Internet Treatment for Behavior Problems in Preschoolers with Developmental Delay

 描述（由申请人提供）：儿童早期发育迟缓（DD）使幼儿及其家庭面临各种问题的高风险。除了定义幼儿未能达到预期发育里程碑的各种语言，认知和运动缺陷外，患有DD的幼儿存在严重行为问题的重大风险，他们的家庭面临非常高的压力。许多受影响的儿童来自少数民族和种族背景，更有可能生活在贫困中，并依赖政府服务，例如通过残疾人和教育法（IDEA）C部分的早期干预（EI）。尽管与EI承诺，这些服务通常集中在延迟，而不是相关的行为问题，是显着和因果关系与功能和学术成果。此外，教育融入服务在3岁时结束，随后的干预措施只能通过学校特殊教育，通过《教育融入发展倡议》的B部分接受。家庭服务方面的这种差距对于生活贫困的儿童以及来自少数民族和种族群体的儿童来说尤其成问题，因为对他们来说，交通和其他服务障碍相当大，诊所治疗可能不太可行。此外，许多受影响的家庭报告说，儿童服务太远，许多人表示，他们没有办法去诊所。受过循证方案培训的专业人员数量不足，影响了护理的可用性，因为美国相当一部分县没有心理学家，精神病学家或社会工作者。因此，这一新的和早期的研究者发起的R 01申请建议建立在研究者进行的广泛的试点工作的基础上，通过随机对照试验，评估互联网提供的父母培训计划在传统上服务不足的DD幼儿中的破坏性行为问题的增量效用。居住在农村或贫困地区的家庭可以远程参与实时治疗，无论其地理位置是否靠近诊所或是否有能力前往服务。此外，在自然环境中对待家庭（即，在儿童行为有问题的环境中，通过向父母提供现场观察和反馈，可以加强护理的生态有效性。具体来说，我们感兴趣的是互联网提供的亲子互动治疗（I-PCIT）对儿童破坏性行为问题，父母的做法，父母的痛苦，和早期的学术技能相对于传统的转介照常（RAU）的影响。 在C部分EI服务之外的青年老化问题。第二个目标是评估机制，解释在何种情况下，为谁，并通过哪些调解途径I-PCIT是最有效的幼儿DD。技术创新克服了传统的障碍，有效地照顾传统上服务不足的人口，并提出了一个显着的公共卫生影响的服务不足的人口的幼儿和他们的家庭老化的C部分EI服务。

 DESCRIPTION (provided by applicant): Early childhood developmental delay (DD) places young children and their families at elevated risk for a variety of problems. In addition to the various language, cognitive, and motor deficits that define young children failing to reach expected developmental milestones, young children with DD are at significant risk for serious behavior problems, and their families are at risk for very high levels of stress. Many affected children are from ethnic and racial minority backgrounds and are more likely to live in poverty and rely on government services, such as Early Intervention (EI) via Part C of the Individuals with Disabilities and Education Act (IDEA). Despite promise with EI, these services typically focus on the delay rather than associated behavior problems that are significantly and causally linked with functional and academic outcomes. Furthermore, EI services end at 3 years, and subsequent interventions can only be received through Part B of the IDEA through school-based special education. This gap in family-based services can be especially problematic for children living in poverty and from ethnic and racial minority groups for whom transportation and other barriers to services are considerable and clinic-based treatments may not be as feasible. Moreover, substantial numbers of affected families report children's services are too far away, and many indicate that they have no way to get to a clinic. Inadequate numbers of professionals trained in evidence-based programs impinge on the availability of care, as a considerable proportion of U.S. counties have no psychologist, psychiatrist, or social worker. Therefore, this new and early investigator-initiated R01 application proposes to build on extensive pilot work conducted by the investigators to evaluate, via a randomized controlled trial, the incremental utility of an Internet-delivered parent-training program for disruptive behavioral problems in traditionally underserved young children with DD. Families dwelling in rural or impoverished regions can participate in real-time treatment remotely, regardless of their geographic proximity to a clinic or ability to transport to services. Moreover, treating families within their natural settings (i.e., their homes) may enhance the ecological validity of care by providing live observation and feedback to parents in the very settings in which child behaviors are problematic. Specifically, we are interested in the impact of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) on child disruptive behavior problems, parenting practices, parental distress, and early academic skills relative to traditional referrals as usual (RAU) for behavioral problems among youth aging out of Part C EI services. A secondary goal is to evaluate mechanisms that explain under which circumstances, for whom, and through which mediating pathways I-PCIT is most effective for young children with DD. Technological innovations overcome traditional barriers to effective care for traditionally underserved populations and are proposed to have a significant public health impact on the underserved population of young children and their families aging out of Part C EI services.