Preventive Intervention for Behavior Problems in Infants from High-Risk Families

项目摘要/摘要 当前R01应用程序的主要目标是检查基于家庭的 预防干预减少高危家庭婴儿的行为问题。行为问题是 在儿童早期非常常见，与高度损害和长期的负面影响有关 负面结果的轨迹。尽管有经验证据支持使用以临床为基础的父母- 早期行为问题的培训治疗，经济困难儿童和 代表不足的少数族裔家庭行为问题的风险相当高，他们有更高的风险 治疗中途辍学率和完成治疗后较差的结果。相反，我们建议进行干预 在婴儿期，这可能需要较少的密集和较短的干预，从而减少 高危家庭的负担。扩展基于家庭的干预的试点测试的有希望的发现 针对父母养育行为的变化(K23 MH085659：Pi，Bagner)，我们建议进行充分的 动力随机对照试验(n=288)证实其在降低体重方面的疗效和维持 与加强儿科初级保健活动相关的行为问题和不断增加的婴儿监管 控制条件。根据目前调查小组和其他人的工作，我们还将审查 父母教养行为变化的中介作用和父母痛苦对干预的调节作用 结果。与其只关注干预的效果能否产生，一个重要的 在预防科学中进一步发展证据基础的一步是检查如何和为了谁而表明 预防性干预是有效的。拟议的工作符合儿童基金会的研究优先事项 NICHD的发展和行为处(CDBB)调查行为促进的影响 在儿科初级保健中进行干预，并找出促进短期保健的发展因素和机制。 对暴露在高危家庭和社区中的儿童进行长期的心理社会适应 环境。鉴于低收入和贫困人口面临的广泛需求和日益枯竭的资源 对于代表不足的少数族裔家庭，拟议的工作提供了一个独特的机会，有助于促进最优 并降低来自最脆弱家庭的婴儿患精神疾病的风险。

Project Summary/Abstract The primary aim of the current R01 application is to examine the efficacy and maintenance of a home-based preventive intervention to decrease behavior problems in infants from high-risk families. Behavior problems are exceedingly common in early childhood and are associated with high impairment and a long-term negative trajectory for negative outcomes. Despite the empirical evidence supporting the use of clinic-based parent- training treatments for early behavior problems, children from economically disadvantaged and underrepresented minority families, who are at considerably higher risk for behavior problems, have higher treatment dropout rates and poorer outcomes when completing treatment. We propose instead to intervene during infancy, which would likely require less intensive and shorter interventions, thereby decreasing the burden for high-risk families. Extending promising findings from pilot testing of a home-based intervention targeting changes in parenting behavior (K23 MH085659: PI, Bagner), we propose to conduct an adequately powered randomized controlled trial (n = 288) to demonstrate its efficacy and maintenance in reducing behavior problems and increasing infant regulation relative to an enhanced pediatric primary care active control condition. Based on work by the current investigative team and others, we also will examine the mediating role of changes in parenting behavior and the moderating role of parental distress on intervention outcome. Rather than focus exclusively on whether the effect of the intervention can be produced, an important step in further developing the evidence base in prevention science is to examine how and for whom indicated preventive interventions work. The proposed work is consistent with the research priorities of the Child Development and Behavior Branch (CDBB) of the NICHD to investigate the impact of a behavioral promotion intervention in pediatric primary care and identify developmental factors and mechanisms which promote short- and long-term psychosocial adjustment for children exposed to high-risk family and neighborhood environments. In light of the extensive needs and depleting resources faced by low-income and underrepresented minority families, the proposed work provides a unique opportunity to help promote optimal behavioral functioning and reduce the risk for psychopathology in infants from the most vulnerable families.