Recovery from Early Life Stress in Children Adopted from Institutions

描述（由申请人提供）：这是研究孤儿院/机构养育形式的早期生活压力（ELS）对儿童威胁和压力反应系统的影响的提案的第一次修订，以及收养后支持这些系统恢复并降低随后情绪和注意力问题风险的养育方面。150名从孤儿院/机构领养的国际儿童及其家庭将在收养后2个月开始，对儿童在家庭中的头2年进行4次8个月间隔的研究，第5次结果评估为4.5-5.5。年（收养后2.5-3.5年）。以前的工作将采用后的头几年记录为快速反弹/恢复的一年。然而，在婴儿期后被收养的儿童（本研究中大多数为18-30岁）在结果上表现出很大的异质性。基于对ELS的动物研究，我们将检验在收养时威胁和压力反应系统功能的敏感性以及这些系统的恢复能力是情绪和注意力问题异质性的基础。此外，我们将检验收养后养育方式的变化与这些系统的敏感性相互作用以影响恢复轨迹的假设。一种多方法、多层次的方法将用于家庭和实验室评估威胁和压力系统功能的行为和生理指标：负面情绪的行为测量、皮质醇的唾液测量和ANS功能的电生理测量。结果测量将包括家长、老师和孩子的报告，这些报告由脑电图功率和不对称性、恐惧增强惊吓（EMG惊吓）、ERP和执行注意力的行为测量的实验室评估增强。家长行为将使用结构化的实验室评估和来自家长日记报告的测量方法进行评估。最后，我们还将探讨5 -羟色胺转运体基因多态性是否会调节受虐待儿童的抑郁风险和动物模型中的HPA轴反应性，从而调节儿童对早期机构护理的脆弱性和/或恢复能力。这项工作的最终目标是：(1)更好地理解早期生活压力增加情绪和行为问题风险的机制；(2)确定情绪和注意力问题风险最大的儿童；(3)确定在随后的随机干预试验中针对的育儿模式，以改善这些儿童和类似儿童的结果。公共卫生相关性：拟议的研究考察了孤儿院/机构养育形式的早期生活压力（ELS）对儿童威胁和压力反应系统的影响，以及收养后支持这些系统恢复并降低随后情绪和注意力问题风险的养育方面。这项工作的目标是：(1)建立对早期生活压力增加情绪和行为问题风险的机制的更好理解；(2)确定情绪和注意力问题风险最大的儿童；(3)确定在随后的随机干预试验中针对的育儿模式，以改善这些儿童和类似儿童的结果。

DESCRIPTION (provided by applicant): This is the first revision of a proposal to study the effects of early life stress (ELS) in the form of orphanage/institutional rearing on children's threat- and stress-response systems and aspects of parenting post-adoption that support recovery of these systems and decreases subsequent risk of emotional and attentional problems. 150 children internationally-adopted from orphanages/institutions and their families will be studied at four 8-mo intervals beginning 2 mos post-adoption for the child's first 2 yrs in the family with a 5th outcome assessed at 4.5-5.5. yrs (2.5-3.5 yrs post-adoption). Previous work documents the first yrs post-adoption as ones of rapid rebound/recovery. However, children adopted post-infancy (18-30 mos in this study) exhibit great heterogeneity in outcomes. Based on animal studies of ELS, we will test the hypothesis that sensitization of threat- and stress-response system functioning at adoption and the capacity of these systems to recover underlies heterogeneity in emotional and attentional problems. Further, we will test the hypothesis that variations in post-adoption parenting interacts with sensitization of these systems to affect recovery trajectories. A multi-method, multi-level approach will be used with home and laboratory assessments of behavioral and physiological indices of threat- and stress-system functioning: behavioral measures of negative emotionality, salivary measures of cortisol, and electrophysiological measures of ANS functioning. Outcome measures will include parent, teacher and child reports augmented by laboratory assessments of EEG power and asymmetry, fear-potentiated startle (EMG startle), and ERP and behavioral measures of executive attention. Parent behavior will be assessed using structured laboratory assessments and measures derived from parent diary reports. Finally, we will also explore whether the serotonin transporter gene polymorphism, shown to moderate risk for depression in maltreated children and HPA axis reactivity in animal models, moderates children's vulnerability to early institutional care and/or capacity to recover. The ultimate goals of this work are (1) to establish a better understanding of the mechanisms through which early life stress increases risks of emotional and behavioral problems, (2) identify children at the greatest risk of emotional and attentional problems and (3) identify patterns of parenting to target in subsequent randomized intervention trials to improve outcomes for these and similar children. PUBLIC HEALTH RELEVANCE: The proposed study examines effects of early life stress (ELS) in the form of orphanage/institutional rearing on children's threat- and stress-response systems and aspects of parenting post-adoption that support recovery of these systems and decrease subsequent risk of emotional and attentional problems. The goals of this work are (1) to establish a better understanding of the mechanisms through which early life stress increases risks of emotional and behavioral problems, (2) identify children at the greatest risk of emotional and attentional problems and (3) identify patterns of parenting to target in subsequent randomized intervention trials to improve outcomes for these and similar children.