Clancy Blair - US grants

DESCRIPTION (provided by applicant): The proposed project examines the physiological and psychological developmental origins of adaptive behavior and engagement in the classroom among children in Head Start. The primary thesis of this application is that individual differences in heart rate variability as assessed by vagal tone and in emotionality as assessed by measures of temperament have important implications for young children's readiness to learn. Specific objectives are to examine individual differences in vagal tone and emotionality and relate them to assessments of executive function and of behavior in the classroom. Prior work has noted relations between vagal tone and emotionality among middle SES samples but no study to date has examined relations between these variables among children facing socioeconomic disadvantage. Prior work has also noted relations between attention and anxiety in adult samples but no study has explicitly examined relations among negative emotionality, regulation, and executive function among children at risk for school failure. Neuroscientific study of the mind suggests relations among negative, particularly fearful, emotionality and the attention, planning, and problem solving abilities that comprise executive function. The developmental implications of these relations for child competence in school, however, have not been previously investigated. One hundred participants will be seen during the Head Start year and followed into kindergarten. During the spring of participants' Head Start year information will be collected on child emotionality, vagal tone, executive function, language, and classroom behavior. During the spring of participants' kindergarten year, information on child academic skills and classroom behavior will be collected. It is expected that the proposed research can provide valuable information with which to promote readiness among children at risk for school failure, and lay the foundation for ongoing programmatic investigation of school adjustment by the principal investigator and his graduate students. The proposed investigation extends the study of relations between emotionality and school adjustment downward to preschool and kindergarten age ranges, and goes beyond prior work to model developmental relations between cognition and emotion in the study of children's school adjustment and readiness to learn.

DESCRIPTION (provided by applicant): Executive function (EF), also referred to as fluid cognition, is comprised of working memory, inhibitory control, and attention shifting processes known to be dependent upon cortical circuitry associated primarily with the prefrontal cortex and to develop rapidly in early childhood. As a unique aspect of developing cognitive competence with a well-defined neurobiological basis, EF has been shown to play a central role in developing aspects of self-regulation important for social and academic competence and readiness for school. However, given the relation of EF to the development of self-regulation, there is currently no uniform measurement battery that can reliably and validly measure individual differences in change in EF in early childhood. There is an urgent need to develop such a measurement battery, particularly for use in the context of large-scale studies. Its absence limits knowledge of basic developmental questions regarding intraindividual change in EF and the relation of that change to the primary accomplishments of early childhood. Accordingly this application proposes to develop an easily administered, highly portable battery of working memory, inhibitory control, and attention shifting cognitive tasks to measure EF in 3 to 5 year old children;to utilize item response theory to establish the psychometric properties and scoring procedures for the measurement battery in a cross sectional sample of 300 children age 3 to 5 years;to collect data on developmental change using the EF battery with a racially and economically diverse, epidemiologically derived sample of 600 children that are being followed from birth to age 3 in a study known as the Family Life Project and that will be followed from ages 3 to 5 years under this application to create a normative database for the newly developed EF measurement battery;and to establish the validity of the EF measurement battery with the normative sample of 600 by determining the extent to which performance on the battery accounts for unique variance over and above that associated with general intelligence and language ability in standardized laboratory and teacher and parent report measures of social and academic competence and emotional reactivity and effortful control, and by determining the extent to which the battery identifies EF deficits in low severity/high incidence developmental disorders such as learning disability and attention deficit-hyperactivity disorder.

toxic stress, parenting interventions, Early Head Start, early childhood, Playing and Learning Strategies (PALS), self-regulation;

Conduct problems in childhood increase risk for school failure, adolescent substance use, and criminality in adulthood. Little is known, however, about the early antecedents of childhood conduct problems in prenatal through late toddler stages. To address this research gap, this project examines family influences on the development of self-regulation, specifically executive functions and behavioral self-control, in early childhood. The key broader impacts of this research include new knowledge about mechanisms that increase risk for conduct problems and insights into ways to prevent these problems from developing into poor lifetime outcomes.

In this study, the researchers will follow a sample of 400 expectant mothers and their partners over three years and collect a variety of data on physiology, behavior in structured interactions, and executive function and emotion regulation. A major innovation of the project is its focus on the role of stress and stress hormones in the development of both parents and children. The researchers are interested in ways in which high levels of stress hormones in the expectant mother influence the child prenatally through effects on nervous system development and also on mother-child, mother-father, and father-child interaction in infancy through toddlerhood. A second innovation of this project is a focus on fathers and the ways in which fathers may decrease or increase risk associated with maternal factors. A third area of innovation concerns the international nature of the sample, which will include 200 expectant mother-father pairs in the United Kingdom and 100 each in the United States and the Netherlands. This aspect of the proejct will allow the researchers to conduct cross-country analyses and assess the generalizability of the findings and perhaps suggest how cultural factors impact development.

? DESCRIPTION (provided by applicant): Early adolescence represents a key transition period in development yet little is known, particularly for children in rural poverty, about the ways in which trajectories established in early childhood support or constrain the development of self-regulation with implications for key outcomes. Accordingly, we propose to continue to follow a population-based predominantly low-income longitudinal sample known as the Family Life Project (N=1292 oversampled for African American ethnicity and poverty). Extensive child, family, home, and school data were collected through two rounds of funding as an NICHD program project with 11% attrition. Data collection beginning at child age 2mos through age 8yrs occurred in 10 home visits, 5 childcare visits, and 8 school visits. In this follow-up, we continue to focus on child self-regulation and stress response physiology, as well as family, peer, school, and neighborhood contexts measured in the first two phases. Data will be collected in 1 home visit (7th grade) and 2 school visits (6th & 8th grades.) We will test specific hypotheses about the influence of the timing and chronicity of poverty-related adversity in families on the development of stress response physiology and self-regulation from early childhood through early adolescence. Most importantly, we will test hypotheses about the ways in which peer, school, and neighborhood contexts increase or decrease risk for key outcomes, including mental health, substance use, and school achievement. Primary innovation in this phase concerns our ability to test key questions about the malleability of self-regulation development and the role of emerging sensitivity to reward and delay in risk taking behavior in early adolescence. We hypothesize that alterations to the stress response and accompanying self-regulation difficulties will be most severe and most likely to lead to poor outcomes for children facing sustained high levels of poverty-related adversity; however, we also hypothesize that this influence will be moderated by the quality of peer relations, as well as school, and community characteristics. Specifically, for children facing sustained adversity, higher quality peer relatios (taking into account potential bidirectional relations between self-regulation and peer quality, including social isolation and affiliation with deviant peers), higher levels of school quality, an higher levels of neighborhood quality will each be associated with improvements in stress responsivity and in self- regulation abilities, and thereby higher achievement, reduced substance use, and better mental health. To our knowledge this is the first study of its kind to test complex longitudinal relations among adversity, stress response physiology, self-regulation, and key outcomes across multiple geographically and economically defined social contexts in a population-based sample. By testing the malleability of development using a psychobiological model, the proposed research will have clear implications for prevention efforts and efforts to promote positive youth development.

Project Summary/ Abstract The inverse association between SES and health is well established. Its underlying causes are not. This application leverages and extends an active prospective longitudinal cohort of children and families in rural poverty to test key hypotheses about the ways in which early psychosocial and chemical exposures (0-5yrs) adversely affect pediatric health outcomes in the areas of neurodevelopment and obesity. We describe an ongoing population-based longitudinal study, the Family Life Project (FLP) with N=1292 children and their primary and when available, secondary caregivers, followed from birth and oversampled for poverty and African American ethnicity in predominantly low-income, non-urban counties in Pennsylvania and in North Carolina. Participants were seen at 8 time points birth to 5 years and at 6 time points 7 to 13 years. A primary focus of data collection and analysis has been the prospective investigation of associations between psychosocial early life stress and neurodevelopment in the areas of executive function, emotion regulation, tolerance for delay, language, school achievement, ADHD and LD. This application builds on and extends our prior data collection retrospectively and prospectively in order to amplify and enhance our focus on adverse exposures in relation to neurodevelopment and obesity risk. In the UG3 retrospective phase we expand our investigation of chemical and neighborhood level exposures when study children were 0 to 5yrs. In the UH3 prospective phase we propose data collection during two clinic visits when children are 16 and 18yrs. These visits will include the collection of all ECHO core elements plus biospecimens (blood, saliva, urine). With these data we will develop clearly defined neurodevelopment and obesity phenotypes and test our primary hypotheses linking early exposures to later health outcomes. We hypothesize direct effects of chemical and psychosocial exposures on our phenotypes as well as mediation of exposures through effects of allostatic load on the development of the central nervous system and the inflammatory processes of the immune system. Importantly, follow-up of the FLP sample into late adolescence will provide much needed information with which to reduce health disparities in high-risk, understudied rural populations. This follow-up will provide data to address key questions about the rural context and individual differences relating to race, gender, and geographic location that moderate relations between early exposures and later health outcomes. The FLP will make a unique and valued contribution to the ECHO synthetic cohort. Inclusion of the FLP will allow for the identification of factors that relate mechanistically to rural health outcomes and that can serve as the focus of prevention and intervention efforts.

Project Summary/ Abstract The inverse association between SES and health is well established. Its underlying causes are not. This application leverages and extends an active prospective longitudinal cohort of children and families in rural poverty to test key hypotheses about the ways in which early psychosocial and chemical exposures (0-5yrs) adversely affect pediatric health outcomes in the areas of neurodevelopment and obesity. We describe an ongoing population-based longitudinal study, the Family Life Project (FLP) with N=1292 children and their primary and when available, secondary caregivers, followed from birth and oversampled for poverty and African American ethnicity in predominantly low-income, non-urban counties in Pennsylvania and in North Carolina. Participants were seen at 8 time points birth to 5 years and at 6 time points 7 to 13 years. A primary focus of data collection and analysis has been the prospective investigation of associations between psychosocial early life stress and neurodevelopment in the areas of executive function, emotion regulation, tolerance for delay, language, school achievement, ADHD and LD. This application builds on and extends our prior data collection retrospectively and prospectively in order to amplify and enhance our focus on adverse exposures in relation to neurodevelopment and obesity risk. In the UG3 retrospective phase we expand our investigation of chemical and neighborhood level exposures when study children were 0 to 5yrs. In the UH3 prospective phase we propose data collection during two clinic visits when children are 16 and 18yrs. These visits will include the collection of all ECHO core elements plus biospecimens (blood, saliva, urine). With these data we will develop clearly defined neurodevelopment and obesity phenotypes and test our primary hypotheses linking early exposures to later health outcomes. We hypothesize direct effects of chemical and psychosocial exposures on our phenotypes as well as mediation of exposures through effects of allostatic load on the development of the central nervous system and the inflammatory processes of the immune system. Importantly, follow-up of the FLP sample into late adolescence will provide much needed information with which to reduce health disparities in high-risk, understudied rural populations. This follow-up will provide data to address key questions about the rural context and individual differences relating to race, gender, and geographic location that moderate relations between early exposures and later health outcomes. The FLP will make a unique and valued contribution to the ECHO synthetic cohort. Inclusion of the FLP will allow for the identification of factors that relate mechanistically to rural health outcomes and that can serve as the focus of prevention and intervention efforts.

Project Summary/Abstract Mental health and developmental disorders begin early in life, are prevalent, impairing, and predict mental health and health challenges in later childhood and in adulthood. One in nine preschoolers has an impairing mental health disorder, yet less than 15% receive any treatment. In immigrant communities, the disparity between mental health needs and care is greater because of cultural and language barriers, limited mental health literacy, and decreased use of health IT solutions, like Electronic Health Record (EHR) patient portals. Chinese American immigrant families are a fast-growing immigrant group with unmet early childhood mental health needs. We propose to design, build, and implement OurChild, an integrated mHealth/EHR solution to increase access to early childhood mental health knowledge and mental health services and resources for Chinese American children ages 2-6 years old and their parents in Sunset Park, Brooklyn. Our proposal unites our longstanding partnership with the Chinese American community in Sunset Park and the safety-net clinics serving it with our team's 1) clinical and scientific expertise in health disparities, participatory research and early childhood mental health and 2) the digital health/health IT expertise of the WonderLab, a digital incubator in the NYU Langone Department of Child and Adolescent Psychiatry. Our goal is to reduce health disparities by explicitly designing a digital solution that facilitates connection and bidirectional exchange of information across the cultural, contextual, language, and setting differences that are key barriers to early childhood mental health knowledge and access to care for this immigrant population. Our first aim is to iteratively design, build, and test OurChild. To do this we will 1) collaborate with our family, clinical, and community stakeholders to conduct an early childhood mental health context/needs analysis and participatory design and discovery activities; 2) use these insights to adapt and user-test iterative prototypes; 3) evaluate the usability and acceptability of a beta version of OurChild in a mixed-methods pilot with 20 Chinese American parents and their 2- to 6-year-old children who receive care at the Sunset Park 7th Avenue Family Health Center; and 4) optimize the design, features, and performance to create OurChild 1.0.Our second aim it to evaluate the Reach, Effectiveness, Adoption, and Implementation of OurChild 1.0 with a 6- month longitudinal implementation cohort study with 200 parent/child dyads. We will use a mixed-methods approach using metadata collected with the OurChild app, parent-reported data from the app, EHR data, and post-implementation focus groups with providers to determine whether use of Our Child increases referrals of young children for a mental health consultation or evaluation (Primary Aim). Our secondary aims will examine whether use of OurChild 1) increases parent self-efficacy; 2) parent?provider engagement; and 3) linkage with community early childhood resources. Both OurChild and our digital methodology will be designed to be scaled to other Chinese populations and efficiently adapted for other health disparity populations.