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The Brown Center For The Study Of Children At Risk - Research


Postpartum Sleep Effects on Smoking Relapse – The Rest Assured Study

Rates of postpartum smoking relapse are high (70-90%) among women who quit smoking in anticipation of or during pregnancy, despite the fact that relapse is unintentional for a substantial number of these women.

In addition to well-established health consequences for smokers, maternal smoking poses health risks for infants, including respiratory and gastrointestinal problems. Standard relapse prevention interventions are not effective for postpartum women. Sleep loss and sleep fragmentation, prevalent for the first 3 months postpartum, may contribute to this problem. Poor sleep is known to diminish stress management skills and behavioral coping and may impact relapse prevention among new mothers through these and other mechanisms.

The primary goals of this project are 1) to measure unique postpartum factors, such as sleep duration and continuity, to see if those factors affect new mothers’ ability to stay smoke-free and 2) to develop, refine, and pilot test an integrative smoking relapse prevention intervention for postpartum women called Rest Assured. The long-term objective of this research is to foster postpartum relapse prevention for women with a history of smoking, which, in turn, would improve the overall health of postpartum women and their families.

For more information contact Kristen Stone, PhD at kstone@wihri.org or download the Rest Assured Study brochure (pdf).
   

Adolescent Development Study

This prospective longitudinal investigation is one of a few in which the course of competence outcomes have been examined in children born at various degrees of perinatal morbidity.  With rising number of preterm infant survivors, it serves as a model to understand how preterm infants born today will do when they reach late adolescence.  This study, inclusive from birth to age 17, will provide a comprehensive understanding of specific developmental trajectories, and risk and protective processes that exacerbate or ameliorate the impact of cumulative risk on competency outcomes in full term and preterm children. 

The ultimate reason to understand the trajectories of long term outcomes is identification of possibilities for preventative interventions.  Formulating a science of prevention requires attention to complex interactions between children and their contexts across periods of time.  For more information contact:  Mary Sullivan at MCSullivan@uri.edu.


Autism Spectrum Disorders

Current research at the Brown Center for Children seeks to understand how children with Autism Spectrum Disorders (ASD) respond to social information and explores individual differences in social functioning in ASD. Our research also seeks to identify signs and markers of autism in the prenatal and early infant periods. Active grant funded studies include a study of prenatal behavioral signs of autism and infant cry as an early marker of autism.

The lead investigator for autism studies at the Center is Stephen Sheinkopf, Ph.D. Collaborators at the Center include Barry Lester,Ph.D., Cynthia Loncar, Ph.D., Amy Salisbury, Ph.D., Todd Levine, MD, and Daniel Bagner, Ph.D. For more information contact: Stephen Sheinkopf at Stephen_Sheinkopf@brown.edu or our study email at WHAutism@CareNE.org.


Infant Cry as an Early Sign of Autism

Researchers at the Brown Center are investigating signs of autism in early infancy. This study analyzes the sounds that babies make in the first 6 months of life. Researchers will analyze the cries of babies that parents have recorded on home videotapes.

Who can participate?
Families of children with autism who have videotapes of their children from when they were young infants (less than 6 months of age) may be eligible to participate.

Where does the study take place?
This study takes place here at the Brown Center for the Study of Risk in Providence, RI. However, you do not need to live nearby the Center to participate. Center staff will work with families by phone and mail. Our staff will assist families to identify appropriate videotapes and will provide families with postage-paid mailers for study materials.

How to participate:

If interested in this study, please contact the researchers by telephone (401-453-7637) or by e-mail at WHAutism@CareNE.org.


Autism Fetal Behavior Study

Researchers at the Brown Center are investigating signs of autism in the fetal and newborn periods in babies at risk for an autism spectrum disorder. This study involves observations of babies before birth using fetal ultrasound, and then an additional observation of your baby after he or she is born.

Who can participate?
If you are an expectant mother with one or more older children with an autism spectrum disorder, you may be eligible to participate. Observations will be made during the 3rd trimester of your pregnancy and then within the first month after your baby's birth.

Where does the study take place?
The Fetal Behavior Lab, located at the Brown Center for the Study of Risk in Providence, RI

How to participate:

If interested in this study, please contact the researchers by telephone (401-453-7637) or by e-mail at WHAutism@CareNE.org.


Study of Social Anxiety in Asperger's Disorder

The goal of this pilot study is to determine if social anxiety manifests itself differently in children with Asperger's Disorder compared to children with social anxiety alone. We will examine heart rate, stress hormone response (cortisol), galvanic skin response, as well as parent and child reports of anxiety during a mild social stressor (The Trier Social Stress Test). We will compare these data between the two groups and determine if neurobiological differences do exist which can help elucidate differential response to stress and social anxiety. For more information contact: Todd Levine at tlevine@wihri.org.


Depression in Pregnancy

Approximately 600,000 infants born each year are exposed to maternal depression.  At least 40% of those infants will also be exposed to psychotropic medication.  Fetal exposure during pregnancy to maternal depression and the medications to treat the disorder have been associated with neurobehavioral differences in infants.  We do not currently know if treatment of the disorder is better or worse for the developing fetus. 

This study directly addresses this question by examining the effects of maternal antidepressant use and maternal depression on fetal and newborn neurobehavioral development.  Fetal neurobehavior measures are obtained by ultrasound and fetal heart rate evaluation at 26-28 and 36-38 weeks gestational age.  After delivery, we observe the infants motor patterns, reflexes, behavior, sleep, and attention. 

The study has enrolled over 160 participants and is actively recruiting new participants.  For more information, contact Kate Halloran at 401-453-7960 or khalloran@wihri.org.


Evaluation of the Vulnerable Infants Program

The purpose of this project is to evaluate the Vulnerable Infants Program of Rhode Island (VIP-RI).  VIP is a statewide model of coordinated care and support for drug-exposed infants and their families and has been expanded to include the needs of biological and foster parents, siblings and families.  This unique hospital based program is designed to improve the community’s ability to manage cases of drug-exposed children at-risk for compromised development, and to provide the earliest and best intervention for vulnerable infants and their families. 

The program now includes the Family Treatment Drug Court with the goal of permanent placement and reunification with the biological mother, where feasible, based on a treatment model.  In addition, VIP will track and screen infants and their siblings thus assisting the state in complying with CAPTA law.  This work is being done in collaboration with Chief Judge Jeremiah at the Rhode Island Court and the National Perinatal Information Center.  For more information contact: Lynne Andreozzi Fontaine at landreozzi@wihri.org.


Infant Developmental Environment and Lifestyle Study (IDEAL)

Despite the dramatic increase in the use of methamphetamine by pregnant women in most of the U.S., there is virtually nothing known about the developmental outcome of these children.  IDEAL is a longitudinal study of children with prenatal methamphetamine exposure.  More than 400 children were enrolled in the study at birth in Iowa, Oklahoma, California, and Hawaii with additional children being enrolled in Auckland, New Zealand.  In the first 5-year period the behavior and developmental outcome of the children will be studied at age 3.  For more information contact: Sheri DellaGrotta at sdellagrotta@wihri.org.

Dr. Linda Lagasse led a team whose research was published in the April 2012 issue of Pediatrics associating prenatal use of methamphetamine with behavior problems in children as young as three years old.


Maternal Lifestyle Study (MLS)

In the mid 1980’s cocaine use by pregnant women was identified as a major public health problem.  Yet, little is known about the long-term developmental outcome of cocaine-exposed children.  MLS is the largest prospective study of cocaine-exposed children.  Approximately 1400 children were enrolled in the study at birth in Detroit, Memphis, Miami, and Providence.  These children are now turning 13 and we are studying how prenatal cocaine exposure by itself and in combination with other drug and environmental factors affects their cognitive, school, psychological, behavioral and emotional outcomes.  For more information contact: Linda Lagasse at Linda_Lagasse@brown.edu.


Maternal Opioid Treatment: Human Experimental Research

Though clearly beneficial, the use of methadone during pregnancy remains controversial in part due to the large percentage of newborns having signs of opioid withdrawal requiring medical intervention and extended hospitalization.  A new medication, Buprenorphine, is approved by the Food and Drug Administration (FDA) for the treatment of non-pregnant opioid dependent patients and produces only a mild abstinence syndrome following abrupt withdrawal. 

This randomized, parallel group study is the first multi-site trial to assess in opioid-dependent pregnant women the efficacy of buprenorphine for reducing withdrawal relative to methadone. Johns Hopkins School of Medicine (Dr. Hendree Jones) is the Lead Site for this study involving six United States and two international sites study. Opioid-dependent pregnant women at the Brown site in New Bedford will be randomized to optimal doses of methadone or buprenorphine and followed throughout pregnancy. Treatment groups will be compared on the primary outcome measures related to severity of withdrawal. 

This study will provide pivotal data to the FDA to support an indication for the use of buprenorphine during pregnancy and potentially optimize strategies for safe and effective treatment of pregnant opioid-dependent women. The study is directed by Dr. Mara Coyle at Women and Infants Hospital and St. Lukes Hospital. For more information contact: Lee Breault at lbreault@wihri.org.


MRI/fMRI and Kinematics in Preterm Infants

We use Magnetic Resonance Imaging (MRI) and Functional Magnetic Resonance Imaging (fMRI) to detect structural abnormalities in brain motor areas and differences in neuroactivation during motor tasks in children with poor motor performance and suspected brain pathology due to perinatal.  The research protocol is designed to acclimate children of a wide age range to the Magnetic Resonance system in a developmentally appealing paradigm adjusted for complexity by using nearly identical visual motor and kinematic assessment in a pre-MR session that are repeated in the magnet in an expanded visual-spatial task. 

Kinematic analysis provides a precise measure of the position of the moving limb in 3-dimensional space at all points during the reach, generating parameters that relate to the efficiency of the reaching process.  This is a new application of kinematic analysis which is particularly relevant to this project because it is sensitive to perinatal insult or residual brain damage in children and adolescents, particularly those with subsequent motor diagnoses; and, kinematic parameters are sensitive to cognitive load, which may be more compromised in children with deficits in visual-motor integration. 

Motor planning and execution of a directed reach includes processing information (e.g., attention, discrimination), localization of target, and implementation of the reach by muscles and joints.  The kinematic assessment is being done in collaboration with Dr. LaGasse at the Center.  This project also includes collaboration with the University of Rhode Island and the Brown University MR Facility.  For more information contact: Mary Sullivan at MCSullivan@uri.edu .


Neuroimaging

We are conducting two types of neuroimaging research in collaboration with on-campus departments at Brown University as well as collaborators at other institutions.  First, a series of studies is investigating the potential long term impact of prenatal cocaine exposure on brain development.  This research has included an initial investigation of brain function in 8 – 9 year old children with prenatal exposure to cocaine.  Using fMRI, we have identified preliminary evidence for the effects of prenatal cocaine on frontal brain functioning during a simple response inhibition task. 

This research has been conducted in collaboration with Dr. Jerome Sanes in the Department of Neuroscience, as well as Dr. B.J. Casey at Cornell Medical School.  Morphological studies of the brains of these children are being conducted in collaboration with Dr. Barry Kosofsky, also at Cornell.  In addition, in a related effort, and also in collaboration with Dr. Kosofsky, we are working to implement multi-site MRI scanning procedures for use in pediatric populations, interfacing with the Biomedical Informatics Research Network (BIRN). 

A second set of MRI studies involves understanding the response of individuals with Autism Spectrum Disorders to social information using fMRI.  These studies are in collaboration with the Pessoa and Tarr labs at Brown University (see Autism Research).  For more information contact: Stephen Sheinkopf at Stephen_Sheinkopf@brown.edu.


Outcome of the Rhode Island Family Treatment Drug Court

After ASFA: Outcome of the Rhode Island Family Treatment Drug Court (FTDC), examines the long-term trajectories of parents who participate in FTDC, the developmental outcomes of their substance-exposed infants, and the success of the FTDC in complying with the Adoption and Safe Families Act (ASFA) guidelines for permanent placement.  Parenting and child assessments are done at 6 month intervals between infant ages of 12 to 30 months. 

This project will provide the first longitudinal preliminary descriptive data on participants of a FTDC specifically designed for perinatal substance users.  The outcome measures from this study includes data on parent and child strengths and vulnerabilities.  Factors that affect substance-using parents’ ability to successfully become the permanent placement for their infant, including home environments, substance use, mental health, parenting attitudes, social support and child abuse potential are examined.  Study results can be applied to developing more efficacious services for perinatal substance users and their children and to better inform public policy decisions related to families affected by perinatal substance use. 

This work is being done in collaboration with Chief Judge Jeremiah at the Rhode Island Court and the National Perinatal Information Center.  For more information contact: Jean Twomey, at jtwomey@wihri.org.


Preventing Psychosocial and Neurodevelopmental Consequences of Preterm Birth

Preterm birth continues to represent up to 10% of all live births in this country.  These infants are at high risk for a wide range of biomedical, social, emotional and intellectual deficits. This study examines the impact of a short-term, family-based intervention program for mothers of preterm infants admitted to the NICU (Neonatal Intensive Care Unit) at Women and Infants Hospital. 

The goal of the program is to improve the short-term developmental outcome of preterm infants and maternal well-being and attitudes through enhanced social and educational services and increased maternal visitation. One hundred twenty mothers of preterm infants (born at 26-31 weeks gestation) are randomly assigned to groups that receive either (a) standard hospital care or (b) alternate care of enhanced education and contact.

Outcome measures at discharge include parenting attitudes, mother infant feeding interaction, autonomic activity, NNNS neurobehavioral assessment, behavioral state and motor activity. This research is being conducted in collaboration with Dr. Sandy Zeskind at Carolinas Medical School. For more information contact: Lee Breault at lbreault@wihri.org.


Screening for Depression at Developmental Follow-Up Visits in Mothers of Preterm Infants

This study screens for maternal depression at infant follow-up visits to determine whether mothers of children born prematurely experience ongoing depressive symptoms following their infants discharge.  The focus of the study is to provide pilot data for a larger parenting intervention grant designed to support mothers of preterm infants who are experiencing postpartum depression. 

Under the larger parenting intervention grant, parents will be instructed in specific strategies shown to be beneficial to the development of preterm infants’ social regulation skills.  Parents in the intervention group would also be provided with supports related to their depressive symptoms.  This work is being done in collaboration with Dr. Betty Vohr, Director of the Neonatal Follow-up program at Women & Infants Hospital.  For more information contact: Cynthia Loncar, at Cynthia_Loncar@brown.edu.

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