A Randomized Control Trial of a Responsive Parenting Intervention to Support Healthy Brain Development and Self-regulation in Toddlers Born Preterm

响应性育儿干预支持早产儿健康大脑发育和自我调节的随机对照试验

• 批准号: 10667483
• 负责人: Johanna Renee Bick
• 金额: $ 65.5万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-07 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667483
• 关键词: Accounting; Age; Anxiety; Area; Attention deficit hyperactivity disorder; Automobile Driving; Awareness; Behavior; Behavioral; Benchmarking; Birth; Brain; Brain Injuries; Brain region; Caring; Child; Child Rearing; Childhood; Clinical; Clinical Trials; Cognitive; Data; Development; Electroencephalography; Ensure; Environmental Risk Factor; Health; High Prevalence; Hippocampus; Home; Hyperactivity; Impulsivity; Infant; Informal Social Control; Instruction; Internet; Intervention; Investigation; Limbic System; Link; Magnetic Resonance Imaging; Maps; Measures; Mediating; Medical; Mental Depression; Mental Health; Mental disorders; Methodology; Mission; National Institute of Child Health and Human Development; Nervous System Trauma; Neuroanatomy; Neurologic; Neurological outcome; Neuronal Plasticity; Neurophysiology - biologic function; Online Systems; Outcome; Parents; Participant; Pattern; Personal Satisfaction; Persons; Play; Population; Prefrontal Cortex; Pregnancy; Premature Infant; Problem behavior; Productivity; Psychopathology; Psychosocial Factor; Randomized; Randomized, Controlled Trials; Rehabilitation therapy; Research; Sleep; Structure; Technology; Testing; Thick; Toddler; Videoconferencing; Work; active control; awake; behavior change; behavioral construct; behavioral outcome; brain morphology; caregiving; clinical risk; comparison control; directed attention; early childhood; externalizing behavior; extreme prematurity; gray matter; high risk; improved; inattention; innovation; interest; intervention effect; learning strategy; multimodality; nervous system disorder; neural; neural circuit; neuroimaging; novel; post intervention; premature; programs; psychologic; scaffold; success; sustained attention; symptomatology; telecoaching; treatment program; verbal; web-based intervention; white matter

Technological advances in medical care have increased the survival of very preterm infants (VPT; <32 gestational weeks). However, there is converging evidence of cascading disruption to neurological development resulting from VPT birth. Findings consistently link atypical neurological development in VPT infants with lasting mental health problems in the broader VPT population. Specifically, atypical white matter and grey matter development in VPT infants predict developmental deficit in self-regulation that are linked to later to emerge psychopathology of Attention-Deficit/Hyperactivity Disorder and clinical rates of internalizing and externalizing behavioral problems in VPT children. Innovation is urgently needed to treat neurological and psychiatric diseases in the growing VPT population. The proposed research will test a promising treatment solution. Our prior work has identified parental responsiveness as a modifiable psychological variable with the potential to improve VPT child neurodevelopmental outcomes through our highly effective parenting intervention. Two significant barriers limit implementation of parenting interventions in the clinical setting. First, parenting programs are often considered un-scalable because the most effective parenting interventions are home-based and thus expensive to implement. Second, the potential benefit of increased responsive caregiving to VPT childhood brain development is unclear because this possibility has never been evaluated via clinical trial, making it unknown how increasing responsiveness drives child outcome. In the context of a randomized controlled trial, the proposed study will overcome these barriers by: 1) Testing if participation in a scalable web-based intervention to increase responsive parenting results in more normative brain development and improved self-regulation in toddlers born VPT. 2) Testing if the acting mechanism of any behavioral and neuroanatomic alteration resulting from intervention is mediated by improvements in parent responsiveness. To accomplish these objectives, parents of VPT children (age 15-28-months) will be randomized to a web- based parenting intervention or an active control condition. During intervention one-on-one instruction will be provided via videoconferencing to increase parent responsiveness behaviors and support personal reflection on how to adapt newly acquired responsiveness behaviors to their child’s changing developmental level. We will collect pre- and post-intervention assessments to evaluate: 1) parental responsiveness behaviors, 2) VPT child behavioral outcomes and 3) VPT child neurological outcomes utilizing EEG to measure neural functioning and MRI to measure structural connectivity. This research applies neuroimaging methodologies in a novel way: by leveraging the inherent neuroplasticity of the brain in early childhood to identify intervention related effects on brain maturation and function. Findings from this study could result in a paradigm shift that includes interventions focusing on the parent as an active participant in their child’s developmental success.

医疗保健技术进步提高了极早产儿的存活率（VPT；<32 妊娠周）。然而，有越来越多的证据表明，神经系统会受到连锁性破坏。 VPT 诞生带来的发展。研究结果始终将 VPT 中的非典型神经发育联系起来 在更广泛的 VPT 人群中存在持久心理健康问题的婴儿。具体来说，非典型白质 VPT 婴儿的灰质发育预示着自我调节的发育缺陷，这与 后来出现了注意力缺陷/多动障碍的精神病理学和内化的临床比率 并将 VPT 儿童的行为问题外化。迫切需要创新来治疗神经系统疾病和 不断增长的 VPT 人群中的精神疾病。拟议的研究将测试一种有前途的治疗方法 解决方案。我们之前的工作已将父母的反应确定为一个可修改的心理变量 通过我们高效的养育方式，有可能改善 VPT 儿童神经发育结果 干涉。两个重大障碍限制了在临床环境中实施育儿干预措施。第一的， 育儿计划通常被认为是不可扩展的，因为最有效的育儿干预措施是 以家庭为基础，因此实施起来成本昂贵。其次，提高响应能力的潜在好处 护理对 VPT 儿童大脑发育的影响尚不清楚，因为这种可能性从未被评估过 通过临床试验，人们不知道增加反应性如何影响儿童的结局。在一个背景下 随机对照试验中，拟议的研究将通过以下方式克服这些障碍： 1) 测试参与可扩展的基于网络的干预措施是否会提高响应性育儿结果 出生 VPT 的幼儿的大脑发育更加规范，自我调节能力得到改善。 2) 测试干预是否导致任何行为和神经解剖学改变的作用机制 是通过父母反应能力的改善来调节的。 为了实现这些目标，VPT 儿童（15-28 个月）的父母将被随机分配到网络- 基于育儿干预或主动控制条件。在干预期间，将进行一对一的指导 通过视频会议提供，以提高家长的响应行为并支持个人反思 关于如何使新获得的反应行为适应孩子不断变化的发展水平。我们 将收集干预前和干预后的评估来评估：1) 父母的反应行为，2) VPT 儿童行为结果和 3) VPT 儿童神经系统结果，利用 EEG 测量神经功能 和 MRI 来测量结构连接性。这项研究将神经影像学方法应用于一种新颖的 方式：通过利用幼儿时期大脑固有的神经可塑性来识别相关的干预措施 对大脑成熟和功能的影响。这项研究的结果可能会导致范式转变，包括 干预措施侧重于父母作为孩子成功发展的积极参与者。

项目成果

Parenting Influences on Frontal Lobe Gray Matter and Preterm Toddlers' Problem-Solving Skills.

养育方式对额叶灰质和早产儿解决问题能力的影响。

• DOI: 10.3390/children11020206
• 发表时间: 2024
• 期刊: Children (Basel, Switzerland)
• 作者: Muñoz,JosselynS;Giles,MeganE;Vaughn,KellyA;Wang,Ying;Landry,SusanH;Bick,JohannaR;DeMaster,DanaM
• 通讯作者: DeMaster,DanaM

Timing of adoption is associated with electrophysiological brain activity and externalizing problems among children adopted internationally.

• DOI: 10.1002/dev.22249
• 发表时间: 2022-05
• 期刊: DEVELOPMENTAL PSYCHOBIOLOGY
• 影响因子: 2.2
• 作者: Bick, Johanna;Lipschutz, Rebecca;Tabachnick, Alexandra;Biekman, Brian;Katz, Danielle;Simons, Robert;Dozier, Mary
• 通讯作者: Dozier, Mary