Neurodevelopmental outcomes associated with care setting in children orphaned by AIDS

艾滋病孤儿的神经发育结果与护理环境相关

• 批准号: 9137889
• 负责人: MICHAEL E BEHEN
• 金额: $ 22.86万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9137889
• 关键词: 8 year old; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Advocate; Affect; Age; Age of Onset; Behavior assessment; Behavioral; Behavioral Symptoms; Belief; Brain region; Caregivers; Caring; Child; China; Chinese People; Cognition; Cognitive; Communities; Data; Diffusion Magnetic Resonance Imaging; Education; Ethnic Origin; Exposure to; Family; Functional Magnetic Resonance Imaging; Funding; Gender; Group Homes; HIV; Health; Home environment; Image; Imaging Techniques; Impaired cognition; Incidence; Inferior; Intervention; Intervention Trial; Investigation; Lateral; Link; Magnetic Resonance Imaging; Medial; Modeling; Neurobehavioral Manifestations; Neurologic; Neurophysiology - biologic function; Orphan; Orphanages; Outcome; Parents; Pathology; Pathway interactions; Pattern; Personal Satisfaction; Phenotype; Policy Making; Problem behavior; Protocols documentation; Psychosocial Assessment and Care; Quality of Care; Randomized; Recording of previous events; Research; Rest; Romania; Sampling; Seeds; Structural defect; Structure; Symptoms; Temporal Lobe; Testing; Time; Trauma; Treatment Protocols; United States National Institutes of Health; base; behavioral impairment; cingulate cortex; cognitive testing; cohort; community based care; community intervention; community setting; early experience; foster care; inattention; indexing; neural correlate; physical conditioning; programs; psychologic; psychosocial; public health relevance; relating to nervous system; resilience; social deprivation

 DESCRIPTION (provided by applicant): In this exploratory study, we are proposing to apply cognitive and behavioral assessments and advanced imaging techniques to identify the functional and structural neural alterations that are associated with history of adversity and subsequent exposure to different care settings in Chinese children who have been orphaned by AIDS. These children are a subsample of a longitudinal cohort (n=800) in an ongoing NIH-funded psychosocial intervention trial (R01NR013466). The sample will include 90 orphaned children from three care settings (orphanages, kinship care, community based group homes) in Henan China. The children, across settings (n= 30 from each setting), will be matched on age, gender, duration of care, age of entry into care, ethnicity, parent and child education. Specifically, we are proposing to use cognitive and behavioral assessments and advanced imaging techniques such as functional (resting state functional MRI sequences) and structural (diffusion weighted imaging sequences) MRI protocols to investigate whether care settings are differentially related to healthy or pathological functional and structural neural abnormalities (Aim 1). We hypothesize that children raised in kinship and orphanage settings will show increased incidence of specific cognitive/behavioral impairments and altered patterns of functional and structural connectivity, including reduced node strength and efficiency from lateral and medial temporal seeds to subcortical/cortical targets; and increased indices of connectivity strength in local frontal and cerebellar connectivity as compared to community placed children. We also are attempting to more fully characterize some of the neurodevelopmental phenotypes associated with loss and subsequent care, and to determine whether functional and structural neural outcomes depend on the interaction of duration in care x care setting (Aim 2). Here we hypothesize that specific cognitive and behavioral symptoms will be differentially associated with distinct functional and structural abnormalities, and further tha the magnitude of neurodevelopmental outcomes will depend on the interaction of duration in care x care setting - children in low quality care (orphanages, kinship settings) will show greater incidence of cognitive/behavioral symptoms and increased magnitude of neural abnormalities (identified in Aim 1) as time in care setting is increased. Conversely, children in high quality cae (community group homes) will show less incidence of cognitive/behavioral patterns and reduced magnitude of neural abnormalities over time. We further expect that the relationships identified between neurodevelopmental outcomes and duration in care x care setting will be moderated by age of loss/entry into care. Finally, we are testing whether children orphaned during their first 3 years will show greater improvement over time in high quality settings (community group homes) and increased magnitude of problems/abnormalities as compared to children orphaned >8 years of age; whereas, we expect that children orphaned >8 years will show similar levels of healthy outcomes in high quality care, and reduced magnitude of negative outcomes over time in low quality care.

 描述（由申请人提供）：在这项探索性研究中，我们建议应用认知和行为评估以及先进的成像技术来识别与艾滋病孤儿的逆境史和随后接触不同护理环境相关的功能和结构神经改变。这些儿童是 NIH 资助的一项正在进行的心理社会干预试验 (R01NR013466) 中纵向队列 (n=800) 的子样本。样本将包括来自中国河南三个护理机构（孤儿院、亲属护理机构、社区团体之家）的 90 名孤儿。不同环境下的儿童（每个环境中的 n = 30 名）将在年龄、性别、护理持续时间、进入护理年龄、种族、父母和儿童教育方面进行匹配。具体来说，我们建议使用认知和行为评估以及先进的成像技术，例如功能性（静息态功能性 MRI 序列）和结构性（扩散加权成像序列）MRI 方案来研究护理环境是否与健康或病理性功能和结构性神经异常存在差异相关（目标 1）。我们假设在亲属关系和孤儿院环境中长大的儿童将表现出特定认知/行为障碍的发生率增加以及功能和结构连接模式的改变，包括从外侧和内侧颞种子到皮质下/皮质目​​标的节点强度和效率降低；与社区安置的儿童相比，局部额叶和小脑连接的连接强度指数有所增加。我们还试图更全面地描述与丧失和后续护理相关的一些神经发育表型，并确定功能和结构神经结果是否取决于护理持续时间与护理环境的相互作用（目标 2）。在这里，我们假设特定的认知和行为症状与不同的功能和结构异常有不同的相关性，而且神经发育结果的程度将取决于护理时间与护理环境的相互作用——低质量护理（孤儿院、亲属环境）中的儿童会表现出更大的神经发育结果。 随着护理环境时间的增加，认知/行为症状的发生率和神经异常程度（在目标 1 中确定）增加。相反，随着时间的推移，生活在高质量 cae（社区团体之家）中的儿童认知/行为模式的发生率会降低，神经异常的程度也会降低。我们进一步期望，神经发育结果与护理x护理环境持续时间之间确定的关系将受到失去/进入护理的年龄的调节。最后，我们正在测试儿童在出生后的前 3 年是否成为孤儿。 与 8 岁以上的孤儿相比，随着时间的推移，高质量环境（社区团体之家）将显示出更大的改善，问题/异常的程度也会增加；然而，我们预计 8 岁以上的孤儿在高质量护理中将表现出相似水平的健康结果，并且随着时间的推移，在低质量护理中负面结果的程度会减少。