Network coordination, PROSPECT and RCT
AMIS_PROSPECT aims at a detailed longitudinal investigation of the well-characterized Leipzig sample of N = 851 children and adolescents. This includes samples of n = 325 children with experience of abuse, as well as control groups of n = 357 children without experience of abuse from the population and n = 169 children without experience of abuse from a high-risk group. This is intended to clarify the chronological sequence of child abuse and psychological symptoms. In addition, the aim is to investigate which psychosocial risk and protective factors for child abuse and psychological symptoms can be identified, as well as which factors, in addition to child abuse, have a predictive significance for psychological symptoms, mediating the course of child abuse on psychological symptoms in the longitudinal section (mediators) and the risk for favor or alleviate psychological symptoms as a result of child abuse (moderators). The aim of AMIS_RCT is to increase the effectiveness of Child and Parent-directed Individualized Psychotherapy (CPIP), which is offered in addition to extended support by the General Social Service (ECS), compared to only one ECS within a group of N = 200 3 to Review 8-year-olds with neglect and anxiety and depression disorders. CPIP represents an innovative and personalized therapy method, which is primarily based on psychodynamic focal therapy methods and, if necessary, supplemented by further techniques of trauma-focused cognitive behavioral therapy, video feedback and interaction guidance. Together with the project partners, AMIS_RCT also aims to investigate potential mechanisms / moderators of therapy effectiveness, in particular the family context, the child’s mentalization ability, emotional availability, endocrine stress regulation and epigenetic risk scores.
Datenerfassung PROSPECT und Kontrollbedingung RCT
AMIS_CPS hat zum Ziel, den in AMIS-I neu entwickelten Multi-Source-Ansatz (MSA) zur Erfassung von Kindesmisshandlung in einem longitudinalen Studiendesign zu evaluieren. Dieser Ansatz vereint Informationen zu Misshandlungserfahrungen aus drei verschiedenen Quellen: Jugendamtsakten, Auskünfte der Bezugsperson und des betroffenen Kindes selbst. Das Projekt zielt darauf ab, eine bessere Integration der Informationen aus unterschiedlichen Quellen zu ermöglichen, den klinischen Nutzen von Eltern- und Kindauskunft für Jugendamtsentscheidungen zu erhöhen und die Anzahl unentdeckter Fälle von Kindesmisshandlung zu reduzieren. Im Rahmen des Teilprojekts AMIS_CPS wird angestrebt, die Stabilität der längsschnittlichen Erfassung der Misshandlungserfahrungen mittels des MSA und ihren prädiktiven Wert für die psychische Gesundheit von Kindern zu untersuchen sowie auf die bestehenden Misshandlungsinterviews aus AMIS-I aufzubauen, um die Kinderinterviews weiter zu entwickeln. AMIS_RCT untersucht, ob die pathogenen Folgen der Vernachlässigung im Kindesalter durch wirksame, moderne Interventionen gemildert werden können. Dafür werden wir eine neu entwickelte individualisierte Psychotherapie, die Child and Parent-directed Individualized Psychotherapy (CPIP), zusätzlich zu einer erweiterten Hilfe zur Erziehung (Enhanced Caregiving Support; ECS) für vernachlässigte Kinder mit Internalisierungsstörungen im Alter von drei bis acht Jahren einsetzen und im Vergleich zu einer Kontrollgruppe, die nur die ECS erhält, evaluieren. Die ECS wird durchgeführt durch den Allgemeinen Sozialdienst in Leipzig sowie in München. Durch die Entwicklung und Erprobung eines neuen evidenzbasierten Konzeptes zur psychotherapeutischen Behandlung der Folgen von Vernachlässigung im Kindesalter leistet die klinische Studie AMIS_RCT einen Beitrag zu den förderpolitischen Zielen. Somit trägt sie zu einem Transfer der in AMIS-I gewonnenen Forschungsergebnisse in die Praxis bei.
Child abuse is considered to be a central risk factor for the development of stress-related psychological and physical illnesses, although the causal pathways have not yet been adequately understood. Epigenetic changes represent a promising mechanism with regard to the question of how early aversive experiences can sustainably influence the vulnerability of the individual. Since previous epigenetic human studies have mostly been retrospective cross-sectional studies, longitudinal projects on high-risk samples such as “AMIS-II” offer optimal conditions for the investigation of disease-relevant, epigenetic changes and their reversibility through psychotherapy. Within the subproject 4 AMIS_EPIGEN, the predictive value of epigenetic risk profiles for the development of psychiatric symptoms as well as a dysregulation of central stress hormone systems is to be investigated longitudinally. Since epigenetic profiles are potentially reversible, longitudinal research should also be carried out to determine whether epigenetic risk profiles normalize after therapeutic intervention and to what extent these can be used as predictors of symptom improvement.
Hair steroid analyzes
The results of AMIS-I and other studies show that experiences of abuse in childhood and adolescence are associated with psychosocial problems, neuroendocrine abnormalities and an increased vulnerability to later psychological and physical illnesses. At present, however, there is insufficient longitudinal evidence that allows a detailed understanding of the biological mechanisms involved, particularly with regard to the long-term neuroendocrine consequences of child abuse. Hair steroid analysis is an innovative research method for recording long-term accumulated hormone levels, which has already been successfully used in AMIS-I and is to be used for the first time in “AMIS-II” to generate longitudinal data in this research context.
CPIP intervention, preparation and analysis
AMIS_EA: a) Prospective arm: The focus here is on clarifying the connections between child abuse, the quality of interaction between child and caregiver and the development of psychiatric symptoms in the child. Specifically, the effects of abuse of the child on the quality of interaction and the effects of the quality of interaction on the course of psychiatric symptoms in children are considered. In addition, the moderating / mediating role of the quality of interaction for the connection between experiences of abuse and the course of psychiatric symptoms in children is examined. b) Intervention arm: This project focuses on the question of whether child and parent-directed Individualized Psychotherapy (CPIP; see AMIS_RCT) in 3 to 8-year-old children with internalizing disorders in the context of physical or emotional neglect leads to an improvement in the Quality of interaction between child and caregiver leads and whether this in turn influences the child’s symptom reduction.
AMIS_RCT: In this project, together with the child and adolescent psychiatry of the University of Leipzig, the effectiveness of Child and Parent-directed Individualized Psychotherapy (CPIP) for children with internalizing disorders in the context of physical or emotional neglect is examined using a sample of 3- to 8-year-olds evaluated. CPIP is an integrative, personalized and innovative therapy method, which is primarily based on psychodynamic therapy methods and is focal-oriented. The aim of AMIS_RCT is to assess whether CPIP, which is provided in addition to extended support from the General Social Service (extended support for education), is more effective than only extended support from the General Social Service. In this context, potential influencing factors on the effectiveness of the therapy are also examined.