A longitudinal investigation of caregiving and adolescent post-traumatic stress symptoms during COVID-19: evidence for high resting RSA as a susceptibility factor.

BACKGROUND: Post-traumatic stress symptoms (PTSS) were the most frequently reported mental health concern for youth during COVID-19, yet variations in youth's PTSS responses warrant empirical consideration. Features of the caregiving environment influence youth's responses to environmental stressors, and youth's parasympathetic nervous system regulation may qualify the magnitude and/or direction of these effects. This prospective investigation evaluated diathesis stress and differential susceptibility models of caregiving and parasympathetic influences on youth's PTSS responses to COVID-19. METHOD: Participants were 225 caregiver-youth dyads (youth 49.8% female at birth; 88.4% non-white) followed from childhood through adolescence and COVID-19. Youth's resting respiratory sinus arrhythmia (RSA; Mage = 6.11, s.d. = 0.21), caregiving features (i.e. attachment security [youth Mage = 12.24, s.d. = 0.35] and caregiver internalizing psychopathology [caregiver Mage = 39.29, s.d. = 6.78]) were assessed pre-pandemic. Youth's PTSS was assessed one year prior to the US COVID-19 pandemic (Mage = 14.24, s.d. = 0.50) and during the spring of 2020 at the height of the pandemic (Mage = 15.23, s.d. = 0.57). RESULTS: Youth's PTSS increased during COVID-19. Youth with relatively high resting RSA evidenced the lowest PTSS when their caregiving environment featured high attachment security or low caregiver internalizing problems, but the highest PTSS when their caregiving environment featured low attachment security or high caregiver internalizing problems. In contrast, PTSS levels of youth with relatively low or average resting RSA did not differ significantly depending on attachment security or caregiver internalizing. CONCLUSIONS: Results are consistent with a differential susceptibility hypothesis, wherein relatively high resting RSA conferred heightened sensitivity to caregiving environments in a for-better-and-for-worse manner during COVID-19.

Intergenerational transmission of stress: Multi-domain stressors from maternal childhood and pregnancy predict children's mental health in a racially and socioeconomically diverse, multi-site cohort.

PURPOSE: Despite growing recognition that unfortunately common maternal stress exposures in childhood and pregnancy may have intergenerational impacts on children's psychiatric health, studies rarely take a life course approach. With child psychopathology on the rise, the identification of modifiable risk factors is needed to promote maternal and child well-being. In this study, we examined associations of maternal exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE) with child mental health problems in a large, sociodemographically diverse sample. METHODS: Participants were mother-child dyads in the ECHO-PATHWAYS consortium's harmonized data across three U.S. pregnancy cohorts. Women completed questionnaires regarding their own exposure to CTE and PSLE, and their 4-6-year-old child's mental health problems using the Child Behavior Checklist (CBCL). Regression analyses estimated associations between stressors and child total behavior problems, adjusting for confounders. RESULTS: Among 1948 dyads (child age M = 5.13 (SD = 1.02) years; 38% Black, 44% White; 8.5% Hispanic), maternal history of CTE and PSLE were independently associated with children's psychopathology: higher CTE and PSLE counts were related to higher total problems ([ßCTE = 0.11, 95% CI [.06, .16]; ßSLE = 0.21, 95% CI [.14, 0.27]) and greater odds of clinical levels of problems (ORCTE = 1.41; 95% CI [1.12, 1.78]; ORPSLE = 1.36; 95% CI [1.23, 1.51]). Tests of interaction showed PSLEs were more strongly associated with child problems for each additional CTE experienced. CONCLUSION: Findings confirm that maternal exposure to CTE and PSLE are independently associated with child mental health, and history of CTE exacerbates the risk associated with PSLE, highlighting intergenerational risk pathways for early psychopathology. Given the prevalence of these exposures, prevention and intervention programs that reduce childhood trauma and stress during pregnancy will likely positively impact women's and their children's health.

Infant weight-for-length gain associated with autonomic nervous system reactivity.

BACKGROUND: Research suggests that children's health and well-being are supported by core adaptive systems, including the autonomic nervous system (ANS). Despite evidence for the importance of adulthood ANS regulation in the development of disease, few studies have examined how early development may influence emerging ANS function. Therefore, we examined how infant adiposity gain during early infancy related to ANS regulation at 6 months. METHODS: Infant weight and length were abstracted from birth records and measured during the 6-month assessment in a low-income, racially/ethnically diverse sample (N = 60). WHO-standardized weight-for-length-gain change was calculated across the first 6 months of life. ANS reactivity was measured as the combined sympathetic (i.e., pre-ejection period) and parasympathetic (i.e., respiratory sinus arrhythmia) nervous system responses during the developmentally challenging Still Face Paradigm (SFP). ANS "classic reactivity" response was characterized by paired sympathetic activation and parasympathetic withdrawal. RESULTS: Lower weight-for-length gain in the first 6 months predicted classic reactivity during still face. However, greater weight-for-length gain predicted "classic reactivity" during the reunion, when infants were expected to recover, suggesting autonomic dysregulation. CONCLUSIONS: These findings suggest an association between early life adiposity gain and the development of infant ANS regulation. IMPACT: Adiposity gain during early infancy was associated with autonomic nervous system regulation at 6 months. This study identifies early adiposity gain (greater than average infant weight-for-length gain) as a risk for ANS dysregulation. This research focuses on a critical developmental period of ANS plasticity. If confirmed, findings can be used to inform early intervention programs targeting obesity prevention and to promote self-regulation.

Developmental Consequences of Early Life Stress on Risk for Psychopathology: Longitudinal Associations with Children's Multisystem Physiological Regulation and Executive Functioning.

The etiology of psychopathology is multifaceted and warrants consideration of factors at multiple levels and across developmental time. Although experiences of adversity in early life have been associated with increased risk of developing psychopathology, pathways toward maladaptation or resilience are complex and depend upon a variety of factors, including individuals' physiological regulation and cognitive functioning. Therefore, in a longitudinal cohort of 113 mother-child dyads, we explored associations from early adverse experiences to physiological co-regulation across multiple systems and subsequent variations in executive functioning. Latent profile analysis derived multisystem profiles based on children's heart rate, respiratory sinus arrhythmia, pre-ejection period, and cortisol measured during periods of rest and reactivity throughout a developmentally challenging protocol. Three distinct profiles of multisystem regulation emerged: heightened multisystem baseline activity (Anticipatory Arousal/ANS Responder), typically adaptive patterns across all systems (Active Copers/Mobilizers) and heightened HPA axis activity (HPA Axis Responders). Path models revealed that children exposed to adversity before 18-months were more likely to evidence an Anticipatory Arousal/ANS Responders response at 36-months, and children in this profile had lower executive functioning scores than the Active Copers/Mobilizers. In sum, these findings provide important information about potential physiological associations linking early adversity to variations in children's task-based executive functioning.

The implications of sympathetic and parasympathetic regulatory coordination for understanding child adjustment.

The autonomic nervous system (ANS) is comprised of sympathetic and parasympathetic branches that control core adaptive systems, including cardiac regulation, across periods of rest, reactivity, and recovery. Despite their heavily intertwined functions, research examining the coordination of parasympathetic and sympathetic ANS regulation is limited. This study examined the effects of 6-year-olds' (N = 198; 49.5% female; 46% Latinx) capacity for ANS reactivity and recovery in both sympathetic (i.e., pre-ejection period [PEP]) and parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) systems on their caregiver- and examiner-reported adaptability and attention problems at age 8. Results indicated that children's later adaptation was better accounted for by the coordination of their PEP and RSA activity than by either system in isolation. Children who evidenced optimal reactivity and recovery patterns, which entail reciprocal sympathetic and parasympathetic activity, evidenced more adaptability and fewer attention problems at age 8. In contrast, children who displayed discoordinated ANS reactivity patterns (e.g., high activation of both systems) or a total failure to recover (e.g., short PEP connoting high sympathetic activity and low RSA connoting low parasympathetic activity) evidenced poorer adjustment. These findings illustrate the incremental knowledge afforded by the joint consideration of both sympathetic and parasympathetic branches of ANS regulation in concert, as well as the importance of considering both ANS reactivity and recovery capacities for understanding adaptation.

The role of prenatal violence exposure in the development of disparities in children's adiposity from birth to middle childhood.

OBJECTIVE: This study examined whether women's exposure to multiple types of violence during childhood and pregnancy was associated with children's BMI trajectories and whether parenting quality moderated those associations. METHODS: A cohort of 1288 women who gave birth between 2006 and 2011 self-reported their exposure to childhood traumatic events, intimate partner violence (IPV), and residential address (linked to geocoded index of violent crime) during pregnancy. Children's length/height and weight at birth and at age 1, 2, 3, 4 to 6, and 8 years were converted to BMI z scores. Observed mother-child interactions were behaviorally coded during a dyadic teaching task. RESULTS: Covariate-adjusted growth mixture models identified three trajectories of children's BMI from birth to 8 years old: Low-Stable (17%), Moderate-Stable (59%), and High-Rising (22%). Children whose mothers experienced more types of IPV during pregnancy were more likely to be in the High-Rising than the Low-Stable (odds ratio [OR] = 2.62; 95% CI: 1.27-5.41) trajectory. Children whose mothers lived in higher crime neighborhoods were more likely to be in the High-Rising than the Low-Stable (OR = 1.11; 95% CI:1.03-1.17) or Moderate-Stable trajectories (OR = 1.08; CI: 1.03-1.13). Main effects of childhood traumatic events and moderation by parenting were not detected. CONCLUSIONS: Maternal experiences of violence during pregnancy increase children's risk for developing overweight, highlighting intergenerational transmission of social adversity in children's health.

The prism of reactivity: Concordance between biobehavioral domains of infant stress reactivity.

Across a range of challenging contexts, a complex system of stress responses within multiple domains (e.g., behavior, physiology) support, or thwart, an infant's capacity to navigate an ever-changing world. As understanding of these individual stress response systems has improved, researchers have called for integrated examinations across multiple systems and domains. However, extant research has usually focused on reactivity within a single system and very few explore the associations between multiple domains of stress responding. Drawing on a diverse sample of 135 mother-infant dyads, the current study explored biobehavioral concordance across the Autonomic Nervous System (ANS; measured via both cardiac and salivary indicators), Hypothalamic-pituitary-adrenal (HPA; measured via salivary indicators) axis, observed behavior, and maternal reports of temperament. Correlation analysis generally revealed moderate negative associations between ANS and HPA axis, moderate negative associations between ANS and coded negative behavior, and small-to-moderate positive associations between ANS and coded object engagement and social behavior. Salivary biomarkers and maternal report of infant temperament showed less concordance across systems and domains than cardiac ANS indicators. These findings provide a foundational understanding of the associations between biobehavioral indicators of stress responses in infancy, a period of high developmental plasticity.

Associations Between Maternal Stressful Life Events and Perceived Distress during Pregnancy and Child Mental Health at Age 4.

Accumulating evidence suggests that maternal exposure to objectively stressful events and subjective distress during pregnancy may have intergenerational impacts on children's mental health, yet evidence is limited. In a multisite longitudinal cohort (N = 454), we used multi-variable linear regression models to evaluate the predictive value of exposure to stressful events and perceived distress in pregnancy for children's internalizing problems, externalizing problems, and adaptive skills at age 4. We also explored two- and three-way interactions between stressful events, distress, and child sex. Both objective and subjective maternal stress independently predicted children's behavior, with more stressful events and higher distress predicting more internalizing and externalizing problems and worse adaptability; stress types did not significantly interact. There was some evidence that more stressful events predicted higher externalizing behaviors only for girls. Three-way interactions were not significant. The current findings highlight the importance of considering the type of stress measurement being used (e.g., counts of objective event exposure or subjective perceptions), suggest prenatal stress effects may be transdiagnostic, and meet calls for rigor and reproducibility by confirming these independent main effects in a relatively large group of families across multiple U.S. regions. Results point to adversity prevention having a two-generation impact and that pre- and postnatal family-focused intervention targets may help curb the rising rates of children's mental health problems.

Maternal childhood trauma and prenatal stressors are associated with child behavioral health.

Maternal adversity and prenatal stress confer risk for child behavioral health problems. Few studies have examined this intergenerational process across multiple dimensions of stress; fewer have explored potential protective factors. Using a large, diverse sample of mother-child dyads, we examined associations between maternal childhood trauma, prenatal stressors, and offspring socioemotional-behavioral development, while also examining potential resilience-promoting factors. The Conditions Affecting Neurocognitive Development and Learning and Early Childhood (CANDLE) study prospectively followed 1503 mother-child dyads (65% Black, 32% White) from pregnancy. Exposures included maternal childhood trauma, socioeconomic risk, intimate partner violence, and geocode-linked neighborhood violent crime during pregnancy. Child socioemotional-behavioral functioning was measured via the Brief Infant Toddler Social Emotional Assessment (mean age = 1.1 years). Maternal social support and parenting knowledge during pregnancy were tested as potential moderators. Multiple linear regressions (N = 1127) revealed that maternal childhood trauma, socioeconomic risk, and intimate partner violence were independently, positively associated with child socioemotional-behavioral problems at age one in fully adjusted models. Maternal parenting knowledge moderated associations between both maternal childhood trauma and prenatal socioeconomic risk on child problems: greater knowledge was protective against the effects of socioeconomic risk and was promotive in the context of low maternal history of childhood trauma. Findings indicate that multiple dimensions of maternal stress and adversity are independently associated with child socioemotional-behavioral problems. Further, modifiable environmental factors, including knowledge regarding child development, can mitigate these risks. Both findings support the importance of parental screening and early intervention to promote child socioemotional-behavioral health.

Identifying profiles of multisystem physiological activity across early childhood: Examining developmental shifts and associations with stress and internalizing problems.

Physiological regulation is an important predictor of health across the lifespan. Regulation occurs across multiple collaborative systems, yet few empirical studies explore multisystem activity and how this collaborative regulation develops early in life. The current study used latent profile analysis to evaluate multisystem regulation in the autonomic nervous system and hypothalamic pituitary adrenal (HPA) axis in 150 racially/ethnically diverse, low-income children at 18- and 36-months. At both timepoints, profiles of generally moderate activity (Moderate Arousal) and heightened baseline activity (Anticipatory Arousal) emerged. A profile of typically adaptive patterns across all systems (Active Copers) emerged at 18-months and a profile of heightened HPA Axis activity (HPA-axis Responders) emerged at 36-months. Persistent membership in the Anticipatory Arousal profile across time was associated with exposure to greater maternal stress at 18-months and child internalizing problems at 36-months. These findings highlight early multisystem profile development and suggest associations with stress and later behavior problems.

The physical health costs of positive adaptation to childhood adversity.

Theories of allostatic load suggest that recurrent adaptive adjustments in contexts of adversity may have a negative impact on physical well-being. To test this hypothesis, this study evaluated 6-year-old children's ego-resilience and physical abuse experiences on behavior problems and physical illness at the age of 8 years. A significant interaction between ego-resilience and physical abuse exposure indicated that, although ego-resilience buffered physically abused children from internalizing problems, it also predicted more physical illness in that group. Findings contribute to the growing body of evidence suggesting that efforts to mobilize an adaptive response in contexts of adversity may exact a cost on physical well-being.

A latent change score approach to understanding dynamic autonomic coordination.

Children's self-regulation is a core adaptive system in child development. Physiological indices of regulation, particularly the autonomic nervous system (ANS), have garnered increased attention as an informative level of analysis in regulation research. Cardiography supports the simultaneous examination of both ANS branches via measures of pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) as indicators of sympathetic and parasympathetic activity, respectively. However, despite their heavily intertwined functions, research examining autonomic coordination across sympathetic and parasympathetic systems is scarce. Moreover, extant efforts have favored static, mean level reactivity analyses, despite the dynamic nature of ANS regulation and the availability of analytic tools that can model these processes across time. This study drew on a sample of 198 six-year-old children from a diverse community sample (49.5% female, 43.9% Latinx) to examine dynamic autonomic coordination using bivariate latent change score modeling to evaluate bidirectional influences of sympathetic and parasympathetic activity over the course of a challenging puzzle completion task. Results indicated that children evidenced reciprocal sympathetic activation (i.e., PEP attenuation and RSA withdrawal) across the challenge task, and these regulatory responses were characterized by a temporally leading influence of PEP on lagging changes in RSA. The current findings contribute to our understanding of children's autonomic coordination while illustrating a novel analytic technique to advance ongoing efforts to understand the etiology and developmental significance of children's physiological self-regulation.

Children's physiological reactivity in emotion contexts and prosocial behavior.

INTRODUCTION: Building on prior evidence that prosocial behavior is related to the regulation of personal distress in difficult situations, and given that physiological regulation is a central contributor to effective emotion regulation, this investigation evaluated whether and how children's autonomic nervous system (ANS) reactivity during emotion challenges influenced later expressions of prosocial behavior. METHODS: The current study utilized a diverse sample of school-aged children (N = 169; 47.9% female; 47.3% Latinx) to evaluate relations between children's parasympathetic (i.e., respiratory sinus arrhythmia; RSA) and sympathetic (i.e., pre-ejection period; PEP) reactivity in response to each of three film-elicited emotion challenges (i.e., sadness, happiness, and fear) at age 7 and both observed and parent-reported prosocial behavior one year later. RESULTS: Children's parasympathetic reactivity to a film eliciting sadness evidenced a nonlinear relation with later prosocial sharing such that children who evidenced either RSA withdrawal or augmentation in response to the sad emotion challenge engaged in higher levels of prosocial behavior than children who evidenced relatively low or absent reactivity. Parasympathetic reactivity to films eliciting happiness or fear was not significantly related to later prosocial behavior. Likewise, children's sympathetic reactivity in response to the emotion challenges did not significantly predict later prosocial behavior. CONCLUSIONS: These findings provide preliminary support for a nonlinear association between children's parasympathetic emotion reactivity and later prosocial behavior, and suggest that children's ANS regulation in sad emotion contexts may be particularly important for understanding prosocial development.

Prospective relations between intrusive parenting and child behavior problems: Differential moderation by parasympathetic nervous system regulation and child sex.

This study examined children's parasympathetic nervous system (PNS) regulation, which was indexed by respiratory sinus arrhythmia (RSA) during rest, reactivity, and recovery episodes, and sex as moderators of predicted relations between observed intrusive parenting and later observer-rated child behavior problems. Child-caregiver dyads (N=250; 50% girls; 46% Latino/a) completed a series of laboratory assessments yielding independent measures of intrusive parenting at age 4, PNS regulation at age 6, and child behavior problems at age 8. Results indicated that intrusive parenting was related to more internalizing problems among boys who showed low RSA reactivity (i.e., PNS withdrawal from pre-startle to startle challenge), but RSA reactivity did not moderate this relation among girls. Interestingly, RSA recovery (i.e., PNS activation from startle challenge to post-startle) moderated these relations differently for boys and girls. For girls with relatively low RSA post-startle (i.e., less recovery), intrusive parenting was positively related to both internalizing and externalizing problems. However, the reverse was true for boys, such that there was a significant positive relation between intrusive parenting and later externalizing problems among boys who evidenced relatively high RSA post-startle (i.e., more recovery). Findings provide evidence for the moderation of intrusive caregiving effects by children's PNS regulation while highlighting the differential patterning of these relations across distinct phases of the regulatory response and as a function of child sex.