Targeting neurobiological & behavioral mechanisms of self-regulation in high-risk families

描述(由申请人提供)：虐待儿童(CM)在美国构成一个严重的公共卫生问题1，众所周知，它会损害儿童自我调节能力的发展，并放大药物使用和其他调节障碍的风险。在涉及身体虐待和忽视的CM案件中，超过80%与父母有关，因此是干预的关键目标。对CM父母在育儿过程中的生理反应的研究表明，在这一人群中，育儿干预可能不那么有效2，因为它们无法影响导致严厉、厌恶父母养育的调节失调的神经行为标记物。亲子互动疗法(PCIT)是一种强化的、20个疗程的育儿干预措施，已被证明可以提高CM父母教育的质量，改善积极的父母教育和儿童行为，并降低CM再犯罪率，3，4尽管其影响的机制尚不清楚。在其现场指导的、每时每刻积极育儿的脚手架的基础上，我们的理论是，PCIT建立了父母的监管力量，然后支持持久的行为改变。使用PCIT独有的耳中虫技术，为父母提供了立即获得积极育儿的治疗师增援，以对抗父母高度的生理唤醒，抑制(主要)厌恶反应，并支持更多地使用(非显性)积极育儿行为。这项研究旨在扩大我们调查团队的集体工作。它使用实验干预设计作为一种工具来测试自我调节的神经行为指数变化的因果模型。具体地说，我们建议进行一项PCIT治疗CM的随机对照试验，并测试PCIT对CM父母及其小学生自我调节和行为的影响。250名受虐待的母亲及其子女(5-8岁)将从儿童保护服务机构中抽出，随机接受PCIT干预或控制条件(照常提供服务)。将评估关键的背景风险因素，包括累积风险、父母心理健康和父母物质使用。一种多评级、多方法的评估方法将包括CM母亲及其子女的神经(EEG/ERP)、生理(ECG)、行为和自我报告的自我调节措施，以及父母养育技能和孩子行为结果的标准衡量标准。家庭将在6个月时接受自我调节、父母教养和儿童行为结果的跟踪调查，并对CM累犯进行1年的跟踪调查。通过(A)确定CM父母和孩子的神经行为自我调节系统对干预的敏感性，以及(B)识别在自我调节中中介和适度反应干预和长期维持收益的自我调节的个体差异，这项拟议研究的结果有望对优化CM父母养育干预措施具有重要意义。

DESCRIPTION (provided by applicant): Child maltreatment (CM) constitutes a serious public health problem in the United States1 and is known to compromise children's developing self-regulation skills and amplify risk for substance use and other regulatory disorders. Parents are implicated in more than 80% of CM cases involving physical abuse and neglect and thus represent critical targets of intervention. Research on the physiological response of CM parents during parenting suggests that parenting interventions may be less effective with this population2 because they fail to affect the neurobehavioral markers of dysregulation that drive harsh, aversive parenting. Parent-Child Interaction Therapy (PCIT), an intensive, 20-session parenting intervention, has been shown to improve the quality of CM parenting, improve positive parenting and child behavior, and produce declines in CM recidivism,3,4 though the mechanisms underlying its effects are little understood. On the basis of its live- coached, moment-by-moment scaffolding of positive parenting, we theorize that PCIT builds regulatory strength in parents, which then supports lasting behavior change. Use of bug-in-the-ear technology-unique to PCIT-provides parents with immediate access to therapist reinforcements for positive parenting that work to counter parents' heightened physiological arousal, inhibit (prepotent) aversive responding, and support greater use of (nondominant) positive parenting behavior. This study is designed to extend the collective work of our investigative team. It uses an experimental intervention design as a vehicle for testing a causal model of change in neurobehavioral indices of self-regulation. Specifically, we propose to conduct a randomized, controlled trial of PCIT for CM and test the effects of PCIT on self-regulation and behavior in CM parents and their elementary-school children. Two hundred-fifty (250) maltreating mothers and their children (age 5-8 years) will be drawn from Child Protective Services and randomized to the PCIT intervention or a control condition (services as usual). Key contextual risk factors will be assessed, including cumulative risk, parent mental health, and parent substance use. A multirater, multimethod approach to assessment will include neural (EEG/ERP), physiological (ECG), behavioral, and self-report measures of self-regulation in CM mothers and their children, as well as standard measures of parenting skills and children's behavior outcomes. Families will be followed at 6 months for self-regulation, parenting, and child behavioral outcomes, and to 1 year for CM recidivism. Findings from this proposed study are expected to have significant implications for optimizing CM parenting interventions by (a) determining the sensitivity of CM parent and child neurobehavioral self-regulation systems to intervention, and (b) identifying individual differences in self-regulation that mediate and moderate response to intervention and long-term maintenance of gains.