Preventive Intervention for Behavior Problems in Infants from High-Risk Families

项目总结/摘要 当前R 01应用程序的主要目的是检查基于家庭的 预防性干预，以减少高危家庭婴儿的行为问题。行为问题是 在幼儿期非常常见，并与高度损伤和长期负面影响有关。 消极结果的轨迹。尽管有经验证据支持使用基于诊所的父母- 培训治疗早期行为问题，来自经济困难的儿童， 代表性不足的少数民族家庭，谁是在相当高的风险行为问题，有较高的 治疗退出率和完成治疗时的不良结局。我们建议， 在婴儿期，这可能需要较少的密集和较短的干预，从而减少 高风险家庭的负担。推广家庭干预试点测试的有希望的结果 针对育儿行为的变化（K23 MH 085659：PI，Bagner），我们建议进行充分的 有把握度的随机对照试验（n = 288），以证明其在降低 行为问题和增加婴儿调节相对于增强的儿科初级保健活动 控制条件根据目前调查小组和其他人的工作，我们还将审查 父母教养行为变化的中介作用和父母苦恼对干预的调节作用 结果。与其只关注干预是否能产生效果， 进一步发展预防科学证据基础的一个步骤是研究如何和为谁表明， 预防干预工作。拟议的工作与儿童基金会的研究优先事项一致 NICHD的发展和行为分支（CDBB）调查行为促进的影响 干预儿科初级保健，并确定促进短期- 对暴露于高危家庭和社区的儿童进行长期的心理社会调整 环境.鉴于低收入和低收入群体面临的广泛需求和资源枯竭， 代表性不足的少数民族家庭，拟议的工作提供了一个独特的机会，以帮助促进最佳的 行为功能，并减少来自最脆弱家庭的婴儿患精神病理学的风险。

Project Summary/Abstract The primary aim of the current R01 application is to examine the efficacy and maintenance of a home-based preventive intervention to decrease behavior problems in infants from high-risk families. Behavior problems are exceedingly common in early childhood and are associated with high impairment and a long-term negative trajectory for negative outcomes. Despite the empirical evidence supporting the use of clinic-based parent- training treatments for early behavior problems, children from economically disadvantaged and underrepresented minority families, who are at considerably higher risk for behavior problems, have higher treatment dropout rates and poorer outcomes when completing treatment. We propose instead to intervene during infancy, which would likely require less intensive and shorter interventions, thereby decreasing the burden for high-risk families. Extending promising findings from pilot testing of a home-based intervention targeting changes in parenting behavior (K23 MH085659: PI, Bagner), we propose to conduct an adequately powered randomized controlled trial (n = 288) to demonstrate its efficacy and maintenance in reducing behavior problems and increasing infant regulation relative to an enhanced pediatric primary care active control condition. Based on work by the current investigative team and others, we also will examine the mediating role of changes in parenting behavior and the moderating role of parental distress on intervention outcome. Rather than focus exclusively on whether the effect of the intervention can be produced, an important step in further developing the evidence base in prevention science is to examine how and for whom indicated preventive interventions work. The proposed work is consistent with the research priorities of the Child Development and Behavior Branch (CDBB) of the NICHD to investigate the impact of a behavioral promotion intervention in pediatric primary care and identify developmental factors and mechanisms which promote short- and long-term psychosocial adjustment for children exposed to high-risk family and neighborhood environments. In light of the extensive needs and depleting resources faced by low-income and underrepresented minority families, the proposed work provides a unique opportunity to help promote optimal behavioral functioning and reduce the risk for psychopathology in infants from the most vulnerable families.