The Effects of Intranasal Oxytocin Administration on Sensitive Caregiving in Mothers with Postnatal Depression.

Postnatal depression (PND) is common and negatively affects the mother-infant relationship; oxytocin (OT) has been found to have positive effects on parenting, although psychiatric disorders may reduce these effects. Thus, we explored the role of OT in mothers diagnosed with PND. A within-subject, randomized controlled double-blind design was used to test the effects of nasal administration of OT or placebo on sensitive caregiving. The outcome measures were perceptual and caregiving responses to prerecorded cry sounds, as well as observed maternal sensitivity. We found that in the OT condition mothers with PND were more likely to rate an infant cry as more urgent and they were more likely to indicate they would chose a harsh caregiving strategy in response. There was no effect of OT on maternal sensitive interaction with their own baby. Further research is required prior to consideration of OT administration in depressed mothers of infants.

Parental PTSD, adverse parenting and child attachment in a refugee sample.

In contrast with traumatic experiences, there is a dearth of studies on the link between trauma symptoms, disconnected (frightened, threatening and dissociative) parenting behavior, extremely insensitive parenting behavior and child attachment. This study extends previous work on the impact of posttraumatic stress disorder (PTSD) on families by studying the unique contribution of disconnected and extremely insensitive parenting behavior on child attachment in a highly traumatized sample of 68 asylum seekers and refugees and their children (18-42 months). The results show that parental symptoms of PTSD are directly related to children's insecure attachment and disorganized attachment. The greatest proportion of the risk could be attributed to factors related to the dyad and not the family. A mediation effect of adverse parenting behavior was not confirmed. On the one hand the results indicate the need for an effective treatment of PTSD symptomatology while on the other hand the results indicate the need for clinical attention to insecure attachment relationships.

Beating the brain about abuse: Empirical and meta-analytic studies of the association between maltreatment and hippocampal volume across childhood and adolescence.

We present new empirical data and meta-analytic evidence for the association of childhood maltreatment with reduced hippocampal volume. In Study 1, we examined the effects of maltreatment experiences reported during the Adult Attachment Interview on hippocampal volume in female twin pairs. We found that reduced hippocampal volume was related to childhood maltreatment. In addition, individuals who reported having experienced maltreatment at older ages had larger reductions in hippocampal volume compared to individuals who reported maltreatment in early childhood. In Study 2, we present the results of a meta-analysis of 49 studies (including 2,720 participants) examining hippocampal volume in relation to experiences of child maltreatment, and test the moderating role of the timing of the maltreatment, the severity of maltreatment, and the time after exposure to maltreatment. The results of the meta-analysis confirmed that experiences of childhood maltreatment are associated with a reduction in hippocampal volume and that the effects of maltreatment are more pronounced when the maltreatment occurs in middle childhood compared to early childhood or adolescence.

Associations between the prenatal environment and cardiovascular risk factors in adolescent girls: Internalizing and externalizing behavior symptoms as mediators.

This longitudinal study examines links among adolescent internalizing and externalizing symptoms, the prenatal environment (e.g., nicotine exposure) and pre/perinatal maternal health, and cardiovascular risk factors. Girls (N=262) ages 11-17 reported internalizing and externalizing behaviors and mothers reported about the prenatal environment and maternal health during and 3 months post-pregnancy. Adolescent cardiovascular risk included adiposity, smoking, blood pressure, and salivary C-reactive protein. Internalizing symptoms mediated relations between prenatal exposures/maternal health and adiposity; externalizing symptoms mediated relations between prenatal exposures and adolescent smoking. Healthcare providers who attend to internalizing and externalizing symptoms in girls may ultimately influence cardiovascular health, especially among those with pre/perinatal risk factors.

Elevated salivary alpha amylase in adolescent sexual abuse survivors with posttraumatic stress disorder symptoms.

OBJECTIVE: Little is known regarding neuroendocrine responses in adolescent girls with posttraumatic stress disorder (PTSD) who have experienced sexual abuse. Therefore, we collected saliva samples three times daily for 3 days to assess concentrations of salivary alpha amylase (sAA) - a surrogate marker for autonomic nervous system (ANS) activity and, in particular, sympathetic activity - in sexually abused adolescent girls. METHODS: Twenty-four girls (mean age: 15±1.4 years) who had experienced recent sexual abuse (i.e., sexual abuse occurred 1-6 months prior to study enrollment) and 12 healthy comparison subjects (mean age: 14.8±1.3 years) completed a structured interview and assessments to ascertain symptoms of posttraumatic stress, then collected saliva at home upon awakening, 30 minutes after waking, and at 5 p.m. on three consecutive school days. RESULTS: For sexually abused girls, total PTSD symptoms were associated with higher overall morning levels of sAA (r[20]=0.51, p=0.02), a finding driven by intrusive symptoms (r[20]=0.43, p<0.05) and hyperarousal symptoms (r[20]=0.58, p=0.01). There were no significant differences in diurnal sAA secretion between the sexually abused girls and healthy comparison adolescents. CONCLUSIONS: Overall morning concentrations of sAA in sexually abused girls are associated with overall PTSD severity as well as symptoms of hyperarousal and intrusive symptoms, possibly reflecting symptom-linked increases in ANS tone. These data raise the possibility that alterations in ANS activity are related to the pathophysiology of sexual abuse-related PTSD in adolescent girls, and may inform therapeutic interventions (e.g., antiadrenergic medications).

Tympanic membrane temperature in adopted children associated with sleep problems and pre-adoption living arrangements: an exploratory study.

BACKGROUND: Tympanic membrane temperature (TMT) has been proposed as an indicator of cerebral activation and TMT asymmetry may indicate lateralization, which has been associated with specific (problem) behaviors in children and adults. The current study explored the relations between pre-adoption living arrangements, TMT, and behavior and sleep problems in a sample of adopted toddlers. METHODS: Ninety-two families who had adopted a Chinese girl who had previously been placed in an institution or foster care reported on behavior problems using the Child Behavior Checklist and TMT two months (Time 1) and six months (Time 2) after adoption. RESULTS: Structural equation modeling revealed that institutionalized children had significantly higher left than right TMTs compared with foster care children at Time 2. A higher left than right TMT was associated with increased sleep problems and total behavior problems at Time 1, but not at Time 2. CONCLUSIONS: Our findings with regard to pre-adoption living arrangements, TMT asymmetry, and sleep problems suggest that TMT is sensitive to early environmental influences and may be a biological marker of vulnerability to the development of sleep problems in children from adverse backgrounds.

Hormones, behavior, and social network analysis: exploring associations between cortisol, testosterone, and network structure.

We used a new interdisciplinary paradigm of social network analysis (SNA) to investigate associations between hormones and social network structures. We examine these biobehavioral processes and test hypotheses about how hormones are associated with social network structures using exponential random graph modeling (ERGM) in a cohort of first-year students (n=74; 93% female; M age=27 years) from a highly competitive, accelerated nursing program. Participants completed friendship nominations and as a group simultaneously donated saliva (later assayed for cortisol and testosterone). ERGM analyses revealed that salivary cortisol levels were inversely associated with the number of outgoing ties (i.e., network activity). By contrast, testosterone was not related to friendship network structure. Integration of SNA and salivary bioscience creates a novel approach to understanding hormone-behavior relationships within the context of human social ecologies.

Individual differences in the cortisol and salivary α-amylase awakening responses in early childhood: relations to age, sex, and sleep.

Recent studies have examined post-waking changes in cortisol as a marker of HPA functioning, but questions remain about the stability of this response, as well as its relation to sleep and other ANS markers. The purposes of this study were to a) examine the presence and developmental changes in the cortisol awakening response (CAR) and salivary α-amylase awakening (sAA-AR) in a toddler sample and b) determine whether and how sleep relates to these responses in this age group. We measured cortisol and sAA upon awakening (and 30 min post-waking) and sleep characteristics using actigraphy (e.g., total sleep time, sleep efficiency, number of awakenings) in toddlers (N = 47; 36% female, ages 12-24 months). Forty-six percent of toddlers demonstrated a CAR and 52% demonstrated a sAA-AR. Strength of either response did not change linearly with age. Additionally, likelihood of demonstrating the CAR and sAA-AR was unrelated to age, sex, awakening time, time between samples, and time since feeding. Higher waking cortisol levels were associated with a shorter total sleep time and an earlier awakening. No associations were observed between sleep characteristics and the sAA-AR, ps > .05. Our findings suggest that these awakening responses function independently of sleep in toddlers. Additionally, the lack of change in percentage of children showing a CAR or sAA-AR across these ages suggests that these responses are stable and not emerging reliably across the second year of life.

Salivary cytokines in healthy adolescent girls: Intercorrelations, stability, and associations with serum cytokines, age, and pubertal stage.

Theoretically, the measurement of cytokines in saliva may have utility for studies of brain, behavior, and immunity in youth. Cytokines in saliva and serum were analyzed across three annual assessments in healthy adolescent girls (N = 114, 11-17 years at enrollment). Samples were assayed for GM-CSF, IFNγ, IL-1ß, IL-2, IL-6, IL-8, IL-10, IL-12p70, TNFα, adiponectin, and cotinine. Results revealed: (1) cytokine levels, except IFNγ and IL-10, were detectable in saliva, and salivary levels, except IL-8 and IL-1ß, were lower than serum levels; (2) salivary cytokine levels were lower in older girls and positively associated with adiponectin; (3) compared to serum levels, the correlations between salivary cytokines were higher, but salivary cytokines were less stable across years; and (4) except for IL-1ß, there were no significant serum-saliva associations. Variation in basal salivary cytokine levels in healthy adolescent girls reflect compartmentalized activity of the oral mucosal immune system, rather than systemic cytokine activity.

Cortisol awakening response in adolescents with acute sexual abuse related posttraumatic stress disorder.

BACKGROUND: Little is known regarding changes in the hypothalamic-pituitary-adrenal axis (HPA axis) of adolescent girls with and without posttraumatic stress disorder (PTSD) who have recently experienced sexual abuse. Therefore, in this pilot study, we utilized non-stressed home saliva collection three times a day for three days to assess the levels, diurnal variation and awakening response of cortisol in recently sexually abused adolescent girls. METHODS: Twenty-four adolescent girls (mean age: 15 ± 1.5 years) with a history of recent sexual abuse (sexual abuse occurred 1-6 months prior to study enrollment) and 12 healthy, nontraumatized comparison subjects (mean age: 14.8 ± 1.3 years) collected saliva at home upon awakening, 30 min after waking, and in the late afternoon on three consecutive school days. RESULTS: Among sexually abused girls, flattening of the morning cortisol awakening response was associated with PTSD severity (r = -.41, P < .05) as well as intrusive symptoms (r = -.42, P < .05). Increased adversity prior to sexual abuse was also associated with flattening of the cortisol awakening response (r = -.53, P < .01). CONCLUSIONS: Attenuation of the cortisol awakening response in recently sexually abused girls suggests that alterations in HPA-axis functioning may occur relatively proximate to the traumatic event and correlate with symptom severity of PTSD, intrusive symptoms, and hyperarousal symptoms. These data raise the possibility that subacute alterations in the dynamic secretion of cortisol are directly related to the pathophysiology of sexual abuse-related PTSD symptoms in adolescent girls.

One doll fits all: validation of the Leiden Infant Simulator Sensitivity Assessment (LISSA).

Children vary hugely in how demanding of their caregivers they are. This creates differences in demands on parents during observation, making the comparison of sensitivity between parents difficult. It would therefore be of interest to create standard situations in which all caregivers are faced with the same level of demand. This study developed an ecologically valid but standardized setting using an infant simulator with interactive features, the Leiden Infant Simulator Sensitivity Assessment (LISSA). The infant simulator resembles a real infant in appearance and it produces crying sounds that are life-like. The simulator begins with fussing and progresses to more intense crying in case of no care or inappropriate care. It responds by being calm again if appropriate care is given. One hundred and eighty-one female participants took care of the infant simulator for two evenings and in a 30 min lab session with increasing competing demands. Sensitive parenting behavior during the lab session was coded with the Ainsworth Sensitivity Scale. Sensitivity ratings covered the whole range of the scale (1-9), and were stable across settings (free play, competing demands). Sensitivity was related to an increase of positive affect during caretaking, and insensitivity was related to intended harsh caregiving response during a computerized cry paradigm. Sensitivity was unrelated to social desirability and self-reported quality of care given to the infant simulator. We discuss the potentials of the infant simulator for research on sensitive parenting, for preventive interventions, and for clinical practices.

Friendship network position and salivary cortisol levels.

We employed a social network analysis approach to examine the associations between friendship network position and cortisol levels. The sample consisted of 74 first-year students (93% female, ages 22-38 years, M = 27) from a highly competitive, accelerated Nursing program. Participants completed questionnaires online, and the entire group met at one time to complete a series of sociometric nominations and donated a saliva sample. Saliva was later assayed for cortisol. Metrics derived from directed friendship nominations indexed each student's friendship network status regarding popularity, gregariousness, and degree of interconnectedness. Results revealed that (1) individuals with lower gregariousness status (i.e., lowest number of outgoing ties) had higher cortisol levels, and (2) individuals with higher popularity status (i.e., higher numbers of incoming ties) had higher cortisol levels. Popularity and gregariousness-based network status is significantly associated with hypothalamic-pituitary-adrenal axis activity. Implications for prevailing theories of the social determinants of individual differences in biological sensitivity and susceptibility to context are discussed.

Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.

This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations.

Disentangling sources of individual differences in diurnal salivary α-amylase: reliability, stability and sensitivity to context.

In the present study, we employ a longitudinal design and a generalizability framework to examine the sources of variance in the diurnal rhythm of salivary α-amylase (sAA). The sample consisted of 122 first-year law students (55% male, mean age=23.9 years), who collected five saliva samples on each of three consecutive days at each of five data collection waves. In total, over 6900 saliva samples were collected, which allowed us to examine the properties of diurnal variation in sAA in great detail. Systematic individual differences accounted for 15-29% of the variability in the awakening response and diurnal slope, and for 61-65% of the variation in overall daily levels (i.e., diurnal mean, area under the curve with respect to ground [AUCg]). Although less than 1% of the variation was due to differences between waves and between days, the generalizability analyses revealed that between 16% and 17% of the variance in the diurnal mean, slope and AUCg is due to person by wave interactions, indicating that individuals vary in their biological sensitivity to environmental influences. In sum, this study documents sufficient stability and variation in diurnal sAA to warrant future studies on the origins and consequences of alterations in the diurnal rhythm of sAA worthwhile, and proposes guidelines on obtaining reliable measures.

Salivary α-amylase and intended harsh caregiving in response to infant crying: evidence for physiological hyperreactivity.

This is the first study on adults' physiological reactivity to infant cry sounds and the association with intended harsh parenting using salivary α-amylase (sAA) as a novel and noninvasive marker of autonomic nervous system activity. The sample consisted of 184 adult twin pairs. In an experimental design, cry sounds were presented and adults' perception and their intended caregiving responses were measured. Saliva samples were collected after each cry sound. For the majority of the sample, a decrease in sAA across the cry paradigm was observed. However, adults who indicated that they would respond in a harsh way to the crying infant were significantly less likely to show a decrease in sAA. Consistent with previous studies on physiological hyperreactivity in abusive parents, these findings suggest that failure to habituate to repeated infant crying may be one of the mediating mechanisms through which excessive, inconsolable, and high-pitched infant crying triggers less optimal caregiving.

Attachment in the brain: adult attachment representations predict amygdala and behavioral responses to infant crying.

Current research found that adult attachment representations influence neural, emotional, and behavioral responses to infant crying, thus validating the Berkeley Adult Attachment Interview with functional Magnetic Resonance Imaging. This study examined amygdala activation, feelings of irritation, and the use of excessive force as indicated by grip strength using a handgrip dynamometer during exposure to infant crying and scrambled control sounds in 21 women without children. Individuals with insecure attachment representations showed heightened amygdala activation when exposed to infant crying compared to individuals with secure attachment representations. In addition, insecure individuals experienced more irritation during infant crying and used more excessive force than individuals with a secure representation. Amygdala hyperactivity might be one of the mechanisms underlying the experience of negative emotions during exposure to infant crying in insecure individuals and might explain why insecure parents respond inconsistently to infant signals or reject their infants' attachment behavior.

Incorporating salivary biomarkers into nursing research: an overview and review of best practices.

Analytes and biomarkers present in saliva may provide insight into individual differences in environmental chemical exposures, variation in reproductive hormones, therapeutic and illegal substance use, changes in stress-related physiology, and the immunologic footprints of infectious disease. The wealth of information provided by salivary analytes has the potential to enrich biobehavioral nursing research by enabling researchers to measure these individual differences in the clinic as well as in patients' and participants' everyday social worlds. In this article, the authors provide a roadmap for researchers new to this area who would like to learn more about integrating salivary biospecimens into the next generation of health research. In addition, the authors highlight best practices and strategies to avoid common pitfalls for researchers already engaged in this field.

Focus on methodology: salivary bioscience and research on adolescence: an integrated perspective.

The characterization of the salivary proteome and advances in biotechnology create an opportunity for developmental scientists to measure multi-level components of biological systems in oral fluids and identify relationships with developmental processes and behavioral and social forces. The implications for developmental science are profound because from a single oral fluid specimen, information can be obtained about a broad array of biological systems and the genetic polymorphisms related to their function. The purpose of this review is to provide a conceptual and tactical roadmap for investigators interested in integrating these measurement tools into research on adolescent health and development.

Assessing salivary C-reactive protein: longitudinal associations with systemic inflammation and cardiovascular disease risk in women exposed to intimate partner violence.

This study evaluated individual differences in levels of C-reactive protein (CRP) measured in saliva, cross-sectionally and prospectively, in relation to systemic inflammation and risk for cardiovascular disease (CVD). Plasma and saliva samples, later assayed for CRP, were collected multiple times from an ethnically diverse group of women seeking help from domestic violence crisis shelters-agencies (N=107; mean age at study start=34 years). Plasma and saliva CRP levels were moderately associated cross-sectionally and across two years. There were indications that saliva CRP levels were, on average, higher in the morning than evening. Higher levels of saliva and plasma CRP were associated with a higher body mass index, but did not differ between women who did and did not smoke. Salivary CRP reliably discriminated between high and low levels of plasma CRP, using a clinically relevant cutoff point of 3mg/L, recommended by the American Heart Association. Results build upon an emerging literature suggesting that under specific conditions levels of CRP in saliva may reflect low-grade inflammation and have the potential to serve as a screen for CVD risk status.

State and trait variance in salivary α-amylase: a behavioral genetic study.

This is the first behavior genetic study of salivary α-amylase (sAA), focusing on genetic and environmental influences on stability and change in sAA during baseline and exposure to infant crying. The sample consisted of 184 adult twin pairs. Although there was significant variation between individuals in basal levels of sAA and in responsivity to infant crying, strong stability in sAA concentrations across conditions was found. Similar genetic mechanisms influenced sAA at baseline and in response to cry sounds (explained variance: 51-62%), accounting for part of the stability in sAA. Unique environmental factors explained the remaining variance in sAA, some of them only emerging in response to the cry sounds, explaining individual differences in the pattern of reactivity. These findings confirm that sAA is sensitive to the effects of potentially stressful stimuli (state variance) and at the same time demonstrate its relative robustness and stability across time and conditions (trait variance).