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.

中文翻译：

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确定预防儿童逆境心理健康后果的干预策略：一项改进的德尔菲研究

暴露于童年逆境是精神病理学的一个强大风险因素。尽管付出了广泛的努力，但我们尚未确定有效或可扩展的干预措施来防止经历过逆境的儿童出现心理健康问题。在这项改进的德尔菲研究中，我们确定了有效针对连接童年逆境和精神病理学的神经发育机制的干预策略——包括情绪反应增强、情绪调节困难、奖励处理迟钝和社会信息处理偏差，以及一系列精神病理学症状。我们通过三项调查反复综合来自该领域专家的信息和相关元分析，首先是干预开发、预防和儿童逆境方面的专家（n= 32），然后在我们的研究团队中（n= 8). 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少年和父母的干预策略的证据评级方面产生了更高的稳定性和良好的共识。更广泛地说，我们的研究结果强调了干预决策如何通过元分析提供信息，如何通过集体反馈得到加强，在达成共识之前就已经饱和，以及如何持续主观甚至矛盾。最终，结果集中在几个有前途的干预策略上，用于针对暴露于逆境的青少年进行预防规划，这些策略将在即将进行的临床试验中进行测试。