Pathways Linking Early Adversity and Support to Behavioral and Physical Health

项目摘要 早期逆境的破坏性影响，如长期贫困和虐待儿童， 在整个生命周期中增加精神和身体健康障碍的风险。从理论上理解- 儿童逆境在精神病理学和身体健康状况不佳方面的知情机制 以及可能减轻这些毒性影响的过程，是公共卫生的首要任务。有一个 关于描绘逆境如何“深入皮肤”的前瞻性、纵向研究存在重大差距， 以及可能保护儿童免受早期逆境的过程。由医疗-运输部告知 儿童虐待模型和儿童逆境模型的生物嵌入，目前的项目目的是 1）前瞻性地研究早期逆境对儿童心理和生理的增强作用， 健康;（2）了解逆境与儿童健康的联系机制，重点是父母的监管 过程（精神病理学，皮质醇），和儿童的行为（EF，情绪调节，努力控制， 不稳定性）和生物调节（皮质醇，炎症）;（3）评估支持对 儿童健康结果作为增加母亲支持的父母干预的功能。完成 这些目标，我们将评估母亲和孩子的二对（N = 240）谁以前参加了纵向 一项针对受虐待的学龄前儿童及其父母干预的随机临床试验（RCT） 回忆和情绪训练（RET）。虐待家庭被随机分配到RET 条件或社区标准（CS）病例管理条件。的比较条件 人口统计学匹配的非虐待家庭（NC）也包括在内。所有的孩子都经历过 3-6岁之间的重大逆境，入学时。在目前的提案中，240个家庭将参加 两个新的后续评估，间隔一年，当儿童年龄在8-11岁。多方法，多- 领域成套测验包括逆境和虐待儿童的评估，儿童行为和生物自我， 监管，产妇监管，产妇和替代照顾者的支持，儿童心理 （内化，外化）和身体健康（代谢风险）。初步证据显示， 干预改善了产妇支持;因此，我们的设计提供了一个独特的机会，通过实验 评估支持对儿童自我调节和生理的保护作用，以及是否 关系干预可以改善身心健康。总的来说，结果可能是 对干预科学、公共卫生和旨在减少艾滋病毒/艾滋病的社会政策具有重大意义。 早期遭受逆境的儿童的心理和身体健康问题负担。而且将 通过描绘与级联影响相关的特定机制来推进我们的理论模型， 早期生活逆境和虐待对儿童行为和身体健康的影响，以及建立 这是一个可以通过可再生能源技术的干预来改善负面影响的关键的可修改过程。

PROJECT SUMMARY The destructive effects of early adversity, such as chronic poverty and child maltreatment, substantially increase the risk for mental and physical health disorders across the lifespan. Understanding theoretically- informed mechanisms through which child adversity eventuates in psychopathology and poor physical health as well as the processes that may ameliorate those toxic effects, are top public health priorities. There is a significant gap regarding prospective, longitudinal research that delineates how adversity “gets under the skin”, as well as processes that may protect children from early adversity. Informed by the Ecological-Transactional Model of Child Maltreatment and the Biological Embedding of Child Adversity Model, the current project aims to 1) prospectively examine the potentiating effect of early adversity on children's psychological and physical health; (2) understand mechanisms linking adversity to child health, with a focus on parent regulatory processes (psychopathology, cortisol), and children's behavioral (EF, emotion regulation, effortful control, lability), and biological regulation (cortisol, inflammation); and (3) evaluate the role of caregiving support on child health outcomes as a function of a parenting intervention that increased maternal support. To accomplish these aims, we will assess mother-child dyads (N = 240) who previously participated in a longitudinal randomized clinical trial (RCT) of a parenting intervention for maltreated preschool-aged children and their mothers, Reminiscing and Emotion Training (RET). Maltreating families were randomized into the RET condition or a Community Standard (CS) case management condition. A comparison condition of demographically matched nonmaltreating families (NC) was also included. All children had experienced significant adversity between ages 3-6, when enrolled. In the current proposal, 240 families will participate in two new follow-up assessments, one year apart, when children are ages 8-11. The multi-method, multi- domain battery includes assessment of adversity and child maltreatment, child behavioral and biological self- regulation, maternal regulation, maternal and alternate caregiver support, and child psychological (internalizing, externalizing) and physical health (metabolic risk). Preliminary evidence indicates that the RET intervention improved maternal support; thus, our design provides a unique opportunity to experimentally evaluate the protective role of caregiving support on children's self-regulation and physiology, and whether relational interventions may improve physical as well as mental health. Overall, the results may have significant implications for intervention science, public health, and social policies designed to reduce the burden of mental and physical health problems among children exposed to early adversity. Moreover, it will advance our theoretical model by delineating specific mechanisms associated with the cascading influence of early life adversity and maltreatment on child behavioral and physical health outcomes, as well as establishing a key modifiable process that may ameliorate negative effects via the RET intervention.