Targeting neurobiological & behavioral mechanisms of self-regulation in high-risk families

描述（由申请人提供）：儿童虐待（CM）在美国构成了一个严重的公共卫生问题1，并且已知会损害儿童正在发展的自我调节技能，并放大物质使用和其他调节障碍的风险。80%以上涉及身体虐待和忽视的CM案件涉及父母，因此是干预的关键目标。对CM父母在养育过程中的生理反应的研究表明，养育干预对这一人群可能不太有效2，因为它们无法影响导致严厉，厌恶养育的神经行为失调标志物。亲子互动疗法（PCIT），一个密集的，20届家长干预，已被证明可以提高CM养育的质量，改善积极的养育和儿童行为，并产生CM累犯率下降，3，4虽然其影响的机制知之甚少。根据其现场指导，积极育儿的时刻脚手架，我们的理论，PCIT建立在父母的监管力量，然后支持持久的行为改变。使用耳内窃听器技术（PCIT独有的技术）为父母提供了立即获得治疗师强化的积极育儿方法，以对抗父母的高度生理唤醒，抑制（优势）厌恶反应，并支持更多地使用（非显性）积极育儿行为。这项研究旨在扩大我们调查小组的集体工作。它使用实验干预设计作为一种工具，用于测试自我调节的神经行为指数变化的因果模型。具体来说，我们建议进行一项随机对照试验的PCIT CM和测试的影响PCIT的自我调节和行为的CM父母和他们的小学生。将从儿童保护服务中心抽取二百五十（250）名虐待母亲及其子女（5-8岁），并随机分配至PCIT干预组或对照组（服务照常）。将评估关键的背景风险因素，包括累积风险、父母心理健康和父母物质使用。一个多评估者，多方法的评估方法将包括神经（EEG/ERP），生理（ECG），行为和自我报告的CM母亲和他们的孩子的自我调节措施，以及标准的育儿技巧和儿童的行为结果的措施。家庭将在6个月后进行自我调节，养育子女和儿童行为结果，并在1年后进行CM累犯。这项拟议的研究结果预计将有显着的影响，优化CM父母的干预措施，（a）确定CM父母和儿童的神经行为自我调节系统的干预的敏感性，（B）确定个体差异的自我调节，调解和适度的干预和长期维护的收益。

DESCRIPTION (provided by applicant): Child maltreatment (CM) constitutes a serious public health problem in the United States1 and is known to compromise children's developing self-regulation skills and amplify risk for substance use and other regulatory disorders. Parents are implicated in more than 80% of CM cases involving physical abuse and neglect and thus represent critical targets of intervention. Research on the physiological response of CM parents during parenting suggests that parenting interventions may be less effective with this population2 because they fail to affect the neurobehavioral markers of dysregulation that drive harsh, aversive parenting. Parent-Child Interaction Therapy (PCIT), an intensive, 20-session parenting intervention, has been shown to improve the quality of CM parenting, improve positive parenting and child behavior, and produce declines in CM recidivism,3,4 though the mechanisms underlying its effects are little understood. On the basis of its live- coached, moment-by-moment scaffolding of positive parenting, we theorize that PCIT builds regulatory strength in parents, which then supports lasting behavior change. Use of bug-in-the-ear technology-unique to PCIT-provides parents with immediate access to therapist reinforcements for positive parenting that work to counter parents' heightened physiological arousal, inhibit (prepotent) aversive responding, and support greater use of (nondominant) positive parenting behavior. This study is designed to extend the collective work of our investigative team. It uses an experimental intervention design as a vehicle for testing a causal model of change in neurobehavioral indices of self-regulation. Specifically, we propose to conduct a randomized, controlled trial of PCIT for CM and test the effects of PCIT on self-regulation and behavior in CM parents and their elementary-school children. Two hundred-fifty (250) maltreating mothers and their children (age 5-8 years) will be drawn from Child Protective Services and randomized to the PCIT intervention or a control condition (services as usual). Key contextual risk factors will be assessed, including cumulative risk, parent mental health, and parent substance use. A multirater, multimethod approach to assessment will include neural (EEG/ERP), physiological (ECG), behavioral, and self-report measures of self-regulation in CM mothers and their children, as well as standard measures of parenting skills and children's behavior outcomes. Families will be followed at 6 months for self-regulation, parenting, and child behavioral outcomes, and to 1 year for CM recidivism. Findings from this proposed study are expected to have significant implications for optimizing CM parenting interventions by (a) determining the sensitivity of CM parent and child neurobehavioral self-regulation systems to intervention, and (b) identifying individual differences in self-regulation that mediate and moderate response to intervention and long-term maintenance of gains.