Fostering healthy development among maltreated preschool-aged children

描述（由申请人提供）：虐待儿童对儿童的心理和生理发展具有破坏性，显著增加其一生中出现精神健康障碍的风险。因此，迫切需要转化研究，利用我们对风险和保护因素的知识，在多个层面进行分析，为受虐待儿童提供信息和评估基于证据的干预措施（Cicchetti & Valentino, 2006）。由于儿童虐待是一种致病的关系经历，通常开始于幼儿时期和在亲子关系的背景下，因此有必要采取双重干预措施，解决学龄前受虐待儿童及其父母的发展需要。然而，关于针对受虐待学龄前儿童及其父母的经验支持治疗方法的建立，包括确定有益结果的潜在机制，存在重大差距。因此，本项目的目的是评估(1)回忆与情绪训练（RET），一种针对受虐待学龄前儿童及其母亲的简短的二元干预，在促进受虐待儿童在认知、情感和生理领域的发展以及改善其母亲的养育方式方面的功效；(2)干预效果的具体机制，包括儿童和母亲昼夜皮质醇调节的作用。为了实现这些目标，该项目将招募240名学龄前儿童及其母亲进行随机临床试验。虐待家庭将被随机分为两种情况：RET条件或社区标准条件（CS），后者作为积极控制。此外，将包括一个人口统计学上匹配的非虐待家庭组，以确定RET组中家庭随时间的变化在多大程度上近似于非虐待家庭的功能。RET的关键组成部分包括培训母亲(a)提出开放式问题，(b)使用详细描述并以儿童的反应为基础，(c)在儿童的经历和情绪之间建立因果关系，以及(d)谈论情绪解决方案。家庭将参与基线、8周后、6个月和1年的随访评估，包括访谈、观察和评估孕产妇和儿童的行为和生物功能。RET干预和生理评估程序是基于广泛的新的试点研究。这种多层次、多测量的方法将使研究人员能够全面评估RET干预的效果，以及干预效果的机制。因此，该项目通过评估一项创新性的简短干预措施，解决了与受虐待儿童的心理和生物健康有关的重大社会问题。因此，这项研究有可能显著推进科学知识，并为更有效的临床和政策努力提供信息，这些努力旨在改善受虐待儿童和家庭的福利，包括可能很容易在全国社区传播的项目。

DESCRIPTION (provided by applicant): Child maltreatment is destructive to the psychological and biological development of children, significantly increasing their risk for mental health disorders throughout the lifespan. Thus, translational research which uses our knowledge of risk and protective factors, at multiple levels of analysis, to inform and evaluate evidence-based interventions for young maltreated children is sorely needed (Cicchetti & Valentino, 2006). Because child maltreatment is a pathogenic relational experience, often beginning during early childhood and in the context of the parent-child relationship, dyadic interventions that address the developmental needs of preschool-aged maltreated children and their parents are necessary. There is a significant gap, however, regarding the establishment of empirically supported treatments targeted toward both maltreated preschool- aged children and their parents, including the identification of the mechanisms underlying beneficial outcomes. Accordingly, the aims of this project are to evaluate (1) the efficacy of Reminiscing and Emotion Training (RET), a brief, dyadic intervention for maltreated preschool-aged children and their mothers, in fostering maltreated children's development in cognitive, emotional, and physiological domains and in improving their mothers' parenting; and (2) the specific mechanisms underlying intervention effects, including the role of child and maternal diurnal cortisol regulation. To accomplish these aims, the project will enroll 240 preschool-aged children and their mothers into a randomized clinical trial. Maltreating families will be randomized into one of two conditions: the RET condition, or a Community Standard condition (CS), which serves as an active control. Additionally a demographically matched group of nonmaltreating families will be included to determine the extent to which families in the RET group approximate functioning of nonmaltreated families over time. Key components of the RET include training mothers to (a) ask open-ended questions, (b) use detailed descriptions and build on children's responses, (c) make causal connections between children's experiences and emotions, and (d) talk about emotion resolutions. Families will participate in baseline, 8 week post, 6 month and 1 year follow-up assessments with a repeated measures battery of interviews, observations, and assessments of maternal and child behavioral and biological functioning. The RET intervention and physiological assessment procedures are based on extensive new pilot research. This multi-level, multi-measure approach will enable researchers to fully evaluate the efficacy of the RET intervention, and the mechanisms underlying intervention effects. Consequently, this project addresses significant societal concerns relevant to the psychological and biological health of maltreated children through the evaluation of an innovative brief intervention. As such, the study has potential to significantly advance scientific knowledge and to inform more effective clinical and policy efforts designed to improve the welfare of maltreated children and families, including programs that may be readily disseminated to communities nationally.