Pediatrician and parental evaluation of child neurodevelopment at 2 years of age.

BACKGROUND: The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development. METHODS: Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs. RESULTS: The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37). CONCLUSIONS: Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

Newborns' perception of approach and withdrawal from biological movement: A closeness story.

Since birth, infants discriminate the biological motion (BM) revealed by point-light displays (PLDs). To date, no studies have explored whether newborns differentiate BM that approaches rather than withdraws from them. Yet, approach and withdrawal are two fundamental motivations in the socio-emotional world, key to developing empathy and prosocial behavior. Through a looking-behavior paradigm, we demonstrated that a few hours after birth, a human figure approaching attracted more visual attention than a human figure receding, showing that newborns are attuned to PLDs of others moving toward rather than walking away from them. Further, a withdrawing body appears to be less attractive than withdrawing scrambled points. Altogether, these observations support the existence of an early predisposition toward social closeness that might have its roots in an evolutionary perspective.

Encoding interactive scripts at 10 months of age.

Understanding action-reaction associations that give origin to interactive scripts (e.g., give-and-take interactions) is essential for appreciating social exchanges. However, studies on infants' action understanding have mainly investigated the case of actions performed by individual agents. Moreover, although extensive literature has explored infants' comprehension of action-effect relationships in object functioning, no study has addressed whether it also plays a role when observing social interactions, an issue we addressed here. In a first study, 10-month-old infants observed short videos of dyadic exchanges. We investigated whether they were able to link specific human gestures directed toward another person to specific vocal reactions in the receiver. We used a double-habituation paradigm in which infants were sequentially habituated to two specific action-reaction associations. In the test phase, infants watched one of the two habituated (Familiar) videos, a video with a reversed action-reaction association (Violation), and a Novel video. Results showed that the infants looked longer at both the Novel and Violation test trials than at the Familiar test trials. In a control study, we show that these results could not be accounted for by associative learning; indeed, learning of the action-reaction association did not occur when the vocalization was not produced by the receiver but only contingent on the agent's action. Thus, we show that 10-month-old infants can encode specific social action-effect relationships during the observation of dyadic interactions and that the interactivity of the social context may be critical to shaping young infants' understanding of others' behaviors.

Newborns' early attuning to hand-to-mouth coordinated actions.

Already inside the womb, fetuses frequently bring their hands to the mouth, anticipating hand-to-mouth contact by opening the mouth. Here, we explored whether 2-day-old newborns discriminate between hand actions directed towards different targets of the face-that is, a thumb that reaches the mouth and a thumb that reaches the chin. Newborns looked longer towards the thumb-to-mouth compared to the thumb-to-chin action only in the presence, and not absence, of anticipatory mouth opening movements, preceding the thumb arrival. Overall, our results show that newborns are sensitive to hand-to-face coordinated actions, being capable to discriminate between body-related actions directed towards different targets of the face, but only when a salient visual cue that anticipates the target of the action is present. The role of newborns' sensorimotor experience with hand-to-mouth gestures in driving this capacity is discussed.

Post-partum Women's Anxiety and Parenting Stress: Home-Visiting Protective Effect During the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic resulted in a particularly adverse and stressful environment for expecting mothers, possibly enhancing feelings of anxiety and parenting stress. The present work assesses mothers' anxiety levels at delivery and parenting stress after 3 months as moderated by home-visiting sessions. METHODS: Women (n = 177) in their second or third trimester of pregnancy during the COVID-19 lockdown were enrolled in northern Italy and split into those who did and did not receive home visits. After 3 months, the association between anxiety at delivery and parenting stress was assessed with bivariate correlations in the whole sample and comparing the two groups. RESULTS: Higher anxiety at birth correlated with greater perceived stress after 3 months. Mothers who received at least one home-visiting session reported lower parenting stress at 3 months than counterparts who did not receive home visits. CONCLUSIONS FOR PRACTICE: The perinatal period is a sensitive time window for mother-infant health, especially during a critical time like the COVID-19 pandemic. We suggest that home-visiting programs could be beneficial during global healthcare emergencies to promote maternal well-being after delivery.

Single point motion kinematics convey emotional signals in children and adults.

This study investigates whether humans recognize different emotions conveyed only by the kinematics of a single moving geometrical shape and how this competence unfolds during development, from childhood to adulthood. To this aim, animations in which a shape moved according to happy, fearful, or neutral cartoons were shown, in a forced-choice paradigm, to 7- and 10-year-old children and adults. Accuracy and response times were recorded, and the movement of the mouse while the participants selected a response was tracked. Results showed that 10-year-old children and adults recognize happiness and fear when conveyed solely by different kinematics, with an advantage for fearful stimuli. Fearful stimuli were also accurately identified at 7-year-olds, together with neutral stimuli, while, at this age, the accuracy for happiness was not significantly different than chance. Overall, results demonstrates that emotions can be identified by a single point motion alone during both childhood and adulthood. Moreover, motion contributes in various measures to the comprehension of emotions, with fear recognized earlier in development and more readily even later on, when all emotions are accurately labeled.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study.

PURPOSE: Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time. METHODS: Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings. RESULTS: 2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05-3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45-0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05-1.44 -ꭓ2 6.25, p = 0.012). CONCLUSIONS: The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

Envisioning translational hyperscanning: how applied neuroscience might improve family-centered care.

From the very beginning of their life, human beings are immersed in a social and interactive environment that contributes to shaping their social and cognitive development under typical and at-risk conditions. In order to understand human development in its bidirectional relationship with the social environment, we need to develop a 'complexity-sensitive' approach in neuroscience. Recent advances have started to do so with the application of hyperscanning techniques which involve recording adult and child neural activity simultaneously and highlighting the presence of similar patterns of brain activity in the dyad. Numerous studies focused on typically developing children have been published in recent years with the application of this technique to different fields of developmental research. However, hyperscanning techniques could also be extremely beneficial and effective in studying development in atypical and clinical populations. Such application, namely translational hyperscanning, should foster the transition toward a two-brain translational neuroscience. In this paper, we envision how the application of hyperscanning to atypical and clinical child populations can inform family-centered care for children and their parents.

Transitioning to adult mental health services for young people with ADHD: an Italian-based survey on practices for pediatric and adult services.

BACKGROUND: Supporting young ADHD patients in transition to adult services is essential. Yet, the low percentages of successful referrals and the issues reported by patients and clinicians stress the need for further attention to transitioning practices. The present study assessed the transitioning process of Attention-Deficit/Hyperactivity Disorder (ADHD) patients in Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Italian territory. We asked child and adult psychiatrists to report the current state of services and their observations on limitations and possible future matters that must be addressed. METHOD: Seventy-seven centers (42 CAMHS, 35 AMHS) filled in a web-based survey in which they reported the number of ADHD patients, how many transitioning patients they had within the past year, and how they structured transition. RESULTS: A fragmented picture emerged from the survey. Lack of resources, training, and communication between services hinder the transition process, and many adult patients remain under CAMHS' care. While some services have a protocol, there is no structured guidance that can help improve integration and continuity of treatment. CONCLUSION: The observed situation reflects a need for improvement and standard guidelines to enable a successful transition process, considering clinicians' and patients' necessities.

Only an inkblot? A literature review of the neural correlates of the Rorschach inkblot test.

The Rorschach inkblot test allows access to psychological processes that usually do not emerge in self-report measures and it has been widely used in clinical psychological and psychiatric settings. Recordings of brain activity during the administration of the Rorschach inkblots test could provide information on neural correlates of the underlying perceptual-cognitive processing and potentially identify neuroimaging markers of psychopathology risk. The present paper offers a systematization of the available literature on the Rorschach inkblot test and neuroimaging research. The 13 selected studies had been conducted with healthy participants and using fMRI, EEG, and fNIRS to investigate the neural underpinnings of Rorschach inkblot test responses. The neural processes underlying the visual, social, and emotional processes described by the included papers are systematically summarized. Research on the neural correlates of the Rorschach inkblot test is promising and would further benefit from studies on clinical populations, broader samples, and younger age groups.

Early detection of neurodevelopmental disorders in African children living in informal settlements in Nairobi.

BACKGROUND: Children in low-income and middle-income countries (LMICs) are at a substantially increased risk of delayed physical, emotional and sociocognitive outcomes, with consequential neurodevelopmental disorders. Evidence based, cost-effective and culturally appropriate screening tools are recommended for early identification of developmental disorders. METHODS: The present study aims to assess the feasibility of early screening for neurodevelopmental disorders in children living in informal settlements in Nairobi, Kenya (Korogocho). The selected tools (ie, the CDC checklist and the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)), widely used in high-income countries, are applied in two different populations: one from Kenya (LMIC) and one from Italy, to compare the different scores. RESULTS: Of 509 children screened, 8.6% were classified at-risk based on the results of the screening tools. Significant risk factors are history of low birth weight and Apgar score, presence of neurological disorders, malnutrition and/or rickets, younger age of the child and older age of the mother. Caesarean section delivery, first pregnancy and mothers' older age were common risk factors among the Kenyan and the Italian samples. The Italian sample had a significantly greater rate of missed milestones. CONCLUSIONS: Our data demonstrate the feasibility of using the CDC and M-CHAT-R tools in informal settlement dwellers. Further studies are needed to explore the opportunity for early diagnosis of developmental disorders in LMICs.

Maternal pandemic-related stress during pregnancy associates with infants' socio-cognitive development at 12 months: A longitudinal multi-centric study.

BACKGROUND: Prenatal maternal stress is a key risk factor for infants' development. Previous research has highlighted consequences for infants' socio-emotional and cognitive outcomes, but less is known for what regards socio-cognitive development. In this study, we report on the effects of maternal prenatal stress related to the COVID-19 pandemic on 12-month-old infants' behavioral markers of socio-cognitive development. METHODS: Ninety infants and their mothers provided complete longitudinal data from birth to 12 months. At birth, mothers reported on pandemic-related stress during pregnancy. At infants' 12-month-age, a remote mother-infant interaction was videotaped: after an initial 2-min face-to-face episode, the experimenter remotely played a series of four auditory stimuli (2 human and 2 non-human sounds). The auditory stimuli sequence was counterbalanced among participants and each sound was repeated three times every 10 seconds (Exposure, 30 seconds) while mothers were instructed not to interact with their infants and to display a neutral still-face expression. Infants' orienting, communication, and pointing toward the auditory source was coded micro-analytically and a socio-cognitive score (SCS) was obtained by means of a principal component analysis. RESULTS: Infants equally oriented to human and non-human auditory stimuli. All infants oriented toward the sound during the Exposure episode, 80% exhibited any communication directed to the auditory source, and 48% showed at least one pointing toward the sound. Mothers who reported greater prenatal pandemic-related stress had infants with higher probability of showing no communication, t = 2.14 (p = .035), or pointing, t = 1.93 (p = .057). A significant and negative linear association was found between maternal prenatal pandemic-related stress and infants' SCS at 12 months, R2 = .07 (p = .010), while adjusting for potential confounders. CONCLUSIONS: This study suggests that prenatal maternal stress during the COVID-19 pandemic might have increased the risk of an altered socio-cognitive development in infants as assessed through an observational paradigm at 12 months. Special preventive attention should be devoted to infants born during the pandemic.

Do infants represent human actions cross-modally? An ERP visual-auditory priming study.

Recent findings indicate that 7-months-old infants perceive and represent the sounds inherent to moving human bodies. However, it is not known whether infants integrate auditory and visual information in representations of specific human actions. To address this issue, we used ERPs to investigate infants' neural sensitivity to the correspondence between sounds and images of human actions. In a cross-modal priming paradigm, 7-months-olds were presented with the sounds generated by two types of human body movement, walking and handclapping, after watching the kinematics of those actions in either a congruent or incongruent manner. ERPs recorded from frontal, central and parietal electrodes in response to action sounds indicate that 7-months-old infants perceptually link the visual and auditory cues of human actions. However, at this age these percepts do not seem to be integrated in cognitive multimodal representations of human actions.

Sensorimotor Activity and Network Connectivity to Dynamic and Static Emotional Faces in 7-Month-Old Infants.

The present study investigated whether, as in adults, 7-month-old infants' sensorimotor brain areas are recruited in response to the observation of emotional facial expressions. Activity of the sensorimotor cortex, as indexed by µ rhythm suppression, was recorded using electroencephalography (EEG) while infants observed neutral, angry, and happy facial expressions either in a static (N = 19) or dynamic (N = 19) condition. Graph theory analysis was used to investigate to which extent neural activity was functionally localized in specific cortical areas. Happy facial expressions elicited greater sensorimotor activation compared to angry faces in the dynamic experimental condition, while no difference was found between the three expressions in the static condition. Results also revealed that happy but not angry nor neutral expressions elicited a significant right-lateralized activation in the dynamic condition. Furthermore, dynamic emotional faces generated more efficient processing as they elicited higher global efficiency and lower networks' diameter compared to static faces. Overall, current results suggest that, contrarily to neutral and angry faces, happy expressions elicit sensorimotor activity at 7 months and dynamic emotional faces are more efficiently processed by functional brain networks. Finally, current data provide evidence of the existence of a right-lateralized activity for the processing of happy facial expressions.

Observation of the point-light animation of a grasping hand activates sensorimotor cortex in nine-month-old infants.

Measuring changes in sensorimotor alpha band activity in nine-month-old infants we sought to understand the involvement of the sensorimotor cortex during observation of the Point-Light (PL) animation of a grasping hand. Attenuation of alpha activity was found both when the PL display moved towards the to-be-grasped object and when the object was deleted from the video. Before the beginning of the movement of the PL stimuli, only in the presence of the object evoked attenuation of sensorimotor alpha activity was documented, possibly interpreted either as movement prediction or as graspable object perception. Our main findings demonstrate that, during observation of stimuli moving with biological kinematics, the infants' sensorimotor system is activated when the pictorial information is absent or highly reduced, and independently of the presence of the goal-directed object. The possible compensatory function of the sensorimotor system during observation of highly degraded moving stimuli is discussed.

Eight-month-old infants' behavioral responses to peers' emotions as related to the asymmetric frontal cortex activity.

Infants are sensitive to and converge emotionally with peers' distress. It is unclear whether these responses extend to positive affect and whether observing peer emotions motivates infants' behaviors. This study investigates 8-month-olds' asymmetric frontal EEG during peers' cry and laughter, and its relation to approach and withdrawal behaviors. Participants observed videos of infant crying or laughing during two separate sessions. Frontal EEG alpha power was recorded during the first, while infants' behaviors and emotional expressions were recorded during the second session. Facial and vocal expressions of affect suggest that infants converge emotionally with their peers' distress, and, to a certain extent, with their happiness. At group level, the crying peer elicited right lateralized frontal activity. However, those infants with reduced right and increased left frontal activity in this situation, were more likely to approach their peer. Overall, 8-month-olds did not show asymmetric frontal activity in response to peer laughter. But, those infants who tended to look longer at their happy peer were more likely to respond with left lateralized frontal activity. The link between variations in left frontal activity and simple approach behaviors indicates the presence of a motivational dimension to infants' responses to distressed peers.