及描绘儿童在大多数人认为可怕的情况下的场景，或可能导致悲伤或愤怒。我们将评估更广泛的约540名儿童与简短，但相关的措施。在7岁和9岁时，我们将从父母、教师和儿童自己那里获得有关儿童行为和情绪的标准化信息。

Young children who frequently hit other people, who disobey rules and are disruptive in social and school settings, are much more likely than other children to show continued behaviour problems into adult life, including criminality, unstable relationships, poor work record, depression, alcohol and drug problems. They are more likely to expose their own children to maltreatment. The problems arise from a complicated mix of genetic and environmental influences, in which key factors probably include, prenatal stress, early infant emotionality, and harsh or abusive parenting as risk, and warm parenting as protective factors. Prevention needs to start in pregnancy and infancy, and treatment in early childhood.There are strong indications that there are important differences among children with aggressive and disruptive behaviour problems. There are some whose behaviours are driven mainly by angry, impulsive, reactions to the behaviours of other people, and some where lack of emotional reactivity and of empathic responses to others' feelings are the key. We predict that infants who are highly emotional, especially those who react strongly to frustration, and also those who show higher hormonal and nervous system reactions to stress, and who are exposed to family adversity, are more likely later to see others' behaviours as threatening and to react angrily and aggressively. By contrast we expect the unempathic children, as infants to have engaged less with other people, and to have shown lack of fear to ordinary stressors, and that this will have contributed to a lack of emotional responsiveness to others, and hence indifference to their distress. We propose that persistent levels of threat in the early environment will contribute to a third route to aggressive and disruptive behaviours, in which the young child initially shows high reactivity, but then adapts by developing low reactivity leading to a lack of responsiveness to others' distress. It is essential to identify these differences as a basis for developing specific interventions in pregnancy and infancy, and treatments in early childhood. This will be the first study following children from pregnancy to age 9 years that will test for the three proposed pathways. Funded by two previous MRC grants we have followed, from pregnancy, first time mothers and their children with assessments at two time points in pregnancy and at 5 and 9 weeks after birth, then 7 months, 14 months, 2.5 years, 3.5 years, and 4.5 years, and now plan to assess at 7 and 9 years. We initially recruited 1286 first time pregnant women who were representative of the general population. Of these 1233 mothers were available for postnatal follow-up together with their infant. We have studies them from birth to age 4.5 years using questionnaires, health visitor reports, and home assessments. During pregnancy we invited a smaller number of women (316), of whom many reported high relationship stress, to form a higher risk group for more intensive assessments over time. We have interviewed the mothers regularly about their own mental health and social support, and assessed their children in interaction with their mothers, and as individuals, up to the age of 4.5 years. At age 7 years we will assess around 300 children and their parents with a comprehensive battery of measures, many of which, such as of planning and inhibiting inappropriate responses, we have used before. Measures of particular interest will be of children's behavioural and physiological reactions to a social exclusion game, to emotionally arousing pictures, and to scenes depicting children in situations that most people see as frightening, or likely to lead to sadness or anger. We will assess the wider group of around 540 children with briefer, but related measures. At ages 7 and 9 years we will obtain standardized information about the children's behaviours and emotions from parents, teachers, and the children themselves.