Are cortisol concentrations in human breast milk associated with infant crying?

The present longitudinal study is the first to investigate the association between human breast milk cortisol and infant crying over the first three months of life. Higher concentrations of breast milk cortisol were expected to be differentially associated with fussing and crying in boys and girls. At 2, 6, and 12 weeks of infant age, mothers (N = 70) collected a morning sample of their milk and kept a 3-day diary to measure infant fussing and crying. Cortisol was extracted and quantified from milk samples. Results showed that breast milk cortisol concentrations increased from 2 weeks through 12 weeks of infant age. Milk cortisol was unrelated to the total duration, frequency, and bout length of infant fussing and crying for both boys and girls. Directions for future research aiming to extend our knowledge on the biology of milk cortisol in relation to infant behavior and development are discussed.

Fostering Emotion Expression and Affective Involvement with Communication Partners in People with Congenital Deafblindness and Intellectual Disabilities.

BACKGROUND: Recent studies have shown that it is possible to foster affective involvement between people with congenital deafblindness and their communication partners. Affective involvement is crucial for well-being, and it is important to know whether it can also be fostered with people who have congenital deafblindness and intellectual disabilities. METHODS: This study used a multiple-baseline design to examine whether an intervention based on the Intervention Model for Affective Involvement would (i) increase affective involvement between four participants with congenital deafblindness and intellectual disabilities and their 13 communication partners and (ii) increase the participants' positive emotions and decrease their negative emotions. RESULTS: In all cases, dyadic affective involvement increased, the participants' very positive emotions also increased and the participants' negative emotions decreased. CONCLUSION: The results indicate that communication partners of persons with congenital deafblindness and intellectual disabilities can be successfully trained to foster affective involvement.

Cortisol levels of infants in center care across the first year of life: links with quality of care and infant temperament.

Cortisol concentrations of older children in childcare centers have been found to be higher than at home. This study focuses on infant cortisol in childcare centers throughout the first year of life, and aims to investigate whether inter-individual differences can be explained by temperament, the quality of maternal behavior, and the quality of center care. Sixty-four infants were followed for 9 months after entering care at 3 months of age. Salivary samples were taken at 10.00 h and 16.00 h in center care (in post-entry weeks 1, 2, 3, 4, 8, 12, 16, 24, and 36) and at home (in post-entry weeks 1, 24, and 36). Prior to entry, mothers completed a temperament questionnaire and the quality of maternal behavior (sensitivity and cooperation) was observed during routine bathing sessions. Subsequently, the infants were visited three times at center care to observe the quality of infant's interactive experiences with their professional caregiver. Longitudinal regression models showed that both morning and afternoon cortisol were higher in center care compared to home. Longitudinal regression models showed that infants receiving higher quality of maternal behavior displayed higher morning cortisol in center care, compared to infants receiving lower quality of maternal behavior. Higher quality of maternal behavior was also related to higher afternoon cortisol in center care, but only in infants high in negative emotionality. Center care quality was not related to cortisol. In sum, young infants show higher cortisol concentrations in center care that are related to infant temperament and quality of maternal behavior at home.

Does the arrival index predict physiological stress reactivity in children.

Knowledge about children's stress reactivity and its correlates is mostly based on one stress task, making it hard to assess the generalizability of the results. The development of an additional stress paradigm for children, that also limits stress exposure and test time, could greatly advance this field of research. Research in adults may provide a starting point for the development of such an additional stress paradigm, as changes in salivary cortisol and alpha-amylase (sAA) over a 1-h pre-stress period in the laboratory correlated strongly with subsequent reactivity to stress task (Balodis et al., 2010, Psychoneuroendocrinology 35:1363-73). The present study examined whether such strong correlations could be replicated in 9- to 11-year-old children. Cortisol and sAA samples were collected from 158 children (83 girls) during a 2.5-h visit to the laboratory. This visit included a 1-h pre-stress period in which children performed some non-stressful tasks and relaxed before taking part in a psychosocial stress task (TSST-C). A higher cortisol arrival index was significantly and weakly correlated with a higher AUCg but unrelated to cortisol reactivity to the stressor. A higher sAA arrival index was significantly and moderately related to lower stress reactivity and to a lower AUCi. Children's personality and emotion regulation variables were unrelated to the cortisol and sAA arrival indices. The results of this study do not provide a basis for the development of an additional stress paradigm for children. Further replications in children and adults are needed to clarify the potential meaning of an arrival index.

Acute psychosocial stress and children's memory.

We investigated whether children's performance on working memory (WM) and delayed retrieval (DR) tasks decreased after stress exposure, and how physiological stress responses related to performance under stress. About 158 children (83 girls; Mage = 10.61 years, SD = 0.52) performed two WM tasks (WM forward and WM backward) and a DR memory task first during a control condition, and 1 week later during a stress challenge. Salivary alpha-amylase (sAA) and cortisol were assessed during the challenge. Only WM backward performance declined over conditions. Correlations between physiological stress responses and performance within the stress challenge were present only for WM forward and DR. For WM forward, higher cortisol responses were related to better performance. For DR, there was an inverted U-shape relation between cortisol responses and performance, as well as a cortisol × sAA interaction, with concurrent high or low responses related to optimal performance. This emphasizes the importance of including curvilinear and interaction effects when relating physiology to memory.

The relation between gaze aversion and cortisol reactivity in middle childhood.

The present study sought to investigate the relation between ethological observations of children's gaze aversion during a psychosocial stress task and their cortisol reactivity to the task, and how this relation might be moderated by how stressful the children perceived the stress task to be. Videos of 140 children (74 girls; Mage=10.60years) performing a psychosocial stress task in front of a jury were coded for displays of the children's gaze aversion from the jury, and saliva samples were taken to determine their cortisol reactivity. A questionnaire assessed the children's level of perceived stress. Results showed higher cortisol reactivity in children who perceived the task as more stressful. Furthermore, a quadratic relation between gaze aversion and cortisol was found which depended on the level of perceived stress: for children with low levels of perceived stress, cortisol reactivity was lowest with intermediate levels of gaze aversion, whereas for children with high levels of perceived stress cortisol reactivity was highest at intermediate levels of gaze aversion. The results suggest a modest association between subjective and physiological stress responses in 9- to 11-year-olds, and indicate that gaze aversion may play only a minor role as a behavioural coping strategy at this age.

Need fulfillment, need importance, and depressive symptoms of residents over the first eight months of living in a nursing home.

BACKGROUND: Based on self-determination theory and adaptation theories, the study aim was to investigate the relationship between need fulfillment (of autonomy, relatedness, and competence), need importance, and depressive symptoms during the first months of living in a nursing home. METHODS: Eight-month longitudinal questionnaire study in which 75 persons newly admitted to units for physically frail residents participated at baseline. Twenty-three longitudinal participants were remaining at the third and final measurement wave. RESULTS: The results show a main effect of need fulfillment and an interaction effect of need fulfillment and need importance on depressive symptoms over time. A prototypical plot shows that residents with low need fulfillment had higher initial levels of depressive symptoms that decreased modestly over time, regardless of their need importance. Residents with high need fulfillment had lower initial levels of depressive symptoms, but their trajectories differed for participants with low and high need importance. Residents with low need importance started with lower levels of depressive symptoms but remained stable over time, whereas residents with high need importance had more depressive symptoms at T1 that decreased slightly over time. CONCLUSIONS: In general, depressive symptoms do not change over time. However, individual trajectories of depressive symptoms seem to depend on individual need fulfillment and need importance. The residents that consider need fulfillment to be highly important but experience low need fulfillment had higher initial levels of depressive symptoms that decreased modestly over time, although the level of depressive symptoms remained higher as compared to the other residents.

Cortisol regulation in 12-month-old human infants: associations with the infants' early history of breastfeeding and co-sleeping.

Experiences during early life are suggested to affect the physiological systems underlying stress responses, including the hypothalamic-pituitary-adrenal axis (HPA axis). While stressful early experiences have been associated with dysregulated HPA-axis functioning, positive early experiences, i.e. high maternal caregiving quality, contribute to more optimal HPA-axis functioning. Influences of other early caregiving factors, however, are less well documented. The goal of this study was to examine whether breastfeeding and co-sleeping during the first 6 months of life were associated with infant cortisol regulation, i.e. cortisol reactivity and recovery, to a stressor at 12 months of age. Participants were 193 infants and their mothers. Information on breastfeeding and co-sleeping was collected using weekly and daily sleep diaries, respectively, for the first 6 months of life. Co-sleeping was defined as sleeping in the parents' bed or sleeping in the parents' room. At 12 months of age, infants were subjected to a psychological stressor [Strange Situation Procedure (SSP); Ainsworth et al. 1978]. Salivary cortisol was measured prestressor and at 25, 40, and 60 min poststressor to measure reactivity and recovery. Regression analyses showed that after controlling for maternal sensitivity, infant attachment status, feeding, and sleeping arrangements at 12 months of age and other confounders, more weeks of co-sleeping predicted lower infant cortisol reactivity to the SSP. Also, more weeks of breastfeeding predicted quicker cortisol recovery. These results indicate that an early history of co-sleeping and breastfeeding contributes positively to cortisol regulation in 12-month-olds.

Early school outcomes for children of postpartum depressed mothers: comparison with a community sample.

Previous studies of the long-term effects of maternal postpartum depression (PPD) on child development have mostly focused on a limited set of outcomes, and have often not controlled for risk factors associated with maternal depression. The present study compared children of postpartum depressed mothers (n = 29) with children from a community sample (n = 113) in terms of a broad range of developmental outcomes in the early school period. Controlling for risk factors associated with maternal depression, we found that children of postpartum depressed mothers had lower ego-resiliency, lower peer social competence, and lower school adjustment than the community sample children. In addition, girls of postpartum depressed mothers showed lower verbal intelligence, and, unexpectedly, showed fewer externalizing problems than their counterparts in the community sample. Results show that children's capacities to deal with stress and interact with peers in the early school period may be particularly affected by their mothers' PPD.

Peer rejection and HPA activity in middle childhood: friendship makes a difference.

Exclusion and victimization by classmates were related to levels and diurnal change in cortisol in 97 fourth graders (53% boys, M = 9.3 years). Number and quality of friendships were considered as moderators. Salivary cortisol was collected 5 times daily on 2 school days. Excluded children had elevated cortisol levels at school and a flattened diurnal cortisol curve, suggesting hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation. This effect was weaker for children with more friends or better friendships. Victimization was not associated with cortisol level or change. The results demonstrate the role of HPA activity in peer group processes and indicate that group and dyadic factors interact in predicting stress in the peer group.

Which preventive interventions effectively enhance depressed mothers' sensitivity? A meta-analysis.

Improving depressed mothers' sensitivity is assumed to be a key element in preventing adverse outcomes for children of such mothers. This meta-analysis examines the short-term effectiveness of preventive interventions in terms of enhancing depressed mothers' sensitivity toward their child and investigates what type of intervention is most effective. Thirteen interventions, reported in 10 controlled outcome studies, met the inclusion criteria (N = 918). Meta-analytic results showed a small to medium, significant mean effect size (g = 0.32) with large variation in individual effect sizes (-0.56-1.76). Interventions including baby massage were highly effective in improving maternal sensitivity (g = 0.85). In contrast, individual therapy for the mother proved ineffective in terms of improving maternal sensitivity (g = -0.00). Two other significant predictors of greater effect sizes were the inclusion of a support group and the use of a higher number of intervention methods; however, the significance of these results was largely accounted for by one single study. Our meta-analysis confirms that depressed mothers' sensitivity can be improved by preventive intervention and suggests that baby massage may be an effective intervention method to evoke short-term changes in maternal sensitivity. It is unclear whether these changes are maintained over time.

Long-term effects of a home-visiting intervention for depressed mothers and their infants.

BACKGROUND: Whereas preventive interventions for depressed mothers and their infants have yielded positive short-term outcomes, few studies have examined their long-term effectiveness. The present follow-up of a randomised controlled trial (RCT) is one of the first to examine the longer-term effects of an intervention for mothers with postpartum depression and their infants at school-age. In early infancy, the intervention was found effective in improving mother-infant interaction and the child's attachment to its mother. METHODS: Twenty-nine mother-child pairs who completed the intervention are compared with 29 untreated mother-child dyads as to the quality of maternal interactive behaviour and the child outcomes of attachment security to the mother, self-esteem, ego-resiliency, verbal intelligence, prosocial behaviour, school adjustment, and behaviour problems at age 5 (M=68 months). RESULTS: In the total sample no lasting treatment benefits were found, but in families reporting a higher number of stressful life events, children in the intervention group had fewer externalising behaviour problems as rated by their mothers than children in the control group. CONCLUSIONS: In the context of multiple stressful life events the intervention served as a buffer by preventing the development of externalising problems in the child. The results warrant cautious interpretation because of the relatively small sample size and differential attrition revealing the mothers that completed the follow-up assessment to have improved less on maternal sensitivity following the intervention than the mothers who did not participate in the follow-up.

The predictive value of different infant attachment measures for socioemotional development at age 5 years.

The predictive value of different infant attachment measures was examined in a community-based sample of 111 healthy children (59 boys, 52 girls). Two procedures to assess infant attachment, the Attachment Q-Set (applied on a relatively short observation period) and a shortened version of the Strange Situation Procedure (SSSP), were applied to the children at age 15 months and related to a comprehensive set of indicators of the children's socioemotional development at age 5 years. Three attachment measures were used as predictors: AQS security, SSSP security, and SSSP attachment disorganization. AQS security and SSSP security jointly predicted the security of the children's attachment representation at age 5. Apart from that, SSSP attachment disorganization was a better predictor of the children's later socioemotional development than were the other two early attachment measures. First, attachment disorganization was the only attachment measure to predict the children's later ego-resiliency, school adjustment, and dissociation. Second, as for the socioemotional measures at age 5 that also were related to AQS or SSSP security (i.e., peer social competence and externalizing problems), the attachment security measures did not explain any extra variance beyond what was explained by attachment disorganization.

A randomized controlled trial of a home-visiting intervention aimed at preventing relationship problems in depressed mothers and their infants.

This study examined the effect of a mother-baby intervention on the quality of mother-child interaction, infant-mother attachment security, and infant socioemotional functioning in a group of depressed mothers with infants aged 1-12 months. A randomized controlled trial compared an experimental group (n = 35) receiving the intervention (8-10 home visits) with a control group (n = 36) receiving parenting support by telephone. There were assessments pre, post, and follow-up after 6 months. The intervention had positive effects on the quality of mother-infant interaction. Infants in the experimental group had higher scores for attachment security and for one aspect of socioemotional functioning, namely, competence. The intervention proved successful in preventing deterioration of the quality of mother-child interaction.

Adrenocortical and behavioral attunement in parents with 1-year-old infants.

Sethre-Hofstad et al. [2002, Psychoneuroendocrinology 27:731-747] found that behaviorally well-attuned or sensitive parents showed better physiological attunement with their 2- to 4-year-old toddlers' adrenocortical responses to a potentially challenging task than less sensitive parents. In the present study we aimed to replicate this finding in a sample of 83 parents with 15-month-old infants. Parental and infant cortisol responses were assessed using saliva samples collected before and 21 min after the child's confrontation with a stranger and a moving robot. Infant behaviors reflecting distress/uncertainty during the stranger-robot session were rated from videotape. Parental sensitivity was observed during a parent-infant teaching episode. Our findings replicate those of Sethre-Hofstad et al. [2002, Psychoneuroendocrinology 27:731-747] by showing correlated parent-infant cortisol responses for sensitive parents but not for less sensitive parents. Furthermore, sensitive parents cortisol responses were associated with their children's distress/uncertainty during the stranger-robot episode, whereas this was not true for less sensitive parents. Results indicate an important connection between behavior and physiology in parent-infant interactions that deserve more research.

The quality of children's home environment and attachment security in Indonesia.

The authors examined the relation of the Home Observation for Measurement of the Environment (HOME) Inventory (B. M. Caldwell & R. H. Bradley, 1984) for 0- to 6-year-old Sundanese Indonesian children with the quality of the mother-child attachment relationship (n=44) and attachment-related behaviors during play interactions (n=37) and with characteristics of the Indonesian caregiving context (N=77). Results showed that infants and toddlers with secure attachment relationships lived in higher quality home environments than did children with insecure attachment relationships. In particular, children with insecure-resistant attachment relationships lived in more unsafe and less organized homes with less play material available. For preschoolers, a lower quality home environment predicted more negativity and noncompliance toward their mothers in a play setting outside the home. With regard to the caregiving context, the socioeconomic status of the family was strongly related to the quality of preschoolers' home environment. Scores on the HOME Inventory for Infants/Toddlers and the HOME Inventory for Early Childhood were related to other culture-specific contextual characteristics for 0- to 6-year old Indonesian children as well. As a whole, the HOME was a good indicator of the general quality of the Sundanese Indonesian home environment.

Child care in The Netherlands: trends in quality over the years 1995-2005.

The authors assessed the quality of child care in a representative national sample of 42 child-care centers in the Netherlands and compared it with the quality of care that researchers have found using similar samples in 1995 (M. H. van IJzendoorn, L. W. C. Tavecchio, G. J. J. M. Stams, M. J. E. Verhoeven, & E. J. Reiling, 1998) and 2001 (M. J. J. M. Gevers Deynoot-Schaub & J. M. A. Riksen-Walraven, 2005). In the present study, results showed a low level of overall process quality for the 2005 sample, measured by the Infant/Toddler Environment Rating Scale-Revised (T. Harms, D. Cryer, & R. M. Clifford, 2003) and the Early Childhood Environment Rating Scale-Revised (T. Harms, R. M. Clifford, & D. Cryer, 1998). The present authors found a significant decline in process quality in comparison with the 1995 and 2001 findings. They concluded that, from an international perspective, the Netherlands has lost its leading position in child-care quality compared with that from 10 years ago.

Correlates of depressed mothers' sensitivity toward their infants: the role of maternal, child, and contextual characteristics.

OBJECTIVE: To examine various maternal, child, and contextual characteristics, as well as the number of risk factors present, to distinguish which factors explain variance in the sensitivity of depressed mothers toward their infants. METHOD: Participants were depressed mothers (n = 84) with their infants ages 1 month up to 1 year. Mothers were videotaped while bathing their children. The recordings were rated using the sensitivity scale of the Emotional Availability Scales. RESULTS: Three characteristics independently contributed to the explained variance in maternal sensitivity: level of education, feelings of parental incompetence, and family income. In addition, two subgroups were found to be particularly at risk: young mothers with high levels of depressive symptoms and low-income mothers who felt insecure about their parental competence. Together, these factors explained 23% of the variation in sensitivity in our sample of depressed mothers. The number of risk factors explained 9.8% of the variation in sensitivity. CONCLUSIONS: The present results have implications for preventive interventions. Identifying specific groups at risk for low maternal sensitivity at an early stage may lead to favorable outcomes of targeted interventions that focus on enhancing depressed mothers' maternal sensitivity and feelings of parental competence.

Multiple determinants of externalizing behavior in 5-year-olds: a longitudinal model.

In a community sample of 116 children, assessments of parent-child interaction, parent-child attachment, and various parental, child, and contextual characteristics at 15 and 28 months and at age 5 were used to predict externalizing behavior at age 5, as rated by parents and teachers. Hierarchical multiple regression analysis and path analysis yielded a significant longitudinal model for the prediction of age 5 externalizing behavior, with independent contributions from the following predictors: child sex, partner support reported by the caregiver, disorganized infant-parent attachment at 15 months, child anger proneness at 28 months, and one of the two parent-child interaction factors observed at 28 months, namely negative parent-child interactions. The other, i.e., a lack of effective guidance, predicted externalizing problems only in highly anger-prone children. Furthermore, mediated pathways of influence were found for the parent-child interaction at 15 months (via disorganized attachment) and parental ego-resiliency (via negative parent-child interaction at 28 months).

Effects of the Caregiver Interaction Profile Training on Caregiver-Child Interactions in Dutch Child Care Centers: A Randomized Controlled Trial.

BACKGROUND: Previous studies underscore the need to improve caregiver-child interactions in early child care centers. OBJECTIVE: In this study we used a randomized controlled trial to examine whether a 5-week video feedback training can improve six key interactive skills of caregivers in early child care centers: Sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. METHOD: A total of 139 caregivers from 68 early child care groups for 0- to 4-year-old children in Dutch child care centers participated in this RCT, 69 in the intervention condition and 70 in the control condition. Caregiver interactive skills during everyday interactions with the children were rated from videotape using the Caregiver Interaction Profile (CIP) scales at pretest, posttest, and follow-up 3 months after the posttest. RESULTS: Results at posttest indicate a significant positive training effect on all six caregiver interactive skills. Effect sizes of the CIP training range between d = 0.35 and d = 0.79. Three months after the posttest, caregivers in the intervention group still scored significantly higher on sensitive responsiveness, respect for autonomy, verbal communication, and fostering positive peer interactions than caregivers in the control group with effect sizes ranging between d = 0.47 and d = 0.70. CONCLUSIONS: This study shows that the quality of caregiver-child interactions can be improved for all six important caregiver skills, with a relatively short training program. Possible ways to further improve the training and to implement it in practice and education are discussed.