Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review.

BACKGROUND: Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts. METHODS: We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field. RESULTS: Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers. CONCLUSIONS: We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Objectives: Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods: Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results: Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions: These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.

The Effects of a Prenatal Mindfulness Intervention on Infant Autonomic and Behavioral Reactivity and Regulation.

OBJECTIVE: Maternal health and wellness during pregnancy are associated with long-term health outcomes in children. The current study examined whether infants of women who participated in a mindfulness-based intervention during pregnancy that reduced levels of stress and depression, increased physical activity, and improved glucose tolerance differed on biobehavioral markers of psychopathological and physical health risk compared with infants of women who did not. METHODS: Participants were 135 mother-infant dyads drawn from a racially and ethnically diverse, low-income sample experiencing high stress. The women participated in an intervention trial during pregnancy that involved assignment to either mindfulness-based intervention or treatment-as-usual (TAU). Infants of women from both groups were assessed at 6 months of age on sympathetic (preejection period), parasympathetic (respiratory sinus arrhythmia), and observed behavioral (negativity and object engagement) reactivity and regulation during the still face paradigm. Linear mixed-effects and generalized linear mixed-effects models were used to examine treatment group differences in infant outcomes. RESULTS: Relative to those in the intervention group, infants in the TAU group showed a delay in sympathetic activation and subsequent recovery across the still face paradigm. In addition, infants in the intervention group engaged in higher proportions of self-regulatory behavior during the paradigm, compared with the TAU group. No significant effect of intervention was found for parasympathetic response or for behavioral negativity during the still face paradigm. CONCLUSIONS: Findings provide evidence that maternal participation in a short-term, group mindfulness-based intervention during pregnancy is associated with the early development of salutary profiles of biobehavioral reactivity and regulation in their infants. Because these systems are relevant for psychopathology and physical health, prenatal behavioral interventions may benefit two generations.

Developmental patterns of emotion regulation in toddlerhood: Examining predictors of change and long-term resilience.

Emotion regulation is critical for optimal functioning across a wide range of domains and may be even more important for individuals in high-risk environments. While evidence suggests that childhood is generally a period of emotion regulation growth and development, research is needed to examine factors that may contribute to deviations from a typical trajectory. In a prospective study of 1,905 children, latent class growth analysis (LCGA) was used to identify trajectory groups of emotion regulation across toddlerhood (age 14-36 months), examine predictors of those trajectory groups from child temperament, parenting behaviors, and environmental risk, and explore predictions of resilience in 5th grade from the identified groups. LGCA supported a three-class model, with a Stable Incline group, a Decline group, and a Catch-Up group. Child negative emotionality, positive and negative parenting, and environmental risk predicted group membership. These trajectory groups in toddlerhood were predictive of child resilient functioning in the 5th grade. Our findings highlight the importance of utilizing developmental models of emotion regulation and provide implications for prevention and early intervention services to enhance emotion regulation development in early childhood.

La regulación de la emoción es crítica para el funcionamiento óptimo a lo largo de una amplia gama de dominios, y pudiera ser aún más importante para individuos en ambientes de alto riesgo. Aunque la evidencia sugiere que la niñez es generalmente un período de crecimiento y desarrollo de la regulación emocional, se necesita investigación para examinar los factores que pudieran contribuir a las desviaciones de esta trayectoria. En un estudio de probabilidad de 1,905 niños, se usó un análisis de crecimiento de clase latente (LCGA) para identificar grupos de trayectoria de la regulación emocional a lo largo de la primera infancia (edad 14-36 meses), examinar los factores de predicción de esos grupos de trayectoria como el temperamento del niño, conductas de crianza, y riesgo del ambiente, y explorar las predicciones de resistencia de los grupos en el quinto grado. LCGA apoyó un modelo de tres clases, con un grupo inclinado a la estabilidad, un grupo que disminuye, y un grupo que trata de alcanzar. La emocionalidad negativa del niño, la crianza positiva y negativa, así como el riesgo del ambiente predijeron la pertenencia al grupo. Estos grupos de trayectoria en la primera infancia predijeron el funcionamiento de la resistencia en el quinto grado. Nuestros resultados subrayan la importancia de utilizar modelos de desarrollo de la regulación de la emoción y proveer implicaciones para la prevención y servicios de intervención temprana.

La régulation de l'émotion est critique pour le fonctionnement optimal au travers d'un grand éventail de domaines et peut être même plus importante pour les individus dans des environnements à haut risque. Alors que l'évidence suggère que l'enfance est généralement une période de croissance de la régulation de l'émotion et de son développement, des recherches sont nécessaires afin d'examiner les facteurs qui pourraient contribuer à des déviations de cette trajectoire. Dans une étude prospective de 1 905 enfants, une analyse de la croissance à classes latentes (LGCA) a été utilisée afin d'identifier des groupes de trajectoires de la régulation de l'émotion au travers de la petite enfance (âge de 14-36 mois), d'examiner les prédicteurs de ces groupes de trajectoire à partir du tempérament de l'enfant, les comportements de parentage et le risque environnemental, et afin d'explorer des prédictions de résilience en dernière classe d'école élémentaire à partir de groupes identifiés. Une LGCA a soutenu un modèle de trois classes, avec un Groupe Stable Incliné, un groupe Déclin, et un groupe de rattrapage. L'émotion négative de l'enfant, le parentage positif et négatif, et le risque environnemental ont prédit l'appartenance au groupe. Ces groupes de trajectoire dans la petite enfance ont prédit le fonctionnement de résilience de l'enfant en dernière classe d'école élémentaire. Nos résultats mettent en lumière l'importance de l'utilisation de modèles développementaux de la régulation de l'émotion et offrent des implications pour la prévention et les services d'intervention précoce.

Unpredictable maternal behavior is associated with a blunted infant cortisol response.

BACKGROUND: Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with poor physical and mental health. Early-life adversity may dysregulate cortisol response to subsequent stress. This study examines the association between patterns of maternal behavior and infant stress response to a challenge. Specifically, we test whether infant exposure to unpredictable maternal sensory signals is related to the cortisol response to a painful stressor. METHOD: Participants were 102 mothers and their children enrolled in a longitudinal study. Patterns of maternal sensory signals were evaluated at 6 and 12 months during a 10-min mother-infant play episode. Entropy rate was calculated as a quantitative measure of the degree of unpredictability of maternal sensory signals (visual, auditory, and tactile) exhibited during the play episode. Infant saliva samples were collected for cortisol analysis before and after inoculation at 12 months. RESULTS: Unpredictable patterns of maternal sensory signals were associated with a blunted infant cortisol response to a painful stressor. This relation persisted after evaluation of covariates including maternal sensitivity and maternal psychological distress. CONCLUSIONS: This study provides evidence that unpredictable patterns of maternal sensory signals are one process through which caregiving affects the function of infant stress response systems.