Acute Maternal Stress Disrupts Infant Regulation of the Autonomic Nervous System and Behavior: A CASP Study.

Exposure to maternal stress is assumed to influence infant health and development across the lifespan. The autonomic nervous system (ANS) is especially sensitive to the effects of the early caregiving environment and linked to predictors of later mental health. Understanding how exposure to maternal stress adversely affects the developing ANS could inform prevention. However, there is no agreed upon definition of maternal stress making its study difficult. Here we use the Caretaker Acute Stress Paradigm (CASP) to study the effects of maternal stress in an experimentally controlled laboratory setting. The CASP has 5 episodes, a natural play, followed by a caretaker stressor (or control) condition, another play, a classic still face episode, followed by another play. A total of 104 4-months-old infants and their mothers were randomly assigned to either the caretaker-stress or caretaker-control condition. Changes in behavior, heart rate (HR), and respiratory sinus arrhythmia (RSA) before and after the introduction of the stressor (or control condition) were recorded and compared. Infants in the maternal stress condition showed significantly more behavioral distress [X 2 = (1, N = 104) = 4.662, p = 0.031]. Moreover, infants whose mothers were in the stress condition showed an significant increase in heart rate after the caretaker condition [F (1, 102) = 9.81, p = 0.002]. Finally we observed a trend to faster RSA recovery in infants of the control condition [F (1, 75) = 3.539, p = 0.064]. Results indicate that exposure to acute maternal stress affects infant regulation of the autonomic nervous system and behavior.

A Caretaker Acute Stress Paradigm: Effects on behavior and physiology of caretaker and infant.

While experimental stress paradigms of infants (arm restraint; the Still-Face) are powerful tools for infant research, no study has experimentally stressed mothers to observe its independent effects on infant stress regulation. Extant caretaker/maternal stress studies essentially are correlational and confounded by other conditions (e.g., depression). Here, we present a standard procedure, the Caregiver Acute Stress Paradigm (CASP), for stressing mothers during en face interactions with their infants. We hypothesized that infants of the stressed mothers would be more distressed than infants of non-stressed mothers. A total of 106 four-month-old infants and their mothers were randomly assigned to the experimental stress or non-stress manipulation. Confirming our hypothesis, infants of the stressed mothers were significantly more likely to become distressed and require terminating the procedure. While objective ratings of maternal behavior showed no difference between groups, mother in the stress condition self-rated the episode following the caretaker stress significantly lower than mothers in the non-stress group. The self-ratings in the maternal stress-group were reflected in infant cortisol. The findings indicate that CASP is an effective experimental paradigm for exploring the independent effects of an acute stress on caretakers, including effects of conditions, such as poverty or mental illness.

Emerging patterns of infant regulatory behavior in the Still-Face paradigm at 3 and 9 months predict mother-infant attachment at 12 months.

Prior research described three stable patterns of organized behavior employed by infants to manage stressful interactive situations with their mothers in the Face-to-Face Still-Face paradigm (FFSF) at 3 and 9 months postpartum.  The current longitudinal study expands this research by examining the extent to which these patterns predict infants' later attachment quality. For that purpose, 108 full-term infants and their mothers participated in the FFSF at 3 and 9 months, and in the Strange Situation at 12 months. Cross-tabulation analyses indicated a significant association between (1) the Social-positive oriented pattern and secure attachment, (2) the Distressed-inconsolable pattern and insecure-ambivalent attachment, and (3) the Self-comfort oriented pattern and insecure-avoidant attachment. Our results contribute to a growing body of studies suggesting that patterns of infants' regulatory behavior assessed during the FFSF during the first year, may be early developmental precursors of attachment patterns at 12 months.

Intersubjectivity: Conceptual Considerations in Meaning-Making With a Clinical Illustration.

This manuscript explores intersubjectivity through a conceptual construct for meaning-making that emphasizes three major interrelated elements-meaning making in interaction, making meaning with the body as well as the mind, and meaning making within an open dynamic system. These three elements are present in the literature on intersubjectivity with a wide range of terms used to describe various theoretical formulations. One objective of this manuscript is to illustrate how such a construct can be useful to understand the meaning-making observed in psychoanalysis, such as in the treatment of a young child on the autistic spectrum. The challenges in establishing an intersubjective state with a child on the autistic spectrum serve to highlight important features of intersubjectivity. As an important background to this clinical illustration, we illustrate the construct with the scientific paradigm of the well-known face-to-face still-face.

Infant affect response in the face-to-face still face among Chinese- and European American mother-infant dyads.

Early face-to-face interactions with caregivers allow infants to learn how to express and exchange emotions with others. Within the field, however, the research regarding infant regulatory processes across cultures remains limited. The Double Face-to-Face Still Face (FFSF) paradigm provided an opportunity to examine infant affect in dyadic interactions with European American (EA, n = 54) and Chinese American (CA, n = 48) infants and caregivers. Consistent with our hypothesis that CA infants are less reactive than EA infants, CA infants in our study showed less negative and more neutral affect compared to EA infants. We also examined the number of infants who were unable to complete the full FFSF paradigm due to high levels of distress (e.g., 30-sec of sustained hard cries). Compared to EA infants, more CA infants were unable to complete the paradigm due to negative affect (e.g., sustained cries). Analyses showed an association between mothers' negative affect from the start of the paradigm with infant incompletion of the paradigm. These findings point to cultural differences in infant affect within the FFSF. As well, researchers should consider the characteristics of infants who do not complete the FFSF paradigm as they can provide meaningful data in understanding infant affect and regulation. Taken together, our findings suggest that the Double FFSF paradigm provides a reasonable threshold for distinguishing infants on their ability to regulate during a repeated social stressor.

The power of disconnection during the COVID-19 emergency: From isolation to reparation.

The coronavirus disease 2019 represents an unprecedented threat to human health worldwide. In the absence of a specific available cure for this disease, countries are adopting mitigation strategies that largely depend on physical distancing, with a dramatic restriction of social contacts. Whereas the psychological burden related to the coronavirus disease 2019 pandemic is starting to be well characterized by population-based surveys, we would like to capitalize from infant research evidence about the potentials of psychological reparation for human trauma and disconnection. Reparation can be defined as the human ability to coregulate emotions and to resolve interactive mismatches and separations by reciprocally engaging in attuned interactive exchanges capable of expanding our capacities for resilience. Alongside economical and medical health solutions, investing in psychological, emotional, and affective reparatory acts is warranted to be a key component of the recovery strategies worldwide. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effect of Maternal Distress on Perceptions of Infant Behavior May Differ in Chinese-American and European-American Mothers and Infants.

OBJECTIVE: This study examined the associations between maternal distress (symptoms of depression and anxiety) and observer and maternal ratings of infant temperament in Chinese-American (CA) and European-American (EA) 4-month-old infants (N = 114 dyads). METHODS: Maternal distress was obtained through self-reported symptoms of depression and anxiety. Mothers reported infant temperament (distress at limitations, soothability, and fear) through the short form of the Infant Behavior Questionnaire-Revised. To obtain observer-rated infant reactivity, infants were administered a battery of visual and auditory stimuli in the laboratory, in which infant behaviors (fret/cry, limb activity, and arching of the back) were coded. RESULTS: Maternal distress accounted more for the maternal perception of her infant among EA mothers than among CA mothers, but the relation was only observed for soothability. Higher maternal distress was associated with maternal report of lower soothability for EA mothers. Observer-rated infant reactivity, but not maternal distress, was positively associated with EA and CA maternal report of distress at limitations. Observer-rated infant negativity was associated with somewhat higher ratings of infant fear for EA mothers, although this association for EA mothers was not significantly different from CA mothers. CONCLUSIONS: Potential biases in maternal report of infant behavior due to effects from maternal distress may not be generalizable across cultures but may vary because of cultural norms for emotional experience and expectations for infant behavior. EA mothers' ratings of infant distress and soothability, but not fear, may be influenced by maternal distress.

Early Life Exposure to Violence: Developmental Consequences on Brain and Behavior.

Exposure to intimate partner violence (IPV) can have long-lasting effects on a child's socio-emotional and neurological development. Research has focused on the effects of IPV on women or older children, while the developmental consequences of exposure to domestic violence during early childhood are less well documented. However, one would expect significant developmental effects since the infant's brain and stress-related systems are especially susceptible to environmental stimuli. The goal of this mini-review is to examine how findings on infant exposure to IPV can be related to risk and resilience of development in infancy. We describe the known effects of witnessing violence during the perinatal period on socio-emotional development and the possible pathways by which IPV affects brain and stress-regulating systems. Exposure to IPV during infancy disrupts the infant's emotional and cognitive development, the development of the Hypothalamus-Pituitary-Adrenal (HPA) axis and brain structures related to witnessing itself (auditory and visual cortex). The findings are embedded in the context of the resource depletion hypothesis. A central problem is the dearth of research on exposure to IPV during infancy, its effect on caregiving, and infant development. Nonetheless, the available evidence makes it clear that policies for prevention of IPV are critically needed.

NICU Network Neurobehavioral Scale: 1-month normative data and variation from birth to 1 month.

BackgroundThe Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is a standardized method for infant neurobehavioral assessment. Normative values are available for newborns, but the NNNS is not always feasible at birth. Unfortunately, 1-month NNNS normative data are lacking.AimsTo provide normative data for the NNNS examination at 1 month and to assess birth-to-one-month changes in NNNS summary scores.Study designThe NNNS was administered at birth and at 1 month within a longitudinal prospective study design.SubjectsA cohort of 99 clinically healthy full-term infants were recruited from a well-child nursery.Outcome measuresBirth-to-1-month NNNS variations were evaluated and the association of neonatal and sociodemographic variables with the rate of change of NNNS summary scores were investigated.Results and conclusionsNNNS scores from the 10th to the 90th percentile represent a range of normative performance at 1 month. A complex pattern of stability and change emerged comparing NNNS summary scores from birth to 1 month. Orienting, Regulation, and Quality of movements significantly increased, whereas Lethargy and Hypotonicity significantly decreased. Birth-to-1-month changes in NNNS performance suggest improvements in neurobehavioral organization. These data are useful for research purposes and for clinical evaluation of neurobehavioral performance in both healthy and at-risk 1-month-old infants.

Here Today, Gone Tomorrow? Changes in 4-Month-Olds' Physiologic and Behavioral Responses Do Not Indicate Memory for a Social Stressor.

Although much is known about early memory development, only a few studies have explored infants' memory of social stress. While these few studies suggest that infants can remember stressful interactions, limitations seen in both methodology and statistical analyses give pause. In the current study, 4-month-olds and their mothers participated in both stressful and non-stressful interactions over 2 days. On Day 1, memory group infants participated in the double Face-to-Face Still-Face (FFSF) paradigm and control group infants participated in typical play. Both groups experienced the double FFSF paradigm on Day 2. Memory group infants exhibited the standard SF response but no differences in infant cortisol on Day 1. Both infant groups exhibited the standard SF response on Day 2. However, infants in the memory group, who saw the FFSF paradigm for the second time, did not demonstrate changes in cortisol or behavior indicative of memory across the 2 days. There was also no relationship between changes in cortisol and behavior for both days. The findings question the use of salivary cortisol as a measure of social stress and suggest that, although 4-month-olds reacted to the Still-Face social stressor immediately, they did not remember the following day.

Diminished respiratory sinus arrhythmia response in infants later diagnosed with autism spectrum disorder.

Indicators of risk for developing Autism Spectrum Disorder (ASD) are difficult to detect within the first year of life. In this study, infants who were originally followed prospectively to examine general developmental risks due to substance exposure interacted with their mother and an unfamiliar experimenter for 2-min episodes at 4 months of age. Electrocardiogram was collected to measure respiratory sinus arrhythmia (RSA) and the session was video recorded for behavioral coding. Two groups of infants were compared: infants with a diagnosed ASD outcome (N = 8) and matched controls (N = 186). Infants were compared on mean RSA and infant behavioral codes for each 2-min episode. No significant group differences were revealed on RSA or behavior during interactions between the infants and mothers. However, in response to play with a stranger, infants with an ASD outcome had lower RSA (M = 2.49, 95% CI [2.30, 2.98]) than controls (M = 3.12, 95% CI [3.06, 3.18]). During the interaction with a stranger, lower RSA response was associated with more protesting behaviors (P < 0.01), whereas higher RSA response was associated with more social monitoring (P = 0.001). Lower RSA suggests that 4-month-old infants later diagnosed with ASD exhibited poorer autonomic regulation during interaction with an unfamiliar adult than did controls. Physiological regulation during interactions with a new social partner may be disrupted early in infancy in children with ASD, as indicated here by lower RSA, and therefore be a potential target for developing early risk screening tools for ASD. Autism Res 2018, 11: 726-731. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism Spectrum Disorder (ASD) emerges within the first years of life; however, it is difficult to identify children who will develop autism before 12 months of age based on behavioral measures. In a study of infants who were followed from birth, infants who were later diagnosed with ASD had poorer physiological regulation during play with a new adult. With additional evidence, poorer physiological regulation may function as an early sign of ASD risk.

ASSOCIATIONS BETWEEN EARLY MATERNAL DEPRESSIVE SYMPTOM TRAJECTORIES AND TODDLERS' FELT SECURITY AT 18 MONTHS: ARE BOYS AND GIRLS AT DIFFERENTIAL RISK?

The goal of this study was to evaluate whether there are sex differences in children's vulnerability to caregiving risk, as indexed by trajectories of maternal depressive symptoms assessed from 2 to 18 months' postpartum, and children's rated attachment security in toddlerhood, adjusting for maternal social support and demographic risk. Analyses utilized longitudinal data collected for 182 African American mother-child dyads from economically diverse backgrounds. Participants were recruited at the time of the child's birth and followed to 18 months' postpartum. Results of conditional latent growth models indicated that an increasing rate of change in level of maternal depressive symptoms over time negatively predicted toddlers' felt attachment security. Higher social support was associated with decreasing levels of maternal depressive symptoms over time whereas higher demographic risk was associated with increasing levels of maternal depressive symptoms. A subsequent multigroup conditional latent growth model revealed that child sex moderated these associations. For male (but not female) children, a rapid increase in maternal depressive symptoms was associated with lower felt attachment security at 18 months. These findings suggest that boys, as compared to girls, may be more vulnerable to early caregiving risks such as maternal depression, with negative consequences for mother-child attachment security in toddlerhood.

Maternal and infant affect at 4 months predicts performance and verbal IQ at 4 and 7 years in a diverse population.

Using existing longitudinal data from 570 infants in the Maternal Lifestyle Study, we explored the predictive value of maternal and infant affect and maternal vocalizations during 2 minutes of face-to-face interactions at 4 months on IQ scores at 4.5 and 7 years. After controlling for demographic factors, maternal depression, and prenatal drug exposure, maternal positive affect and maternal positive vocalizations emerged as predictors of both verbal and performance IQ at 4.5 and 7 years. Although infant positive affect during the interaction with the mother was not predictive of these outcome measures, infant positive affect towards an examiner predicted verbal but not performance IQ at 4.5 years. These results suggest that maternal positive affect may index emotional engagement in interaction that facilitates both verbal and nonverbal cognitive development, while infant social positive affect is specifically related to the acquisition of verbal reasoning abilities. These findings are significant because they are based on a discrete snapshot of observable behavior in infancy (just 2 minutes of interaction), because they extend the range of maternal behaviors and characteristics known to support positive developmental outcomes, and because they are derived from high-risk infants where prevention efforts may be beneficial. Potential mechanisms for these associations are discussed, as are the clinical implications for identifying dyads most in need of targeted interventions.

U.S. Caregivers with Mental Health Problems: Parenting Experiences and Children's Functioning.

The 2007 National Survey of Children's Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and children's functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report children's problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and children's functioning.

Infants' early visual attention and social engagement as developmental precursors to joint attention.

This study examined infants' early visual attention (at 1 month of age) and social engagement (4 months) as predictors of their later joint attention (12 and 18 months). The sample (n = 325), drawn from the Maternal Lifestyle Study, a longitudinal multicenter project conducted at 4 centers of the National Institute of Child Health and Human Development Neonatal Research Network, included high-risk (cocaine-exposed) and matched noncocaine-exposed infants. Hierarchical regressions revealed that infants' attention orienting at 1 month significantly predicted more frequent initiating joint attention at 12 (but not 18) months of age. Social engagement at 4 months predicted initiating joint attention at 18 months. Results provide the first empirical evidence for the role of visual attention and social engagement behaviors as developmental precursors for later joint attention outcome. (PsycINFO Database Record

Effects of Maternal Anxiety Disorders on Infant Self-Comforting Behaviors: The Role of Maternal Bonding, Infant Gender and Age.

BACKGROUND/AIMS: We investigated the links between maternal bonding, maternal anxiety disorders, and infant self-comforting behaviors. Furthermore, we looked at the moderating roles of infant gender and age. METHODS: Our sample (n = 69) comprised 28 mothers with an anxiety disorder (according to DSM-IV criteria) and 41 controls, each with their 2.5- to 8-month-old infant (41 females and 28 males). Infant behaviors were recorded during the Face-to-Face Still-Face paradigm. Maternal bonding was assessed by the Postpartum Bonding Questionnaire. RESULTS: Conditional process analyses revealed that lower maternal bonding partially mediated between maternal anxiety disorders and increased self-comforting behaviors but only in older female infants (over 5.5 months of age). However, considering maternal anxiety disorders without the influence of bonding, older female infants (over 5.5 months of age) showed decreased rates of self-comforting behaviors, while younger male infants (under 3 months of age) showed increased rates in the case of maternal anxiety disorder. CONCLUSIONS: The results suggest that older female infants (over 5.5 months of age) are more sensitive to lower maternal bonding in the context of maternal anxiety disorders. Furthermore, results suggest a different use of self-directed regulation strategies for male and female infants of mothers with anxiety disorders and low bonding, depending on infant age. The results are discussed in the light of gender-specific developmental trajectories.

Waddington, Dynamic Systems, and Epigenetics.

Waddington coined the term "epigenetic" to attempt to explain the complex, dynamic interactions between the developmental environment and the genome that led to the production of phenotype. Waddington's thoughts on the importance of both adaptability and canalization of phenotypic development are worth recalling as well, as they emphasize the available range for epigenetic action and the importance of environmental feedback (or lack thereof) in the development of complex traits. We suggest that a dynamic systems view fits well with Waddington's conception of epigenetics in the developmental context, as well as shedding light on the study of the molecular epigenetic effects of the environment on brain and behavior. Further, the dynamic systems view emphasizes the importance of the multi-directional interchange between the organism, the genome and various aspects of the environment to the ultimate phenotype.

Serotonin Transporter Gene (SLC6A4) Methylation Associates With Neonatal Intensive Care Unit Stay and 3-Month-Old Temperament in Preterm Infants.

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene (SLC6A4), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study examined a moderation model in which the exposure to NICU-related stress and SLC6A4 methylation moderated infant temperament at 3 months of age. SLC6A4 methylation at 20 CpG sites was quantified in preterm infants (N = 48) and full-term infants (N = 30) from Italian middle-class families. Results suggested that in preterm infants NICU-related stress might be associated with alterations of serotonergic tone as a consequence of SLC6A4 methylation, which in turn, might associate with temperamental difficulties assessed at 3 months of age.