Early social referencing predicts object mastery motivation in infancy: Social antecedents of object mastery motivation.

The researchers sought to understand the typical development of social referencing and object mastery motivation in infancy and to determine the relationship between social referencing and object mastery behaviors in infants from 7 to 22 months of age. The study included 36 infants who were followed as part of a longitudinal study of at-risk infants but were not determined to need care in the neonatal intesive care unit at birth. Both mastery behaviors of persistence and success showed a statistically significant effect of age, while social behaviors remained stable from 7 to 22 months. Social behaviors at 7 and 10 months were correlated with persistence at 22 months and success at 16 to 22 months demonstrating that early social referencing predicts object mastery behaviors in later infancy. Further research should determine if this trend extends to early childhood.

An open resource for transdiagnostic research in pediatric mental health and learning disorders.

Technological and methodological innovations are equipping researchers with unprecedented capabilities for detecting and characterizing pathologic processes in the developing human brain. As a result, ambitions to achieve clinically useful tools to assist in the diagnosis and management of mental health and learning disorders are gaining momentum. To this end, it is critical to accrue large-scale multimodal datasets that capture a broad range of commonly encountered clinical psychopathology. The Child Mind Institute has launched the Healthy Brain Network (HBN), an ongoing initiative focused on creating and sharing a biobank of data from 10,000 New York area participants (ages 5-21). The HBN Biobank houses data about psychiatric, behavioral, cognitive, and lifestyle phenotypes, as well as multimodal brain imaging (resting and naturalistic viewing fMRI, diffusion MRI, morphometric MRI), electroencephalography, eye-tracking, voice and video recordings, genetics and actigraphy. Here, we present the rationale, design and implementation of HBN protocols. We describe the first data release (n=664) and the potential of the biobank to advance related areas (e.g., biophysical modeling, voice analysis).

Using the PDD Behavior Inventory as a Level 2 Screener: A Classification and Regression Trees Analysis.

In order to improve discrimination accuracy between Autism Spectrum Disorder (ASD) and similar neurodevelopmental disorders, a data mining procedure, Classification and Regression Trees (CART), was used on a large multi-site sample of PDD Behavior Inventory (PDDBI) forms on children with and without ASD. Discrimination accuracy exceeded 80 %, generalized to an independent validation set, and generalized across age groups and sites, and agreed well with ADOS classifications. Parent PDDBIs yielded better results than teacher PDDBIs but, when CART predictions agreed across informants, sensitivity increased. Results also revealed three subtypes of ASD: minimally verbal, verbal, and atypical; and two, relatively common subtypes of non-ASD children: social pragmatic problems and good social skills. These subgroups corresponded to differences in behavior profiles and associated bio-medical findings.

Infant twins' social interactions with caregivers and same-age siblings.

The study of twin behavior offers the opportunity to study differential patterns of social and communicative interactions in a context where the adult partner and same-age peer are equally familiar. We investigated the development of social engagement, communicative gestures, and imitation in 7- to 25-month-old twins. Twin dyads (N=20 pairs) participated in 10-min, semi-structured play sessions, with the mother seated in a chair completing paperwork for half the session, and on the floor with her children for the other half. Overall, twins engaged more with their mothers than with their siblings: they showed objects and imitated speech and object use more frequently when interacting with their mothers than with their siblings. When the mother was otherwise engaged, the twins played with toys separately, observed each other's toy play, or were unengaged. These results demonstrate that adult scaffolding of social interactions supports increased communicative bids even in a context where both familiar peers and adults are available as communicative partners.

Rating scale measures are associated with Noldus EthoVision-XT video tracking of behaviors of children on the autism spectrum.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) show unusual social behaviors and repetitive behaviors. Some of these behaviors, e.g., time spent in an area or turning rate/direction, can be automatically tracked. Automated tracking has several advantages over subjective ratings including reliability, amount of information provided, and consistency across laboratories, and is potentially of importance for diagnosis, animal models and objective assessment of treatment efficacy. However, its validity for ASD has not been examined. In this exploratory study, we examined associations between rating scale data with automated tracking of children's movements using the Noldus EthoVision XT system; i.e., tracking not involving a human observer. Based on our observations and previous research, we predicted that time spent in the periphery of the room would be associated with autism severity and that rate and direction of turning would be associated with stereotypies. METHODS: Children with and without ASD were observed in a free-play situation for 3 min before and 3 min after Autism Diagnostic Observation Scale - Generic (ADOS-G) testing. The Noldus system provided measures of the rate and direction of turning, latency to approach and time spend near the periphery or the parent. RESULTS: Ratings of the severity of maladaptive social behaviors, stereotypies, autism severity, and arousal problems were positively correlated with increases in percent time spent in the periphery in the total sample and in the ASD subset. Adaptive social communication skills decreased with increases in the percentage of time spent in the periphery and increases in the latency to approach the parent in the ASD group. The rate and direction of turning was linked with stereotypies only in the group without ASD (the faster the rate of a turn to the left, the worse the rating). In the ASD group, there was a shift from a neutral turning bias prior to the ADOS assessment to a strong left turn bias after the ADOS assessment. In the entire sample, this left turn bias was associated with measures of autism severity. CONCLUSION: Results suggest that automated tracking yields valid and unbiased information for assessing children with autism. Turning bias is an interesting and unexplored measure related to autism.

Neonatal Intensive-Care Unit Graduates Show Persistent Difficulties in an Intra-Dimensional Shift Card Sort.

Neonatal intensive-care unit (NICU) graduates, a group at risk for attention problems and ADHD, performed an intra-dimensional shift card sort at 34, 42, 51, and 60 months to assess executive function and to examine effects of individual risk factors. In the 'silly' game, children sorted cards (airplanes and dogs) so they were not the same as targets. In the 'same' game they did the opposite. Performance on the 'silly' game was poor, especially when it was presented first. Success in following 'silly' game rules improved with age, and was significantly linked to maternal education and birth weight for gestational age, a measure of intrauterine stress. Degree of CNS injury differentiated children who completed the task from children who did not, and also affected the need to repeat instructions in the 'same' game. These results confirm an increased likelihood of impairments in executive function during preschool years in NICU graduates.

Neonatal brainstem function and 4-month arousal-modulated attention are jointly associated with autism.

The authors evaluated the contribution of initially abnormal neonatal auditory brainstem responses (ABRs) and 4-month arousal-modulated attention visual preference to later autism spectrum disorder (ASD) behaviors in neonatal intensive care unit (NICU) graduates. A longitudinal study design was used to compare NICU graduates with normal ABRs (n = 28) to those with initially abnormal ABRs (n = 46) that later resolved. At 4 months postterm age, visual preference (measured after feeding) for a random check pattern flashing at 1, 3, or 8 Hz and gestational age (GA) served as additional predictors. Outcome measures were PDD Behavior Inventory (PDDBI) scores at 3.4 years (standard deviation = 1.2), and developmental quotients (DQ) obtained around the same age with the Griffiths Mental Development Scales (GMDS). Preferences for higher rates of stimulation at 4 months were highly correlated with PDDBI scores (all P-values < 0.01) and the GMDS Hearing and Speech DQ, but only in those with initially abnormal ABRs. Effects were strongest for a PDDBI social competence measure most associated with a diagnosis of autism. For those with abnormal ABRs, increases in preference for higher rates of stimulation as infants were linked to nonlinear increases in severity of ASD at 3 years and to an ASD diagnosis. Abnormal ABRs were associated with later reports of repetitive and ritualistic behaviors irrespective of 4-month preference for stimulation. The joint occurrence of initially abnormal neonatal ABRs and preference for more stimulation at 4 months, both indices of early brainstem dysfunction, may be a marker for the development of autism in this cohort.

The development of selective attention and inhibition in NICU graduates during the preschool years.

Neonatal intensive care unit (NICU) graduates have a higher incidence of attention problems including attention deficit hyperactivity disorder (ADHD). Thus, we examined the effect of risk factors (birth weight (BW), central nervous system (CNS) injury, gender, maternal education) on attention/inhibition during reaction time, continuous performance and Go/No-Go tasks at 42, 51, and 60 months (n = 271). Very low BW NICU graduates (<1,500 g) performed worse than typical BW ones (>2,500 g), displaying poorer target/non-target discrimination. Males responded faster than females, but made more false alarms and random responses. Despite short duration tasks, attention waned. Performance improved with age, but even at 60 months children had difficulty inhibiting random responding.

Early medical and behavioral characteristics of NICU infants later classified with ASD.

OBJECTIVES: Recent evidence suggests higher prevalence of autism spectrum disorder (ASD) in NICU graduates. This aim of this study was to identify retrospectively early behaviors found more frequently in NICU infants who went on to develop ASD. METHODS: Twenty-eight NICU graduates who later received a diagnosis of ASD were compared with 2169 other NICU graduates recruited from 1994 to 2005. They differed in gender, gestational age, and birth cohort. These characteristics were used to draw a matched control sample (n=112) to determine which, if any, early behaviors discriminated subsequent ASD diagnosis. Behavioral testing at targeted ages (adjusted for gestation) included the Rapid Neonatal Neurobehavioral Assessment (hospital discharge, 1 month), Arousal-Modulated Attention (hospital discharge, 1 and 4 months), and Bayley Scales of Infant Development (multiple times, 4-25 months). RESULTS: At 1 month, children with ASD but not control children had persistent neurobehavioral abnormalities and higher incidences of asymmetric visual tracking and arm tone deficits. At 4 months, children with ASD had continued visual preference for higher amounts of stimulation than did control children, behaving more like newborns. Unlike control children, children with ASD had declining mental and motor performance by 7 to 10 months, resembling infants with severe central nervous system involvement. CONCLUSIONS: Differences in specific behavior domains between NICU graduates who later receive a diagnosis of ASD and matched NICU control children may be identified in early infancy. Studies with this cohort may provide insights to help understand and detect early disabilities, including ASD.

Parent PDD behavior inventory profiles of young children classified according to autism diagnostic observation schedule-generic and autism diagnostic interview-revised criteria.

Quantitative variations in score profiles from the parent version of the PDD Behavior Inventory (PDDBI) were examined in young Autism and PDD-NOS groups defined by ADOS-G and ADI-R criteria, relative to a not spectrum (NS) group of similar age. Both the Autism and the PDD-NOS group profiles markedly differed from the NS group. The most sensitive measures of group differences were those domain and composite scores that assessed social communication competence, as well as the overall Autism Composite score. Sensitivity, specificity and positive and negative predictability measures were quite good for these measures. It was concluded that the PDDBI is useful in assisting in the differential diagnosis of autism spectrum disorder.

Auditory brainstem evoked responses in newborns with Down syndrome.

Auditory brainstem evoked responses (ABRs) were compared in 15 newborns with Down syndrome and 15 sex-, age-, and weight-matched control newborns. Participants had normal ABRs based upon values specific to 32- to 42-weeks postconceptional age. Although Wave III and Wave V component latencies and the Wave I-III interpeak latency (IPL) were shorter in ABRs of infants with Down syndrome, the Wave III-V IPL was not, pointing to anomalies in the lower rather than upper brainstem auditory pathways. Shorter Down syndrome ABR latencies have been reported at many ages. Extending these findings to newborns suggests that the underlying basis for this develops prenatally. ABR patterns in infants with Down syndrome were similar to reports for intrauterine growth restricted newborns.

The Mother-Infant Feeding Relationship Across the First Year and the Development of Feeding Difficulties in Low-Risk Premature Infants.

Although feeding problems are common during infancy and are typically accompanied by relational difficulties, little research observed the mother-infant feeding relationship across the first year as an antecedent to the development of feeding difficulties. We followed 76 low-risk premature infants and their mothers from the transition to oral feeding in the neonatal period to the end of the first year. Prior to hospital discharge, microlevel patterns of maternal touch and gaze were coded during feeding and nonfeeding interactions, global patterns of maternal adaptation were assessed, and infants' neurobehavioral status was tested. Psychomotor development was evaluated at 4 months. At 1 year, feeding difficulties were determined on the basis of maternal interview and direct observations of feeding interactions. Mothers of infants who exhibited feeding difficulties at 1 year showed less affectionate touch and gaze during nonfeeding interactions and more gaze aversion and lower adaptability during feeding interactions already in the neonatal period. Infants with feeding difficulties demonstrated poorer psychomotor performance at 4 months. Feeding interactions of infants with feeding difficulties at 1 year were characterized by higher maternal intrusiveness, lower infant involvement, and greater infant withdrawal. Less maternal affectionate touch and lower maternal adaptation in the neonatal period, poor infant psychomotor skills, and higher maternal intrusiveness and lower infant involvement at 1 year predicted feeding difficulties. The findings underscore the role of the relational components across the first year in the development of feeding difficulties.

The transition to oral feeding in low-risk premature infants: relation to infant neurobehavioral functioning and mother-infant feeding interaction.

BACKGROUND: The achievement of oral feeding is a critical task for the premature infant-mother dyad, yet neurobehavioral and relational factors associated with feeding difficulties of low-risk premature infants during hospitalization are not well understood. AIM: To examine the relations between infant neurobehavioral functioning, the transition to oral feeding, and the emerging mother-infant feeding relationship in premature infants. STUDY DESIGN AND SUBJECTS: Ninety-seven low-risk premature infants (birth weight>1000 g; gestational age>30 weeks) and their mothers were followed at the NICU. Neurobehavioral functioning was assessed with the Rapid Neonatal Neurobehavioral Assessment Procedure. OUTCOME MEASURES: The duration of the transition to oral feeding and specific feeding difficulties during the transition were assessed. Infant feeding robustness, suck and milk transfer rates, and maternal adaptability, affect, intrusiveness and distractibility were coded from videotaped mother-infant feeding interactions prior to discharge from the NICU. RESULTS: Thirty percent of the infants presented feeding difficulties during the transition to oral feedings. Infants with abnormal neurobehavioral functioning (37% of the cohort) showed more feeding difficulties, slower suck rates, and lower feeding robustness, and their mothers displayed less adaptive and more intrusive behavior. Maternal intrusiveness was related to lower feeding robustness and to lower suck and milk transfer rates. Neurobehavioral functioning and maternal feeding behavior predicted feeding robustness. CONCLUSIONS: Less intact neurobehavioral functioning in the neonatal period is related to difficulties during the transition to oral feeding and to less optimal early mother-infant feeding interactions. Low-risk premature infants with poor neurobehavioral functioning should receive special attention and care.

Neurobehavioral assessment in the neonatal period--the impact of Ferenc Katona.

BACKGROUND AND PURPOSE: Identifying and treating CNS-injured infants has always been Ferenc Katona's main goal. Early on, he showed the importance of "elementary motor patterns" to development, and their application in treatment of early brain injury. We report on a neonatal neurobehavioral assessment derived from Katona that has concurrent and predictive validity in the NICU population. It evaluates early behavioral capabilities and dysfunctions in areas often disrupted by CNS injury, such as attention, motor organization, and autoregulation; provides a valuable approach for assessing recovery from CNS injury; and predicts later mental and motor performance. METHODS: A population-based NICU sample (n=3226) studied from 1989-2004 had CNS injury ranging from none to severe. Our neurobehavioral assessment is a categorical clinical evaluation suitable for small, sick, high-risk neonates that is composed of visual, auditory, head control, tone, state, and elicited active motor behaviors designed to challenge the infant. Infants are tested at hospital discharge and one month post term. A series of tasks are administered enabling a trained examiner to make judgments of abnormality on over 20 categories of behavior. RESULTS: Maximum likelihood ordered logistic regression and multiple regression specified the relation of abnormality in neurobehavioral performance to concurrent estimates of CNS injury and to later cognitive and motor outcome. All behavioral categories were significantly associated with CNS abnormality at one or both ages (p's<0.03-0.0001). Multiple regression showed a significant linear relationship (p<0.0001) of CNS injury to number of neurobehavioral abnormalities, which decreased with decreasing injury and across age. CONCLUSIONS: Katona's strong contributions form the basis of neurobehavioral assessment that can detect early abnormalities and help design early interventions. He is unique in his understanding of the neural mechanisms underlying early CNS injury and its behavioral consequences. His concepts allowed us to devise a valid newborn neurobehavioral assessment to evaluate early behavioral capabilities frequently disrupted by CNS injury.