Bruce E. Compas - US grants

The proposed research is designed (a) to examine factors associated with increased risk for emotional and behavioral maladjustment in children and parents in families under extreme stress and (b) to describe the nature of coping processes (including problem- and emotion-focused coping, causal attributions, and social support) in families under extreme stress which may protect children and parents from the development of emotional and behavioral disorders. For the purposes of this study families in which a parent has recently been diagnosed and is undergoing treatment for cancer have been selected as a prototypic group of families under conditions of extreme stress. The levels of stress, coping processes, and degree of maladjustment in these families and a sample of matched control families will be assessed at four points in time over one year. Assessments will be conducted at points in time coinciding with four events during the disease and its treatment--diagnosis, post surgery, during radiation or chemotherapy, and post-treatment. It is hypothesized that the presence of a catastrophic illness in a parent will increase the risk for emotional/behavioral maladjustment in children and their parents. The aims of the study include the following: (1) To identify factors which may increase the risk of maladjustment in children of cancer patients, including sex and age of the child, the level of psychological symptoms displayed by the parents, and whether the mother or father has the disease. (2) To examine stress-symptom relations between family members in families under extreme stress as compared with families under normative stressful conditions. (3) To identify characteristics of effective coping in families under extreme stress, including the use of flexible as opposed to rigid patterns of coping and the match between the type of coping used and the degree of perceived control over the stressor. (4) To examine the degree of similarity between coping strategies used by parents and children in response to a major stressor confronting the family.

Four years of continued funding are requested for the project entitled "Coping and Adjustment in Families Under Extreme Stress" to continue to pursue the initial goals of the project as well as to initiate the investigation of several additional research questions. The goals of the project include the continued investigation of the degree of risk for psychological maladjustment and processes of coping in an expanded sample of adult cancer patients, their spouses, and their children. This will include longitudinal analyses of stress, coping and adjustment in these families as well as comparisons of families in which patients experience remission of their cancer, recurrence or metastasis of the original cancer, or death as a result of the cancer. Specifically, the continuation is designed to initiate the investigation of the following research questions with a sample of cancer patients and their families: (a) follow-up of these families over a period of 3 to 5 years after the patients' initial diagnosis of cancer to determine the long-term impact of the illness, (b) examination of the impact of the stress associated with a recurrence or metastasis of the original cancer, (c) examination of the impact of the death of the patient on spouse and children, (d) examination of within family differences between siblings in the ways that they cope with parental cancer and in their psychological adjustment, (e) examination of families, resilience under the stress of cancer by assessing the quality of life experienced by patients and family members, and (f) examination of the impact of parental cancer on children's perceived vulnerability to cancer and other illnesses and their ways of coping with increased perceptions of vulnerability. These research questions will be pursued through the longitudinal investigation of a sample of 300 cancer patients and their families. The original cancer cohort (n = 150) recruited during the first 3 years of the project will continue to complete measures of stress, coping, psychological symptoms, quality of life, and perceived vulnerability to illness every six months for up to 5 years post diagnosis. A second cohort of cancer patients and their families (n = 150) will complete measures of these variables every four months for a period of 1 year after diagnosis.

DESCRIPTION: The proposed study will evaluate the efficacy of two 12-week psychosocial interventions, one emphasizing the development of specific coping skills and the other emphasizing the receipt and provision of social support, for women with newly diagnosed breast cancer (N = 280). Breast cancer patients will be randomly assigned at diagnosis either to the coping skills intervention, social support intervention, or a waiting list control. Women assigned to the waiting list condition will be randomly assigned to one of the two interventions 6 months after their diagnosis. The impact of the coping skills versus social support intervention delivered early (time of diagnosis) or delayed (6 months post-diagnosis) will be evaluated on psychological and medical variables. Psychological measures will include quality of life, affective distress, and ways of coping with the disease. Data will be obtained pre- and post-intervention and at follow-ups from 1 to 2 years post-diagnosis. Additional analyses will examine the efficacy of the interventions for women at high-risk for prolonged affective distress. High-risk status will be defined in two ways, one based on psychological risk factors (pessimism, high information seeking, high distress at diagnosis) and a second based on disease severity (Stage I, node negative versus Stage II-IV, node positive). Both the coping skills and social support interventions are hypothesized to lead to higher quality of life when compared to waiting list controls at post-intervention. The coping skills intervention is hypothesized to lead to lower affective distress than the social support intervention, with larger effects for those women at high-risk. The effects of the interventions on affective distress are hypothesized to be mediated by decreased use of avoidance coping methods, decreased levels of intrusive negative thoughts, and increased use of engagement coping.

DESCRIPTION (provided by applicant): Children of depressed parents are at significantly increased risk for depression and other forms of psychopathology. Three psychosocial mechanisms are associated with increased risk for psychopathology in these children---stressful parent-child interactions, the ways that children respond to and cope with these stressful interactions, and children's negative cognitions. Specifically, parenting behavior that is characterized by intrusiveness and withdrawal and children's negative attributional style are associated with increased problems in children. In contrast, children's use of secondary control coping (cognitive restructuring, acceptance, distraction) is related to lower problems. Based on these findings, we have established the feasibility and acceptability of a preventive intervention for depressed parents and their families. This study will examine in a randomized clinical trial the efficacy of a family-based cognitive behavioral intervention to prevent the adverse effects of parental depression on offspring. Depressed parents, their spouses, and their children (ages 9 to 16-years-old) will be randomly assigned to a multifamily cognitive behavioral group intervention or to a self-study control condition. The 12 session (8 acute and 4 follow-up) family cognitive behavioral intervention will include coping skills training for children and parenting skills training for depressed parents and their spouses. Families in the control condition will receive only written educational materials about depression and its effects on families. Measures administered at pre-, post- and 6-, 12-, 18-, and 24-month follow-ups will include assessment of mood disorders and other psychiatric disorders, internalizing and externalizing problems in children. Possible mediators of the effects of the intervention will also be evaluated, including parental depressive symptoms and episodes of depression, parental intrusiveness and withdrawal, and children's coping and stress responses. Our goal is to determine the efficacy of this intervention that is unique in its focus on helping children of depressed parents to cope with stressful interactions with their parents, and to improve the parenting skills of depressed parents.

DESCRIPTION (provided by applicant): This is a competing renewal application to conduct theoretically-driven research to determine the course and predictors of mental health, social, and physical health outcomes in a cohort of children with cancer and their parents. We have been following a sample of 258 children (ages 5 to 17-years at entry into the study) from near the time of their cancer diagnosis over the first year after their diagnosis with a very high retention rate. By the end of this grant period we will have collected 3 waves of data including observations, interviews and questionnaires and we now propose to collect 2 additional waves of data, including direct observations of parent-child interactions, up to 5 years after diagnosis. Child and their parents completed measures about sources of cancer-related stress, how they cope with cancer, standardized indicators of distress and mental health problems, and they participated in video recorded observations. We propose to extend this work to examine the transition off treatment and into survivorship. Our aims are: 1) To examine continuity and change in parent-child communication about cancer; 2) To identify early predictors of later mental and physical health outcomes for children with cancer and their parents; and 3) To examine reciprocal relationships between parent and child coping, mental and physical health. To meet these aims, we propose to collect 2 additional waves of interview, observational and multi-agent questionnaire data spaced 12 months apart. The project is designed to identify risk and protective factors and processes that can be used to establish a theory-driven model of coping and adaptation to childhood cancer and to identify targets for the future early preventive psychosocial interventions with children with cancer and their parents.

DESCRIPTION (provided by applicant): Children with sickle cell disease (SCD) experience significant problems in neurocognitive development, including deficits in overall intellectual functioning and in specific areas such as attention and executive function. A number of disease-related factors have been shown to be predictive of the extent of neurocognitive problems including sickle cell genotype, history of overt stroke/cerebral infarct, history of silent infarct/micro infarcts, chronic hypoxia due to anemia, acute hypoxia, nutritional deficits, increased peak cerebral blood flow velocity, and sleep disordered breathing/sleep apnea. However, social-environmental risk factors that may contribute additional risk for neurocognitive problems in children with SCD have received relatively little attention. The lone exceptions are two studies that have shown that low family socioeconomic status (SES) is related to poorer neurocognitive function in children with SCD. A growing body of research on children growing up in poverty has shown that environmental stress is a significant risk factor for cognitive impairment in children growing up poor and that disrupted/non-responsive parenting is a central mediator of the effects of poverty and stress on children's cognitive function and development. However, no studies to date have examined the potential role of parenting as a contributing factor in neurocognitive impairment in children with SCD. The goal of the proposed research is to test the feasibility, acceptability and initial proof of concept of social-environmental predictrs of cognitive function in children with SCD. We will (a) recruit a wide age range of children with SCD and their parents; (b) recruit a sibling control sample; (c) recruit a sample of healthy contro children from families without chronic illness; (d) administer cognitive tests to children with SCD their parents, and their siblings, as well as healthy control children and their parents; and (e) conduct direct observations of interactions of parents with children with SCD and interactions of parents with sibling controls and healthy controls and their parents.

DESCRIPTION (provided by applicant): Depression is a major public health problem affecting over 15 million U.S. adults annually and is especially prevalent in those of parenting age. Offspring of depressed parents are at increased risk of depression and therefore are a critical target for preventive interventions. Informed in part by the investigators' prior work, the field i now poised to make significant advances toward reducing the rate of depression by adopting an innovative, family-based approach to simultaneously preventing depression in at-risk children and in their affected parents. The rationale for this approach is based on (a) our conceptual model that integrates parenting processes, stressors (particularly those associated with parental depression), and children's self-regulatory skills in the face of stress, (b) strong evidence of th familial nature of depression, (c) promising results from family- and child-focused depression prevention programs, (d) evidence that in adults, cognitive-behavioral therapy (CBT) reduces both depressive episodes and their recurrence, and (e) growing consensus among scientists, clinicians, and policymakers on the need for family-based models of healthcare. The proposed 5- year, two-site randomized controlled trial will test a Family Depression Prevention (FDP) program for children (ages 9-15) and their parents with depressive disorders (past or current). This dual prevention approach is a novel synthesis of existing evidence-based intervention techniques drawn from child prevention and adult treatment models. Participating families (N=300) will be randomized to either FDP (12 weekly + 3 monthly sessions) or a written information control (WI) condition. Parents and children will be evaluated at pre-, mid-, and immediately post-intervention, and at 6-, 12-, 18-, and 24-months from baseline. This single integrated intervention aims to prevent depressive symptoms and episodes in both children and parents, reduce associated disorders, and improve functioning (Aim 1). We also will assess the cost-effectiveness (CE) of FDP relative to the WI control and benchmarked against the CE of landmark studies in child prevention and adult depression treatment (Aim 1). Additionally, we will examine mediators (e.g., parenting behaviors; parents' cognitions; children's coping) and evaluate bidirectional effects between child and parent processes and outcomes (Aim 2). Finally, we will explore moderators [e.g., parental depression severity (Aim 3)] of the intervention-outcome relation.

DESCRIPTION (provided by applicant): Over 4,000 children are diagnosed with brain tumors in the U.S. each year and advances in treatment have led to significant increases in survival rates for these patients. However, as a result of the disease and treatment with surgery, radiation and chemotherapy, pediatric brain tumor patients show deficits in frontal lobe functions including several aspects of executive function, showing significant declines over time. Remediation of these deficits is a critical target for research. Major changes in brain maturation and connectivity occur during childhood and adolescence, making this a potentially critical window of opportunity for neuroplasticity-based cognitive interventions to support the neural changes that integrate multiple key regions. Computerized cognitive training programs have been used successfully with the patients with schizophrenia, individuals with ADHD, and prodromal adolescents at risk for psychosis. However, these programs have been limited in their application to pediatric brain tumor survivors and untested in brain tumor patients who are undergoing treatment. In the context of an innovative longitudinal design, we aim to test the feasibility, acceptability, and initial efficacy of a neuroplasticiy-based cognitive training progrm, Cogmed, to enhance working memory and attention in children and adolescents who have been diagnosed with brain tumors. We will recruit 72 children with brain tumors at the time of their diagnosis and conduct cognitive testing at baseline (pre-surgery), and at 4-, 5-, and 6-month follow-ups. At 4 months, half will undergo Cogmed adaptive computerized cognitive training (treatment condition) for 5 weeks and half will be assigned to a control condition (the non-adaptive version of Cogmed). Cognitive assessments will be conducted at completion of the cognitive intervention and at 5-weeks post-intervention. We will use near infrared spectroscopy, a noninvasive functional imaging method that uses infrared light to detect changes in cortical hemoglobin levels at pre- and post-cognitive intervention and at 5-weeks post-intervention. We expect that Cogmed adaptive, which will be administered at home, will be feasible and acceptable for the majority (85% or more) of patients. Further, we hypothesize that Cogmed adaptive will help improve working memory and attention skills and increase frontal cortical activity in the brain tumor patients who receive the remediation program compared to those who do not. Using growth curve analyses, we expect that patients who receive the intervention will show a deflection in the negative trajectory of cognitive functions over time. Findings from this pilot study will be used to develop an application for a multi- site randomized clinical trial to test this intervention in a large sample of pediatric brain tumor patients.

PROJECT SUMMARY Adverse childhood experiences (ACEs) involving threat and deprivation early in development have pervasive and long-lasting negative effects on physical and mental health, including health risk behaviors, increased levels of biomarkers for disease, depression, posttraumatic stress disorder, and disruptive behavior disorders. The long-term harmful effects of early ACEs are mediated and moderated by biological, psychological, behavioral, and environmental processes later in development. Specifically, stress sensitivity models of risk have shown that the effects of early ACEs are exacerbated by exposure to stressful events and chronic adversity, including additional exposure to ACEs, later in development, with early adolescence representing a particularly vulnerable developmental period. Continued development of interventions to reduce physical and mental health problems associated with early ACEs and later exposure to stress depends on improved understanding of mechanisms of risk and resilience associated with exposure to stress during adolescence. Recent research suggests that important target mechanisms for interventions involves processes of emotion regulation (ER) and physiological reactivity (PR) in response to stress in adolescents and their caregivers, as deficits and disruptions in these processes increase the risk for physical and mental health problems associated with stress during adolescence (Compas et al., 2017). The proposed project will test a comprehensive multi-method protocol that includes a novel laboratory paradigm using video-mediated recall (VMR) and state-of-the-art measures to examine processes of emotion regulation in response to current stress, along with closely related processes of physiological reactivity, in adolescents who have been exposed to varying levels of ACEs early in development and their current caregivers. We will test the convergence of multiple measures of ER in adolescents and their caregivers, provide an initial test of latent indicators of adolescent and caregiver ER as predictors of symptoms of adolescent physical health problems and psychopathology, and set the stage for larger longitudinal and intervention studies with adolescents who have experienced early ACEs.