John Knutson - US grants

emotional adjustment; cochlear implants; performance; health behavior; deaf aid; psychological tests; interview; human subject;

Although child neglect is the most prevalent form of child maltreatment, there has been a comparative lack of empirical research into the characteristics of neglecting families and the psychological consequences of neglect. In studying neglectful families, existing research has failed to distinguish between two forms of neglect -- denial of critical care and supervision -- and to use micro-social coding of direct observations of parent-child interactions to develop an understanding of the parent-child relations in neglecting families. The work will then be able to test the hypothesis that it is the relational aspects of neglect that determine the impact of neglect on the psychological outcome for the child. Because neglect is often associated with physical abuse and punitive discipline, the proposed research is also designed to understand the relative importance of neglect and punitive discipline in the development of children's aggression. By distinguishing between instrumental or proactive, and irritable or reactive aggression, the research will be able to determine whether neglect and punitive discipline differentially influence the development of two different kinds of aggression in young school-age children. To conduct the research and to assure a sample that is ethnically diverse and drawn from both rural and urban areas, 270 maltreating families and 270 economically disadvantaged, or high risk, families will be recruited in Iowa, Nebraska, and Wisconsin. Structural equation modeling will be used to determine the role of neglect, punitive discipline, and parent attributes, as well as the mediating influences of peer interaction and social competence, on young children's aggression. Because all of the constructs studied will be based on a multimethod/multisource approach, including direct observations of family interaction and social competence in children, and peer nomination indices of aggression, the research is designed to provide an understanding of family function and children's aggression that is not compromised by shared method and shared source variance.

[unreadable] DESCRIPTION (provided by applicant): The high prevalence of domestic violence results in large numbers of young children being exposed to extreme conflict between parents. Although there is evidence that childhood exposure to domestic violence occasions considerable risk for developing internalizing and externalizing problems, the specific link between that exposure and the outcome is not known. This state of affairs is due, in part, to limitations in establishing how the child was exposed to the domestic violence and, in part, because domestic violence is often imbedded in other familial and environmental circumstances associated with adverse child outcomes. The primary goal of the research is to test a theoretical model positing that the adverse outcomes for children exposed to domestic violence are mediated by the parenting of that child. To test the theory, the research is designed to detail the actual experiences of exposure by 4-8 year old children who come from households in which domestic violence has occurred. Multimethod/multisource assessments of parenting, including micro-social coding of direct observations of parent-child interactions, will be used in structural equation modeling to test the theory that specific aspects of parenting will determine the specific outcomes of the children. By controlling for other adverse family circumstances (e.g., economic disadvantage; community violence), and using a multisource/multimethod approach to assessing child outcomes (including direct observations of peer interactions), it should be possible to disambiguate the factors that determine internalizing and externalizing disorders as well as subclinical adjustment difficulties. To conduct the research and to assure a sample that is ethnically diverse and drawn from both rural and urban areas, 600 children and their parent(s) will be recruited in Iowa and Wisconsin and tested in a design that includes two annual follow-up assessments. [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): The overall mission of this proposed program is to develop a research infrastructure in primary health care settings in rural Iowa so that interventions can be evaluated to address underage drinking. Our infrastructure will include a central research office at the University of Iowa (Center for Addictions Research), a primary care setting for youth only (Adolescent Health & Resource Center or AHRC) and several cooperating primary health care clinics that are members of the University of Iowa Community Medical Services (UICMS) system. In Phase 1, we will begin with 5 UICMS clinics and the AHRC, and then, as our infrastructure becomes more efficient, we will add the remaining UICMS clinics for Phase 2. Additionally, we will develop an innovative Video Doctor computer application, which will consist of two main components: (1) the GAPS (Guidelines for [unreadable] Adolescent Preventive Services) screening system and (2) the Video Doctor - a computerized video clips of physicians giving age-appropriate motivational feedback about alcohol consumption - based on responses to screening items. The GAPS program was developed by the American Medical Association and used in many Adolescent Medicine clinics. The Video Doctor will be developed in the first 6 months of our project and then subjected to extensive and sequential review by youth in three age categories (10-12 years; 13 - 15 years; and 16 - 18 years) participating in Positive Youth Development groups. Finally, after the beta version has been developed, this intervention will be pilot tested in our primary health care clinics with each age group. Based on the results from Phase 1, we will then develop an application for a Phase 2 study that includes a more rigorous design and additional sites. To accomplish the goals of this develop project, we have developed interdisciplinary support for our infrastructure improvement plan and for our proposed pilot study. In summary, we propose to develop a research infrastructure by (1) partnering with primary health care clinics in the UICMS system, (2) providing training for the clinic staff about alcohol abuse issues and health services research skills, and (3) developing an age appropriate Video Doctor computer application which can be used easily in primary health care settings. This project focuses on a significant public health problem - underage drinking in rural Iowa. In many of our rural communities, many adolescents describe a culture of binge drinking - especially on the weekends. However, these episodes of alcohol consumption often lead to fairly negative consequences ranging from school absence, conflict with parents, physical violence, unprotected sexual activity and use of other illegal substances. We argue that our primary care clinics can have a positive impact on this culture of alcohol consumption by underage drinkers through a combination of primary prevention and early intervention. [unreadable] [unreadable] [unreadable]