Department of Psychology, Harvard University, Cambridge, MA, USA.
Department of Psychology, University of Washington, Seattle, WA, USA.
Dev Psychopathol. 2021 May;33(2):748-765. doi: 10.1017/S0954579420002059.
Exposure to childhood adversity is a powerful risk factor for psychopathology. Despite extensive efforts, we have not yet identified effective or scalable interventions that prevent the emergence of mental health problems in children who have experienced adversity. In this modified Delphi study, we identified intervention strategies for effectively targeting both the neurodevelopmental mechanisms linking childhood adversity and psychopathology - including heightened emotional reactivity, difficulties with emotion regulation, blunted reward processing, and social information processing biases, as well as a range of psychopathology symptoms. We iteratively synthesized information from experts in the field and relevant meta-analyses through three surveys, first with experts in intervention development, prevention, and childhood adversity (n = 32), and then within our study team (n = 8). The results produced increasing stability and good consensus on intervention strategy recommendations for specific neurodevelopmental mechanisms and symptom presentations and on strength of evidence ratings of intervention strategies targeting youth and parents. More broadly, our findings highlight how intervention decision making can be informed by meta-analyses, enhanced by aggregate group feedback, saturated before consensus, and persistently subjective or even contradictory. Ultimately, the results converged on several promising intervention strategies for prevention programming with adversity-exposed youth, which will be tested in an upcoming clinical trial.
儿童期逆境暴露是精神病理学的一个强大风险因素。尽管我们已经付出了广泛的努力，但仍未找到有效或可扩展的干预措施，以防止经历逆境的儿童出现心理健康问题。在这项改良德尔菲研究中，我们确定了干预策略，以有效地针对将儿童期逆境与精神病理学联系起来的神经发育机制，包括情绪反应增强、情绪调节困难、奖赏加工迟钝和社会信息处理偏差，以及一系列精神病理学症状。我们通过三轮调查，从该领域的专家和相关荟萃分析中迭代综合信息，第一轮是针对干预措施的开发、预防和儿童期逆境的专家（n=32），然后是在我们的研究团队内（n=8）。研究结果在针对特定神经发育机制和症状表现的干预策略建议以及针对青年和家长的干预策略的证据强度评级方面产生了越来越高的稳定性和良好共识。更广泛地说，我们的研究结果强调了如何通过荟萃分析为干预决策提供信息，如何通过汇总群体反馈、在达成共识之前进行饱和、以及始终保持主观性甚至矛盾来增强干预决策。最终，研究结果收敛到了几项针对有逆境经历的青年的预防方案的有前途的干预策略，这些策略将在即将进行的临床试验中进行测试。
