Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity.

Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still-Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.

Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants.

Little is known about whether postnatal intervention enhances autonomic regulation among infants at risk for dysregulation due to prenatal opioid exposure. The present study evaluated the effects of modified Attachment Behavioral Catch-up (mABC) on autonomic regulation for opioid-exposed infants in a pilot randomized clinical trial. We hypothesized that, compared to a control intervention (modified Developmental Education for Families [mDEF]), mABC would be associated with higher resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as well as greater reactivity to and recovery from a social stressor (Still-Face Paradigm). Pregnant or peripartum women receiving opioid agonist therapy (61 mothers of 64 infants; final N = 36 infants) were randomly assigned to mABC or mDEF, 12-session home visiting programs beginning in the third trimester; mABC targets sensitive parenting, and mDEF targets cognitive and motor development. mABC was associated with significantly greater RSA reactivity and marginally greater PEP reactivity. In models accommodating missing data, mABC was additionally associated with significantly greater RSA recovery. In sensitivity analyses removing siblings, mABC predicted significantly enhanced PEP reactivity. Overall, in these preliminary analyses, mABC was associated with healthier autonomic regulation during a social stressor than mDEF. Thus, mABC may be a promising strategy to promote autonomic regulation among opioid-exposed infants through parenting intervention.

Development of a measure of the relative reinforcing value of food versus parent-child interaction for young children.

The relative reinforcing value (RRV) of food captures individual differences in the motivation to eat and is associated with weight status among infants, children, and adults. Currently, there is no concurrent measure of the RRV of food versus a non-food alternative for 4-to-5-year-old children. The present study aimed to develop and validate a measure of the RRV of food versus time spent interacting with a parent in the context of reading among 4-to-5-year-old children. The first phase of the study involved an online survey. Parents of 4-to-5 year olds (n = 102) reported their children's consumption frequency and liking for thirty-six snack foods. A priori criteria were used to identify snacks that were well-liked and served at least sometimes for use in the subsequent laboratory study. Then, a validation study was conducted in the laboratory to examine the construct validity of the finalized RRV task. Thirty-one parent-child dyads completed a laboratory visit, in which children's RRV of food versus time spent reading with a parent was measured concurrently on a progressive ratio reward schedule. Linear regression was used to assess validity of the task. Children's RRV of food positively and significantly predicted BMI z-scores among children with complete data (B = 0.41, p < 0.05, n = 28). Maximum schedules reached for food also positively and significantly predicted BMI z-scores (B = 0.30, p < 0.05). The relationship between maximum schedules reached for parent-child reading and BMI z-scores was in the expected direction, but this relationship was non-significant. Results support the validity and feasibility of the RRV paradigm used in the present study. Future research could continue to examine the measurement properties of this paradigm, as well as the potential for positive parent-child interactions to serve as a novel alternative to food.

Prenatal cocaine exposure and trajectories of externalizing behavior problems in early childhood: examining the role of maternal negative affect.

This study examined the association between prenatal cocaine exposure (PCE) and developmental trajectories of externalizing behavior problems from 18 to 54 months of child age. A hypothesized indirect association between PCE and externalizing trajectories via maternal negative affect was also examined. Caregiving environmental risk and child sex were evaluated as moderators. This study consisted of 196 mother-child dyads recruited at delivery from local area hospitals (107 PCE, 89 non-PCE) and assessed at seven time points across the toddler to preschool periods. Results revealed no direct associations between PCE and externalizing behavior problem trajectories. However, results did indicate that PCE shared a significant indirect relationship with externalizing behavior problem trajectories via higher levels of maternal negative affect. The association between PCE and externalizing problem trajectories was also moderated by caregiving environmental risk such that PCE children in high-risk caregiving environments did not experience the well-documented normative decline in externalizing behavior problems beginning at around 3 years of age. This study suggests potential pathways to externalizing behavior problems among high-risk children.

The relationship between sexual abuse during childhood and parenting outcomes: modeling direct and indirect pathways.

OBJECTIVE: This study examined the association between childhood sexual abuse (CSA) and parenting outcomes including parenting stress, feelings of competence and discipline strategies. Maternal depression and current partner violence were hypothesized to be mediators of the association between CSA and parenting. METHOD: This study is based on secondary data analysis of archived data. The participants were 263 primiparous mothers (107 with a history of CSA and 156 comparison mothers recruited from a prenatal clinic prior to the birth of their first child. Mothers were interviewed twice: once when they were between 28 and 32 weeks gestation and again when their child was between 2 and 4 years of age. During the first interview, women were asked about childhood experiences of sexual abuse. During their second interview, they were asked about current symptoms of pathology and experiences with partner violence and parenting beliefs and practices. RESULTS: Structural Equation Modeling indicated that the relationship between CSA and punitive discipline was mediated by maternal depression and current partner violence. CSA was associated with higher maternal depression and higher partner violence. CSA, maternal depression, and current partner violence were associated with more negative parental perceptions and higher punitive discipline. Once maternal depression and current partner violence were in the model, the relationship between CSA and parenting outcomes was no different from zero. CONCLUSION: These results highlight the risks associated with CSA for parenting outcomes and suggest two potential pathways for this increased risk.

The Effects of Alcohol in Breast Milk on Infant Behavioral State and Mother-Infant Feeding Interactions.

The short-term impact of infant exposure to alcohol in breast milk on mother-infant interactions and infant arousal was examined. Fourteen mother-infant dyads were tested on 2 occasions that consisted of an alcohol administration and a nonalcohol condition. Mother-infant interactions during feeding were videotaped and coded for dyadic reciprocity, maternal noncontingency, and dyadic conflict. Infants were observed for 1 hr after receiving either plain breast milk or breast milk containing alcohol. Behavioral state, startles, and tremors were recorded every 30 sec. Mother-infant interactions were characterized by higher noncontingency and dyadic conflict in the alcohol condition. After drinking breast milk containing alcohol, infants changed behavioral state more often, startled more, and spent less time in quiet sleep and more time in quiet alert and crying states. These findings suggest that exposure to breast milk containing alcohol may not have a sedating effect, as commonly believed.

TEMPERAMENT AND BEHAVIORAL PROBLEMS AMONG INFANTS IN ALCOHOLIC FAMILIES.

This study examined the association between paternal alcoholism and 12-month infant temperament and 18-month behavior problems. The role of associated parental psychopathology and maternal drinking in exacerbating risk for maladaptive behavioral outcomes was also examined. Participants were 213 families (102 control families, 94 paternal alcoholic families, and 17 families with alcoholic fathers and heavy drinking mothers) who were assessed when their child was 12 months old and reassessed again when their child was 18 months old. Infants of alcoholics displayed marginally more stubborn/persistent temperaments at 12 months of age, but significantly more internalizing problems at 18 months. Analyses suggested that internalizing problems in the infants of alcoholics could be attributed to the paternal depression concomitant with paternal alcoholism. In addition, an interaction was observed, indicating that paternal alcohol problems predicted 18-month externalizing problems among families with low maternal depression, but not among families with high maternal depression. Children of depressed mothers exhibited uniformly higher externalizing scores, but were not further impacted by paternal alcohol problems. However, children of nondepressed mothers were adversely affected by fathers' drinking as reflected by higher externalizing behavior scores. The results highlight the necessity of addressing the overall contextual risks that occur with paternal alcoholism in studies of the development of children in alcoholic families.

Sociodemographic differences and infant dietary patterns.

OBJECTIVES: To identify dietary patterns in US infants at age 6 and 12 months, sociodemographic differences in these patterns, and their associations with infant growth from age 6 to 12 months. METHODS: We analyzed a subsample (760 boys and 795 girls) of the Infant Feeding Practices Study II (2005-2007). Mothers reported their infants' intakes of 18 types of foods in the past 7 days, which were used to derive dietary patterns at ages 6 and 12 months by principal component analysis. RESULTS: Similar dietary patterns were identified at ages 6 and 12 months. At 12 months, infants of mothers who had low education or non-Hispanic African American mothers (vs non-Hispanic white) had a higher score on "High sugar/fat/protein" dietary pattern. Both "High sugar/fat/protein" and "High dairy/regular cereal" patterns at 6 months were associated with a smaller increase in length-for-age z score (adjusted ß per 1 unit dietary pattern score, -1.36 [95% confidence interval (CI), -2.35 to -0.37] and -0.30 [-0.54 to -0.06], respectively), while with greater increase in BMI z score (1.00 [0.11 to 1.89] and 0.32 [0.10 to 0.53], respectively) from age 6 to 12 months. The "Formula" pattern was associated with greater increase in BMI z score (0.25 [0.09 to 0.40]). The "Infant guideline solids" pattern (vegetables, fruits, baby cereal, and meat) was not associated with change in length-for-age or BMI z score. CONCLUSIONS: Distinct dietary patterns exist among US infants, vary by maternal race/ethnicity and education, and have differential influences on infant growth. Use of "Infant guideline solids" with prolonged breastfeeding is a promising healthy diet for infants after age 6 months.

Trajectories of Reinforcement Sensitivity During Adolescence and Risk for Substance Use.

Developmental neuroscience models suggest that changes in responsiveness to incentives contribute to increases in adolescent risk behavior, including substance use. Trajectories of sensitivity to reward (SR) and sensitivity to punishment (SP) were examined and tested as predictors of escalation of early substance use in a community sample of adolescents (N=765, mean baseline age 11.8 years, 54% female). SR and SP were assessed using a laboratory task. Across three annual assessments, SR increased, and rapid escalation was associated with increases in substance use. SP declined and was unrelated to substance use. Findings support contemporary views of adolescent brain development, and suggest that early adolescent substance use is motivated by approach responses to reward, rather than failure to avoid potential aversive consequences.

Behaviour problems in 18- to 36-month old children of alcoholic fathers: secure mother-infant attachment as a protective factor.

This study examined the relationship between paternal alcoholism and toddler behavior problems from 18 to 36 months of age, as well as the potential moderating effects of 12-month infant-mother attachment security on this relationship. Children with alcoholic fathers had higher levels of internalizing and externalizing behavior than children of nonalcoholic fathers. Simple effects testing of an interaction effect of child age, group, and attachment security with mothers on externalizing behaviour suggested that at 24 and 36 months of age mother-infant attachment security moderated the relationship between alcohol group status and externalizing behaviour. Namely, within the alcohol group, those children with secure relationships with their mothers had significantly lower externalizing than insecure children of alcoholics. A similar pattern was noted for internalizing behavior at 36 months of age. Implications for intervention are discussed.

Mother-infant and father-infant attachment among alcoholic families.

This study examined the association between fathers' alcoholism and other risk factors such as parental depression, family conflict, infant temperament, and parent-infant attachment. The quality of parent-infant interactions was hypothesized to be a proximal mediator of the associations among alcoholism and other risk factors and attachment. The participants were 223 families (104 nonalcoholic families and 119 alcoholic families) with 12-month-old infants recruited through birth records. Infants in families with two parents with alcohol problem had significantly higher rates of insecure attachment with both parents. Structural Equations Modeling indicated that the fathers' alcohol problem was associated with lower paternal sensitivity (higher negative affect, lower positive engagement, and lower sensitive responding) during father-infant play interactions, and this in tum was associated with higher risk for infant attachment insecurity with fathers. The association between the fathers' alcohol problem and infant attachment security with the mother was mediated by matemal depression, and matemal alcohol problems and family conflict were associated with maternal sensitivity during play interactions. These results indicate that the fathers' alcoholism is associated with higher family risk including the quality of the parent-infant relationship; infant attachment develops in a family context; and this context has a significant association with attachment security.

The effects of prenatal alcohol exposure on infant mental development: a meta-analytical review.

AIMS: Although research on fetal alcohol exposure has had a significant effect on social norms and public policy, there has been little quantitative review of this literature. METHODS: Meta-analysis was used to examine the effects of prenatal alcohol exposure on infant mental development, assessed using the Mental Development Index (MDI) from the Bayley Scales of Infant Development, a widely used, standardized measure. The current study examined the effects of three levels of average daily exposure during pregnancy: less than 1 drink per day, 1-1.99 drinks per day and 2 or more drinks per day. Analyses were conducted separately for effects derived from observations of 6-8-, 12-13- and 18-26-month-old children. RESULTS: Fetal alcohol exposure at all three dosage levels was associated with significantly lower MDI scores among 12-13-month-olds. The effect was attenuated, but not eliminated, when effect sizes adjusted for relevant covariates were used. For younger and older children, the effect of fetal alcohol exposure did not attain statistical significance at any dosage level. CONCLUSIONS: This pattern of results may reflect differences in MDI item content at different ages and the differential sensitivity of these abilities to prenatal alcohol exposure. Because the body of relevant literature is neither large nor conclusive, and because of heterogeneity in measurement, analysis and samples, caution is urged in interpreting results. Future research would benefit from use of more specific measures of infant outcomes and consideration of the impact of relevant covariates, different dosage patterns and timing of drinking on infant mental development.