Browsing by Author "Ramey, Sharon L."

Now showing 1 - 13 of 13
  • Thumbnail Image
    Access to Autism Spectrum Disorder Services for Rural Appalachian Citizens
    Scarpa, Angela; Jensen, Laura S.; Gracanin, Denis; Ramey, Sharon L.; Dahiya, Angela V.; Ingram, L. Maria; Albright, Jordan; Gatto, Alyssa J.; Scott, Jen Pollard; Ruble, Lisa (2020-01)
    Background: Low-resource rural communities face significant challenges regarding availability and adequacy of evidence-based services. Purposes: With respect to accessing evidence-based services for Autism Spectrum Disorder (ASD), this brief report summarizes needs of rural citizens in the South-Central Appalachian region, an area notable for persistent health disparities. Methods: A mixed-methods approach was used to collect quantitative and qualitative data during focus groups with 33 service providers and 15 caregivers of children with ASD in rural southwest Virginia. Results: Results supported the barriers of availability and affordability of ASD services in this region, especially relating to the need for more ASD-trained providers, better coordination and navigation of services, and addition of programs to assist with family financial and emotional stressors. Results also suggested cultural attitudes related to autonomy and trust towards outside professionals that may prevent families from engaging in treatment. Implications: Relevant policy recommendations are discussed related to provider incentives, insurance coverage, and telehealth. Integration of autism services into already existing systems and multicultural sensitivity of providers are also implicated.
  • Thumbnail Image
    The Association between Early Care and Education and Midlife Outcomes: The Abecedarian 5th Decade Follow-up
    Sonnier-Netto, Mary Elizabeth (Virginia Tech, 2018-04-26)
    This dissertation focuses on the midlife adjustment of individuals from a longitudinal study in its 5th decade of follow-up. The Abecedarian Project, a prospective randomized control trial (RCT), began in 1972 with the primary goal of preventing cognitive impairments and school failure in children born into impoverished families with multiple risk factors by randomly assigning 111 infants to either an early education (n = 57) or control group (n = 54). This dissertation reports midlife outcomes at ages 39 – 45 for 42 individuals who received the early education treatment and 36 who were controls. This dissertation focuses on two primary hypotheses within a twojournal manuscript format. The first primary hypothesis of this dissertation is that the Abecedarian early education intervention will increase the number of successful outcomes over the lifespan, showing the cumulative effect of positive experiences (Sameroff, 2009) and a sense of personal efficacy (Dweck, 2008; Seeman, 1959). The second primary hypothesis of this dissertation is that response contingent learning and being an active agent in early cognitive and social settings during the first five years of life will provide a strong foundation for future perceptions of control over important areas in one’s life (Furnham & Steele, 1993; Walden & Ramey, 1983; Wallston, Wallston, & DeVellis, 1978). The analysis of midlife indices of strength and risk reveal results favoring the treatment group compared to the controls on both the Midlife Strengths Index (F (1,76) = 15.85, p = .000) and the Midlife Risk Index (F (1,76 = 8.88, p = .004). Additionally, a significant interaction exists between group assignment and IQ at age 48 months for the Midlife Strengths Index (β = -.215, p < .05). Analyses of Locus of Control scales reveal that the control group reports “powerful others” have more influence on both their health behaviors (F (1, 76) = 3.962, p = .05) on the Multidimensional Health Locus of Control Scale and their economic behaviors (F (1, 76) = 5.146, p = .026) within the Economic Locus of Control Scale. Additionally, the control group reported more external economic locus of control than the treatment group with a marginal statistical significance (F (1, 76) = 3.359, p = .071). Results are consistent with the conclusion for children born into multi-risk, economically impoverished families there are lifelong benefits of receiving high-quality early care and education that extend into the midlife years.
  • Thumbnail Image
    Children with Hemiparesis Arm and Movement Project (CHAMP): Protocol for a multisite comparative efficacy trial of paediatric constraint-induced movement therapy (CIMT) testing effects of dosage and type of constraint for children with hemiparetic cerebral palsy
    Ramey, Sharon L.; DeLuca, Stephanie C.; Stevenson, Richard D.; Case-Smith, Jane; Darragh, Amy; Conaway, Mark (BMJ Publishing Group, 2019-01-15)
    Introduction: The Children with Hemiparesis Arm and Movement Project (CHAMP) addresses two pressing issues concerning paediatric constraint-induced movement therapy (CIMT): effects of two dosages and two types of constraint on functional outcomes. Systematic reviews conclude that CIMT is one of the most efficacious treatments, but wide variations in treatment protocols, outcome measures and patient characteristics have prevented conclusions about potential effects of dosage levels and constraint methods. Methods and analysis: CHAMP is a multisite comparative efficacy randomised controlled trial of 135 children (2-8 years) with hemiparetic cerebral palsy. The 2×2 factorial design tests two dosage levels - 60 hours (3.0 hours/day, 5 days/week × 4 weeks) and 30 hours (2.5 hours/day, 3 days/week × 4 weeks) and two constraint conditions - full-arm, full-time cast and part-time splint, plus usual and customary (UCT) controls, yielding five groups: (1) 60 hours CIMT+full-time cast, (2) 60 hours CIMT+part-time splint, (3) 30 hours CIMT+full-time cast, (4) 30 hours CIMT+part-time splint and (5) UCT. Trained therapists deliver the standardised ACQUIREc protocol for CIMT. Blinded assessments at baseline, end of treatment, and 6 and 12 months post treatment include the Assisting Hand Assessment, and subscales from the Peabody Developmental Motor Scales-2 and modified Quality of Upper Extremity Skills Test. Parents complete the Pediatric Motor Activity Log and Pediatric Evaluation of Disability Inventory. A new Fidelity of Implementation Rehabilitation Measure monitors treatment delivery. Data analyses involve repeated-measures multivariate analysis of co-variance controlling for selected baseline variables. Ethics and dissemination: Ethics boards at site universities approved the study protocol. To promote equipoise, parents of UCT controls are offered ACQUIREc after 6 months. A Data Safety and Monitoring Committee reviews results regularly, including measures of child and family stress. We will disseminate CHAMP results via peer-reviewed publications and presentations to professional and advocacy organisations. © Author(s) (or their employer(s)) 2019.
  • Thumbnail Image
    Early Childhood Education that Promotes Lifelong Learning, Health, and Social Well-being: The Abecedarian Project and its Replications
    Ramey, Craig T.; Ramey, Sharon L. (European Society of Medicine, 2023-11-30)
    Introduction: The Abecedarian Project was a randomized controlled trial (RCT) that tested the effects of 5 years of early education combined with social and health supports on learning and cognitive development in infants from high-risk environments. This article provides a reflective review of its key findings from 50 years along with results from variations also tested in RCTs. Methods: The Abecedarian Project and its replications all used a comparative efficacy RCT design. The Early Education treatment group received systematic early education with pediatric health care, early nutritional enhancement, and family social services while the Health/Social Services comparison group received health and family supports but not the formal early education program. In childhood, key outcomes were cognition and school-age academic achievement; in adulthood, assessments included post-high school educational attainment, employment, income/assets, adult family relationships, brain development, and social decision-making. Results: At all tested ages after 12 months of age, the Abecedarian Early Education was associated with significant benefits in children’s cognitive development, school and educational achievements, and multiple indicators of positive health and indicators of adult social adjustment. Collectively, the major replication studies provide affirmation of the positive impact of high-quality early education, although the breadth and magnitude of benefits vary with the child’s environmental risks and dosage of the early education intervention. Some unexpected long-term associations include enhanced caring and future planning in social decision-making, positive relationships with parents, altered brain structure, and improved cardiovascular health. Conclusions: This series of RCTs improved developmental trajectories of infants born into multi-risk social, economic, and biological life circumstances, thus strongly resolving that human malleability is achievable. The challenge ahead concerns how to effectively disseminate and practically use these findings to realize widespread benefits. We nominate both a guiding conceptual framework to help plan and measure strategic interventions as well as a set of hallmarks associated with successful community implementation of effective child and family programs.
  • Thumbnail Image
    Early childhood investment impacts social decision-making four decades later
    Luo, Yi; Hétu, Sébastien; Lohrenz, Terry; Hula, Andreas; Dayan, Peter; Ramey, Sharon L.; Sonnier-Netto, Mary Elizabeth; Lisinski, Jonathan; LaConte, Stephen M.; Nolte, Tobias; Fonagy, Peter; Rahmani, Elham; Montague, P. Read; Ramey, Craig T. (Nature Research, 2018-11-20)
    Early childhood educational investment produces positive effects on cognitive and non-cognitive skills, health, and socio-economic success. However, the effects of such interventions on social decision-making later in life are unknown. We recalled participants from one of the oldest randomized controlled studies of early childhood investment—the Abecedarian Project (ABC)—to participate in well-validated interactive economic games that probe social norm enforcement and planning. We show that in a repeated-play ultimatum game, ABC participants who received high-quality early interventions strongly reject unequal division of money across players (disadvantageous or advantageous) even at significant cost to themselves. Using a multi-round trust game and computational modeling of social exchange, we show that the same intervention participants also plan further into the future. These findings suggest that high quality early childhood investment can result in long-term changes in social decision-making and promote social norm enforcement in order to reap future benefits.
  • Thumbnail Image
    Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions
    DeLuca, Stephanie C.; Trucks, Mary Rebekah; Wallace, Dorian; Ramey, Sharon L. (MDPI, 2023-06-07)
    Intensive therapies have become increasingly popular for children with hemiparesis in the last two decades and are specifically recommended because of high levels of scientific evidence associated with them, including multiple randomized controlled trials and systematic reviews. Common features of most intensive therapies that have documented efficacy include: high dosages of therapy hours; active engagement of the child; individualized goal-directed activities; and the systematic application of operant conditioning techniques to elicit and progress skills with an emphasis on success-oriented play. However, the scientific protocols have not resulted in guiding principles designed to aid clinicians with understanding the complexity of applying these principles to a heterogeneous clinical population, nor have we gathered sufficient clinical data using intensive therapies to justify their widespread clinical use beyond hemiparesis. We define a framework for describing moment-by-moment therapeutic interactions that we have used to train therapists across multiple clinical trials in implementing intensive therapy protocols. We also document outcomes from the use of this framework during intensive therapies provided clinically to children (7 months–20 years) from a wide array of diagnoses that present with motor impairments, including hemiparesis and quadriparesis. Results indicate that children from a wide array of diagnostic categories demonstrated functional improvements.
  • Thumbnail Image
    Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income women
    Ramey, Sharon L.; O'Campo, Patricia; Schetter, Christine Dunkel; Guardinoc, Christine M.; Vance, Maxine Reed; Hobele, Calvin J.; Shalowitzg, Madeleine U.; Community Child Health Network (Elsevier, 2016-12)
    Background: Racial and ethnic inequalities in women's health are widely documented, but not for the postpartum period, and few studies examine whether neighborhood, psychosocial, and biological factors explain these gaps in women's health. Methods: Using prospective longitudinal data collected from 1766 low to middle income women between 2008 and 2012 by the Community Child Health Network (CCHN), we tested the extent to which adjustment for neighborhood, economic, psychological, and medical conditions following a birth explained differences between African American, Latina, and White women in an indicator of physiological dysregulation allostatic load (AL), at one year postpartum as measured by 10 biomarkers: Body Mass Index, Waist Hip Ratio, systolic and diastolic blood pressure, high sensitivity C-reactive protein, Hemoglobin A1c, high-density lipoprotein and cholesterol ratio, and diurnal cortisol. Results: Mean postpartum AL scores were 4.65 for African American, 4.57 for Latina and 3.86 for White women. Unadjusted regression estimates for high AL for African American women (with White as the reference) were 0.80 (SD = 0.11) and 0.53 (SD = 0.15) for Latina women. Adjustment for household poverty, neighborhood, stress, and resilience variables resulted in a reduction of 36% of the excess risk in high AL for African Americans versus Whites and 42% of the excess risk for Latinas compared to Whites. Conclusions: Racial and ethnic inequalities in AL were accounted for largely by household poverty with additional contributions by psychological, economic, neighbourhood and medical variables. There remained a significant inequality between African American, and Latina women as compared to Whites even after adjustment for this set of variables. Future research into health inequalities among women should include a fuller consideration of the social determinants of health including employment, housing and prepregnancy medical conditions.
  • Thumbnail Image
    Maternal early life stress is associated with pro-inflammatory processes during pregnancy
    Méndez Leal, Adriana S.; Silvers, Jennifer A.; Carroll, Judith E.; Cole, Steve W.; Ross, Kharah M.; Ramey, Sharon L.; Shalowitz, Madeleine U.; Dunkel Schetter, Christine (Elsevier, 2023-03)
    Early life stress (ELS) is common in the United States and worldwide, and contributes to the development of psychopathology in individuals with these experiences and their offspring. A growing body of research suggests that early life stress may contribute to adverse health partly through modulation of immune (and particularly inflammatory) responses. Therefore, increased maternal prenatal inflammation has been proposed as a mechanistic pathway by which the observed cross-generational effects of parental early life stress on child neuropsychiatric outcomes may be exerted. We examined associations between early life stress and molecular markers of inflammation (specifically pro-inflammatory gene expression and receptor-mediated transcription factor activity) and a commonly studied circulating marker of inflammation (C-Reactive Protein) in a diverse group of women in or near their third trimester of pregnancy, covarying for age, race/ethnicity, BMI, concurrent infection, concurrent perceived stress, and per capita household income. Mothers who experienced higher levels of early life stress had significantly increased pro-inflammatory (NF-κB) and decreased anti-viral (IRF) transcription factor activity. Transcripts that were up or down regulated in mothers with high ELS were preferentially derived from both CD16+ and CD16- monocytes. Early life stress was not associated with elevated CRP. Taken together, these findings provide preliminary evidence for an association between ELS and a pro-inflammatory transcriptional phenotype during pregnancy that may serve as a mechanistic pathway for cross-generational transmission of the effects of early life stress on mental and physical health.
  • Thumbnail Image
    Mental Health and Social Development Effects of the Abecedarian Approach
    Sparling, Joseph; Ramey, Sharon L.; Ramey, Craig T. (MDPI, 2021-06-30)
    The Abecedarian Approach is an early intervention and contains a broad-spectrum adult/child curriculum. The Approach has been studied in three longitudinal randomized controlled trials in the USA, starting in 1972 and continuing today. Recent research studies in multiple countries have examined the Abecedarian Approach during the first three years of life. The collective findings from these studies lead to the conclusion that human development is malleable, especially in the years before school entry, and that high-quality early intervention exerts positive, early, and long-lasting influences on human development, including social development and mental health.
  • Thumbnail Image
    Neuroimaging Strategies Addressing Challenges in Using fMRI for the Children with Cerebral Palsy
    Lee-Park, Juniper J.; Deshpande, Harshawardhan; Lisinski, Jonathan; LaConte, Stephen M.; Ramey, Sharon L.; DeLuca, Stephanie C. (Scientific Research Publishing Inc., 2018-05-17)
    Aim: This study sought to develop a process and methodology that could be a useful clinical and research tool for successfully completing functional magnetic resonance imaging (fMRI) scanning in children with Cerebral Palsy. Method: Six children with CP (mean age of 8.83 years; five with spastic hemiplegia, one with spastic quadriplegia) and three children with typical development (mean age of 9.33 years) completed an fMRI scanning protocol that used real-time motion feedback as a means of minimizing head and trunk motion. Anatomical, resting-state, and motor-task scans were sequentially obtained from each subject. Precentral “hand-knob” regions were identified on the anatomical scan and served as seed regions to reveal the functional connectivity of each subject’s brain as associated with hand movement. Results: Real-time motion feedback aided children in successful completion of resting state scans. Functional connectivity and brain activity mapping were obtained based on anatomical landmarks, and laterality indices were developed based on the obtained functional-connectivity map to specify a dominant side of brain activity that was matched to a clinical profile, despite anatomical variations that occur with Cerebral Palsy. Interpretation: Real-time motion feedback and the development of laterality indices can improve the clinical and research utility of fMRI scanning. What this paper adds: 1)Presents a real-time imaging protocol for fMRI to help children complete scanning; 2) Presents an fMRI methodology to obtain laterality indices in the presence of abnormal anatomy; 3) Provides findings of LI that match clinical diagnosis.
  • Thumbnail Image
    Preconception maternal posttraumatic stress and child negative affectivity: Prospectively evaluating the intergenerational impact of trauma
    Swales, Danielle A.; Davis, Elysia Poggi; Mahrer, Nicole E.; Guardino, Christine M.; Shalowitz, Madeleine U.; Ramey, Sharon L.; Schetter, Chris Dunkel (Cambridge University Press, 2022-01-25)
    The developmental origins of psychopathology begin before birth and perhaps even prior to conception. Understanding the intergenerational transmission of psychopathological risk is critical to identify sensitive windows for prevention and early intervention. Prior research demonstrates that maternal trauma history, typically assessed retrospectively, has adverse consequences for child socioemotional development. However, very few prospective studies of preconception trauma exist, and the role of preconception symptoms of posttraumatic stress disorder (PTSD) remains unknown. The current study prospectively evaluates whether maternal preconception PTSD symptoms predict early childhood negative affectivity, a key dimension of temperament and predictor of later psychopathology. One hundred and eighteen women were recruited following a birth and prior to conception of the study child and were followed until the study child was 3-5 years old. Higher maternal PTSD symptoms prior to conception predicted greater child negative affectivity, adjusting for concurrent maternal depressive symptoms and sociodemographic covariates. In exploratory analyses, we found that neither maternal prenatal nor postpartum depressive symptoms or perceived stress mediated this association. These findings add to a limited prospective literature, highlighting the importance of assessing the mental health of women prior to conception and providing interventions that can disrupt the intergenerational sequelae of trauma.
  • Thumbnail Image
    Randomized Manipulation of Early Cognitive Experience Impacts Adult Brain Structure
    Farah, Martha J.; Sternberg, Saul; Nichols, Thomas A.; Duda, Jeffrey T.; Lohrenz, Terry; Luo, Yi; Sonnier, Libbie; Ramey, Sharon L.; Montague, P. Read; Ramey, Craig T. (Massachusetts Institute of Technology, 2021)
    Does early exposure to cognitive and linguistic stimulation impact brain structure? Or do genetic predispositions account for the co-occurrence of certain neuroanatomical phenotypes and a tendency to engage children in cognitively stimulating activities? Low socioeconomic status infants were randomized to either 5 years of cognitively and linguistically stimulating center-based care or a comparison condition. The intervention resulted in large and statistically significant changes in brain structure measured in midlife, particularly for male individuals. These findings are the first to extend the large literature on cognitive enrichment effects on animal brains to humans, and to demonstrate the effects of uniquely human features such as linguistic stimulation.
  • Thumbnail Image
    Training Paediatric Therapists to Deliver Constraint- Induced Movement Therapy (CIMT) in Sub-Saharan Africa
    Ramey, Sharon L.; Coker-Bolt, Patty; DeLuca, Stephanie C. (Wiley, 2015-05)
    Hospitals and therapists in developing countries often seek to learn how to deliver new forms of evidenced-based practice (EBP), including paediatric constraint-induced movement therapy (CIMT). This study examines a partnership implemented in Ethiopia, which trained therapists in CIMT and proposes a framework for sustainable EBP training. The aim of this study is to apply a translational and implementation framework to build capacity for CIMT in Addis Ababa, Ethiopia, that included intensive in-country training and hands-on delivery with patients, followed by clinical implementation and feedback. A goal was to develop a locally feasible, culturally relevant form of CIMT. We framed our partnership model in terms of an implementation science model for therapists from multiple hospitals in Addis Ababa. Measures included workshop attendance, delivery of the curriculum and assessment of therapist’s knowledge, skills and feedback postworkshop. We established a successful partnership with a lead hospital and completed training for 12 therapists from five hospitals who demonstrated increases in knowledge and skills following training. We developed a new, practically useful, culturally appropriate form of CIMT for later implementation. This partnership was limited to training of paediatric therapists in sub-Saharan Africa. Future studies will report on therapists’ ability to integrate this EBP training into clinical practice as well as future training.