Recovery from Early Life Stress in Children Adopted from Institutions

描述（由申请人提供）：这是研究孤儿院/机构养育形式的早期生活压力（ELS）对儿童的威胁和压力反应系统以及收养后养育方面的影响的提案的第一次修订，该提案支持这些系统的恢复，并降低随后的情绪和注意力问题的风险。150名从孤儿院/机构及其家庭中国际收养的儿童将在收养后2个月开始，以4个8个月的间隔进行研究，以评估儿童在家庭中的前2年，第5个结果为4.5-5.5。年（采用后2.5-3.5年）。以前的工作记录了采用后的第一年，作为快速反弹/恢复的一年。然而，婴儿期后（本研究中为18-30个月）收养的儿童在结局方面表现出很大的异质性。基于ELS的动物研究，我们将测试的假设，即敏感的威胁和压力反应系统的功能，在通过和这些系统的能力，以恢复基础异质性的情绪和注意力问题。此外，我们将测试的假设，即在收养后养育的变化与这些系统的敏感性，影响恢复轨迹的相互作用。一个多方法，多层次的方法将用于家庭和实验室评估的行为和生理指标的威胁和压力系统功能：行为措施的负面情绪，唾液皮质醇的措施，和电生理措施的ANS功能。结果的措施将包括家长，教师和儿童的报告，增强了实验室评估的EEG功率和不对称性，恐惧增强惊吓（EMG惊吓），ERP和行为措施的行政注意。将使用结构化实验室评估和来自父母日记报告的测量来评估父母行为。最后，我们还将探讨是否5-羟色胺转运蛋白基因多态性，显示中度风险的抑郁症虐待儿童和HPA轴反应的动物模型，缓和儿童的脆弱性，早期机构的照顾和/或恢复能力。这项工作的最终目标是：（1）更好地理解早期生活压力增加情绪和行为问题风险的机制;（2）识别出情绪和注意力问题风险最大的儿童;（3）识别出在随后的随机干预试验中针对这些儿童和类似儿童的育儿模式，以改善其结果。公共卫生相关性：拟议的研究探讨了早期生活压力（ELS）的孤儿院/机构养育的形式对儿童的威胁和压力反应系统和养育收养后，支持这些系统的恢复和减少随后的情绪和注意力问题的风险方面的影响。这项工作的目标是（1）建立一个更好的理解的机制，通过早期生活压力增加情绪和行为问题的风险，（2）确定儿童的情绪和注意力问题的风险最大，（3）确定模式的父母在随后的随机干预试验，以改善这些和类似的儿童的结果。

DESCRIPTION (provided by applicant): This is the first revision of a proposal to study the effects of early life stress (ELS) in the form of orphanage/institutional rearing on children's threat- and stress-response systems and aspects of parenting post-adoption that support recovery of these systems and decreases subsequent risk of emotional and attentional problems. 150 children internationally-adopted from orphanages/institutions and their families will be studied at four 8-mo intervals beginning 2 mos post-adoption for the child's first 2 yrs in the family with a 5th outcome assessed at 4.5-5.5. yrs (2.5-3.5 yrs post-adoption). Previous work documents the first yrs post-adoption as ones of rapid rebound/recovery. However, children adopted post-infancy (18-30 mos in this study) exhibit great heterogeneity in outcomes. Based on animal studies of ELS, we will test the hypothesis that sensitization of threat- and stress-response system functioning at adoption and the capacity of these systems to recover underlies heterogeneity in emotional and attentional problems. Further, we will test the hypothesis that variations in post-adoption parenting interacts with sensitization of these systems to affect recovery trajectories. A multi-method, multi-level approach will be used with home and laboratory assessments of behavioral and physiological indices of threat- and stress-system functioning: behavioral measures of negative emotionality, salivary measures of cortisol, and electrophysiological measures of ANS functioning. Outcome measures will include parent, teacher and child reports augmented by laboratory assessments of EEG power and asymmetry, fear-potentiated startle (EMG startle), and ERP and behavioral measures of executive attention. Parent behavior will be assessed using structured laboratory assessments and measures derived from parent diary reports. Finally, we will also explore whether the serotonin transporter gene polymorphism, shown to moderate risk for depression in maltreated children and HPA axis reactivity in animal models, moderates children's vulnerability to early institutional care and/or capacity to recover. The ultimate goals of this work are (1) to establish a better understanding of the mechanisms through which early life stress increases risks of emotional and behavioral problems, (2) identify children at the greatest risk of emotional and attentional problems and (3) identify patterns of parenting to target in subsequent randomized intervention trials to improve outcomes for these and similar children. PUBLIC HEALTH RELEVANCE: The proposed study examines effects of early life stress (ELS) in the form of orphanage/institutional rearing on children's threat- and stress-response systems and aspects of parenting post-adoption that support recovery of these systems and decrease subsequent risk of emotional and attentional problems. The goals of this work are (1) to establish a better understanding of the mechanisms through which early life stress increases risks of emotional and behavioral problems, (2) identify children at the greatest risk of emotional and attentional problems and (3) identify patterns of parenting to target in subsequent randomized intervention trials to improve outcomes for these and similar children.