Pathways Linking Early Adversity and Support to Behavioral and Physical Health

项目总结 早期逆境的破坏性影响，如长期贫困和虐待儿童， 在一生中增加患心理和身体健康疾病的风险。从理论上理解- 儿童逆境最终导致精神病理和身体健康不良的知情机制 以及可能缓解这些有毒影响的过程，都是公共卫生的首要任务。有一个 关于描绘逆境如何“深入内心”的前瞻性、纵向研究，存在显著差距， 以及可能保护儿童免受早期逆境影响的过程。从生态-交易中获知 儿童虐待模型和儿童逆境模型的生物嵌入，本项目的目标是 1)前瞻性地考察早期逆境对儿童心理和生理的强化作用 健康；(2)了解将逆境与儿童健康联系起来的机制，重点是父母的监管 过程(精神病理学、皮质醇)和儿童行为(EF、情绪调节、努力控制、 和生物调节(皮质醇、炎症)；和(3)评估护理支持在以下方面的作用 作为增加母亲支持的育儿干预的功能的儿童健康结果。要完成 在这些目标中，我们将评估母子二元组(N=240)以前参与过的纵向 虐待学龄前儿童及其子女父母教养干预的随机临床试验 母亲、回忆和情感训练(RET)。虐待家庭被随机分成RET组 情况或社区标准(CS)病例管理情况。的比较条件 人口统计学上匹配的非虐待家庭(NC)也包括在内。所有的孩子都经历过 注册时，3-6岁之间的重大逆境。在目前的提案中，240个家庭将参与 两项新的跟踪评估，相隔一年，在孩子8-11岁时进行。多方法、多层次、多层次的 领域组合包括逆境和虐待儿童的评估，儿童行为和生物自我 管理、产妇管理、母亲和替补照顾者支持以及儿童心理 (内化、外化)和身体健康(代谢风险)。初步证据表明，RET 干预改善了母亲的支持；因此，我们的设计提供了一个独特的实验机会 评估照护支持对儿童自我调节和生理的保护作用，以及 关系干预可能会改善身体和心理健康。总体而言，结果可能会 对干预科学、公共卫生和社会政策的重大影响，旨在减少 处于早期逆境中的儿童的心理和身体健康问题的负担。此外，它还将 通过描绘与以下因素的连锁影响相关的具体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结果的影响，以及建立 一个关键的可修改的过程，可以通过RET干预来缓解负面影响。

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.