Technological advances in medical care have increased the survival of very preterm infants (VPT; <32 gestational weeks). However, there is converging evidence of cascading disruption to neurological development resulting from VPT birth. Findings consistently link atypical neurological development in VPT infants with lasting mental health problems in the broader VPT population. Specifically, atypical white matter and grey matter development in VPT infants predict developmental deficit in self-regulation that are linked to later to emerge psychopathology of Attention-Deficit/Hyperactivity Disorder and clinical rates of internalizing and externalizing behavioral problems in VPT children. Innovation is urgently needed to treat neurological and psychiatric diseases in the growing VPT population. The proposed research will test a promising treatment solution. Our prior work has identified parental responsiveness as a modifiable psychological variable with the potential to improve VPT child neurodevelopmental outcomes through our highly effective parenting intervention. Two significant barriers limit implementation of parenting interventions in the clinical setting. First, parenting programs are often considered un-scalable because the most effective parenting interventions are home-based and thus expensive to implement. Second, the potential benefit of increased responsive caregiving to VPT childhood brain development is unclear because this possibility has never been evaluated via clinical trial, making it unknown how increasing responsiveness drives child outcome. In the context of a randomized controlled trial, the proposed study will overcome these barriers by: 1) Testing if participation in a scalable web-based intervention to increase responsive parenting results in more normative brain development and improved self-regulation in toddlers born VPT. 2) Testing if the acting mechanism of any behavioral and neuroanatomic alteration resulting from intervention is mediated by improvements in parent responsiveness. To accomplish these objectives, parents of VPT children (age 15-28-months) will be randomized to a web- based parenting intervention or an active control condition. During intervention one-on-one instruction will be provided via videoconferencing to increase parent responsiveness behaviors and support personal reflection on how to adapt newly acquired responsiveness behaviors to their child?s changing developmental level. We will collect pre- and post-intervention assessments to evaluate: 1) parental responsiveness behaviors, 2) VPT child behavioral outcomes and 3) VPT child neurological outcomes utilizing EEG to measure neural functioning and MRI to measure structural connectivity. This research applies neuroimaging methodologies in a novel way: by leveraging the inherent neuroplasticity of the brain in early childhood to identify intervention related effects on brain maturation and function. Findings from this study could result in a paradigm shift that includes interventions focusing on the parent as an active participant in their child?s developmental success.

Public Health Relevance

Preterm infants are at high risk of brain injury and there is increasing awareness of a link between neurological injury associated with prematurity and later-to-emerge psychopathology associated with self-regulatory deficits including Attention-Deficit/Hyperactivity Disorder and clinical levels of internalizing and externalizing behaviors. Based on our research and findings of other independent investigations, we have isolated parental responsiveness as a modifiable environmental factor that may normalize trajectories of neurological development with strong implications for improving short- and long-term mental health outcomes for children born preterm. Utilizing a scalable parenting intervention, conducted over the internet, the proposed research will address a paucity of data in this area by providing a benchmark for identifying if parental responsiveness is a modifiable psychosocial factor that improves neurodevelopmental outcomes and brain connectivity in children born preterm, thus directly advancing the NICHD?s mission to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Esposito, Layla E
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University of Texas Health Science Center Houston
Schools of Medicine
United States
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