Laura L. McIntyre, Ph.D. - US grants

DESCRIPTION (provided by applicant): Individuals with mental retardation/developmental disabilities (MR/DD) are 3-4 times more likely to develop a behavior problem or mental health disorder (BP/MH) than typically developing individuals, placing them at risk for a number of negative outcomes (e.g., social isolation, vocational difficulties). Some evidence suggests that these behavior problems begin in early childhood and negatively impact parents. Left untreated, children are at risk for developing a behavior disorder or mental illness, which places significant burden on caregivers and increases the likelihood of out-of-home placement or costly treatment. The proposed study will utilize parent training as an early intervention (secondary prevention) technique with forty parents with young children (2-4 years) with mild/moderate developmental delay. A randomized, treatment / control design is proposed. The Incredible Years Basic Parent Training Early Childhood series (IYBPT; Webster-Stratton, 1984, 1994) will be used as the intervention. This intensive 12- week intervention utilizes group discussion (8-12 parents per group) and videotape vignettes to target four curricular areas: child play, praise, rewards, and effective limit setting. The IYBPT series has been demonstrated to be efficacious in decreasing behavior problems in typically developing children. Furthermore, the Principal Investigator has successfully pilot tested this intervention approach with parents who have young children with developmental delay. Preliminary evidence from pilot data (N=13) suggest initial feasibility, acceptability, and efficacy in terms of reducing negative parent-child interactions and decreasing parent-reported stress. This proposed study will build on the initial pilot work and use a pre-, post treatment/ control design to: (1) utilize the IYBPT - Early Childhood series with caregivers who have young children (2-4 years) with developmental delay, (2) test the efficacy of the IYBPT in reducing child behavior problems and decreasing inappropriate/negative parent-child interactions, (3) explore the potential for parent training to reduce parent stress, daily hassles, and caregiver depression, often implicated in the development of psychopathology in children, and (4) decrease the risk of future behavior problems in this group by focusing on increasing parenting competence.

DESCRIPTION (provided by applicant): The revised application proposes a 5-year study examining the effects of a group-based parent training program as early intervention (secondary prevention) with 200 parents with preschool children who have mild/moderate developmental disabilities. The efficacy of the Incredible Years Parent Training series (IYPT;Webster-Stratton, 1984, 1994) with developmental disabilities modifications (IYPT-DD;McIntyre, 2008a, 2008b) will be compared with treatment as usual. The IYPT-DD is an intensive 12-week group-based intervention (2.5 hours per week) that uses group discussion and videotape vignettes to target 5 curricular areas: child play, praise, rewards, effective limit setting, and handling challenging behavior. The treatment as usual condition will include individual child and family services afforded to children with developmental disabilities in preschool and community settings. The IYPT series has been demonstrated to be efficacious for decreasing behavior problems in typically developing children (Webster-Stratton, 1984, 1994);however, this approach has not been fully investigated with families of young children with developmental disabilities, who are also at risk for significant problem behavior. The PI has successfully pilot tested this intervention with DD modifications with parents who have preschool-age children with developmental disabilities. Preliminary evidence from a funded R03 grant suggests feasibility, acceptability, and efficacy in terms of reducing child behavior problems and negative parent-child interactions (McIntyre, 2008a, 2008b;McIntyre &Phaneuf, 2007;Phaneuf &McIntyre, 2007). This proposed study will build on the initial pilot work and use a longitudinal design and randomized controlled trial to test the efficacy of IYPT-DD for (a) reducing child maladaptive behavior and increasing child adaptive behavior immediately posttreatment and at 6-month, 12-month, and 18-month follow- up assessments;(b) reducing inappropriate/negative parent-child interactions, increasing positive parenting practices, and increasing parental competence and self-efficacy immediately posttreatment and at 6-month, 12-month, and 18-month follow-up assessments;(c) increasing adaptation to school as measured by teacher assessments of children's early sociobehavioral adjustment in kindergarten;(d) determining if changes in child maladaptive and adaptive behavior are a function of changes in parenting behavior;and (e) determining if contextual influences, such as parenting stress, maternal depression, and partner support/relationship quality, moderate child outcomes. Advancements in multivariate data analysis, such as general growth mixture modeling, will be used to study the environmental factors associated with the formation of adaptive and maladaptive developmental trajectories, as well as to determine the efficacy of the parent intervention relevant to altering those trajectories. Economic analyses, including cost analysis, benefit-cost analysis, and cost- effectiveness analysis, will be used to determine the impact of the intervention relative to cost burden and determine the feasibility of uptake in community settings. PUBLIC HEALTH RELEVANCE: This study examines the hypothesis that a 12-week, group-based parent training program, Incredible Years Parent Training with Developmental Disabilities modifications (IYPT-DD;McIntyre, 2008a, 2008b) can be used with parents of preschool children with developmental disabilities and can reduce child maladaptive behavior, increase adaptive behavior, promote positive parenting practices, and promote early adjustment in school. The intervention, if successful, could be cost-effectively implemented across the United States within early education and health delivery systems. The study will also significantly contribute to our understanding of the emergence of childhood behavior disorders and mental health problems in both boys and girls with developmental disabilities.

Project Summary/Abstract Developmental delay (DD) describes the heterogeneous symptoms associated with delay in one or more key aspects of development, including physical, cognitive, communication, social/emotional, and adaptive development. DD is associated with specific diagnoses, such as autism spectrum disorder (ASD), and with global delay or intellectual disability. In some cases the etiology of the delay is known, whereas in other cases, etiology is unknown. The heterogeneity of DD poses problems for identifying underlying mechanisms that may inform intervention and could set them on an optimal trajectory for success and recovery. Although there is significant focus on ASD specifically, many children are first served through early intervention under the broad diagnostic umbrella of DD. Unfortunately, little is known about brain mechanisms or clinical phenotypes associated with shared etiologies in DD, due mainly to the technical challenges of characterizing children at a young age, both behaviorally and with neuroimaging. However, technological advances in both acquisition and denoising of functional connectivity (FC) data may now provide an opportunity to explore these processes in situ. The overarching aim of the proposed study is to explore shared neurobiological etiology in DD and ASD by examining clinical and neurobehavioral indicators, including resting-state fMRI and child clinical outcomes. This proposed research will build on the strengths of our lab by studying two cohorts of children with disabilities, including DD and ASD, that we recruited in early childhood and are following longitudinally. These 255 children in our study cohorts are now in middle childhood. Middle childhood is a time of significant brain changes, including the initiation of large structural changes, such as myelination and synaptic pruning [17, 2], putatively critical in the pathophysiology of ASD [18?20]. Preliminary data from 34 5- and 6-year old children with DD strongly demonstrate the feasibility of our approach and our ability to successfully scan young children with DD and ASD. In the proposed research we will recruit 120 children from our existing cohorts (N = 80 DD; N = 40 ASD) and characterize their clinical and neuropsychological functioning and examine FC through resting-state fMRI. We will apply a recent denoising pipeline [25] from the Human Connectome Project (HCP) to minimize motion-related artifacts in resting-state scans with an admittedly challenging cohort in order to test our hypotheses of shared and unique neurobiological etiology of DD and ASD. Although there is little consensus about the best approach for minimizing micromovements in FC data, this exploratory project will quantify and test the effect of motion. Further, this project is specifically designed to provide extensive open data sharing of all the data that are acquired, so that other novel pipelines could replicate or extend this work readily. If successful, this work could provide novel intervention targets for treatment of DD and provide a roadmap for characterizing children during this critical time period.

7. Project Summary/Abstract This application builds on our previous intervention work (e.g., McIntyre, 2008a, 2008b, 2013; McIntyre & Neece, 2016; Neece, 2014) and proposes a longitudinal intervention study of 230 preschool-age children (ages 3?5 years) with developmental delays (DD). Behavior problems and co-occurring parenting stress are common problems in children with DD and their families. High levels of parental stress are associated with reduced response to behavioral interventions for children with DD; yet, parenting stress is almost never directly addressed in these treatments (McIntyre & Neece, 2016). The proposed study will test the benefit of addressing parental stress prior to delivering behavioral parent training (BPT) in order to more effectively reduce child behavior problems once the intervention is delivered, as well as investigate the mechanisms through which intervention outcomes occur. The study design will use a cross-site randomized, controlled trial (RCT) of standard behavioral parent training with psychoeducation (BPT-E) compared with behavioral parent training plus mindfulness-based stress reduction (BPT-M). The sample will be drawn from Lane County, Oregon, and the Inland Empire in Southern California. All families will participate in home and laboratory assessments at baseline and home assessments immediately posttreatment, as well as at 6 months and 12 months posttreatment. Measures include standardized and validated self-report and teacher-report questionnaires, gold-standard psychological assessments, and observational measures. The primary outcome of interest is child behavior problems. Analyses will be conducted using standard normal theory regression and structural equation modeling techniques, with a particular focus on latent growth modeling. Primary intent-to- treat efficacy hypotheses comparing the BPT-E with BPT-M will be specified within a set of sequential mediation analyses. The proposed study is a cross-site RCT with a PI at each site. Dr. McIntyre (MPI, University of Oregon) has more than 15 years of experience working with children with DD and their families. Her research has focused on early intervention and prevention of behavior problems. Dr. McIntyre adapted the BPT intervention used in this study and has completed two RCTs assessing the efficacy of this intervention (R03 HD047711 and R01 HD059838). Dr. Neece (MPI, Loma Linda University) has more than a decade of experience working with children with DD, and during the past 5 years has studied the feasibility and efficacy of MBSR for a diverse sample of parents of preschool children with DD. Drs. McIntyre and Neece have engaged in collaborative research for more than 10 years and have coauthored publications focused on family factors predictive of behavioral outcomes in children with developmental disabilities.