Prenatal anticipatory stress: Baby preparation and worry scale-revised in the Dutch context.

BACKGROUND: Prenatal distress encompasses a range of different emotions, worries, and experiences of stress. The Baby Preparation and Worry Scale (Baby-PAWS) was recently developed to target anticipatory worries during pregnancy about the postnatal period. However, the Baby-PAWS questionnaire was only examined in the United States of America, limiting the questionnaire's generalizability to different countries. To address this issue, we performed a psychometric evaluation of the questionnaire in a Dutch sample and examined associations between the Baby-PAWS questionnaire and established measures of maternal distress (i.e., EPDS, STAI, PRAQ-R) and infant temperament (i.e., IBQ-R). METHODS: Healthy pregnant women (N = 521) completed questionnaires during their third trimester and postnatally, including the Baby-PAWS and distress measures. A subsample of mothers (N = 194) also reported on infant temperament at 12 weeks postpartum. RESULTS: Exploratory factor analysis suggested a four-factor structure for the 16-item questionnaire in our Dutch sample, as compared to the expected three-factor structure found in the original psychometric evaluation with the American sample. The total Baby-PAWS score was related to pre-and postnatal depression, anxiety, stress, and specific scales of infant temperament. American women scored higher on the Baby-PAWS items than Dutch women. LIMITATIONS: Our participants had higher-than-average socioeconomic status, limiting the generalizability of the findings. CONCLUSION: The current analyses indicate good validity of the Baby-PAWS in a Dutch sample. Furthermore, our results highlight cross-cultural differences in perinatal mental health and show the importance of examining instrument structure of context-dependent constructs, such as prenatal worries.

COVID-19 pandemic effects: Examining prenatal internalizing symptoms and infant temperament.

For pregnant women, the COVID-19 pandemic has resulted in unprecedented stressors, including uncertainty regarding prenatal care and the long-term consequences of perinatal infection. However, few studies have examined the role of this adverse event on maternal wellbeing and infant socioemotional development following the initial wave of the pandemic when less stringent public health restrictions were in place. The current study addressed these gaps in the literature by first comparing prenatal internalizing symptoms and infant temperament collected after the first wave of the pandemic to equivalent measures in a pre-pandemic sample. Second, associations between prenatal pandemic-related stress and infant temperament were examined. Women who were pregnant during the COVID-19 pandemic endorsed higher pregnancy-specific anxiety relative to the pre-pandemic sample. They also reported greater infant negative emotionality and lower positive affectivity and regulatory capacity at 2 months postpartum. Prenatal infection stress directly predicted infant negative affect. Both prenatal infection and preparedness stress were indirectly related to infant negative emotionality through depression symptoms during pregnancy and at 2 months postpartum. These results have implications for prenatal mental health screening procedures during the pandemic and the development of early intervention programs for infants born to mothers during this adverse event.

Emotional Well-Being of Pediatric Brain Tumor Survivors and Comparison Peers: Perspectives From Children and Their Parents.

OBJECTIVE: The aim of this study was to examine the emotional well-being of pediatric brain tumor survivors (PBTS) from the perspective of children's self-reports and parents' reports relative to matched comparison peers (COMP) and their parents. It was hypothesized that PBTS would self-report more depression symptoms, loneliness, and lower self-concept than COMP. We also hypothesized that mothers and fathers of PBTS would report more internalizing symptoms and lower total competence for their children. Age and sex effects were examined in exploratory analyses. METHODS: Families of 187 PBTS and 186 COMP participated across 5 sites. Eligible children in the PBTS group were 8-15 years of age and 1-5 years post-treatment for a primary intracranial tumor without progressive disease. COMP were classmates matched for sex, race, and age. RESULTS: PBTS self-reported lower scholastic, athletic, and social competence, but not more depression, loneliness, or lower global self-worth than COMP. Parents of PBTS reported more internalizing symptoms and lower total competence than parents of COMP. With few exceptions, group differences did not vary as a function of child age and sex. CONCLUSION: PBTS reported diminished self-concept in scholastic, athletic, and social domains, while their parents reported broader challenges with internalizing symptoms and total competence. Discrepancies between self-report and parent report require further study to inform targeted interventions for PBTS. Screening survivors for emotional challenges in follow-up clinic or in school setting may help with the allocation of psychosocial support and services for PBTS and their families.

Psychosocial functioning of caregivers of pediatric brain tumor survivors.

BACKGROUND: Assessment of caregiver needs is a recommended standard of care in pediatric oncology. Caregivers of pediatric brain tumor survivors (PBTS) are a subgroup that may be at highest psychosocial risk. This study examined psychosocial functioning of caregivers of PBTS in comparison to caregivers of youth without cancer history. We hypothesized that caregivers of PBTS would exhibit more psychological symptoms, higher caregiver burden, and lower perceptions of social support than caregivers of comparison youth. PROCEDURE: As part of a five-site study, we utilized a matched sample design to evaluate psychosocial functioning of 301 caregivers of 189 PBTS (ages 8-15) who were 1-5 years post treatment, and 286 caregivers of 187 comparison youth matched for sex, race, and age. Caregivers completed measures of psychological symptoms, caregiver burden, and perceptions of social support. Repeated measures mixed models compared outcomes between groups and examined differences based on caregiver sex. Socioeconomic status (SES) was examined as a moderator of significant main effects. RESULTS: Caregivers of PBTS reported similar levels of psychological symptoms to caregivers of comparison youth. Mothers of PBTS mothers reported higher caregiver burden and lower perceptions of social support than mothers of comparison youth. Low SES exacerbated group differences in caregiver burden. CONCLUSIONS: Mothers of PBTS may have more caregiving responsibilities and perceive less social support, but reported similar levels of psychological symptoms to comparison mothers; fathers of PBTS were similar to comparison fathers. The mechanisms involved in this complex psychosocial dynamic require further investigation.

Investigating the links between parent-child interactions and context-specific electroencephalography asymmetry: Neurophysiology behind a frustrating task.

This study investigated the relations between parent-child interactions and infant brain activity in the context of a frustration eliciting task. Specifically, electroencephalography (EEG) data were recorded and processed to provide alpha frontal asymmetry indicators linked with approach/avoidance emotions and motivation. These data were collected from 53 mother-infant dyads during baseline and a toy retraction task, with play interactions coded for caregiving quality indicators. Hierarchical multiple linear regression analyses indicated that infants of more sensitive/responsive mothers and those engaging in more fast-paced/active play exchanges with caregivers demonstrated a relative left frontal activation response during toy retraction. Reciprocity/synchrony and directedness (parent vs. child directed) did not account for significant amounts of toy retraction EEG asymmetry response variance. It may be that infants experience greater frustration in the context of an attractive toy being removed when their typical play exchanges with caregivers are marked by sensitivity to their needs and are physically/verbally engaging. The findings are discussed in the context of the capability model of EEG asymmetry with regard to infant EEG.

Healthcare professionals' and budtenders' perceptions of perinatal cannabis use.

Background: While national guidelines state that cannabis should not be consumed during pregnancy, cannabis use during pregnancy continues to increase. Pregnant individuals have reported using healthcare professionals and budtenders (i.e., cannabis store retailers) as resources for information on cannabis use during pregnancy and postpartum.Objectives: To determine healthcare professionals' and budtenders' perceptions of risks and benefits of perinatal cannabis use.Method: A qualitative study, using semi-structured, open-ended questions, was conducted with ten healthcare professionals (predominantly nurses; 100% women) and ten budtenders (70% women) in a state where cannabis use is legal for adults 21 years of age and older. Data were interpreted using a qualitative description methodology to identify themes. Themes were generated from participant responses (implicit and explicit). We analyzed data separately and sequentially and present linked themes across samples. Data saturation, rigor, and trustworthiness were discussed and agreed upon by the analytic team.Results: Six themes arose from the healthcare professional and budtender data: 1) Perinatal customers and patients perceive cannabis to be medicinal, 2) Supporting perinatal people who use cannabis, 3) Spectrum of perceived impacts of perinatal cannabis use, 4) Comparison to use of other substances during pregnancy, 5) Perceived limited knowledge and training about cannabis regulation and product safety, and 6) Current trends of purchase and use.Conclusion: Participants reported that perinatal patients/customers perceived cannabis to be medicinal, and highlighted non-judgmental/harm reduction strategies for engaging patients/customers. Training is needed for healthcare professionals and budtenders to assist with patient/customer discussions about perinatal cannabis use.

Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women.

BACKGROUND: Psychological stress and coping experienced during pregnancy can have important effects on maternal and infant health, which can also vary by race, ethnicity, and socioeconomic status. Therefore, we assessed stressors, coping behaviors, and resources needed in relation to the COVID-19 pandemic in a sample of 162 perinatal (125 pregnant and 37 postpartum) women in the United States. METHODS: A mixed-methods study captured quantitative responses regarding stressors and coping, along with qualitative responses to open-ended questions regarding stress and resources needed during the COVID-19 pandemic. Logistic and linear regression models were used to analyze differences between pregnant and postpartum participants, as well as differences across key demographic variables. Qualitative content analysis was used to analyze open-ended questions. RESULTS: During the COVID-pandemic, food scarcity and shelter-in-place restrictions made it difficult for pregnant women to find healthy foods. Participants also reported missing prenatal appointments, though many reported using telemedicine to obtain these services. Financial issues were prevalent in our sample and participants had difficulty obtaining childcare. After controlling for demographic variables, pregnant women were less likely to engage in healthy stress-coping behaviors than postpartum women. Lastly, we were able to detect signals of increased stressors induced by the COVID-19 pandemic, and less social support, in perinatal women of racial and ethnic minority, and lower-income status. Qualitative results support our survey findings as participants expressed concerns about their baby contracting COVID-19 while in the hospital, significant others missing the delivery or key obstetric appointments, and wanting support from friends, family, and birthing classes. Financial resources, COVID-19 information and research as it relates to maternal-infant health outcomes, access to safe healthcare, and access to baby supplies (formula, diapers, etc.) emerged as the primary resources needed by participants. CONCLUSIONS: To better support perinatal women's mental health during the COVID-19 pandemic, healthcare providers should engage in conversations regarding access to resources needed to care for newborns, refer patients to counseling services (which can be delivered online/via telephone) and virtual support groups, and consistently screen pregnant women for stressors.

Understanding emerging regulation: The role of frontal electroencephalography asymmetry and negative affectivity.

The present study examined frontal electroencephalography (EEG) asymmetry and negative affectivity (NA) as predictors of infant behaviors during the Still-Face Paradigm (SFP). It was hypothesized that infants with lower NA subscale scores who also demonstrate greater left frontal activation would exhibit more frequent social engagement and self-soothing behaviors during the SFP. Mothers reported infant temperament at 6-12 months of age (N = 62), and EEG was recorded during a baseline task and the SFP. Social engagement, distress, and self-soothing behaviors were coded during the SFP. A three-factor solution emerged based on exploratory factor analysis of eight infant behaviors. After considering bivariate relations, multiple regression analyses predicting the behavior factor labeled social engagement (containing vocalizations and handwaving; average factor loading = .56) were conducted separately for asymmetry and NA subscales, controlling for infant sex and age. The SFP asymmetry predicted social engagement after controlling for covariates and baseline asymmetry; however, NA subscales (falling reactivity and distress to limitations) did not uniquely explain significant variance. These findings highlight the importance of frontal EEG asymmetry in contributing to emerging social engagement and regulation in infancy. Implications include potentially utilizing asymmetry markers as screening and intervention targets in the first year of life.

Development and validation of the Mindful Parenting in Infancy Scale (MPIS).

Although mindfulness in parenting has been recognized as important for some time, there is a dearth of measurement tools, especially for caregivers of infants. Two studies were conducted: (1) developing and providing an initial psychometric evaluation of the Mindful Parenting in Infancy Scale (MPIS) and (2) reproducing initial findings with an independent sample of infants and caregivers. In Study 1, 37 caregivers of infants (3-12 months of age) responded to MPIS, providing indicators of parenting stress and infant temperament. Study 2 caregivers (N = 57) responded to identical measures, with infant electroencephalogram (EEG) recorded during the Still Face Procedure, along with a baseline condition. Study 1 results indicated good internal consistency, with Study 2 providing additional support for reliability. Correlations with parenting stress markers were also significant across both investigations, indicative of greater stress with lower levels of mindfulness. A number of correlations with temperament scores were also significant, and in the hypothesized direction, across both studies. Importantly, the MPIS score was predictive of infant frontal EEG asymmetry in a path model examined in the context of Study 2. Thus, the present investigation provides support for MPIS as a promising brief measurement tool based on results obtained with two independent samples.

Modeling development of frontal electroencephalogram (EEG) asymmetry: Sex differences and links with temperament.

Asymmetric patterns of frontal brain electrical activity reflect approach and avoidance tendencies, with stability of relative right activation associated with withdrawal emotions/motivation and left hemisphere activation linked with approach and positive affect. However, considerable shifts in approach/avoidance-related lateralization have been reported for children not targeted because of extreme temperament. In this study, dynamic effects of frontal electroencephalogram (EEG) power within and across hemispheres were examined throughout early childhood. Specifically, EEG indicators at 5, 10, 24, 36, 48, and 72 months-of-age (n = 410) were analyzed via a hybrid of difference score and panel design models, with baseline measures and subsequent time-to-time differences modeled as potentially influencing all subsequent amounts of time-to-time change (i.e., predictively saturated). Infant sex was considered as a moderator of dynamic developmental effects, with temperament attributes measured at 5 months examined as predictors of EEG hemisphere development. Overall, change in left and right frontal EEG power predicted declining subsequent change in the same hemisphere, with effects on the opposing neurobehavioral system enhancing later growth. Infant sex moderated the pattern of within and across-hemisphere effects, wherein for girls more prominent left hemisphere influences on the right hemisphere EEG changes were noted and right hemisphere effects were more salient for boys. Largely similar patterns of temperament prediction were observed for the left and the right EEG power changes, with limited sex differences in links between temperament and growth parameters. Results were interpreted in the context of comparable analyses using parietal power values, which provided evidence for unique frontal effects.

ADHD and ODD Symptoms in Toddlers: Common and Specific Associations with Temperament Dimensions.

The aim of this work was to study the relationship between temperament and signs of psychopathology in typically developing toddlers. More specifically, Attentional Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) symptoms were analyzed in connection with fine-grained temperament dimensions. The sample was composed of 65 toddlers aged between 18 and 35 months. Bivariate correlations showed that higher levels of negative emotionality and approach tendencies, and lower levels of inhibitory control, were related to more ADHD and ODD manifestations. Bivariate correlations also indicated unique associations: lower levels of soothability were associated with higher ODD symptoms, whereas lower attentional focusing and low-intensity pleasure were related with higher ADHD symptoms. Additionally, regression and path analysis models indicated that ADHD was predominantly associated with attentional focusing and motor activation whereas ODD was most closely related to frustration. Our findings highlight the relevance of studying early correlates of psychopathological manifestations to identify children who could benefit from prevention and early intervention programs.

Ecological contributions to maternal-infant functioning: Differences between rural and urban family contexts.

AIMS: This study considered urban-rural differences in maternal-infant interactions (sensitivity/responsiveness and synchrony/reciprocity), infant temperament, and parenting stress, for samples similar in socioeconomic and racial composition. Higher sensitivity/responsiveness and synchrony/reciprocity were hypothesized for urban dyads, with more challenging temperament profiles predicted for rural infants. Rural mothers were expected to report more parenting-role stress. METHODS: Urban (n = 68; San Francisco Bay) and rural (n = 120; inland Pacific Northwest) mothers of infants provided ratings of temperament and parenting stress. Parental sensitivity/responsiveness and synchrony/reciprocity were coded from mother-infant play observations. Groups were compared via analyses of covariance. RESULTS: Urban mothers demonstrated significantly more sensitivity/responsiveness and synchrony/reciprocity compared to their rural counterparts. Rural mothers rated their infants significantly higher in negative affectivity and distress in response to limitations. CONCLUSION: Although socioeconomic status is traditionally implicated in rural and urban population differences, our results suggest other factors (e.g., isolation, access to resources) warrant further exploration. Rural ecology appears to present risk that should be examined more closely in maternal-infant interactions and child social-emotional development. The variability of risk within urban and rural classifications (e.g., suburban, inner-city) also requires consideration.

Mapping cortical rhythms to infant behavioral tendencies via baseline EEG and parent-report.

An important goal of developmental science is to understand how the early organization of the brain and behavioral tendencies are interconnected. A foundational step in pursuit of this goal is to identify brain-behavior relations. Much progress has been made identifying such relations during infancy by linking baseline electroencephalography (EEG) activity to infants' performance in lab-based measures of socio-emotional and cognitive development. Parent-report represents another resource in expanding our understanding to infants' behavioral tendencies in their natural environment. The current study explored how parent-report of 6- to 12-month-old (N = 53) infants' attention and regulatory abilities relates to cortical activity. The results confirmed one key hypothesis that lower levels of theta and higher levels of beta and gamma over the frontal region would be related to infants' attentional abilities. These results are consistent with the extant baseline EEG literature. Cuddliness was robustly related to higher levels of theta and lower levels of beta over the posterior, likely reflecting infants' tendency to use another person to self-regulate. Our results indicate links between these cortical rhythms and attention and regulatory processes have infant origins. Our results indicate furture research investigating brain-behavior relations using parent-report is warranted.

Featured Article: Community Crime Exposure and Risk for Obesity in Preschool Children: Moderation by the Hypothalamic-Pituitary-Adrenal-Axis Response.

Objective: Identification of early risk factors related to obesity is critical to preventative public health efforts. In this study, we investigated links between the Hypothalamic-Pituitary-Adrenal (HPA)-axis activity (diurnal cortisol pattern), geospatially operationalized exposure to neighborhood crime, and body mass index (BMI) for a sample of 5-year-old children. Greater community crime exposure and lower HPA-axis activity were hypothesized to contribute to higher BMI, with child HPA-axis moderating the association between crime exposure and BMI. Method: Families residing within the boundaries of the City of Seattle (N = 114) provided information concerning demographic/psychosocial risk factors, used to calculate a Cumulative Risk Index, indicating the number of contextual adversities present. Child BMI and diurnal cortisol pattern (derived from assays of saliva samples) were examined, along with neighborhood crime indices computed with publically available information, based on participants' locations. Results: Hierarchical multiple regression analyses, adjusted for covariates (cumulative risk, age, and sex), indicated that crime proximity made a unique contribution to child BMI, in the direction signaling an increase in the risk for obesity. Consistent with our hypothesis, a significant interaction was observed, indicative of moderation by diurnal cortisol pattern. Follow-up simple slope analyses demonstrated that crime exposure was significantly related to higher BMI for children with low-flat (blunted) diurnal cortisol patterns, where community crime and BMI were not significantly associated at higher levels of cortisol. Conclusion: Community crime exposure contributes to higher BMI as early as the preschool period, and blunted diurnal cortisol patterns may place children experiencing neighborhood adversity at greater risk for obesity.

Positive Affectivity and Fear Trajectories in Infancy: Contributions of Mother-Child Interaction Factors.

Fear and positive emotionality were considered in a growth modeling context. Mothers, primarily Caucasian (91.9%) and of middle socioeconomic status, participated in play interactions with infants at 4 months (N = 148). Infant fear and positive affectivity were evaluated at 6, 8, 10, and 12 months of age. A linear trajectory was superior in explaining growth for parent report and observation-based indicators of positive affectivity and parent report of fearfulness; a piecewise model explained the nonlinear growth of observation-based fear. Responsiveness in mother-infant interactions emerged as a significant predictor of the fear trajectory, with higher sensitivity predicting lower levels of observed fear. Reciprocity, tempo, emotional tone, and intensity of mother-infant interactions also made significant contributions to temperament development; however, analyses addressing these were exploratory.

Prenatal influences on temperament development: The role of environmental epigenetics.

This review summarizes current knowledge and outlines future directions relevant to questions concerning environmental epigenetics and the processes that contribute to temperament development. Links between prenatal adversity, epigenetic programming, and early manifestations of temperament are important in their own right, also informing our understanding of biological foundations for social-emotional development. In addition, infant temperament attributes represent key etiological factors in the onset of developmental psychopathology, and studies elucidating their prenatal foundations expand our understanding of developmental origins of health and disease. Prenatal adversity can take many forms, and this overview is focused on the environmental effects of stress, toxicants, substance use/psychotropic medication, and nutrition. Dysregulation associated with attention-deficit/hyperactivity-disruptive disorders was noted in the context of maternal substance use and toxicant exposures during gestation, as well as stress. Although these links can be made based on the existing literature, currently few studies directly connect environmental influences, epigenetic programming, and changes in brain development/behavior. The chain of events starting with environmental inputs and resulting in alterations to gene expression, physiology, and behavior of the organism is driven by epigenetics. Epigenetics provides the molecular mechanism of how environmental factors impact development and subsequent health and disease, including early brain and temperament development.

Parenting matters: Moderation of biological and community risk for obesity.

Contributions of parental limit setting, negativity, scaffolding, warmth, and responsiveness to Body Mass Index (BMI) were examined. Parenting behaviors were observed in parent-child interactions, and child BMI was assessed at 5 years of age. Mothers provided demographic information and obtained child saliva samples used to derive cortisol concentration indicators (N = 250). Geospatial crime indices were computed based on publically available information for a subsample residing within the boundaries of a Pacific Northwest city (N = 114). Maternal warmth and limit setting moderated the association between child HPA-axis regulation and BMI. BMI was higher for children at lower cortisol concentrations with greater maternal warmth and lower for youngsters with mid-range cortisol values under high maternal limit setting. Maternal scaffolding moderated the effects of crime exposure, so that lower scaffolding translated into higher child BMI with greater neighborhood crime exposure. These parenting behaviors could be leveraged in obesity prevention/intervention efforts.

Intergenerational transmission of traumatization: Theoretical framework and implications for prevention.

Intergenerational transmission of traumatization (ITT) occurs when traumatized parents have offspring with increased risk for emotional and behavioral problems. Although fetal exposure to the maternal biological milieu is known to be one factor in ITT, PTSD-driven parent-child interactions represent an additional important and potentially modifiable contributor. The Perinatal Interactional Model of ITT presented herein proposes that PTSD leads to social learning and suboptimal parent-child interactions, which undermine child regulatory capacity and increase distress, largely explaining poor social-emotional outcomes for offspring of parents with PTSD. Psychosocial intervention, particularly when delivered early in pregnancy, holds the possibility of disrupting ITT.

Sculpting infant soothability: the role of prenatal SSRI antidepressant exposure and neonatal SLC6A4 methylation status.

The role of prenatal Selective Serotonin Reuptake Inhibitor (SSRI) exposure and SLC6A4 promoter methylation status in shaping soothability at 3 and 6 months of age, for infants exposed to antidepressant medication prenatally (n = 46) and those not exposed (n = 69) was investigated. SSRI exposure status and duration of exposure (number of days) were examined along with neonatal methylation status at mean CpG 9,10 and via factor analysis across 10 CpG sites yielding PC1 (CpGs sites: 3,4,5,7) and PC2 (CpG 1,8). Analyses revealed interactions for methylation markers and SSRI exposure variables. A significant interaction between SSRI exposure and mean SLC6A4 methylation at CpG 9,10 and separately for PC1 emerged, controlling for multiple birth/medical and background covariates (e.g., Apgar scores, maternal education). Increased neonatal methylation status was associated with increased soothability changes from 3 to 6 months among infants prenatally exposed to SSRIs.

Do Infant Temperament Characteristics Predict Core Academic Abilities in Preschool-Aged Children?

Examined relationships between temperament, measured via parent report at 4 months and structures laboratory observations at 12 months of age, and a school readiness battery administered at about 4 years of age (N=31). Scores on the School Readiness Assessment of the Bracken Basic Concept Scale (BBCS) were related to infant Positive Affectivity/Surgency (PAS), with infants described as demonstrating higher levels of PAS at 4 months of age later demonstrating greater school readiness in the domains of color, letter, and number skills. Regulatory Capacity/Orienting (RCO) at 4 months also predicted color skills, with more regulated infants demonstrating superior pre-academic functioning in this area. Analyses involving laboratory observations of temperament provided additional information concerning the importance of infant Positive Affectivity/Surgency, predictive of overall letter skills and overall school-readiness scores later in childhood. Results are discussed in the context of implications for theory and research, as well as early education settings.