A challenge to the expected: Lack of longitudinal associations between the early caregiving environment, executive functions in toddlerhood, and self-regulation at 6 years.

Previous research and theory indicate an importance of the quality of the early caregiving environment in the development of self-regulation. However, it is unclear how attachment security and maternal sensitivity, two related but distinct aspects of the early caregiving environment, may differentially predict self-regulation at school start and whether a distinction between hot and cool executive function is informative in characterizing such predictions through mediation. In a 5-year longitudinal study (n = 108), we examined these associations using measures of maternal sensitivity and attachment security at 10-12 months, executive function at 4 years, and self-regulation at 6 years. Surprisingly, and despite methodological rigor, we found few significant bivariate associations between the study variables. We found no credible evidence of a longitudinal association between maternal sensitivity or attachment security in infancy and self-regulation at 6 years, or between executive function at 4 years and self-regulation at 6 years. The lack of bivariate longitudinal associations precluded us from building mediation models as intended. We discuss our null findings in terms of their potential theoretical implications, as well as how measurement type, reliability, and validity, may play a key role in determining longitudinal associations between early caregiving factors and later self-regulation and related abilities. RESEARCH HIGHLIGHTS: The early caregiving environment has been implicated in the development of later self-regulation, which includes more basic skills, such as hot and cool executive functions (EF). In a 5-year longitudinal study, with a sample of 108 children, we rigorously measured aspects of early caregiving, EF, and self-regulation. We found no significant longitudinal associations between early caregiving and self-regulation at 6 years, nor between EF at 4 years and self-regulation at 6 years. These null results highlight the complexity of modeling self-regulation development and raise critical questions about general methodological conventions within self-regulation development research.

The influence of anterior cingulate GABA+ and glutamate on emotion regulation and reactivity in adolescents and adults.

During adolescence, emotion regulation and reactivity are still developing and are in many ways qualitatively different from adulthood. However, the neurobiological processes underpinning these differences remain poorly understood, including the role of maturing neurotransmitter systems. We combined magnetic resonance spectroscopy in the dorsal anterior cingulate cortex (dACC) and self-reported emotion regulation and reactivity in a sample of typically developed adolescents (n = 37; 13-16 years) and adults (n = 39; 30-40 years), and found that adolescents had higher levels of glutamate to total creatine (tCr) ratio in the dACC than adults. A glutamate Í age group interaction indicated a differential relation between dACC glutamate levels and emotion regulation in adolescents and adults, and within-group follow-up analyses showed that higher levels of glutamate/tCr were related to worse emotion regulation skills in adolescents. We found no age-group differences in gamma-aminobutyric acid+macromolecules (GABA+) levels; however, emotion reactivity was positively related to GABA+/tCr in the adult group, but not in the adolescent group. The results demonstrate that there are developmental changes in the concentration of glutamate, but not GABA+, within the dACC from adolescence to adulthood, in accordance with previous findings indicating earlier maturation of the GABA-ergic than the glutamatergic system. Functionally, glutamate and GABA+ are positively related to emotion regulation and reactivity, respectively, in the mature brain. In the adolescent brain, however, glutamate is negatively related to emotion regulation, and GABA+ is not related to emotion reactivity. The findings are consistent with synaptic pruning of glutamatergic synapses from adolescence to adulthood and highlight the importance of brain maturational processes underlying age-related differences in emotion processing.

Behavior problems, social relationships, and adolescents' future orientation. Links from middle to late adolescence.

INTRODUCTION: As adolescents leave high school, plans for the future are of great importance. Future orientation reflects positive thoughts regarding further education, employment, and family life. While future orientation has been found to affect behavior problems, the influence of behavior problems on future orientation is mainly unknown. Positive parent-child and peer relations may boost positive outlooks, but the interplay of behavior problems and social relations for future orientation remains to be studied. METHODS: Participants were 485 adolescents, 54% girls, living in Mid-Sweden. At age 15, parents and adolescents rated ADHD- and internalizing symptoms, parents rated ODD-symptoms, and adolescents rated their relationship with parents and peers. At age 18, adolescents rated future orientation regarding education, employment, and family, and reported on delinquent acts. RESULTS: Low levels of inattention symptoms and of delinquency were important for all higher future orientation aspects. In contrast, higher levels of hyperactive-impulsive symptoms were associated with more positive outlooks on work and family life. Relationships with parents and peers were stronger predictors of future outlooks, compared with behavior problems. There were few interaction effects of behavioral symptoms and social relationship quality. CONCLUSIONS: Behavior problems in middle adolescence may negatively affect future outlooks. However, positive social relations, especially relations with peers, seem more important for optimistic views than behavior problems and thus may have a compensatory effect. The clinical implications should be to address the young person's social world, in the case of misgivings about the future, also in the presence of problematic behaviors.

Disrupted Attention to Other's Eyes is Linked to Symptoms of ADHD in Childhood.

Attention-deficit/hyperactivity disorder (ADHD) is associated with impaired social interaction. Other's eyes are important for understanding the social world. Here, we examined concurrent and longitudinal links between attention to other's eyes and symptoms of ADHD and comorbid externalizing and internalizing symptoms. Eighty-two 8 to 13-year-old children (40% with ADHD) participated. The latency to a first gaze shift to and away from the eye region of human faces, when primed to look at either the eyes or the mouth, was recorded with eye tracking. Parents rated ADHD, externalizing and internalizing symptoms at the time of testing and at 2-year follow-up. The results show that longer looking at the eyes before reorienting was specifically associated with concurrent and future symptoms of inattention, even when accounting for comorbid symptoms. We conclude that the temporal microstructure of attention to other's eyes is altered in children with symptoms of ADHD, which may contribute to social impairments.

Can attachment predict core and comorbid symptoms of attention-deficit/hyperactivity disorder beyond executive functions and emotion regulation?

OBJECTIVE: Previous findings propose an association between attachment and symptoms of attention-deficit/hyperactivity disorder (ADHD). However, the predictive ability of attachment beyond deficits in executive functioning (EF) and emotion regulation is understudied. METHOD: Using a dimensional perspective, we examined the longitudinal role of attachment on ADHD and comorbid symptoms, accounting for EF and emotion regulation. The sample consisted of 84 children (aged 8-13 years), oversampled for ADHD symptoms (42% had a diagnosis of ADHD). We assessed attachment with the Child Attachment Interview, EF with laboratory tests, and emotion regulation with parental ratings. Parents and teachers rated symptoms at baseline (T1) and at follow-up 2 years later (T2). RESULTS: Attachment insecurity was positively correlated with ADHD symptoms at T2 but with no unique contribution to symptoms beyond EF and emotion regulation. In contrast, poor EF and emotion regulation contributed to more ADHD and ODD/CD symptoms at T2. Poor emotion regulation contributed to more anxiety at T2. CONCLUSIONS: The results have important implications for understanding the mechanisms underpinning symptom expression in middle childhood/early adolescence and may guide the search for tailored interventions to reduce and prevent symptoms. PRACTITIONER POINTS: Executive functions and emotion regulation should be explored as targets for intervention in personalized treatment. The current results do not support attachment as a target for intervention at a group level, although this does not rule out that individuals/families with attachment difficulties may benefit from training programmes promoting secure attachment bonds.

Inhibitory control and problem solving in early childhood: Exploring the burdens and benefits of high self-control.

Low inhibitory control (IC) is sometimes associated with enhanced problem-solving amongst adults, yet for young children high IC is primarily framed as inherently better than low IC. Here, we explore associations between IC and performance on a novel problem-solving task, amongst 102 English 2- and 3-year-olds (Study 1) and 84 Swedish children, seen at 18-months and 4-years (Study 2). Generativity during problem-solving was negatively associated with IC, as measured by prohibition-compliance (Study 1, both ages, Study 2 longitudinally from 18-months). High parent-reported IC was associated with poorer overall problem-solving success, and greater perseveration (Study 1, 3-year-olds only). Benefits of high parent-reported IC on persistence could be accounted for by developmental level. No concurrent association was observed between problem-solving performance and IC as measured with a Delay-of-Gratification task (Study 2, concurrent associations at 4-years). We suggest that, for young children, high IC may confer burden on insight- and analytic-aspects of problem-solving.

Increased pupil dilation to happy faces in children with hyperactive/impulsive symptoms of ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is associated with disrupted emotional processes including impaired regulation of approach behavior and positive affect, irritability, and anger. Enhanced reactivity to emotional cues may be an underlying process. Pupil dilation is an indirect index of arousal, modulated by the autonomic nervous system and activity in the locus coeruleus-noradrenergic system. In the current study, pupil dilation was recorded while 8- to 12- year old children (n = 71, 26 with a diagnosis of ADHD and 45 typically developing), viewed images of emotional faces. Parent-rated hyperactive/impulsive symptoms were uniquely linked to higher pupil dilation to happy, but not fearful, angry, or neutral faces. This was not explained by comorbid externalizing symptoms. Together, these results suggest that hyperactive/impulsive symptoms are associated with hyperresponsiveness to approach-related emotional cues across a wide range of symptom severity.

ADHD symptoms and callous-unemotional traits as predictors of violent media use in adolescence.

We investigated ADHD symptoms and CU traits as predictors of violent media use in adolescence, controlling for delinquency and ODD symptoms. The effects on of disinhibition and arousal to negative stimuli, core characteristics of ADHD symptoms and CU traits, and of gender were investigated. At age 15, 88 adolescents, 50 % boys reported on CU traits, ADHD symptoms and delinquency. Parents rated the adolescents' CU traits, ADHD- and ODD symptoms. At age 16, adolescents reported on their media habits and performed tests of disinhibition and arousal to negative stimuli. Boys had higher levels of CU traits and violent media use and girls had higher levels of arousal to negative pictures. CU traits and inattention symptoms predicted violent media use, the latter association applying only to boys, with CU traits being the strongest predictor. Low arousal to threat pictures explained variance in violent media use, above CU traits. Attraction to violent media seems affected by problem behaviors, with CU traits coming forth as especially important.

Mind-wandering in children with and without ADHD.

OBJECTIVES: Mind-wandering (MW) is a commonly experienced phenomenon, characterized by focus of attention drifting away from the present situation to intrinsically originated thoughts. Studies in adults show that MW is related to ADHD symptoms, but this association is understudied in children. We set out to investigate the associations of MW in children with and without ADHD and to simultaneously validate the self-report Mind Excessively Wandering Scale (MEWS) in children. DESIGN: We used a cross-sectional, correlational, design to examine the research questions. METHODS: The sample consisted of 82 children (61 boys) aged 8-13 years (m = 10.46), of which 35 had a diagnosis of ADHD. Children rated MW; parents and teachers rated ADHD symptoms, emotion regulation and academic achievement. Working memory was assessed with Digit Span. RESULTS: MW was positively related to ADHD symptoms, and the MEWS could differentiate between cases and controls with a sensitivity of 0.71 and specificity of 0.81. Psychometric properties of the MEWS were satisfactory. In addition, MW contributed independently to working memory (R2 Δ = .05, p = .01) and emotion regulation (R2 Δ = .04, p = .04) beyond ADHD symptoms. CONCLUSIONS: MW is elevated in children with ADHD and contributes to functional domains. The MEWS is a valid tool for assessing MW in children, and the results are mostly comparable to that of adults (Mowlem et al., 2016, Journal of Attention Disorders, 23, 624), suggesting a similar relationship of MW to ADHD across the lifespan. PRACTITIONER POINTS: Spontaneous mind-wandering is elevated in children with ADHD compared to children without a diagnosis. Elevated spontaneous mind-wandering predicts lower working memory, emotion regulation and academic achievement beyond ADHD symptoms, IQ and socio-economic status. Clinicians should consider evaluating excessive spontaneous mind-wandering and targeting it as an important outcome when treating children with ADHD. The MEWS is a valid tool for assessing excessive mind-wandering in children.

Can auditory warning signals normalize eye movements in children with ADHD?

Attenuated baseline arousal has been hypothesized to underlie symptoms of attention deficit/hyperactivity disorder (ADHD). A behavioral signature of reduced baseline arousal is an increased beneficiary effect of warning signals in reaction tasks. This paradoxical effect is believed to be caused by a temporary increase in arousal induced by warning signals. In a preregistered study, we tested the hypothesis that children with high levels of ADHD symptoms would be hyperresponsive to warning signals in a well-established visual attention task (the gap/overlap paradigm). Previous studies using this task have found slower and more variable saccadic reaction times in children with ADHD compared to typically developing children, suggesting that these eye movement metrics are candidate biomarkers. We examined 71 children, of which 1/3 had a diagnosis of ADHD, using both dimensional analyses and group comparisons. Previously reported findings of reduced saccadic latency and increased latency variability were replicated. Importantly, saccadic latency was normalized by auditory warning signals. Analyses of pupil dilation, a physiological index of arousal and locus coeruleus-noradrenergic activity, confirmed that warning signals led to enhanced arousal. Our findings are novel and contribute to our understanding of arousal and attention in ADHD and have implications for treatment and interventions.

Disorganized attachment representations, externalizing behavior problems, and socioemotional competences in early school-age.

Multifactorial research must examine if disorganized attachment is specifically associated with either ODD- or ADHD-symptoms,and the mechanisms through which disorganization may become associated with externalizing problems. The present short-term longitudinal study therefore examined attachment representations, and several competences important for socio-emotional functioning, in relation to ODD- and ADHD-symptoms at T1 (N = 105, M age = 80 months) and T2 (N = 80, M age = 104 months). There was a main effect of disorganized attachment on ODD-symptoms at both time points but not on ADHD-symptoms. Disorganized children also showed lowered attention to facial expressions, a diminished ability to discriminate facial expressions, and elevated emotional reactivity. Emotional reactivity mediated the link between disorganization and ODD-symptoms at T1, but not at T2. The findings support disorganized attachment as a risk-factor for ODD-symptoms rather than ADHD-symptoms, and suggest that disorganization may become associated with ODD-symptoms through broad effects on multiple competences.

Can reactivity and regulation in infancy predict inattentive and hyperactive/impulsive behavior in 3-year-olds?

A need to identify early infant markers of later occurring inattentive and hyperactive/impulsive behaviors has come to the fore in the current attention-deficit/hyperactivity disorder literature. The purpose of such studies is to identify driving mechanisms that could enable early detection of attention-deficit/hyperactivity disorder liability and thus facilitate early intervention. Here we study independent and interactive effects of cognitive regulation (inhibition and sustained attention), temperament (reactive and regulatory aspects), and maternal sensitivity (as external regulation) in a sample of 112 typically developing 10-month-old infants (59 boys, 52.7%), in relation to inattentive and hyperactive/impulsive behavior at 3 years. The results showed that infant temperamental regulation and maternal sensitivity made independent contributions to both inattention and hyperactivity/impulsivity, in that higher levels of temperamental regulation and maternal sensitivity were related to less inattentive and hyperactive/impulsive behavior. In addition, the temperamental factor positive affectivity/surgency made a significant contribution to later hyperactivity/impulsivity, in that higher levels of positive affectivity/surgency were related to more hyperactive/impulsive behavior. No interaction effects were found. Our findings suggest temperament and parental regulation as potential and independent markers of later inattentive and hyperactive/impulsive behavior.

Does child verbal ability mediate the relationship between maternal sensitivity and later self-regulation? A longitudinal study from infancy to 4 years.

There is a need to further examine the mechanisms by which maternal sensitivity influences the development of child self-regulation. This study investigated the role of maternal sensitivity when infants were 10 months old and child verbal ability at 18 months, in relation to various aspects of self-regulation at 48 months, in a sample of 95 typically developing children (46.3% girls). In particular, the study examined, from a Vygotskian perspective, whether child verbal ability, as measured by receptive and expressive language, mediated the relationship between maternal sensitivity and hot and cool aspects of self-regulation in the child. As hypothesized, maternal sensitivity predicted child verbal ability, as well as working memory, set shifting, and delay of gratification. Child receptive language predicted set shifting, inhibition, and delay of gratification. In addition, receptive language mediated the relationship between maternal sensitivity and inhibition only. Additive effects of maternal sensitivity and child receptive language in relation to set shifting were found, and a main effect of maternal sensitivity on child delay of gratification. The results add to the body of research suggesting that responsive parenting and child verbal ability are important for the development of self-regulation, and suggest that different mechanisms may be at work for different aspects of self-regulation.

Diminished ability to identify facial emotional expressions in children with disorganized attachment representations.

The development of children's ability to identify facial emotional expressions has long been suggested to be experience dependent, with parental caregiving as an important influencing factor. This study attempts to further this knowledge by examining disorganization of the attachment system as a potential psychological mechanism behind aberrant caregiving experiences and deviations in the ability to identify facial emotional expressions. Typically developing children (N = 105, 49.5% boys) aged 6-7 years (M = 6 years 8 months, SD = 1.8 months) completed an attachment representation task and an emotion identification task, and parents rated children's negative emotionality. The results showed a generally diminished ability in disorganized children to identify facial emotional expressions, but no response biases. Disorganized attachment was also related to higher levels of negative emotionality, but discrimination of emotional expressions did not moderate or mediate this relation. Our novel findings relate disorganized attachment to deviations in emotion identification, and therefore suggest that disorganization of the attachment system may constitute a psychological mechanism linking aberrant caregiving experiences to deviations in children's ability to identify facial emotional expressions. Our findings further suggest that deviations in emotion identification in disorganized children, in the absence of maltreatment, may manifest in a generally diminished ability to identify emotional expressions, rather than in specific response biases.

COVID-19 and processes of adjustment in people with persistent pain: the role of psychological flexibility.

OBJECTIVES: The purpose of the current study was to investigate facets of Psychological Flexibility (PF) and Psychological Inflexibility (PI) and their relations with depression, anxiety, and insomnia in people with chronic pain during the COVID-19 pandemic. It was predicted that the full set of facets would significantly predict all three outcomes. The relative contributions of differing facets and dimensions was explored. METHODS: Participants with pain were selected from a sample of 1,657 Swedish adults responding to an online survey of health and COVID-19. Persistent pain was defined as pain on most days, present for three months or more. A total of 560, 33.8% of the total sample, were included in the analyses. Standardized and validated measures were used to measure depression, anxiety, and insomnia, and the Multidimensional Psychological Flexibility Inventory (MPFI) was used to measure both PF and PI. RESULTS: Significant rates of depression, anxiety, and insomnia, at 43.1, 26.4, and 64.2%, respectively, were found in this sample. These rates appear higher than those found in a general sample in Sweden. PF was negatively associated with these problems while PI was positively associated with them. Better prediction of outcome was obtained by PI compared to PF. CONCLUSIONS: PF and especially PI appear to have played a role in relation to health outcomes in people with persistent pain during the COVID-19 pandemic. This group of people appears to have been especially vulnerable to the impacts of the pandemic. This study motivates further investigation and development of treatment approaches, possibly focusing on training PF, for people with persistent pain in the current pandemic context and in the future.

Eye-movement indices of arousal predict ADHD and comorbid externalizing symptoms over a 2-year period.

Attention-deficit/hyperactivity disorder (ADHD) follows a variable course across childhood. Disrupted arousal has been hypothesized to underlie core symptoms as well as comorbid internalizing and externalizing conditions. The current study examined eye-movement and pupil-dilation metrics indexing arousal as longitudinal predictors of ADHD, externalizing, and internalizing symptoms over a 2-year period. Participants aged 8-13 years (N = 54, 30% with a diagnosis of ADHD) completed a modified version of the gap-overlap task including arousal-inducing auditory warning signals. Parents rated symptoms at the time of testing and at 2 years follow-up. Phasic alerting (reaction-time reduction after alerting cues) is an index of arousal. Here, larger phasic alerting effects predicted higher ADHD-symptom levels 2 years later. Blunted pupil-dilation responses predicted externalizing symptoms at T2, controlling for ADHD and externalizing at T1. Our results support the theory that ADHD is associated with altered arousal. Blunted arousal reactivity may be a longitudinal risk factor for externalizing problems in children with ADHD symptoms.

Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk?

BACKGROUND: Children with brain tumors are at high risk of neurocognitive decline after radiotherapy (RT). However, there is a lack of studies on how RT doses to organs at risk (OARs) impacts neurocognition. The aim of this study was to examine dose-risk relationships for mean RT dose to different brain structures important for neurocognitive networks. We explored previously established OARs and potentially new OARs. METHODS: A sample of 44 pediatric brain tumor survivors who had received proton and/or photon RT were included. Correlations between mean RT doses to OARs and IQ were analyzed. Previously established OARs were cochleae, optic chiasm, optic nerve, pituitary gland, hypothalamus, hippocampus and pons. Potential new OARs for RT-induced neurocognitive decline were cerebellum, vermis and thalamus. RESULTS: Mean RT dose to different OARs correlated with several IQ subtests. Higher mean RT dose to cochleae, optic nerve, cerebellum, vermis and pons was correlated with lower performance on particularly full-scale IQ (FIQ), Perceptual Reasoning (PRI), Working Memory (WMI) and Processing Speed Index (PSI). Higher mean RT dose to hippocampus correlated with lower performance on processing speed and working memory. For those receiving whole brain RT (WBRT), higher mean RT dose to the pituitary gland correlated with lower performance on working memory. CONCLUSION: A high dose-risk correlation was found between IQ subtests and mean RT dose in established and potential new OARs. Thus, in the lack of validated dose constraints for vulnerable brain structures, a parsimonious approach in RT planning should be considered to preserve neurocognitive networks.

Using the Infant Sibling-Design to Explore Associations Between Autism and ADHD Traits in Probands and Temperament in the Younger Siblings.

The purpose of the current study was to use the infant sibling design to explore whether proband traits of autism and ADHD could provide information about their infant sibling's temperament. This could help us to gain information about the extent to which infant temperament traits are differentially associated with autism and ADHD traits. We used parent-ratings of autistic traits and ADHD traits (CRS-3) in older siblings diagnosed with autism (age range 4 to 19 years), and their infant siblings' temperament traits (IBQ) at 9 months of age in 216 sibling pairs from two sites (BASIS, UK, and EASE, Sweden) to examine associations across siblings. We found specific, but modest, associations across siblings after controlling for sex, age, developmental level and site. Proband autistic traits were specifically related to low levels of approach in the infant siblings, with infant developmental level explaining part of the variance in infant approach. Proband ADHD traits were specifically related to high levels of infant activity even after controlling for covariates. Our findings suggest that proband traits of autism and ADHD carry information for infant sibling's temperament, indicating that inherited liability may influence early emerging behaviours in infant siblings. The impact of sex, age, developmental level and site are discussed.

Williams syndrome: reduced orienting to other's eyes in a hypersocial phenotype.

Williams syndrome (WS) is a rare genetic condition associated with high sociability, intellectual disability, and social cognitive challenges. Attention to others' eyes is crucial for social understanding. Orienting to, and from other's eyes was studied in WS (n = 37, mean age = 23, age range 9-53). The WS group was compared to a typically developing comparison participants (n = 167) in stratified age groups from infancy to adulthood. Typically developing children and adults were quicker and more likely to orient to eyes than the mouth. This bias was absent in WS. The WS group had reduced peak saccadic velocities, indicating hypo-arousal. The current study indicates reduced orienting to others' eyes in WS, which may affect social interaction skills.

Pupil dilation during negative prediction errors is related to brain choline concentration and depressive symptoms in adolescents.

Depressive symptoms are associated with altered pupillary responses during learning and reward prediction as well as with changes in neurometabolite levels, including brain concentrations of choline, glutamate and gamma-aminobutyric acid (GABA). However, the full link between depressive symptoms, reward-learning-related pupillary responses and neurometabolites is yet to be established as these constructs have not been assessed in the same individuals. The present pilot study, investigated these relations in a sample of 24 adolescents aged 13 years. Participants completed the Revised Child Anxiety and Depression Scale (RCADS) and underwent a reward learning task while measuring pupil dilation and a single voxel dorsal anterior cingulate cortex (dACC) MEGA-PRESS magnetic resonance spectroscopy scan assessing choline, glutamate and GABA concentrations. Pupil dilation was related to prediction errors (PE) during learning, which was captured by a prediction error-weighted pupil dilation response index (PE-PDR) for each individual. Higher PE-PDR scores, indicating larger pupil dilations to negative prediction errors, were related to lower depressive symptoms and lower dACC choline concentrations. Dorsal ACC choline was positively associated with depressive symptoms, whereas glutamate and GABA were not related to PE-PDR or depressive symptoms. The findings support notions of cholinergic involvement in depressive symptoms and cholinergic influence on reward-related pupillary response, suggesting that pupillary responses to negative prediction errors may hold promise as a biomarker of depressive states.