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，并增加物质使用和其他调节障碍的风险。超过80%的CM病例涉及身体虐待和忽视，因此父母是干预的关键目标。对CM父母在育儿过程中的生理反应的研究表明，育儿干预对这一人群可能效果较差，因为它们无法影响导致严厉、厌恶的育儿方式的神经行为失调标志。亲子互动疗法（PCIT）是一种密集的、为期20次的育儿干预，已被证明可以提高CM养育的质量，改善积极的养育方式和孩子的行为，并降低CM再犯3,4，尽管其作用机制尚不清楚。基于它的现场指导，时时刻刻的积极育儿的脚手架，我们推测PCIT在父母中建立监管力量，然后支持持久的行为改变。使用pct独有的耳提耳式技术，为父母提供了立即获得治疗师支持的积极育儿方法，以对抗父母的高生理唤醒，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。这项研究旨在扩展我们调查小组的集体工作。它使用实验干预设计作为测试自我调节神经行为指数变化的因果模型的工具。具体而言，我们建议进行一项随机对照试验，测试PCIT对CM家长及其小学生自我调节和行为的影响。将从儿童保护服务中心抽取250名虐待母亲及其子女（5-8岁），随机分配到PCIT干预组或对照组（照例服务）。将评估关键的环境风险因素，包括累积风险、父母心理健康和父母物质使用情况。一种多指标、多方法的评估方法将包括神经（EEG/ERP）、生理（ECG）、行为和CM母亲及其子女自我调节的自我报告测量，以及育儿技能和儿童行为结果的标准测量。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的跟踪，并对CM累犯进行1年的跟踪。本研究的结果有望通过(a)确定CM父母和儿童神经行为自我调节系统对干预的敏感性，以及(b)确定调节和调节干预反应和长期维持收益的自我调节的个体差异，对优化CM养育干预具有重要意义。

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.