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1.  An Initial Investigation of Baseline Respiratory Sinus Arrhythmia as a Moderator of Treatment Outcome for Young Children Born Premature with Externalizing Behavior Problems 
Behavior therapy  2012;43(3):652-665.
The aim of the current study was to examine the moderating effect of baseline respiratory sinus arrhythmia (RSA) on Parent-Child Interaction Therapy (PCIT), a behavioral parent-training intervention, for young children born premature. In this pilot randomized controlled trial, 28 young children (mean age of 37.79 months), who were born < 37 weeks gestation and presented with elevated externalizing behavior problems, were randomly assigned to an immediate treatment or waitlist control group. RSA, which provides an approximate marker of individual differences in cardiac vagal tone, was measured during a baseline period. Past research has generally shown that higher levels of baseline RSA correlate with various positive psychological states (e.g., empathy, sustained attention), whereas lower levels of baseline RSA correlate with less optimal psychological states (e.g., higher externalizing behavior problems). Results indicated that baseline RSA significantly interacted with treatment condition in predicting changes in child disruptive behavior. Specifically, low levels of baseline RSA were associated with greater improvements in child disruptive behavior following PCIT. While acknowledging the caveats of measuring and interpreting RSA and the need to include a sympathetic-linked cardiac measure in future research, these findings provide preliminary evidence that children with lower capacity for emotion regulation receive even greater treatment gains. Future research should also examine the moderating effect of RSA in larger samples and explore the potential mediating role of RSA on behavioral parenting interventions.
doi:10.1016/j.beth.2011.12.002
PMCID: PMC3475510  PMID: 22697452
respiratory sinus arrhythmia; emotion regulation; prematurity; behavior problems; behavioral parent training
2.  Evidence-Based Intervention for Young Children Born Premature: Preliminary Evidence for Associated Changes in Physiological Regulation 
Infant behavior & development  2012;35(3):417-428.
The current study examined whether changes in maternal behaviors following an evidence-based treatment—Parent Child Interaction Therapy (PCIT)—was associated with improvements in cardiac vagal regulation in young children born premature. Participants included 28 young children (mean age = 37.79 months) that were born premature and presented with elevated externalizing behavior problems. To assess cardiac vagal regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA change (withdrawal or suppression) to a clean-up task were derived pre and post-treatment. Results indicated that an increase in behaviors mothers are taught to use during treatment (i.e., do skills—praise, reflection, and behavioral descriptions) were associated with an improvement in children’s post-treatment RSA suppression levels. The current study illustrates the important role of caregiver behavior in promoting physiological regulation in children born premature.
doi:10.1016/j.infbeh.2012.04.001
PMCID: PMC3409342  PMID: 22721742
cardiac vagal regulation; RSA suppression; emotion regulation; prematurity; child; parent training
3.  Effect of Maternal Depression on Child Behavior: A Sensitive Period? 
Objective
The purpose of this study was to examine the effect of maternal depression during the child’s first year of life (i.e., sensitive period) on subsequent behavior problems.
Method
Participants were 175 mothers participating in the Oregon Adolescent Depression Project (OADP) who met lifetime diagnostic criteria for major depressive disorder (MDD) and completed the child behavior checklist (CBCL) for their first child at some point during the child’s first 12 years (mean = 4.91 years).
Results
Regression analyses indicated that MDD in the sensitive period was a significant predictor of internalizing and total problems scores on the CBCL while controlling for several demographic variables (e.g., child and mother age, child gender). Maternal depression prior to pregnancy and during the prenatal period did not significantly predict later child behavior problems, suggesting the effect was not driven by the presence of previous MDD and was specific to the first year of life.
Conclusions
Presence of maternal MDD during a child’s first year of life represents a sensitive period and increases the risk of adverse child outcome. The findings suggest the importance of identification, prevention, and early intervention. Future studies should examine these findings in more diverse, heterogeneous samples.
doi:10.1016/j.jaac.2010.03.012
PMCID: PMC2901251  PMID: 20610139
child behavior problems; maternal depression; sensitive period
4.  Evidence-Based School Behavior Assessment of Externalizing Behavior in Young Children 
This study examined the psychometric properties of the Revised Edition of the School Observation Coding System (REDSOCS). Participants were 68 children ages 3 to 6 who completed parent-child interaction therapy for Oppositional Defiant Disorder as part of a larger efficacy trial. Interobserver reliability on REDSOCS categories was moderate to high, with percent agreement ranging from 47% to 90% (M = 67%) and Cohen’s kappa coefficients ranging from .69 to .95 (M = .82). Convergent validity of the REDSOCS categories was supported by significant correlations with the Intensity Scale of the Sutter-Eyberg Student Behavior Inventory-Revised and related subscales of the Conners’ Teacher Rating Scale-Revised: Long Version (CTRS-R: L). Divergent validity was indicated by nonsignificant correlations between REDSOCS categories and scales on the CTRS-R: L expected not to relate to disruptive classroom behavior. Treatment sensitivity was demonstrated for two of the three primary REDSOCS categories by significant pre to posttreatment changes. This study provides psychometric support for the designation of REDSOCS as an evidence-based assessment procedure for young children.
doi:10.1353/etc.0.0084
PMCID: PMC3116723  PMID: 21687781
evidence-based assessment; school observation; disruptive behavior; psychometrics; parent-child interaction therapy; preschool children
5.  A Preliminary Study of Cortisol Reactivity and Behavior Problems in Young Children Born Premature 
Developmental psychobiology  2010;52(6):574-582.
The purpose of the present study was to examine the relation between cortisol reactivity and comorbid internalizing and externalizing behavior problems among children born premature. Children between the ages of 18 and 60 months who were born < 37 weeks gestation and presented with clinically significant externalizing behavior problems were included. Children were categorized based on those who mounted a cortisol response to a stressor and those who did not mount a cortisol response. Children demonstrating the cortisol response were reported to have more problems with attention, emotional reactivity, anxiety, and depression based on maternal report and displayed higher rates of negative verbalizations during a mother-child interaction than children without a cortisol response. These results extend the findings of the relation between cortisol reactivity and comorbid internalizing and externalizing behavior problems to a sample of children born premature.
doi:10.1002/dev.20464
PMCID: PMC2933079  PMID: 20806330
cortisol; prematurity; behavior problems; stress; assessment
6.  Infant Neurobehavioral Dysregulation Related to Behavior Problems in Children with Prenatal Substance Exposure 
Pediatrics  2009;124(5):1355-1362.
OBJECTIVE
To test a developmental model of neurobehavioral dysregulation relating prenatal substance exposure to behavior problems at age 7.
PATIENTS AND METHODS
The sample included 360 cocaine-exposed and 480 unexposed children from lower to lower middle class families of which 78% were African American. Structural equation modeling (SEM) was used to test models whereby prenatal exposure to cocaine and other substances would result in neurobehavioral dysregulation in infancy, which would predict externalizing and internalizing behavior problems in early childhood. SEM models were developed for individual and combined parent and teacher report for externalizing, internalizing, and total problem scores on the Child Behavior Checklist.
RESULTS
The Goodness of Fit Statistics indicated that all of the models met criteria for adequate fit with 7 of the 9 models explaining 18 to 60% of the variance in behavior problems at age 7. The paths in the models indicate that there are direct effects of prenatal substance exposure on 7-year behavior problems as well as indirect effects, including neurobehavioral dysregulation.
CONCLUSIONS
Prenatal substance exposure affects behavior problems at age 7 through two mechanisms. The direct pathway is consistent with a teratogenic effect. Indirect pathways suggest cascading effects where prenatal substance exposure results in neurobehavioral dysregulation manifesting as deviations in later behavioral expression. Developmental models provide an understanding of pathways that describe how prenatal substance exposure affects child outcome and have significant implications for early identification and prevention.
doi:10.1542/peds.2008-2898
PMCID: PMC2874881  PMID: 19822596
Prenatal substance exposure; cocaine; neurobehavioral dysregulation; behavior problems
7.  Parenting Intervention for Externalizing Behavior Problems in Children Born Premature: An Initial Examination 
Objective
To examine the initial efficacy of parent-child interaction therapy (PCIT) for treating behavior problems in young children who were born premature.
Method
In this randomized, controlled trial, 28 children between the ages of 18 and 60 months, who were born <37 weeks gestation and presented with clinically significant externalizing behavior problems, were randomly assigned to an immediate treatment (IT) or waitlist (WL) control group.
Results
After 4 months, children who received PCIT were reported by their mother to have less attention problems, aggressive behaviors, and externalizing and internalizing behavior problems, and they were observed to be more compliant to maternal commands than children in the WL group. In addition, mothers in the IT group interacted more positively with their child, reported lower parenting stress related to difficult child behavior and demonstrated improved parenting practices compared with WL mothers. Behavior change maintained for 80% of the IT children 4 months after treatment completion.
Conclusions
This study demonstrates preliminary efficacy of PCIT for the treatment of behavior problems in young children who were born premature.
doi:10.1097/DBP.0b013e3181d5a294
PMCID: PMC2866142  PMID: 20375736
parent-child interaction therapy; behavior problems; prematurity
8.  The Effect of Parenting Stress on Child Behavior Problems in High-Risk Children with Prenatal Drug Exposure 
Objective
To examine the relationship between early parenting stress and later child behavior in a high risk sample and measure the effect of drug exposure on the relationship between parenting stress and child behavior.
Methods
A subset of child-caregiver dyads (n = 607) were selected from the Maternal Lifestyle Study, which is a large sample of children (n = 1388) with prenatal cocaine exposure and a comparison sample unexposed to cocaine. Of the 607 dyads, 221 were prenatally exposed to cocaine and 386 were unexposed to cocaine. Selection was based on the presence of a stable caregiver at 4 and 36 months with no evidence of change in caregiver between those time points.
Results
Parenting stress at 4 months significantly predicted child externalizing behavior at 36 months. These relations were unaffected by cocaine exposure suggesting the relationship between parenting stress and behavioral outcome exists for high-risk children regardless of drug exposure history.
Conclusions
These results extend the findings of the relationship between parenting stress and child behavior to a sample of high-risk children with prenatal drug exposure. Implications for outcome and treatment are discussed.
doi:10.1007/s10578-008-0109-6
PMCID: PMC2861499  PMID: 18626768
disruptive behavior; parenting stress; high-risk children; prenatal drug exposure; cocaine
9.  Parent-Child Interaction Therapy for Children Born Premature: A Case Study and Illustration of Vagal Tone as a Physiological Measure of Treatment Outcome 
Cognitive and behavioral practice  2009;16(4):468-477.
Evidence-based psychosocial interventions for externalizing behavior problems in children born premature have not been reported in the literature. This single-case study describes Parent-Child Interaction Therapy (PCIT) with a 23-month-old child born at 29 weeks gestation weighing 1,020 grams, who presented with significant externalizing behavior problems. Treatment outcome was assessed using standard measures of maternal and child functioning and observational measures of the parent-child interaction, as well as a physiological measure of heart rate variability (i.e., vagal tone) used to assess parasympathetic control in the child. Maternal reports of child behavior problems and their own stress and depressive symptoms decreased after treatment. Behavioral observations demonstrated improved parenting practices and child compliance, and vagal tone showed comparable increases as well. Results suggest that PCIT is a promising psychosocial intervention for children born premature with externalizing behavior problems, and that vagal tone may be a useful measure of treatment outcome.
doi:10.1016/j.cbpra.2009.05.002
PMCID: PMC2860291  PMID: 20428470

Results 1-9 (9)