Katherine L. Rosenblum, Ph.D. - US grants

DESCRIPTION (provided by applicant): Across the United States nearly 2 million children are living in military households; almost 40% are under the age of 6. The impact of deployment on the service member, coupled with distress and emotional symptoms in the nondeployed parent, places military families at particular risk, and this is most pronounced for families in the Nationl Guard and Reserves. Parental deployment has been linked to high levels of parenting stress, parent psychiatric symptoms, and depression and behavior problems in children. Reunification also poses challenges, including the normative tasks of reestablishing relationships, roles and family routines. This project aims to address the needs of military families with young children (2- to 5-years-old) following a deployment, with a particular focus on the Guard and Reserves. STRoNG Families is a brief, group-based parenting intervention for service members, their partners and children, and focuses on enhancing positive parenting through an intervention that incorporates five core pillars: 1) parent education, 2) social support, 3) supporting parent-child interactions, 4) connecting families to resources, and 5) improving stress reduction and self-care skills. Project methods involve a randomized controlled trial (N=160) comparing parents in the STRoNG Families treatment (n=80) to an attentional control condition that involves access to web-based informational resources (n=80). Our core hypotheses are that STRoNG Families participants will evidence enhanced positive parenting and reductions in mental health symptoms. Pre-post assessments will employ a multi-method approach to assess parenting, including self-reported parenting stress, observations of parenting, and interviews to assess parent attributions and representations of their children. Pre- post assessments will also identify changes in parent depression and posttraumatic stress, while exploratory analyses will examine the impact of the intervention on parent- reported child behavior problems. This project will lay the foundation for a subsequent RCT to longitudinally evaluate the effectiveness of the intervention for improving child outcomes. Access to evidence- based parenting support can ultimately improve outcomes for this vulnerable population. This proposal is responsive to the urgent need for acceptable, effective interventions specifically tailored for the experiences of military families with young children. PUBLIC HEALTH RELEVANCE: Nearly 2 million children live in military households, with parental deployment linked to high levels of parenting stress, parental mood and anxiety symptoms, and child behavior problems. This project focuses on the needs of military families with preschool-aged children following deployment. We aim to test the efficacy of a novel parenting group intervention designed to enhance positive parenting and reduce the impact of parental mental health problems among military families with young children. This proposal is responsive to the urgent need to develop acceptable, effective preventive interventions for military families with young children, particularly those in the National Guard/Reserves.

DESCRIPTION (provided by applicant): Childhood mood disorders represent a significant public health concern, with 6 to 11% of the population suffering from symptomology. Among those affected, 70% will have a recurrence during childhood and/or adolescence, and 50% will continue to experience symptoms in adulthood. These patterns of chronicity suggest that mental health problems observed later in life often have identifiable markers during early childhood. Therefore, early identification and intervention is critical. The NIH has put forth the Research Domain Criteria (RDoC), which acts as a heuristic to examine mechanisms of mental illness by suggesting the investigation of several behaviorally and biologically based processes. Although RDoC provides a valuable theoretical framework, the applicability of RDoC for developmental psychopathology research has been limited, primarily due to a lack of validated, feasible, standardized assessment batteries to examine RDoC domains in young children. Our aim is to create and validate behavioral and neurobiological assessments for young children in order to examine the relevance of RDoC domains, Positive and Negative Valence, for childhood depression and anxiety that often precedes or commingles with it. Specifically, we will study the constructs of reward valuation (Positive Valence) and acute threat (Negative Valence) using behavioral and neurophysiologic correlates of these constructs and test for associations with clinically assessed depression and anxiety in 4-6 year old children. Recruitment through the Infant and Early Childhood Clinic at the University of Michigan's Department of Psychiatry, as well as general pediatrics clinics in our health system, will ensure that a broad spectrum of anxiety and depressive symptoms, across the clinical to non-clinical range are represented in the children in our study. We seek NIH pilot funding to investigate the feasibility of behavioral and neurophysiology tasks that will long-term 1) inform assessment procedures, blending basic science advances with accessibility for patients and their families; 2) improve our characterization of underlying mechanisms of child anxiety and depression; and 3) inform subsequent interventions to address personalized child-level deficits. Findings will prove high impact as the NIMH considers the study and future application of RDoC criteria a high priority, and, yet, there are few empirical data exploring such application among young children. This proposal is responsive to the urgent need for validated, feasible, and standardized assessment batteries to examine RDoC domains in young children, and represents a critical step in a long-term plan to achieve effective and mechanism-based identification and treatment strategies for preschool-age children with depression and anxiety.

Clinically significant anxiety affects 20% of preschoolers and can become chronic, leading to depression, substance abuse, school-drop out and even suicide. To reduce anxiety and prevent its sequelae, clinically affected children must be effectively treated early. Available interventions for clinically anxious preschoolers are effective for some, but not all children, with as many as 50% of 4-7 year olds continuing to meet criteria for an anxiety disorder after treatment. To address this problem, we leverage theoretical models and empirical research suggesting that insufficient capacity for Effortful Control (EC) may underlie anxiety from its earliest stages. Insufficient capacity for EC reflects failures of frontal brain regions (e.g., dorsolateral prefrontal cortex/dlPFC and anterior cingulate cortex/ACC) to adaptively regulate threat circuits and maintain on-task behavior. These neural substrates for EC can be indexed using neurophysiological measures, the error-related negativity (ERN) and time frequency interchannel phase synchrony (ICPS), respectively. Findings from our labs and the work of others have shown that reduced ERN and ICPS relate to behavioral deficits in EC and enhanced threat reactivity similar to that documented in clinically anxious children. In response, our team developed a child-friendly group EC training (?Camp Kidpower?) designed to increase ERN, ICPS and related EC behaviors in the service of decreasing anxiety symptoms in preschoolers. Results of our pilot study indicate that this brief cognitive training approach engaged the intended EC neural and behavioral targets and reduced anxiety symptoms. Building on this pilot work, the current project aims to replicate and extend these findings in a larger sample using a randomized controlled design. Participants in this study will be 4- to 6-year-old children (n=90) with clinically significant symptoms who will be randomized into the EC training intervention (n=45) or a playgroup control (n=45). Outcomes will be assessed before and after each condition, using a multi-level approach that includes neurophysiological and behavioral indices of EC, as well as clinician-rated and parent- report on child anxiety symptoms (type and severity). Our aims are to: 1) confirm that participation in our EC training increases ERN and ICPS and improves EC behavior, 2) test whether engagement of these brain-behavior EC targets correspond to reductions in anxiety symptoms and explore whether anxiety reduction by EC training is moderated by baseline threat reactivity measures, and 3) identify whether greater dosage of EC training is associated with greater neuro-behavioral target engagement and reduction of anxiety symptoms. By evaluating how changes in neuroscience-derived targets relate to changes in anxiety symptoms, this work is responsive to the NIMH call for experimental therapeutics and addresses an urgent need for the design of interventions to reduce anxiety in young children.