Preventive Intervention for Behavior Problems in Infants from High-Risk Families

Project Summary/Abstract
The primary aim of the current R01 application is to examine the efficacy and maintenance of a home-based
preventive intervention to decrease behavior problems in infants from high-risk families. Behavior problems are
exceedingly common in early childhood and are associated with high impairment and a long-term negative
trajectory for negative outcomes. Despite the empirical evidence supporting the use of clinic-based parent-
training treatments for early behavior problems, children from economically disadvantaged and
underrepresented minority families, who are at considerably higher risk for behavior problems, have higher
treatment dropout rates and poorer outcomes when completing treatment. We propose instead to intervene
during infancy, which would likely require less intensive and shorter interventions, thereby decreasing the
burden for high-risk families. Extending promising findings from pilot testing of a home-based intervention
targeting changes in parenting behavior (K23 MH085659: PI, Bagner), we propose to conduct an adequately
powered randomized controlled trial (n = 288) to demonstrate its efficacy and maintenance in reducing
behavior problems and increasing infant regulation relative to an enhanced pediatric primary care active
control condition. Based on work by the current investigative team and others, we also will examine the
mediating role of changes in parenting behavior and the moderating role of parental distress on intervention
outcome. Rather than focus exclusively on whether the effect of the intervention can be produced, an important
step in further developing the evidence base in prevention science is to examine how and for whom indicated
preventive interventions work. The proposed work is consistent with the research priorities of the Child
Development and Behavior Branch (CDBB) of the NICHD to investigate the impact of a behavioral promotion
intervention in pediatric primary care and identify developmental factors and mechanisms which promote short-
and long-term psychosocial adjustment for children exposed to high-risk family and neighborhood
environments. In light of the extensive needs and depleting resources faced by low-income and
underrepresented minority families, the proposed work provides a unique opportunity to help promote optimal
behavioral functioning and reduce the risk for psychopathology in infants from the most vulnerable families.

Grant Number: 5R01HD102201-05
NIH Institute/Center: NIH
Principal Investigator: Daniel Bagner