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的患病率大大高于足月出生的儿童。由于这些行为的稳定性和未经治疗的预后不良，早期干预对早期早产儿的破坏性行为至关重要。虽然治疗已被证明对这一人群有效，但专门针对破坏性行为的父母培训干预措施的研究有限。亲子互动疗法（PCIT）是一项基于证据的亲子培训计划，针对具有破坏性行为的学龄前儿童，这种行为尚未在早产儿童中进行过检查。本研究的第一个长期目标是将PCIT的研究基础扩展到早产儿这一需要行为干预的高危人群。本研究的第二个长期目标是探索生理学作为治疗结果中介的潜在作用。本研究的具体目的是通过比较PCIT即时治疗组（IT）和等候名单对照组（WL）来评估PCIT对早产儿家庭的疗效，这些早产儿的父母报告的破坏性行为水平较高。假设与WL组的家庭相比，It组在治疗后会表现出：(a)家长评价的儿童破坏性行为较少；(b)改善家长报告中有关育儿压力和育儿做法的测量方法的分数；(c)在观察到的亲子互动中，儿童的依从性更强；（四）在亲子互动中，更积极有效的教养行为。此外，假设心脏迷走神经张力（心率变异性的量度）的变化将区分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，美国的早产患病率在过去十年中大幅增加，占所有新生儿的12.5%，目前已构成一个重大的公共卫生问题。早产儿在幼儿期出现各种社会心理问题的风险更高，出现破坏性行为障碍的比例也更高。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.