Early Prevention of Aberrant Behavior in Neurodevelopmental Disorders in Peru

描述(由申请人提供)：异常行为，即自我伤害、攻击性和刻板印象行为，是最具破坏性的神经发育障碍(ND)。它们导致健康恶化，有时还导致过早死亡；它们阻碍社区融合；它们损害学习和社交机会；它们是社区工作失败的最主要原因。它们通常与几种基因-大脑-行为功能障碍有关。新城疫在美国、英国和欧洲的患病率估计在总人口研究中平均为10%。在所有ND患者中，这些国家的流行率研究估计约有10%-25%的人有严重的异常行为，但拉丁美洲国家的流行率尚不清楚。关于行为和精神药理治疗和预防的广泛研究已经存在，但在拉丁美洲没有，那里的人口严重得不到足够的服务。该项目旨在研究秘鲁(人口2200万)新城疫患者异常行为的发展和预防，在秘鲁，估计300万新城疫患者中只有2%的人得到了服务。秘鲁安沙利文中心(CASP)是一所位于利马的最先进的神经发育障碍学校，在秘鲁、阿根廷、巴西、玻利维亚、哥伦比亚、危地马拉、尼加拉瓜、厄瓜多尔和西班牙拥有卫星项目网络。CASP与堪萨斯大学生命周期研究所有27年的合作赞助历史。根据Fogarty PAR-08-113，我们建议使用R21对1000名婴幼儿进行筛查，希望发现250名有ND风险的婴儿，6-36个月，其中50%也可能有异常行为(AB)的风险，并跟踪其中100人或更多人与ND匹配的100人或更多，但没有AB风险，每隔6个月进行一次深入的跨学科评估，包括儿科、心理教育、行为、神经学和遗传学评估。以了解他们是否会产生异常行为，正如Berkson等人(2002)在美国所展示的那样。在这一早期识别计划的结果之后，将在秘鲁利马对患有新城疫的婴幼儿进行为期5年的R01早期预防性干预。R21还将致力于通过增加研究基础设施、提高工作人员的研究能力、翻译和验证评估工具，以及与美国、秘鲁和其他拉丁美洲国家大学的适当研究人员合作，在CASP现有的优秀心理教育计划和远程学习网络的基础上进行建设，然后这些研究人员将参与随后的R01。在拉丁美洲，由于社会文化习俗和健康问题，如不受控制的环境污染，异常行为的发展可能存在差异。 公共卫生相关性：该项目涉及秘鲁利马高危环境中患有神经发育障碍(ND)的婴幼儿异常行为发展所涉及的基因-脑-行为关系。我们计划开发一种风险算法，以便能够在早期预防干预方面进行具有成本效益的努力，这种努力可以在整个拉丁美洲、整个亚太减贫战略计划远程教育网络以及其他地区推广，用于患有这些极其虚弱问题的幼儿。

DESCRIPTION (provided by applicant): Aberrant behaviors, i.e. self-injury, aggression, and stereotyped behavior, are some of the most devastating neurodevelopmental disorders (ND). They lead to deteriorating health and, sometimes, early death; they prevent community integration; they impair learning and socialization opportunities; and they are the most salient reason for job failure in the community. They are often linked to several gene-brain-behavior dysfunctions. Prevalence estimates of ND in the U.S., UK, and Europe average c.10% in total population studies. Among all people with ND, prevalence studies in these countries estimate approximately 10-25 % have severe aberrant behaviors, but prevalence is unknown in Latin American countries. Extensive research on behavioral and psychopharmacological treatment and prevention exists, but not in Latin America, where this population is severely underserved. This project aims to study the development and prevention of aberrant behaviors of people with ND in Peru (population 22 million), where only 2% of the population of an estimated 3 million people who have ND are being served. The Centro Ann Sullivan Center del Peru (CASP) is a state-of-the-art school for neurodevelopmental disorders based in Lima, with a network of satellite programs in Peru, Argentina, Brazil, Bolivia, Colombia, Guatemala, Nicaragua, Ecuador, and Spain. CASP has a 27-year history of collaborative sponsorship with the Life Span Institute at the University of Kansas In response to Fogarty PAR-08-113, we propose an R21 to screen 1000 infants and toddlers expecting to find 250 who are at risk for ND, 6-36 mos., 50% of whom are also likely to be at risk for aberrant behaviors (AB) and to follow 100 or more of them plus 100 or more matched controls with ND, but not at risk for AB, at 6- month intervals for 12 months with in-depth interdisciplinary evaluations involving pediatric, psychoeducational, behavioral, neurological, and genetic assessments, to see if they develop aberrant behaviors, as was shown in the U.S. by Berkson, et al.( 2002). The results of this early identification program will be followed by a 5-year R01 on early preventive intervention of aberrant behavior in infants and young children with ND in Lima, Peru. The R21 will also concentrate on building on the existing excellent psycho-educational program and distance learning network at CASP by adding research infrastructure, increasing the research capacity of staff, translation and validation of assessment instruments, and collaborations with appropriate investigators in universities in the U.S., Peru, and other Latin American countries, who will then participate in the subsequent R01. There may be differences in the development of aberrant behavior due to sociocultural practices and health issues, such as uncontrolled environmental pollution, in Latin America. PUBLIC HEALTH RELEVANCE: This project concerns the gene-brain-behavior relationships involved in the development of aberrant behaviors among infants and young children with neurodevelopmental disorders (ND) who live in high-risk environments in Lima, Peru. We plan to develop a risk algorithm that will permit a cost-effective effort at early preventive intervention that can be replicated throughout Latin America, across the CASP distance learning network and beyond, for young children with these extremely debilitating problems.