Trajectories of maternal depressive symptoms from infancy through early childhood: The roles of perceived financial strain, social support, and intimate partner violence.

Although new mothers are at risk of heightened vulnerability for depressive symptoms, there is limited understanding regarding changes in maternal depressive symptoms over the course of the postpartum and early childhood of their child's life among rural, low-income mothers from diverse racial backgrounds. This study examined distinct trajectories of depressive symptoms among rural low-income mothers during the first five years of their child's life, at 6, 15, 24, and 58 months, using data from the Family Life Project (N = 1,292). Latent class growth analysis identified four distinct trajectories of maternal depressive symptoms, including Low-decreasing (50%; n = 622), Low-increasing (26%; n = 324), Moderate-decreasing (13%; n = 156), and Moderate-increasing (11%; n = 131) trajectories. Multinomial logistic regression demonstrated that higher perceived financial strain and intimate partner violence, and lower social support predicted higher-risk trajectories (Low-increasing, Moderate-decreasing, and Moderate-increasing) relative to the Low-decreasing trajectory. Compared to the Low-decreasing trajectory, lower neighborhood safety/quietness predicted to the Low-increasing trajectory. Moreover, lower social support predicted the Moderate-increasing trajectory, the highest-risk trajectory, compared to those in Moderate-decreasing. The current analyses underscore the heterogeneity on patterns of depressive symptoms among rural, low-income mothers, and that the role of both proximal and broader contexts contributing to distinct trajectories of maternal depressive symptoms over early childhood.

Effects of prenatal psychosocial stress and COVID-19 infection on infant attention and socioemotional development.

BACKGROUND: The COVID-19 pandemic dramatically altered the psychosocial environment of pregnant women and new mothers. In addition, prenatal infection is a known risk factor for altered fetal development. Here we examine joint effects of maternal psychosocial stress and COVID-19 infection during pregnancy on infant attention at 6 months postpartum. METHOD: One-hundred and sixty-seven pregnant mothers and infants (40% non-White; n = 71 females) were recruited in New York City (n = 50 COVID+, n = 117 COVID-). Infants' attentional processing was assessed at 6 months, and socioemotional function and neurodevelopmental risk were evaluated at 12 months. RESULTS: Maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted infant attention at 6 months. In mothers reporting positive COVID-19 infection, higher prenatal psychosocial stress was associated with lower infant attention at 6 months. Exploratory analyses indicated that infant attention in turn predicted socioemotional function and neurodevelopmental risk at 12 months. CONCLUSIONS: These data suggest that maternal psychosocial stress and COVID-19 infection during pregnancy may have joint effects on infant attention at 6 months. This work adds to a growing literature on the effects of the COVID-19 pandemic on infant development, and may point to maternal psychosocial stress as an important target for intervention. IMPACT: This study found that elevated maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted lower infant attention scores at 6 months, which is a known marker of risk for neurodevelopmental disorder. In turn, infant attention predicted socioemotional function and risk for neurodevelopmental disorder at 12 months. These data suggest that maternal psychosocial stress may modulate the effects of gestational infection on neurodevelopment and highlight malleable targets for intervention.

Sensitive caregiving and reward responsivity: A novel mechanism linking parenting and executive functions development in early childhood.

Sensitive caregiving is an essential aspect of positive parenting that influences executive functions development, but the mechanisms underlying this association are less clear. Using data from the Family Life Project, a large prospective longitudinal sample of 1292 families residing in rural, predominately low-income communities, the current study examined whether sensitive caregiving impacts executive functions development by shaping behavioral reward processing systems in early postnatal life. Results indicated that higher levels of sensitive caregiving during infancy were associated with heightened reward responsivity at age 4, which in turn predicted superior executive functions ability at age 5. Notably, children's reward responsivity partially mediated the relationship between sensitive caregiving in infancy and executive functions ability at school entry. These findings add to prior work on early experience and children's executive functions and highlight caregiver scaffolding of developing reward processing systems as a potential foundational mechanism for supporting adaptive behavior and self-regulation across the lifespan.

OWLET: An automated, open-source method for infant gaze tracking using smartphone and webcam recordings.

Groundbreaking insights into the origins of the human mind have been garnered through the study of eye movements in preverbal subjects who are unable to explain their thought processes. Developmental research has largely relied on in-lab testing with trained experimenters. This constraint provides a narrow window into infant cognition and impedes large-scale data collection in families from diverse socioeconomic, geographic, and cultural backgrounds. Here we introduce a new open-source methodology for automatically analyzing infant eye-tracking data collected on personal devices in the home. Using algorithms from computer vision, machine learning, and ecological psychology, we develop an online webcam-linked eye tracker (OWLET) that provides robust estimation of infants' point of gaze from smartphone and webcam recordings of infant assessments in the home. We validate OWLET in a large sample of 7-month-old infants (N = 127) tested remotely, using an established visual attention task. We show that this new method reliably estimates infants' point-of-gaze across a variety of contexts, including testing on both computers and mobile devices, and exhibits excellent external validity with parental-report measures of attention. Our platform fills a significant gap in current tools available for rapid online data collection and large-scale assessments of cognitive processes in infants. Remote assessment addresses the need for greater diversity and accessibility in human studies and may support the ecological validity of behavioral experiments. This constitutes a critical and timely advance in a core domain of developmental research and in psychological science more broadly.

Paid maternal leave is associated with infant brain function at 3 months of age.

The first months of life are critical for establishing neural connections relevant for social and cognitive development. Yet, the United States lacks a national policy of paid family leave during this important period of brain development. This study examined associations between paid leave and infant electroencephalography (EEG) at 3 months in a sociodemographically diverse sample of families from New York City (N = 80; 53 males; 48% Latine; data collection occurred 05/2018-12/2019). Variable-centered regression results indicate that paid leave status was related to differences in EEG power (ps < .02, R2 s > .12). Convergent results from person-centered latent profile analyses demonstrate that mothers with paid leave were 7.39 times as likely to have infants with EEG profiles characterized by increased higher-Hz power (95% CI, 1.9-36.9), potentially reflecting more mature patterns of brain activity.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Signal in the noise: Dimensions of predictability in the home auditory environment are associated with neurobehavioral measures of early infant sustained attention.

The home auditory environment influences the development of early language abilities, and excessive noise exposure is increasingly linked with deficits in language and reading scores in children. However, fewer studies have considered the role of noise exposure in shaping the development of attentional processing in early infancy, a foundational neurocognitive skill relevant for learning. Here, we used passive at-home auditory recording to investigate how multiple dimensions of infants' home auditory environments, including both the quantity and the predictability of auditory input, impacts neural and behavioral measures of sustained attention in a sociodemographically diverse sample of 3-month-old infants (N = 98 infants, 62 males; age M = 3.48 months, SD = 0.39; 52% Hispanic/Latino). Results indicated that infants who were exposed to more predictable patterns of auditory input in the home demonstrated longer overall time in sustained attention during laboratory assessments. In addition, infants' who experienced more predictable auditory input also demonstrated greater relative increases in electroencephalography frontal theta power during periods of sustained attention, a neural marker relevant to information processing and attentional control. These findings provide novel evidence into the importance of the predictability of early environmental inputs in shaping developing cortical circuitry and attentional systems from the first months of postnatal life.

All contexts are not created equal: Social stimuli win the competition for organizing reinforcement learning in 9-month-old infants.

Previous work has shown that infants as young as 8 months of age can use certain features of the environment, such as the shape or color of visual stimuli, as cues to organize simple inputs into hierarchical rule structures, a robust form of reinforcement learning that supports generalization of prior learning to new contexts. However, especially in cluttered naturalistic environments, there are an abundance of potential cues that can be used to structure learning into hierarchical rule structures. It is unclear how infants determine what features constitute a higher-order context to organize inputs into hierarchical rule structures. Here, we examine whether 9-month-old infants are biased to use social stimuli, relative to non-social stimuli, as a higher-order context to organize learning of simple visuospatial inputs into hierarchical rule sets. Infants were presented with four face/color-target location pairings, which could be learned most simply as individual associations. Alternatively, infants could use the faces or colorful backgrounds as a higher-order context to organize the inputs into simpler color-location or face-location rules, respectively. Infants were then given a generalization test designed to probe how they learned the initial pairings. The results indicated that infants appeared to use the faces as a higher-order context to organize simpler color-location rules, which then supported generalization of learning to new face contexts. These findings provide new evidence that infants are biased to organize reinforcement learning around social stimuli.

A daytime nap combined with nighttime sleep promotes learning in toddlers.

Napping after learning promotes consolidation of new information during infancy. Yet, whether naps play a similar role during toddlerhood, a stage when many children are beginning to transition away from napping, is less clear. In Experiment 1, we examined whether napping after learning promotes generalization of novel category exemplars 24 h later. Young children (N = 54, age range = 29-36 months) viewed three category exemplars in different contexts from each of three categories and remained awake (No-Nap condition) or napped (Nap condition) after encoding and were then tested 24 h later. Children who napped after learning showed superior generalization 24 h later relative to children who did not nap. In a Nap-Control condition tested 4 h after awakening from a nap, children performed at the same low level as in the No-Nap condition, indicating that generalization stemmed from an additional period of nighttime sleep and not simply from a nap or increased time. In Experiment 2, we examined whether nighttime sleep is sufficient for generalization if it occurs soon after learning. An additional group of children (N = 18) learned before bedtime and were tested 4 h after waking up the next day. Children did not generalize as well as those who had a nap combined with subsequent nighttime sleep. These findings suggest that naps, when combined with a period of nighttime sleep, might help toddlers to retain newly learned information and lead to delayed benefits in generalization.

Adaptive rule learning of event sequences during the A-not-B task in 9-month-old infants.

Prior work indicates that infants can use social information to organize simple audiovisual inputs into predictable rules by 8 months of age. However, it is unclear whether infants can use social information to organize more complex events into predictable rules that can be used to guide motor action. To examine these issues, we tested 9-month-old infants using a modified version of an A-not-B task, in which hiding event sequences were paired with different experimenters, who could be used to organize the events into rules that guide action. We predicted that infants' reaching accuracy would be better when the experimenter changes when the toy's hiding location changes, relative to when the experimenter stays the same, as this should cue a novel rule used to guide action. Experiments 1 and 2 validated this prediction. Experiment 3 showed that reaching accuracy was better when the toy's hiding location switched but was consistent with the rule associated with the experimenter, relative to when the toy's hiding location repeated but was inconsistent with the rule associated with the experimenter. These data suggest that infants can use the identities of experimenters to organize events into predictable rules that guide action in the A-not-B task.

The emergence of object-based visual attention in infancy: A role for family socioeconomic status and competing visual features.

The development of spatial visual attention has been extensively studied in infants, but far less is known about the emergence of object-based visual attention. We tested 3-5- and 9-12-month-old infants on a task that allowed us to measure infants' attention orienting bias toward whole objects when they competed with color, motion, and orientation feature information. Infants' attention orienting to whole objects was affected by the dimension of the competing visual feature. Whether attention was biased toward the whole object or its salient competing feature (e.g., "ball" or "red") changed with age for the color feature, with infants biased toward whole objects with age. Moreover, family socioeconomic status predicted feature-based attention in the youngest infants and object-based attention in the older infants when color feature information competed with whole-object information.

Role of Prefrontal Cortex in Learning and Generalizing Hierarchical Rules in 8-Month-Old Infants.

Recent research indicates that adults and infants spontaneously create and generalize hierarchical rule sets during incidental learning. Computational models and empirical data suggest that, in adults, this process is supported by circuits linking prefrontal cortex (PFC) with striatum and their modulation by dopamine, but the neural circuits supporting this form of learning in infants are largely unknown. We used near-infrared spectroscopy to record PFC activity in 8-month-old human infants during a simple audiovisual hierarchical-rule-learning task. Behavioral results confirmed that infants adopted hierarchical rule sets to learn and generalize spoken object-label mappings across different speaker contexts. Infants had increased activity over right dorsal lateral PFC when rule sets switched from one trial to the next, a neural marker related to updating rule sets into working memory in the adult literature. Infants' eye blink rate, a possible physiological correlate of striatal dopamine activity, also increased when rule sets switched from one trial to the next. Moreover, the increase in right dorsolateral PFC activity in conjunction with eye blink rate also predicted infants' generalization ability, providing exploratory evidence for frontostriatal involvement during learning. These findings provide evidence that PFC is involved in rudimentary hierarchical rule learning in 8-month-old infants, an ability that was previously thought to emerge later in life in concert with PFC maturation. SIGNIFICANCE STATEMENT: Hierarchical rule learning is a powerful learning mechanism that allows rules to be selected in a context-appropriate fashion and transferred or reused in novel contexts. Data from computational models and adults suggests that this learning mechanism is supported by dopamine-innervated interactions between prefrontal cortex (PFC) and striatum. Here, we provide evidence that PFC also supports hierarchical rule learning during infancy, challenging the current dogma that PFC is an underdeveloped brain system until adolescence. These results add new insights into the neurobiological mechanisms available to support learning and generalization in very early postnatal life, providing evidence that PFC and the frontostriatal circuitry are involved in organizing learning and behavior earlier in life than previously known.

8-month-old infants spontaneously learn and generalize hierarchical rules.

The ability to extract hierarchically organized rule structures from noisy environments is critical to human cognitive, social, and emotional intelligence. Adults spontaneously create hierarchical rule structures of this sort. In the present research, we conducted two experiments to examine the previously unknown developmental origins of this hallmark skill. In Experiment 1, we exploited a visual paradigm previously shown to elicit incidental hierarchical rule learning in adults. In Experiment 2, we used the same learning structure to examine whether these hierarchical-rule-learning mechanisms are domain general and can help infants learn spoken object-label mappings across different speaker contexts. In both experiments, we found that 8-month-olds created and generalized hierarchical rules during learning. Eyeblink rate, an exploratory indicator of striatal dopamine activity, mirrored behavioral-learning patterns. Our results provide direct evidence that the human brain is predisposed to extract knowledge from noisy environments, and they add a fundamental learning mechanism to what is currently known about the neurocognitive toolbox available to infants.

Wakefulness (not sleep) promotes generalization of word learning in 2.5-year-old children.

Sleep enhances generalization in adults, but this has not been examined in toddlers. This study examined the impact of napping versus wakefulness on the generalization of word learning in toddlers when the contextual background changes during learning. Thirty 2.5-year-old children (M = 32.94, SE = 0.46) learned labels for novel categories of objects, presented on different contextual backgrounds, and were tested on their ability to generalize the labels to new exemplars after a 4-hr delay with or without a nap. The results demonstrated that only children who did not nap were able to generalize learning. These findings have critical implications for the functions of sleep versus wakefulness in generalization, implicating a role for forgetting during wakefulness in generalization.

Generalizing memories over time: sleep and reinforcement facilitate transitive inference.

The use of reinforcement and rewards is known to enhance memory retention. However, the impact of reinforcement on higher-order forms of memory processing, such as integration and generalization, has not been directly manipulated in previous studies. Furthermore, there is evidence that sleep enhances the integration and generalization of memory, but these studies have only used reinforcement learning paradigms and have not examined whether reinforcement impacts or is critical for memory integration and generalization during sleep. Thus, the aims of the current study were to examine: (1) whether reinforcement during learning impacts the integration and generalization of memory; and (2) whether sleep and reinforcement interact to enhance memory integration and generalization. We investigated these questions using a transitive inference (TI) task, which is thought to require the integration and generalization of disparate relational memories in order to make novel inferences. To examine whether reinforcement influences or is required for the formation of inferences, we compared performance using a reinforcement or an observation based TI task. We examined the impact of sleep by comparing performance after a 12-h delay containing either wake or sleep. Our results showed that: (1) explicit reinforcement during learning is required to make transitive inferences and that sleep further enhances this effect; (2) sleep does not make up for the inability to make inferences when reinforcement does not occur during learning. These data expand upon previous findings and suggest intriguing possibilities for the mechanisms involved in sleep-dependent memory transformation.

Fetal Frontolimbic Connectivity Prospectively Associates With Aggression in Toddlers.

Background: Aggression is a major public health concern that emerges early in development and lacks optimized treatment, highlighting need for improved mechanistic understanding regarding the etiology of aggression. The present study leveraged fetal resting-state functional magnetic resonance imaging to identify candidate neurocircuitry for the onset of aggressive behaviors before symptom emergence. Methods: Pregnant mothers were recruited during the third trimester of pregnancy to complete a fetal resting-state functional magnetic resonance imaging scan. Mothers subsequently completed the Child Behavior Checklist to assess child aggression at 3 years postpartum (n = 79). Independent component analysis was used to define frontal and limbic regions of interest. Results: Child aggression was not related to within-network connectivity of subcortical limbic regions or within-medial prefrontal network connectivity in fetuses. However, weaker functional coupling between the subcortical limbic network and medial prefrontal network in fetuses was prospectively associated with greater maternal-rated child aggression at 3 years of age even after controlling for maternal emotion dysregulation and toddler language ability. We observed similar, but weaker, associations between fetal frontolimbic functional connectivity and toddler internalizing symptoms. Conclusions: Neural correlates of aggressive behavior may be detectable in utero, well before the onset of aggression symptoms. These preliminary results highlight frontolimbic connections as potential candidate neurocircuitry that should be further investigated in relation to the unfolding of child behavior and psychiatric risk.

COVID-19 patient accounts of illness severity, treatments and lasting symptoms.

First-person accounts of COVID-19 illness and treatment can complement and enrich data derived from electronic medical or public health records. With patient-reported data, it is uniquely possible to ascertain in-depth contextual information as well as behavioral and emotional responses to illness. The Novel Coronavirus Illness Patient Report (NCIPR) dataset includes complete survey responses from 1,584 confirmed COVID-19 patients ages 18 to 98. NCIPR survey questions address symptoms, medical complications, home and hospital treatments, lasting effects, anxiety about illness, employment impacts, quarantine behaviors, vaccine-related behaviors and effects, and illness of other family/household members. Additional questions address financial security, perceived discrimination, pandemic impacts (relationship, social, stress, sleep), health history, and coping strategies. Detailed patient reports of illness, environment, and psychosocial impact, proximal to timing of infection and considerate of demographic variation, is meaningful for understanding pandemic-related public health from the perspective of those that contracted the disease.

Perceived discrimination as a modifier of health, disease, and medicine: empirical data from the COVID-19 pandemic.

Increasing reports of long-term symptoms following COVID-19 infection, even among mild cases, necessitate systematic investigation into the prevalence and type of lasting illness. Notably, there is limited data regarding the influence of social determinants of health, like perceived discrimination and economic stress, that may exacerbate COVID-19 health risks. Here, 1,584 recovered COVID-19 patients that experienced mild to severe forms of disease provided detailed medical and psychosocial information. Path analyses examined hypothesized associations between discrimination, illness severity, and lasting symptoms. Secondary analyses evaluated sex differences, timing of infection, and impact of prior mental health problems. Post hoc logistic regressions tested social determinants hypothesized to predict neurological, cognitive, or mood symptoms. 70.6% of patients reported presence of one or more lasting symptom after recovery. 19.4% and 25.1% of patients reported lasting mood or cognitive/memory problems. Perceived discrimination predicted increased illness severity and increased lasting symptom count, even when adjusting for sociodemographic factors and mental/physical health comorbidities. This effect was specific to stress related to discrimination, not to general stress levels. Further, patient perceptions regarding quality of medical care influenced these relationships. Finally, illness early in the pandemic is associated with more severe illness and more frequent lasting complaints. Lasting symptoms after recovery from COVID-19 are highly prevalent and neural systems are significantly impacted. Importantly, psychosocial factors (perceived discrimination and perceived SES) can exacerbate individual health risk. This study provides actionable directions for improved health outcomes by establishing that sociodemographic risk and medical care influence near and long-ranging health outcomes. All data from this study have been made publicly available.

Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic.

The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.