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

项目总结/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前兆， 儿童期精神病理学的主要分类之一。儿童行为障碍的最新概念 将这些诊断归类为神经发育状况，这表明未被探索的产前和早期生活 起源.这项拟议中的研究将检验这样一个前提，即儿童行为失调部分来自产前 暴露于母亲睡眠中断和情绪失调-一个跨诊断指标， 精神病理学来自我们实验室的数据提供了证据， 与新生儿觉醒和注意力的神经发育差异有关， 出生后额外的初步分析显示，这种迟钝的神经发育特征与行为有关， 18个月的问题这项研究的目的是探讨早期睡眠困难是否作为一种行为障碍， 12岁时婴儿神经发育概况与幼儿注意力和行为失调的联系机制 个月睡眠是一种基本的健康行为，也是最早的以家庭为基础的二元调控之一。 流程.我们提出了一个创新的设计，用于测量母亲，父亲和婴儿的睡眠变异性， 定义为每晚睡眠时间的不一致性，使用纵向突发设计。睡眠将通过 在第二和第三个三个月，出生后第1周， 第4、6、9和12个月。我们的目的是测试（1）产前暴露于母亲的情绪失调， 睡眠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相互作用（例如，影响婴儿睡眠 随时间的变化性;以及（3）以高变化性为特征的婴儿睡眠轨迹（即，未能达到 规范稳定性）将介导神经发育概况和幼儿注意力之间的关联， 行为失调一个探索性的目标将包括直接和间接的影响，合作伙伴对孕产妇 婴儿睡眠为了实现这些创新目标，我们将使用既定的协议， 妊娠中期（N=200名妇女）沿着情绪失调的均匀分布， 伙伴这种技术过度代表了具有高度失调的女性，并增加了统计功效。女人， 然后，在出生后的前12个月内，将使用最小化 由于被动监测和简短调查，这项研究建立在严格的先前研究基础上，包括 从我们自己的NIH资助的项目工作，深入研究婴儿睡眠的关键挑战。该研究结合了一个 一流的团队，在产妇情绪失调，婴儿神经发育，成人和婴儿睡眠， 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 确定可改变过程-婴儿和家庭睡眠-可能导致早期精神病理学风险， 从而降低了最早出现和最昂贵的儿科精神痛苦类别之一的风险。

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.