Identifying risk earlier: Prenatal exposures, neurodevelopment, and infant sleep as pathways to toddler attention and behavior dysregulation

项目摘要/摘要 早期的注意力和行为失调是后来破坏性行为障碍的发展先兆， 儿童精神病理学的主要类别之一。儿童行为障碍的最新概念化研究 将这些诊断归类为神经发育疾病，这表明未被发现的产前和早期生命 起源。这项拟议中的研究将检验儿童行为失调在一定程度上源于产前这一前提。 暴露在母亲睡眠和情绪失调的环境中--这是一种跨诊断指标 精神变态学。来自我们实验室的数据提供了接触母性情绪失调的证据 与新生儿觉醒和注意力的神经发育差异有关，在几小时内测量 出生后。另外的飞行员分析表明，这种迟钝的神经发育特征与行为有关。 在18个月的时候出了问题。这项研究的一个目的是探索早期睡眠困难是否作为一种行为 婴儿神经发育特征与12岁幼儿注意力和行为障碍的联系机制 月份。睡眠是一种基本的健康行为，也是最早的二元/基于家庭的调节方式之一 流程。我们提出了一种测量母亲、父亲和婴儿睡眠变异性的创新设计， 定义为每晚睡眠时间不一致，采用纵向爆发式设计。睡眠将通过以下方式进行评估 在怀孕第二个月和第三个月、出生后第一周、然后 4个月、6个月、9个月和12个月。我们的目标是测试(1)产前暴露于母亲情绪失调， 时型和睡眠变异性预测婴儿神经发育和母婴睡眠变异性；(2)婴儿 神经发育与环境睡眠结构(如作息时间)相互作用，影响婴儿睡眠 随时间变化的；和(3)婴儿睡眠轨迹的特征是高度变化(即未能达到 标准稳定性)将在神经发育特征和幼儿注意力之间的联系中起中介作用 行为失调。探索性目标将包括伴侣对母亲的直接和间接影响 和婴儿睡眠。为了实现这些创新目标，我们将使用既定的协议来招收妇女参加 妊娠中期(N=200名妇女)情绪异常的均匀分布及其影响因素 合伙人。这项技术过度代表了高度失调的女性，并增加了统计能力。女人, 伴侣和婴儿将在出生后的头12个月内使用最大限度地减少 由于被动的监测和简短的调查，造成了负担。这项研究建立在严格的先前研究的基础上，包括 从我们自己的NIH资助的项目中着手，深入研究婴儿睡眠的关键挑战。这项研究统一了一项 明星团队，拥有母亲情绪失调、婴儿神经发育、成人和婴儿睡眠方面的专业知识， 纵向设计，幼儿注意力和行为失调。我们的研究意义重大，因为我们可能 确定可改变的过程--婴儿和家庭睡眠--这可能会导致早期的精神病理风险， 从而降低最早出现和代价最高的一类儿科精神疾病的风险。

PROJECT SUMMARY/ABSTRACT Early attention and behavior dysregulation are developmental precursors to later disruptive behavior disorders, one of the major categories of childhood psychopathology. Recent conceptualizations of child behavior disorders classify these diagnoses as neurodevelopmental conditions, which suggests unexplored prenatal and early life origins. The proposed study will test the premise that child behavior dysregulation emerges, in part, from prenatal exposures to disrupted maternal sleep and emotion dysregulation—a transdiagnostic indicator of psychopathology. Data from our laboratories provide evidence that exposure to maternal emotion dysregulation associates with neurodevelopmental differences in newborn arousal and attention, as measured within hours after birth. Additional pilot analyses reveal that this blunted neurodevelopmental profile associates with behavior problems at 18 months. A goal of this study is to explore whether early sleep difficulties function as a behavioral mechanism connecting infant neurodevelopmental profiles to toddler attention and behavior dysregulation at 12 months. Sleep is a foundational health behavior and one of the earliest dyadic/family-based regulatory processes. We propose an innovative design for measuring maternal, paternal, and infant sleep variability, defined as inconsistency in hours slept per night, using a longitudinal burst design. Sleep will be assessed via actigraphy and research-validated consumer devices during the 2nd and 3rd trimester, week 1 after birth, then months 4, 6, 9, and 12. We aim to test whether (1) prenatal exposure to maternal emotion dysregulation, chronotype, and sleep variability predicts infant neurodevelopment and maternal-infant sleep variability; (2) infant neurodevelopment interacts with environmental sleep structure (e.g., bedtime routines) to affect infant sleep variability over time; and (3) infant sleep trajectories characterized by high variability (i.e., failure to attain normative stability) will mediate associations between neurodevelopmental profiles and toddler attention and behavior dysregulation. An exploratory aim will incorporate direct and indirect influences of partners on maternal and infant sleep. To accomplish these innovative aims, we will use established protocols to enroll women in the 2nd trimester of pregnancy (N=200 women) along a uniform distribution of emotion dysregulation, and their partners. This technique overrepresents women with high dysregulation and increases statistical power. Women, partners, and infants will then be followed for the first 12 months after birth using techniques that minimize burden, due to passive monitoring and brief surveys. This study builds upon rigorous prior research, including work from our own NIH-funded projects, to delve into the crucial challenge of infant sleep. The study unites a stellar team, with expertise in maternal emotion dysregulation, infant neurodevelopment, adult and infant sleep, longitudinal designs, and toddler attention and behavior dysregulation. Our study is significant because we may identify modifiable processes—infant and family sleep—that could contribute to early psychopathology risk, thereby reducing risk for one of the earliest-emerging and most costly classes of pediatric psychiatric distress.