Intervening Early: Key Adolescent Outcomes

Study Overview
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Brief Summary
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This study follows children into adolescence who were first randomized to intervention condition in infancy.

Detailed Description
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Parents serve as co-regulators for their young children, helping them regulate behaviors, emotions, and physiology and supporting the development of healthy brain circuitry. Neglecting parents often fail to serve as co-regulators, which has implications for young children's self-regulatory capabilities and brain development. As children become older, these difficulties with self-regulation may become more pronounced. Adolescence represents a period of particular vulnerability for the emergence of mental health problems because of increasing demands for regulation of emotions and behaviors, coupled with on-going development of neural circuits that support emotional and behavioral regulation. The Attachment and Biobehavioral Catch-up (ABC) intervention was designed to help parents learn to interact in responsive and sensitive ways, with the expectation that children would show enhanced ability to regulate behavior, emotions, and physiology. The efficacy of the ABC intervention among parents involved with Child Protective Services (CPS) was assessed. Parents were randomized to ABC or to a control intervention. Children were followed at T1 (ages 1-4) and T2 (ages 8-10). At T1, more of the children in the ABC group developed secure and organized attachments than children in the DEF group, and children in ABC showed more normative production of cortisol, less expression of negative emotions, and poorer inhibitory control than children in DEF. ABC parents were more sensitive and showed more optimal neural activity than DEF parents. At T2, ABC children showed greater prefrontal cortex activation in response to threat than DEF children, suggesting better regulation to threat at the level of brain activation. Also at T2, children in the ABC group reported more secure relationships with parents, and showed more normative cortisol production and more optimal autonomic nervous system functioning than DEF children. In adolescence, the ABC intervention is expected to result in enhanced brain circuitry and more optimal functioning across domains as assessed at multiple levels of analysis relative to the control intervention. In the proposed study, behavioral and neurobiological development among 13-, 14- and 15-year-old adolescents whose parents were referred by CPS to a randomized controlled trial in infancy (n=120), and among low-risk adolescents followed since middle childhood (n=80) will be assessed.

Official Title
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Intervening Early With Neglected Children: Key Adolescent Outcomes

Conditions
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Depressive Symptoms, Conduct Disorder, Anxiety Disorders

Intervention / Treatment
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* Behavioral: Attachment and Biobehavioral Catch-up (ABC)
* Behavioral: Developmental Education for Families (DEF)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must have been included in middle childhood data collection Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: Families randomized to Attachment and Biobehavioral Catch-up (ABC) or to a control intervention (DEF)
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Attachment and Biobehavioral Catch-up (ABC)<br>10 sessions that focused on parental nurturance, and sensitivity | Behavioral: Attachment and Biobehavioral Catch-up (ABC)<br>* Manualized intervention implemented in home with parent and child present focused on parental responsiveness<br>|
| Active Comparator: Developmental Education for Families (DEF)<br>10 sessions that focused on cognitive development | Behavioral: Developmental Education for Families (DEF)<br>* Manualized intervention implemented in home with parent and child present focused on parental enhancement of child learning<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Brain activation in Stop Signal Task | Prefrontal cortex activation assessed through functional magnetic resonance imaging (fMRI) in task requiring inhibitory control | Child age 13 years | 
| Brain activation in Mother-Stranger Task | Functional connectivity assessed through fMRI when viewing photos of mothers vs. strangers | Age 13 years | 
| Brain activation in Mother-Stranger Task | Functional connectivity assessed through fMRI when viewing photos of mothers vs. strangers | Age 15 years | 
| Brain activation in Emotion Go/Nogo task | Functional connectivity between amygdala and PFC assessed through fMRI in an emotion go/no go task | Age 13 years | 
| Brain activation in Emotional Reappraisal Task | Functional connectivity between amygdala and PFC assessed through fMRI in emotional reappraisal task | Age 14 years | 
| Brain activation in Emotion Go/Nogo task | Functional connectivity between amygdala and PFC assessed through fMRI in an emotion go/no go task | Age 15 years | 
| Trier Social Stress Test- Cortisol | Participants will be met by two research assistants (one male, one female), whom they have not met previously. The research assistants will tell the participants that they will have 5 minutes to prepare a speech which they will give to the researchers who will rate the speech. Participants will then give their speeches for 5 minutes; the research assistants will maintain neutral expressions and provide no feedback. Afterwards, participants will be asked to do (age-adjusted) mental arithmetic aloud (Buske-Kirschbaum et al.,1997). For the purpose of assessing cortisol, investigators will collect saliva samples before and after the speech/math. | Age 13 years | 
| Trier Social Stress Test-ANS | Participants will be met by two research assistants (one male, one female), whom they have not met previously. The research assistants will tell the participants that they will have 5 minutes to prepare a speech which they will give to the researchers who will rate the speech. Participants will then give their speeches for 5 minutes; the research assistants will maintain neutral expressions and provide no feedback. Afterwards, participants will be asked to do (age-adjusted) mental arithmetic aloud (Buske-Kirschbaum et al.,1997).Assess child autonomic nervous system regulation, examine reactivity from baseline in RSA. | Age 13 years | 
| Revealed differences task - parent sensitivity. | Parents and children engage in conflict discussion. Assess parental sensitivity using Sensitivity scale. Parental behavior is scored on a 1-7 scale, with higher scores reflecting greater sensitivity. | Age 13 years | 
| Support task- parent sensitivity | Parents and children engage in support discussion (discussing Trier task from previous year). Assess parental sensitivity using Sensitivity scale. Parental behavior is scored on a 1-7 scale, with higher scores reflecting greater sensitivity. | Age 14 years | 
| Revealed differences task- parent sensitivity | Parents and children engage in conflict discussion. Assess parental sensitivity using Sensitivity scale. Parental behavior is scored on a 1-7 scale, with higher scores reflecting greater sensitivity. | Age 15 years | 
| Revealed differences task-adolescent competence | Parents and children engage in conflict discussion. Assess child competence in discussion on Competence scale. Competence is scored on a 1-7 scale, with higher scores reflecting greater competence. | Age 13 years | 
| Support task-adolescent competence | Parents and children engage in conflict discussion. Assess child competence in discussion on Competence scale. Competence is scored on a 1-7 scale, with higher scores reflecting greater competence. | Age 14 years | 
| Revealed differences task-adolescent competence | Parents and children engage in conflict discussion. Assess child competence in discussion on Competence scale. Competence is scored on a 1-7 scale, with higher scores reflecting greater competence. | 15 years of age. | 
| Revealed differences task-adolescent ANS | The control of cardiac functions via the vagal nerve, or vagal tone, is an index of parasympathetic activity. It can be measured by heart rate variability associated with respiration or high frequency respiratory sinus arrhythmia (RSA). RSA data will be collected continuously throughout the parent-child interaction using a MindWare Portable Lab system. Greater changes in RSA from baseline to discussion considered preferable. Parents and children engage in conflict discussion. Assess child autonomic nervous system regulation. Respiratory sinus arrhythmia (RSA) will be measured as a rise from baseline. | 13 years of age. | 
| Support task-adolescent ANS | The control of cardiac functions via the vagal nerve, or vagal tone, is an index of parasympathetic activity. It can be measured by heart rate variability associated with respiration or high frequency respiratory sinus arrhythmia (RSA). RSA data will be collected continuously throughout the parent-child interaction using a MindWare Portable Lab system. Greater changes in RSA from baseline to discussion considered preferable. | 14 years of age. | 
| Revealed differences task-adolescent ANS | The control of cardiac functions via the vagal nerve, or vagal tone, is an index of parasympathetic activity. It can be measured by heart rate variability associated with respiration or high frequency respiratory sinus arrhythmia (RSA). RSA data will be collected continuously throughout the parent-child interaction using a MindWare Portable Lab system. Greater changes in RSA from baseline to discussion considered preferable. | 15 years of age. | 
| Balloon Analogue Risk Task (BART) | This task assesses risk-taking through a computer game in which participants see a balloon on the computer screen and have the option of pumping up the balloon more, and therefore increasing its monetary value, or stopping and collecting the value of the balloon. If the balloon pops on a pump, then all of the value of the balloon is lost and the next trial begins. There is a randomly, pre-determined probability of the balloon popping on any given pump of each trial. A brief version of the task with 15 balloons will be used. A running tally of participants' total monetary gain is kept (and can range from $0 up to a cap of $5). The amount of money earned is the score, with more money reflecting higher risk taking. | 13 years of age | 
| Delay Discounting | Delay Discounting Task is a brief, five-item task on a computer that asks participants their preference between $5 now and $10 at some later time point (Koffarnus, Warren, & Bickel, 2014). No money is actually earned on this task. A score from 0 to 5 is received with lower score indicating better delay (preferred). | 13 years of age | 
| Delay Discounting | Delay Discounting Task is a brief, five-item task on a computer that asks participants their preference between $5 now and $10 at some later time point (Koffarnus, Warren, & Bickel, 2014). No money is actually earned on this task. A score from 0 to 5 is received with lower score indicating better delay (preferred). | 15 years of age | 
| Child Depression | Child Depression Inventory-Short Version (CDI-S): A 10-item measure that screens for depression (Kovacs, 2010). Scores can range from 0-24, with higher scores reflecting greater depression. | 13 years of age | 
| Child Depression | Child Depression Inventory-Short Version (CDI-S): A 10-item measure that screens for depression (Kovacs, 2010). Scores can range from 0-24, with higher scores reflecting greater depression. | 14 years of age | 
| Child Depression | Child Depression Inventory-Short Version (CDI-S): A 10-item measure that screens for depression (Kovacs, 2010). Scores can range from 0-24, with higher scores reflecting greater depression. | 15 years of age | 
| Child problem behaviors | Child Behavior Checklist (CBCL): Parents will complete the 113 items from the CBCL to assess adolescents' internalizing and externalizing symptoms (Achenbach et al., 2001). Raw scores range from 0-240. Higher scores reflect greater problems. | 13 years of age | 
| Child problem behaviors | Child Behavior Checklist (CBCL): Parents will complete the 113 items from the CBCL to assess adolescents' internalizing and externalizing symptoms (Achenbach et al., 2001). Raw scores range from 0-240. Higher scores reflect greater problems. | 14 years of age | 
| Child problem behaviors | Child Behavior Checklist (CBCL): Parents will complete the 113 items from the CBCL to assess adolescents' internalizing and externalizing symptoms (Achenbach et al., 2001). Raw scores range from 0-240. Higher scores reflect greater problems. | 15 years of age | 
| Adolescent substance use | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more substance use, with a possible range of 21-98. | 13 years of age | 
| Adolescent substance use | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more substance use, with a possible range of 21-98. | 14 years of age | 
| Adolescent substance use | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more substance use, with a possible range of 21-98. | 15 years of age | 
| Adolescent risky behaviors | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more risky problems, with a possible range of 8-28. | 13 years of age | 
| Adolescent risky behaviors | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more risky problems, with a possible range of 8-28. | 14 years of age | 
| Adolescent risky behaviors | Adolescents will complete the Youth Risk Behavior Survey. Higher scores reflect more risky problems, with a possible range of 8-28. | 15 years of age | 
| Mini-International Neuropsychiatric Interview for Children and Adolescents | Psychiatric interview. Higher scores reflect more psychiatric symptoms, with a range of 0-8. | 13 years of age | 
| Mini-International Neuropsychiatric Interview for Children and Adolescents | Psychiatric interview. Higher scores reflect more psychiatric symptoms, with a range of 0-8. | 14 years of age | 
| Emotional Regulation Questionnaire | Assesses how effectively adolescents regulate or control emotions. Higher scores reflect better regulation. Scores range from 10-50. | 14 years of age |