Caregiver-Child Communication Following Child Maltreatment: A Dynamic Systems Approach

项目摘要 儿童虐待（CM）是一个重大的公共卫生问题，每年影响100万儿童， 社会成本高达2万亿美元，并增加了一系列不良健康后果的风险。困难 情绪调节（ER）是解释CM如何导致一系列持续不良反应的一个潜在途径。 健康结果和实证努力，以确定影响ER的因素，积极或消极，有显着 为受虐待儿童的干预战略提供信息的潜力。照顾者-儿童（C-C） 这种关系对ER能力的发展至关重要，但到目前为止还没有被彻底研究， CM人群中CM-ER关系的潜在介导者。此外，没有CM研究使用 观察方法来检查动态的，时刻C-C通信过程与老年人 儿童和青少年。这种创新和方法的严谨性将阐明实时，双向 在关键的发展时期，可以突出具体的预防和治疗目标 CM人口。利用从一个大型的、多波的、前瞻性的NIH收集的观察数据， 资助的队列研究，儿童健康研究（P50 HD 089922），本研究将检查C-C 三种互动的沟通动态，重点是加强C-C关系和解决问题 话题CHS通过官方案例文件的编码提供了CM特征的丰富性， 虐待分类系统，对照顾者和儿童健康及社会影响的多信息源评估 情绪健康，和一个既定的C-C干预范式。护理人员确认和无效 在C-C互动过程中的行为将被编码，以及儿童的积极和消极的影响。重要的是， 看护者确认和无效行为还有待于在更密集的时间尺度上进行研究（例如，30 第二个时期），也没有直接关系到儿童的积极和消极的影响，在C-C对话，因此， 本研究有可能作出重大的，创新的贡献，CM文学。这 一项奖学金提案将研究看护者确认和无效的变化和个体内变异 行为（目标1a）和儿童在三个C-C互动过程中的积极和消极影响（目标1b）， 以及照顾者的确认和无效行为是如何纵向和双向相关的， 儿童的积极和消极影响（目标2a）。假设的照顾者和儿童特质特征也将被 作为这些二元沟通过程的主持人进行测试（目标1c和2b）。最后，C-C互动 动力学将作为CM和ER之间纵向关系的介质进行测试（目的3），阐明新的 在CM人群中预防和治疗的行为目标。最终，成功的预防和 治疗工作将减少CM造成的个人和终身公共卫生负担和社会成本。

PROJECT ABSTRACT Child maltreatment (CM) is a significant public health concern that affects one million children annually, exerts a societal cost of $2 trillion, and increases the risk for a range of adverse health outcomes. Difficulties in emotion regulation (ER) is one potential pathway explaining how CM leads to a range of sustained adverse health outcomes and empirical efforts to identify factors effecting ER, positively or negatively, have significant potential to inform intervention strategies for children exposed to maltreatment. The Caregiver-Child (C-C) relationship is critical to the development of ER abilities, but so far has not been thoroughly examined as a potential mediator of the CM-ER relation in the CM population. Furthermore, no CM studies have used observational methodology to examine dynamic, moment-to-moment C-C communication processes with older children and adolescents. Such innovation and methodological rigor will elucidate real-time, bidirectional processes during key developmental periods that can highlight specific targets for prevention and treatment with the CM population. Leveraging observational data collected from a large, multi-wave, prospective NIH- funded cohort study, The Child Health Study (P50HD089922), the present study will examine C-C communication dynamics over three interactions focusing on C-C relationship enhancing and problem-solving topics. The CHS affords richness in characterizations of CM via coding of official case files via the Maltreatment Classification System, multi-informant assessment of caregiver and child health and socio- emotional well-being, and an established C-C interactional paradigm. Caregiver validating and invalidating behaviors during C-C interactions will be coded as well as child positive and negative affect. Importantly, caregiver validating and invalidating behaviors have yet to be studied at more intensive time-scales (e.g., 30 second epochs) nor in direct relation to child positive and negative affect during C-C conversation, and thus the present study has the potential to make a significant, innovative contribution to the CM literature. This fellowship proposal will examine change and intra-individual variability in caregiver validating and invalidating behaviors (Aim 1a) and child positive and negative affect over the course of three C-C interactions (Aim 1b), as well as how caregiver validating and invalidating behaviors are longitudinally and bidirectionally related to child positive and negative affect (Aim 2a). Hypothesized caregiver and child trait characteristics will also be tested as moderators of these dyadic communication process (Aims 1c and 2b). Finally, C-C interaction dynamics will be tested as mediators in the longitudinal relation between CM and ER (Aim 3), elucidating novel behavioral targets for prevention and treatment in the CM population. Ultimately, successful prevention and treatment efforts will reduce the personal and lifelong public health burden and societal cost attributable to CM.