A Randomized Controlled Trial for Disruptive Behavior of Children Born Premature

描述(由申请人提供)：早产儿童的破坏性行为发生率显著高于足月出生的儿童。早期干预早产儿的破坏性行为是至关重要的，因为这些行为的稳定性和不治疗的预后很差。尽管治疗已被证明对这一人群有效，但考察专门针对破坏性行为的父母培训干预的研究一直有限。亲子互动治疗(PCIT)是一项基于证据的父母培训计划，适用于有破坏性行为的学龄前儿童，这些儿童尚未在早产儿童中进行检查。这项研究的第一个长期目标是将PCIT的研究基础扩大到早产儿，这是一个需要行为干预的高危人群。这项研究的第二个长期目标是探索生理学作为治疗结果的中介的潜在作用。这项研究的具体目的是通过比较PCIT即时治疗(IT)组和等待名单(WL)对照组，评估PCIT对父母报告的破坏性行为水平升高的早产儿童家庭的疗效。据假设，与WL组家庭相比，IT组在治疗后将表现出：(A)父母对儿童的破坏性行为较少；(B)在父母报告的父母压力测量和育儿实践方面，得分有所提高；(C)在观察到的亲子互动中，孩子更顺从；以及(D)在亲子互动中，更积极和有效的父母行为。此外，还假设心脏迷走神经张力的变化(心率变异性的测量)将区分IT组和WL组的儿童。与公共卫生的相关性：根据医学研究所关于早产的报告，美国早产的患病率在过去十年中大幅上升，占所有新生儿的12.5%，目前构成了一个重大的公共卫生问题。早产儿在儿童早期患各种心理社会问题的风险增加，并表现出更高的破坏性行为障碍的比率。对这些儿童进行循证治疗的研究对于预防生活中进一步和更严重的问题至关重要。

DESCRIPTION (provided by applicant): The prevalence of disruptive behavior in children born preterm is substantially higher than children born full-term. Early intervention for disruptive behavior in young preterm children is critical due to the stability of these behaviors and poor prognosis without treatment. Although treatment has been shown to be effective with this population, research examining parent-training interventions that specifically target disruptive behavior has been limited. Parent-Child Interaction Therapy (PCIT) is an evidence-based parent-training program for preschool-age children with disruptive behavior that has not been examined in children born preterm. The first long-term objective of this study is to extend the research base of PCIT to preterm children, an at-risk population in need of behavioral intervention. The second long-term goal of this study is to explore the potential role of physiology as a mediator of treatment outcome. The specific aims of the study are to evaluate the efficacy of PCIT with families of children born premature who present with elevated levels of parent-reported disruptive behavior by comparing a PCIT Immediate Treatment (IT) group with a Waitlist (WL) control group. It is hypothesized that in comparison to families in the WL group, the IT group will show after treatment: (a) fewer child disruptive behaviors as rated by parents; (b) improved scores on parent report measures of parenting stress and parenting practices; (c) greater child compliance during observed parent-child interactions; and (d) more positive and effective parenting behaviors during parent- child interactions. Additionally, it is hypothesized that changes in cardiac vagal tone, a measure of heart rate variability, will differentiate children in the IT and WL groups. Relevance to Public Health: According to the Institute of Medicine's report on preterm birth, the prevalence rate of preterm birth in the United States has increased considerably in the last decade to 12.5 percent of all births and currently constitutes a significant public health concern. Infants born preterm are at an increased risk for a variety of psychosocial problems in early childhood and show higher rates of disruptive behavior disorders. Research examining evidence-based treatments with these children is critical in preventing further and more serious problems in life.