Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity.

Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still-Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.

Is Attachment and Biobehavioral Catch-up effective for parents with insecure attachment states of mind?

Prior research suggests that attachment-based interventions, including Attachment and Biobehavioral Catch-up (ABC), may be less effective at enhancing parenting quality among parents who self-report having an insecure attachment style. The current study tested whether effects of ABC on parental behavior were moderated by categorical and dimensional measures of attachment obtained via Adult Attachment Interviews with 454 parents who were approximately 34 years old, primarily female, and predominantly White or African American. Parents randomized to ABC exhibited higher sensitivity and positive regard, and lower intrusiveness shortly after the intervention than parents randomized to the control intervention (|ß|s = .10-.27). The effect of ABC on intrusiveness persisted 2 years later. Effects at either timepoint were not significantly moderated by parents' attachment representations.

Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation.

The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti's body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.

Emotion dysregulation and reward responsiveness as predictors of autonomic reactivity to an infant cry task among substance-using pregnant and postpartum women.

Maternal substance use may interfere with optimal parenting, lowering maternal responsiveness during interactions with their children. Previous work has identified maternal autonomic nervous system (ANS) reactivity to parenting-relevant stressors as a promising indicator of real-world parenting behaviors. However, less is known about the extent to which individual differences in emotion dysregulation and reward processing, two mechanisms of substance use, relate to maternal ANS reactivity in substance-using populations. The current study examined associations among emotion dysregulation, reward responsiveness, and ANS reactivity to an infant cry task among 77 low-income and substance-using women who were either pregnant (n = 63) or postpartum (n = 14). Two indicators of ANS functioning were collected during a 9 min computerized infant cry task (Crybaby task): respiratory sinus arrhythmia (RSA) and pre-ejection period. Mothers also completed self-reported measures of emotion dysregulation and reward responsiveness. Analyses revealed that trait emotion regulation was associated with RSA reactivity to the Crybaby task, such that greater emotion dysregulation was associated with greater RSA reduction during the infant cry task than lower emotion dysregulation. Reward responsiveness was not significantly associated with either indicator of ANS reactivity to the task. Findings revealed distinct patterns of associations linking emotion dysregulation with ANS reactivity during a parenting-related computerized task, suggesting that emotion regulation may be a key intervention target for substance-using mothers.

Childhood bullying victimization, emotion regulation, rumination, distress tolerance, and depressive symptoms: A cross-national examination among young adults in seven countries.

Existing research suggests a robust association between childhood bullying victimization and depressive symptoms in adulthood, but less is known about potential mediators of this link. Furthermore, there is limited cross-national research evaluating similarities and differences in bullying victimization and its associations with mental health. The current study addressed gaps in the literature by evaluating cognitive and affective responses to stress (i.e., emotion regulation, rumination, and distress tolerance) as potential mediators of the link between recalled bullying victimization and current depressive symptoms among 5909 (70.6% female) college students from seven countries. Results revealed specific indirect associations of bullying victimization through distress tolerance and three out of four facets of rumination, as well as a persistent direct association of childhood bullying on adulthood depression. Emotion regulation strategies were not significantly associated with bullying victimization and did not mediate its association with depressive symptoms. Constrained multigroup models indicated that results were invariant across country and gender. Findings provide evidence of statistical mediation in a cross-sectional sample and await replication in prospective studies. Rumination and distress tolerance may be promising targets for resilience-promoting interventions among children experiencing peer victimization. Ongoing research is needed to clarify cross-national patterns in childhood bullying, identify additional mediators accounting for the remaining direct association, and evaluate emotion regulation as a potential moderator of associations between bullying victimization and adult mental health.

Telehealth delivery of modified attachment and biobehavioral catch-up: feasibility, acceptability, and lessons learned.

The COVID-19 pandemic necessitated dramatic shifts in the delivery and evaluation of attachment-based home-visiting services. The pandemic disrupted a pilot randomized clinical trial of modified Attachment and Biobehavioral Catch-Up (mABC), an attachment-based intervention adapted for pregnant and peripartum mothers with opioid use disorders. We transitioned from in-person to telehealth delivery of mABC and modified Developmental Education for Families, an active comparison intervention targeting healthy development. Of 40 mothers then enrolled in study interventions, 30 participated in telehealth, completing an average of 4.7 remote sessions each (SD = 3.0; range = 1-11). Following the transition to telehealth, 52.5% of randomized cases and 65.6% of mothers maintaining custody completed study interventions, comparable to pre-pandemic rates. Overall, telehealth delivery was feasible and acceptable, and mABC parents coaches' ability to observe and comment on attachment-relevant parenting behaviors was preserved. Two mABC case studies are presented and lessons learned for future telehealth implementation of attachment-based interventions are discussed. .

Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants.

Little is known about whether postnatal intervention enhances autonomic regulation among infants at risk for dysregulation due to prenatal opioid exposure. The present study evaluated the effects of modified Attachment Behavioral Catch-up (mABC) on autonomic regulation for opioid-exposed infants in a pilot randomized clinical trial. We hypothesized that, compared to a control intervention (modified Developmental Education for Families [mDEF]), mABC would be associated with higher resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as well as greater reactivity to and recovery from a social stressor (Still-Face Paradigm). Pregnant or peripartum women receiving opioid agonist therapy (61 mothers of 64 infants; final N = 36 infants) were randomly assigned to mABC or mDEF, 12-session home visiting programs beginning in the third trimester; mABC targets sensitive parenting, and mDEF targets cognitive and motor development. mABC was associated with significantly greater RSA reactivity and marginally greater PEP reactivity. In models accommodating missing data, mABC was additionally associated with significantly greater RSA recovery. In sensitivity analyses removing siblings, mABC predicted significantly enhanced PEP reactivity. Overall, in these preliminary analyses, mABC was associated with healthier autonomic regulation during a social stressor than mDEF. Thus, mABC may be a promising strategy to promote autonomic regulation among opioid-exposed infants through parenting intervention.

Emotion socialization in mothers with mood disorders: Affective modeling and recollected responses to childhood emotion.

Growing evidence suggests that emotion socialization may be disrupted by maternal depression. However, little is known about emotion-related parenting by mothers with bipolar disorder or whether affective modeling in early childhood is linked to young adults' recollections of emotion socialization practices. The current study investigates emotion socialization by mothers with histories of major depression, bipolar disorder, or no mood disorder. Affective modeling was coded from parent-child interactions in early childhood and maternal responses to negative emotions were recollected by young adult offspring (n = 131, 59.5% female, M age = 22.16, SD = 2.58). Multilevel models revealed that maternal bipolar disorder was associated with more neglecting, punishing, and magnifying responses to children's emotions, whereas maternal major depression was associated with more magnifying responses; links between maternal diagnosis and magnifying responses were robust to covariates. Young adult recollections of maternal responses to emotion were predicted by affective modeling in early childhood, providing preliminary validity evidence for the Emotions as a Child Scale. Findings provide novel evidence that major depression and bipolar disorder are associated with altered emotion socialization and that maternal affective modeling in early childhood prospectively predicts young adults' recollections of emotion socialization in families with and without mood disorder.

Lifetime stressors, hair cortisol, and executive function: Age-related associations in childhood.

Extant research is mixed regarding the relations among lifetime exposure to stressors, adrenocortical activity, and executive function (EF), particularly in children. Aggregate measures of adrenocortical activity like hair cortisol concentration (HCC), timing of stress exposure, and age at assessment may clarify these associations. This cross-sectional study examined the association among parent-reported exposure to stressors, hair cortisol concentration (HCC), and children's EF via a tablet task in a community sample (n = 318, 52.5% female) of children across a wide age range (4-13 years, M = 9.4, SD = 2.3). Path analyses revealed that parent-reported child lifetime exposure to stressors, but not past-year stressful life events, negatively predicted HCC. There was also a marginally significant moderation by age such that HCC was associated negatively with EF for younger children (age < 9.7 years) but not older children. HCC did not significantly mediate the association between lifetime exposure to stressors and EF. Findings are consistent with the proposition that chronically high cortisol production has a neurotoxic effect on brain regions supporting EF. However, lifetime exposure to stressors predicted relatively lower cumulative cortisol production, consistent with a stress inoculation effect in this normative-risk sample.

Risk and Adversity, Parenting Quality, and Children's Social-Emotional Adjustment in Families Experiencing Homelessness.

A multimethod, multi-informant design was used to examine links among sociodemographic risk, family adversity, parenting quality, and child adjustment in families experiencing homelessness. Participants were 245 homeless parents (Mage  = 31.0, 63.6% African American) and their 4- to 6-year-old children (48.6% male). Path analyses revealed unique associations by risk domain: Higher sociodemographic risk predicted more externalizing behavior and poorer teacher-child relationships, whereas higher family adversity predicted more internalizing behavior. Parenting quality was positively associated with peer acceptance and buffered effects of family adversity on internalizing symptoms, consistent with a protective effect. Parenting quality was associated with lower externalizing behavior only when sociodemographic risk was below the sample mean. Implications for research and practice are discussed.

The Legacy of Early Abuse and Neglect for Social and Academic Competence From Childhood to Adulthood.

This study used data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 267) to investigate whether abuse and neglect experiences during the first 5 years of life have fading or enduring consequences for social and academic competence over the next 3 decades of life. Experiencing early abuse and neglect was consistently associated with more interpersonal problems and lower academic achievement from childhood through adulthood (32-34 years). The predictive significance of early abuse and neglect was not attributable to the stability of developmental competence over time, nor to abuse and neglect occurring later in childhood. Early abuse and neglect had enduring associations with social (but not academic) competence after controlling for potential demographic confounds and early sensitive caregiving.

Romantic functioning mediates prospective associations between childhood abuse and neglect and parenting outcomes in adulthood.

Research suggests intergenerational links between childhood abuse and neglect and subsequent parenting quality, but little is known about the potential mechanisms underlying intergenerational continuities in parenting. Adult romantic functioning may be one plausible mechanism, given its documented associations with both adverse caregiving in childhood and parenting quality in adulthood. The present study used data from the Minnesota Longitudinal Study of Risk and Adaptation to (a) investigate prospective associations between childhood experiences of abuse and neglect and multiple parenting outcomes in adulthood, and (b) evaluate the degree to which adult romantic functioning mediates those associations. Information regarding childhood abuse and neglect was gathered prospectively from birth through age 17.5 years. Multimethod assessments of romantic functioning were collected repeatedly through early adulthood (ages 20 to 32 years), and parenting quality was assessed as participants assumed a parenting role (ages 21 to 38 years). As expected, childhood abuse and neglect experiences predicted less supportive parenting (observed and interview rated) and higher likelihood of self-reported Child Protective Services involvement. The association with interview-rated supportive parenting was partially mediated by lower romantic competence, whereas the association with Child Protective Services involvement was partially mediated by more relational violence in adult romantic relationships. Implications of these novel prospective findings for research and clinical intervention are discussed.

Childhood abuse and neglect and insecure attachment states of mind in adulthood: Prospective, longitudinal evidence from a high-risk sample.

The present report used data from the Minnesota Longitudinal Study of Risk and Adaptation to investigate the factor structure and childhood abuse and/or neglect related antecedents of adults' attachment states of mind in a high-risk sample. Adult Attachment Interviews (AAIs) were collected when participants were age 26 years (N = 164) and Current Relationship Interviews (CRIs) were collected from participants (N = 116) and their romantic partners when target participants were between ages 20 and 28 years (M = 25.3 years). For both the AAI and the CRI, exploratory factor analyses revealed that (a) attachment state of mind scales loaded on two weakly correlated dimensions reflecting dismissing and preoccupied states of mind and (b) ratings of unresolved discourse loaded on the same factor as indicators of preoccupied states of mind. Experiencing any subtype of abuse and/or neglect, especially during multiple developmental periods, and experiencing multiple subtypes of abuse and/or neglect during childhood were associated with risk for preoccupied (but not dismissing) AAI states of mind regarding childhood relationships with caregivers. Analyses focused on the particular subtypes, and perpetrators indicated that the predictive significance of childhood abuse/neglect for adult's AAI preoccupied states of mind was specific to experiences of abuse (but not neglect) perpetrated by primary caregivers. In addition, experiencing chronic or multiple subtypes of childhood abuse and/or neglect increased risk for dismissing (but not preoccupied) CRI states of mind regarding adult romantic partners.

Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury.

This investigation examined preoccupied attachment states of mind as both a risk factor for non-suicidal self-injury (NSSI) and as a mechanism by which prospectively assessed childhood experiences of abuse and neglect predicted the frequency/severity of NSSI behavior up to age 26 years in 164 individuals (83 females) who were followed from birth in the Minnesota Longitudinal Study of Risk and Adaptation. Preoccupied (but not dismissing) states of mind regarding both childhood caregivers and adult romantic partners were correlated with more frequent/severe NSSI. Furthermore, preoccupied states of mind regarding caregivers partially accounted for the association between childhood abuse/neglect and NSSI. This work represents a rare prospective test of a developmental psychopathology framework for understanding NSSI behavior, in which atypical caregiving experiences are carried forward through attachment representations of caregivers that reflect behavioral risk.

A 12-month follow-up of infant neurodevelopmental outcomes of prenatal opioid exposure and polysubstance use.

BACKGROUND: Prenatal opioid exposure has been associated with developmental deficits during infancy, but the literature is limited by simple group comparisons and lack of appropriate controls. Previously published research with the current sample documented unique associations between prenatal opioid exposure and developmental outcomes at three and six months, but less is known about associations later in infancy. METHOD: The current study examined pre- and postnatal opioid and polysubstance exposure as predictors of parent-reported developmental status at 12 months of age. Participants were 85 mother-child dyads, oversampled for mothers taking opioid treatment medications during pregnancy. Maternal opioid and polysubstance use were reported using the Timeline Follow-Back Interview during the third trimester of pregnancy or up to one month postpartum and updated through the child's first year of life. Seventy-eight dyads participated in a 12-month assessment, including 68 with parent-reported developmental status on Ages and Stages Questionnaire. RESULTS: At 12 months, average developmental scores fell within normal ranges and prenatal opioid exposure was not significantly related to any developmental outcomes. However, more prenatal alcohol exposure was significantly related to worse problem-solving scores, and this relationship remained after controlling for adjusted age and other substance exposure. CONCLUSION: Although findings await replication with larger samples and more comprehensive measures, results suggest that unique developmental risks of prenatal opioid exposure may not persist through the first year of life. Effects of prenatal exposure to co-occurring teratogens, such as alcohol, may become apparent as children exposed to opioids develop.

Infant neurodevelopmental outcomes of prenatal opioid exposure and polysubstance use.

BACKGROUND: Prenatal opioid exposure has been linked to adverse birth outcomes and delays in infant development. Existing literature is limited by a simple group-differences approach as well as inadequate controls for sociodemographic factors and polysubstance exposure co-occurring with prenatal opioid use. METHOD: The current study assessed cumulative opioid exposure (duration of prescribed and illicit opioid use) as a predictor of infant birth outcomes and mother-reported developmental status at three and six months of age, controlling for polysubstance exposure. Participants were predominantly low-income pregnant and peripartum women, oversampled for mothers receiving medication-assisted treatment (MAT) for opioid use disorder. Prenatal opioid and non-opioid substance use were reported by mothers using a Timeline Follow-Back Interview completed during the third trimester and updated postnatally (infant age six months). RESULTS: Developmental scores were in the normal range. However, total opioid exposure was positively related to premature birth and inversely related to mother-reported developmental status in specific domains. Associations with three-month fine motor skills and six-month communication skills were robust to controls for polysubstance exposure and sociodemographic covariates. CONCLUSIONS: Results suggest unique effects of prenatal opioid exposure on the early development of fine motor and communication skills. Similar findings were obtained for prescribed and illicit opioid use, underscoring developmental risks of both MAT and untreated substance use. Exploratory analyses investigating type and timing of MAT suggest directions for future research.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up.

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

Maternal Emotion Socialization of Adolescent Girls Engaging in Non-Suicidal Self-Injury.

Non-suicidal self injury (NSSI) is a transdiagnostic maladaptive behavior that is highly prevalent in adolescence. A greater understanding of the mechanisms leading to NSSI is needed to guide the development of prevention efforts. The current study examined the relationship between maternal socialization of emotions and NSSI behaviors in their children. Female adolescents (N = 90, 12-17 years old) who demonstrated a range of NSSI lifetime episodes from none to very frequent were included in this sample. Maternal responses to their children's displays of sadness, anger, and happiness were assessed. Principal components analysis was used to categorize items into supportive and unsupportive maternal emotion socialization responses for the three emotions. Adolescents whose mothers reported less supportive maternal responses to child's expressions of sadness and anger had more lifetime NSSI episodes. Many of these patterns remained when follow-up analyses considered an extreme group approach (e.g., high counts of NSSI versus no NSSI), when analyses focused on specific diagnostic subgroups (e.g., depression and anxiety), and to some extent (socialization of anger) when current NSSI was considered. While the cross-sectional study design prevents causal conclusions, transactional theories raise the possibility that mothers' emotion socialization may impact offspring NSSI and offspring engagement in NSSI may result in mothers altering their socialization practices to accommodate their child's unique needs. Future research should employ longitudinal methodology to examine the time course, consider the role of emotion regulation as an explanatory mechanism, and consider intervention methods that may teach effective emotion socialization for parents.

Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention.

Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.