Fostering Self-Regulation in Infants and Toddlers with FASDs

描述（由申请人提供）：研究人员已经证明，在人类婴儿中，产前酒精暴露（PAE）与状态和自主调节问题、应激后皮质醇水平升高、易怒水平升高、负面影响增加和活动水平增加有关。这些发现表明，PAE可以深刻地损害婴儿的自我调节能力，这反过来可能会使他们走上消极的发展轨道。自我调节的缺陷会损害早期亲子关系，损害儿童管理压力情况的能力，干扰学习和掌握发育适当的任务，并可能影响早期大脑发育，从而使酒精暴露的婴儿更加脆弱。引人注目的是，目前还没有针对患有PAE或被诊断患有胎儿酒精谱系障碍（FASD）的婴幼儿的循证干预措施。鉴于许多酒精诱导的缺陷的持续性和严重性，以及受PAE影响的个体的极差的长期结果，特别是对于那些没有获得益处或早期干预或稳定的养育环境的人，迫切需要为这一高危人群中的婴幼儿开发有效的治疗方法。旨在提高这些儿童调节情绪和行为的能力的早期干预可能是减少这些儿童长期不良后果的努力的一个重大进展。此外，由于产前酒精暴露的后果可能会远远超出酒精暴露个人直接经历的影响，在家庭系统的多个层面上运作的干预措施可能是最有效的。因此，拟议的研究需要一种创新的多组分干预，以促进有PAE病史或诊断为FASD的寄养或收养护理中的婴儿和幼儿的自我调节。该方案有两个组成部分，即家长教育和宣传单元和以依恋为基础的家长小组，将侧重于提高家长的知识和技能，以加强他们以支持自我调节发展的方式对子女作出反应的能力。第三个组成部分是一个以音乐为基础的亲子游戏小组，将有助于促进积极的亲子互动，其依据是研究结果表明，接触唱歌和音乐可以提高幼儿的自我调节能力。提高父母的敏感性，增加父母的承诺，减少父母的压力，提高亲子关系的质量，并最终培养孩子的自我调节能力，都可以在规避与PAE相关的一系列负面发展结果中发挥关键作用。此外，这种多组分的目的是解决自我调节的核心缺陷-损害-可能对其他患有其他神经发育障碍的高危婴儿和幼儿有相关的应用。 公共卫生相关性：产前酒精暴露的儿童一生中经常会出现情绪和行为问题。这项研究的目的是测试一种干预措施，旨在帮助婴幼儿学习技能，帮助他们管理自己的情绪和行为，并教父母如何支持孩子发展这些技能。教导产前酒精暴露的儿童这些技能可能有助于降低他们长期不良后果的风险，如犯罪，学业失败和心理健康问题。

DESCRIPTION (provided by applicant): Researchers have demonstrated that in human infants, prenatal alcohol exposure (PAE) is associated with problems with state and autonomic regulation, increased post-stress cortisol levels, higher levels of irritability, increased negative affect, and increased level of activity. These findings suggest that PAE can profoundly compromise an infant's capacity for self-regulation, which in turn may place them well on course for a negative developmental trajectory. Deficits in self-regulation can confer further vulnerability on the alcohol- exposed infant by compromising early parent-child relationships, impairing a child's ability to manage stressful situations, interfering with learning and mastery of developmentally appropriate tasks, and potentially impacting early brain development. Strikingly, there are currently no evidence-based interventions designed for infants and toddlers with PAE or who have been diagnosed with a Fetal Alcohol Spectrum Disorder (FASD). Given the persistence and severity of many alcohol-induced deficits, and the extremely poor long-term outcomes of individuals affected by PAE, especially for those whom do not receive the benefit or early intervention or a stable, nurturing caregiving environment, the need to develop effective treatments for infants and toddlers in this high-risk population is urgent. Early intervention aimed at enhancing these children's capacity to regulate their emotions and behavior would potentially represent a major advance in efforts to reduce the long-term adverse outcomes for these children. Moreover, as the consequences of prenatal alcohol exposure are likely to reverberate well beyond those experienced directly by the alcohol-exposed individual, interventions that operate at multiple levels of the family system are likely to be the most effective. Thus the proposed study entails an innovative multi-component intervention to foster self-regulation in infants and toddlers in foster or adoptive care with a history of PAE or a diagnosis of an FASD. Two components, a parent education and advocacy module and an attachment-based parent group, will focus on improving parents' knowledge and skills that will enhance their ability to respond to their children in ways that support the development of self- regulation. A third component, a music-based parent-child play group, will serve to promote positive parent- child interactions and is based on findings that exposure to singing and music can enhance self-regulation in young children. Improving parental sensitivity, increasing parental commitment, decreasing parental stress, enhancing the quality of the parent-child relationship, and ultimately, fostering the child's capacity for self- regulation may all play a critical role in circumventing a cascade of negative developmental outcomes associated with PAE. Furthermore, the aim of this multi-component to address a core deficit-impairment in self-regulation--would likely have relevant applications for other high-risk infants and toddlers presenting with other neurodevelopmental disorders. PUBLIC HEALTH RELEVANCE: Children with prenatal alcohol exposure often experience emotional and behavioral problems throughout life. The goal of this study is to test an intervention designed to help infants and toddlers learn skills that will help them manage their emotions and behaviors and teach parents how to support their children's development of those skills. Teaching children with prenatal alcohol exposure these skills may help reduce their risk for negative long-term outcomes, such as delinquency, school failure, and mental health problems.