Cardiac vagal regulation differentiates among children at risk for behavior problems

Respiratory sinus arrhythmia, parenting, and externalizing behavior in children with autism spectrum disorder

Children with autism spectrum disorder exhibit significant difficulties with emotion regulation. Respiratory sinus arrhythmia is a biomarker for processes related to emotion regulation, with higher baseline rates linked to beneficial outcomes. Although reduction in respiratory sinus arrhythmia in response to challenge can index adaptive processes in community samples, excessive withdrawal may suggest loss of regulatory control among children with clinical concerns. Psychophysiological risk for problems may be protected against or exacerbated by parenting environments more or less supportive of the development of children's regulatory competence. Respiratory sinus arrhythmia was examined in 61 children with autism spectrum disorder ages 6-10 years in relation to externalizing behavior, and parenting was considered as a moderator. Respiratory sinus arrhythmia was obtained during laboratory tasks, and positive parenting, negative parenting, and children's externalizing behaviors were each indexed through multiple methods. Respiratory sinus arrhythmia reactivity interacted with negative, but not positive parenting. Higher respiratory sinus arrhythmia reactivity was associated with more externalizing behavior under conditions of higher negative parenting, but with lower externalizing behavior at lower levels of negative parenting. Similarly, negative parenting was only associated with externalizing behaviors in the context of high child respiratory sinus arrhythmia reactivity. Implications for our understanding of emotion regulation in children with autism spectrum disorder, and for related interventions, are discussed.

Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.

Temperamental vulnerability to emotion dysregulation and risk for mental and physical health challenges

Emotion dysregulation characterizes many forms of psychopathology. Patterns of dysregulation occur as a function of a developmental process in which normative and adaptive emotion regulation skills fail to become part of the child's behavioral repertoire due to biological, psychological, and contextual processes and experiences. Here we highlight the processes involved in the dysregulation of temperamental anger and frustration that become core features of externalizing problems and place children at risk for more serious forms of psychopathology. We imbed these processes in a larger self-regulatory framework, and we discuss how they influence mental as well as physical health, using data from our 20-year longitudinal study following a large cohort of children into young adulthood. Recommendations are made for future research involving the integration of biological systems with mental and physical health outcomes.

Autonomic complexity and emotion (dys-)regulation in early childhood across high- and low-risk contexts

Developing the ability to regulate one's emotions in accordance with contextual demands (i.e., emotion regulation) is a central developmental task of early childhood. These processes are supported by the engagement of the autonomic nervous system (ANS), a physiological hub of a vast network tasked with dynamically integrating real-time experiential inputs with internal motivational and goal states. To date, much of what is known about the ANS and emotion regulation has been based on measures of respiratory sinus arrhythmia, a cardiac indicator of parasympathetic activity. In the present study, we draw from dynamical systems models to introduce two nonlinear indices of cardiac complexity (fractality and sample entropy) as potential indicators of these broader ANS dynamics. Using data from a stratified sample of preschoolers living in high- (i.e., emergency homeless shelter) and low-risk contexts (N = 115), we show that, in conjunction with respiratory sinus arrhythmia, these nonlinear indices may help to clarify important differences in the behavioral manifestations of emotion regulation. In particular, our results suggest that cardiac complexity may be especially useful for discerning active, effortful emotion regulation from less effortful regulation and dysregulation.

Using biological factors to individualize interventions for youth with conduct problems: Current state and ethical issues

A growing body of evidence suggests that biological factors such as genes, hormone levels, brain structure, and brain functioning influence the development and trajectory of conduct problems in youth. In addition, biological factors affect how individuals respond to the environment, including how individuals respond to programs designed to prevent or treat conduct problems. Programs designed to reduce behavior problems in youth would have the greatest impact if they were targeted toward youth who need it the most (e.g., who are mostly likely to demonstrate persistent behavior problems) as well as youth who may benefit the most from the program. Biological information may improve our ability to make decisions about which type or level of intervention is best for a particular child, thus maximizing overall effectiveness, but it also raises a number of ethical concerns. These include the idea that we may be providing fewer services to some youth based on biological factors, and that information about biological risk could potentially lead to discrimination or labeling. In this article, I discuss the risks and benefits of using biological information to individualize interventions for youth with conduct problems.

Young Children's Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement - both key components of posttraumatic stress disorder (PTSD) - but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children's patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents' and children's RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers' and children's RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children's psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.

Emotion dysregulation, temperamental vulnerability, and parental depression in adolescents: Correspondence between physiological and informant-report measures

Although numerous studies reveal altered respiratory sinus arrhythmia (RSA) among children, adolescents, and adults who exhibit emotion dysregulation, effects of temperamental vulnerability and parental mental health on RSA remain unclear. We evaluated the relationship among emotion regulation, RSA, and RSA reactivity in a pooled sample of 24 vulnerable and 31 resilient adolescents (mean age = 13.69 years; 60% girls), including associations with temperamental vulnerability and parental depressive symptoms. Participants watched a neutral film clip while their resting RSA was recorded, and then completed a reward and frustration task, using an affective Posner paradigm. Temperament and emotion regulation were assessed via self-report and parent report, and parents reported on their own depressive symptoms. Low resting RSA was associated with temperamental negative emotionality, whereas greater RSA reactivity to frustration was associated with maladaptive emotion regulation strategies. No significant relations were found between RSA and parental depressive symptoms. This study elucidates the role of RSA as a biomarker of individual differences in emotion dysregulation and temperamental vulnerability and stresses the importance of considering multiple units of analyses, as well as functional domains, when studying emotional responding and regulation in adolescents.

Heart rate increase predicts challenging behavior episodes in preschoolers with autism

Identifying triggers for challenging behavior is difficult in some children with autism because of their limited communication abilities. Physiological indicators of stress may provide important insights. This study examined whether heart rate (HR) predicts challenging behavior in children with autism. While wearing an electrocardiograph monitor, 41 children with autism aged 2- to 4-years participated in tasks designed to induce low-level stress (e.g. waiting for a snack). Coders identified 106 time periods during which challenging behaviors occurred and also coded 106 randomly selected time samples that did not include challenging behaviors. Thirteen (32%) participants exhibited challenging behaviors and were included in the study. Baseline-corrected HR was computed for each behavior/time sample. On average, children with autism showed a 22 ± 16% HR increase from baseline 58 ± 22 seconds before the onset of a challenging behavior episode. Peak HR change had moderate predictive utility (area under the curve = .72, p < .001). The increase in HR before challenging behaviors was similar for children of different characteristics (age, autism severity, expressive language ability, overall developmental ability). Results highlight the promise of using physiological stress to predict challenging behavior in preschoolers with autism; although, they need to be replicated in larger samples. Given recent advances in wearable biosensing, it may be useful to incorporate HR monitoring in autism intervention. Lay summary In children with autism, changes in heart rate (HR) may help us predict when challenging behavior is about to occur - but this hypothesis has not been well studied. In this study, HR increase moderately predicted challenging behavior in preschoolers with autism. Given recent advances in wearable sensors, it may be useful to incorporate HR monitoring in autism intervention.

The Association Between Heart Rate Variability and Neurocognitive and Socio-Emotional Development in Nepalese Infants

BACKGROUND

Many young children in developing countries do not reach their developmental potential. Traditional methods for assessing developmental outcome are time consuming, thus, physiological measures that can contribute to the prediction of developmental outcomes in high risk groups have been suggested. Vagally mediated heart rate variability (vmHRV) is considered a neurophysiological or peripheral proxy for prefrontal and executive functioning and might serve as a supplement for traditional measurements of developmental status and as a potential useful risk indicator.

AIM

In the present study, we wanted to describe the vmHRV in Nepalese infants and relate it to the Bayley Scales of infant and toddler development, 3. edition (Bayley-III) subscales.

METHODS

600 Nepalese infants were included in the study. At 6-11 and 17-24 months, we measured neurodevelopmental and socio-emotional outcomes by the Bayley-III. Inter-beat intervals were recorded at two measurement points when the children were 17-24 months.

RESULTS

There was a high intraclass correlation between HRV indices generated from the two measurement points. No significant associations between vmHRV and Bayley-III sub scales were found at any time.

CONCLUSION

This study is the first to describe vmHRV in healthy infants and the relationship between Bayley-III scores. Our results suggest that vmHRV is not associated with measures of general development in infancy.

A Transdiagnostic Examination of Self-Regulation: Comparisons Across Preschoolers with ASD, ADHD, and Typically Developing Children

The purpose of the current study was to identify profiles of self-regulation across executive functioning (EF) and emotion regulation (ER) and examine profiles's impact on treatment outcomes. Participants included 100 preschoolers (M_age = 4.73, 75% Male, 79% Hispanic) including 37 with autism spectrum disorder and attention-deficit/hyperactivity disorder (ASD+ADHD), 32 with ADHD-only, and 31 typically developing children. Parents and teachers reported on children's EF, ER, ASD, and ADHD symptoms. Children were administered an EF battery and observed for ER during a frustration task. Children participated in an intensive behavioral summer treatment program (STP-PreK) aimed at improving school readiness across behavioral, academic, and self-regulation domains. Latent profile analyses produced 4 profiles: (a) Low ER and EF Deficits, (b) High ER Deficits, (c) High EF Deficits, and (d) Moderate ER and EF Deficits. ASD and ADHD symptoms predicted lower membership probability within the Low ER and EF Deficits Profile and higher membership probability within the Moderate ER and EF Deficits Profile. However, only ASD symptoms predicted membership within the High EF Deficits Profile. Only ADHD symptoms predicted membership within the High ER Deficits Profile. Even after accounting for diagnostic symptoms, profile membership was predictive of treatment response across behavioral and academic domains. Children in the High EF Deficits Profile experienced the largest gains. Results highlight the specificity of self-regulation deficits within and across diagnoses. Self-regulation profiles demonstrated clinical utility in predicting treatment response above traditional symptom based classifications, providing evidence for the use of transdiagnostic approaches.

Understanding the Victimization-Aggression Link in Childhood: The Roles of Sympathy and Resting Respiratory Sinus Arrhythmia

With a sample of 4- and 8-year-olds (N = 131), we tested the extent to which more frequent experiences of victimization were associated with heightened aggression towards others, and how sympathetic concern and resting respiratory sinus arrhythmia (RSA) factored into this relationship. Caregivers reported their children's aggression and sympathy. Children reported their victimization and their resting RSA was calculated from electrocardiogram data in response to a nondescript video. Findings revealed that children who reported more frequent victimization were rated as less sympathetic and, in turn, more aggressive. However, resting RSA moderated this path, such that children with high levels were rated as more versus less sympathetic when they reported less versus more victimization, respectively. Results suggest that considering children's sympathetic tendencies and physiology is important to gain a nuanced understanding of their victimization-related aggression.

Vagal Tone as a Putative Mechanism for Pragmatic Competence: An Investigation of Carriers of the FMR1 Premutation

Pragmatic language skills exist across a continuum in typical and clinical populations, and are impaired in many neurodevelopmental disorders, most notably autism. The mechanisms underlying pragmatic impairment are poorly understood, although theory suggests dampened vagal tone plays a role. This study investigated the FMR1 premutation as a genetic model that may lend insight into the relationship between vagal function and pragmatic ability. Participants included 38 women with the FMR1 premutation and 23 controls. Vagal tone accounted for significant variance in pragmatics across both groups and statistically mediated the effect of FMR1 premutation status on pragmatic ability. Results support vagal tone as a biophysiological correlate of pragmatic ability, which informs potential mechanistic underpinnings and could have implications for targeted treatment.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Emotion Regulation Over the Life Span

PURPOSE OF REVIEW

Emotional symptoms are common and persistent in youth and adults with attention-deficit/hyperactivity disorder (ADHD) and cause clinically significant impairments. We review recent neuropsychological, neurophysiological, and peripheral psychophysiological evidence for emotion and emotion regulation deficits in ADHD across youth and adults.

RECENT FINDINGS

Central and autonomous nervous system correlates argue in favor of more general self-regulation deficits and also specific emotional deficits in ADHD. These include general performance deficits in executive functions, and structural as well as functional impairments in neuronal networks associated with top-down self-regulation. Specific deficits with bottom-up emotional activation in the amygdala and emotion evaluation associated with the orbitofrontal cortex have also been described. Furthermore, vagally mediated, high-frequency heart rate variability is associated with emotional self-regulation deficits throughout the life span. The current evidence is based on multilevel studies that assess associations of emotion regulation. However, further studies that adequately consider the processual recursive character of emotion generation and regulation may give important new insights into emotional regulation of ADHD. Emotion regulation deficits in ADHD are associated with specific as well as general self-regulation deficits traceable on the level of neuropsychological, neurophysiological, and psychophysiological assessments. The temporal dynamics of the interplay of those different systems need further study in order to optimize and personalize treatment of emotion regulation difficulties, including emotional reactivity, in patients with ADHD.

Effects of an attachment-based intervention in infancy on children's autonomic regulation during middle childhood

The present study used a longitudinal randomized clinical trial to test whether an early intervention has causal effects on children's autonomic nervous system regulation. When children were infants, parents involved with Child Protective Services received Attachment and Biobehavioral Catch-up (ABC; N = 43), an intervention that promotes sensitive parenting, or a control intervention (N = 53). When children were 9 years old, children whose parents had received ABC exhibited higher respiratory sinus arrhythmia and lower heart rate at rest and during a parent-child interaction than children in the control group. Intervention effects were not detected for children's average skin conductance levels or for indices of autonomic reactivity. Results suggest that a parenting-focused early intervention impacted the development of children's autonomic regulation.

Infants' Biological Sensitivity to the Effects of Maternal Social Support: Evidence Among Mexican American Families

The identification of infants who are most susceptible to both negative and positive social environments is critical for understanding early behavioral development. This study longitudinally assessed the interactive effects of infant vagal tone (respiratory sinus arrhythmia; RSA) and maternal social support on behavioral problems and competence among 322 low-income Mexican American mother-infant dyads (infants: 54.1% female) and explored sex differences. Infant RSA was calculated from resting HR data at 6 weeks of age. Mothers reported on general social support, partner support, and family support at 6 months, and infant behavioral problems and competence at 1 year. Two-way interactions (RSA × support source) were evaluated to predict behavioral problems and competence, adjusting for covariates. Results indicated higher competence among infants with lower RSA whose mothers reported higher general support or higher partner support. Interactive effects on behavior problems of RSA with maternal partner or family support were only found for female infants: Girls with higher RSA showed more behavior problems when mothers reported low support, but fewer problem levels in the context of high support. Our results suggest that infant RSA is an important moderator of the effects of the early social environment on early development.

The Longitudinal Impact of Screen Time on Adolescent Development: Moderation by Respiratory Sinus Arrhythmia

PURPOSE

To date, little is known about underlying psychophysiological contributions to the impact of media content and overall screen time on adolescent psychological functioning. In the present study we examine respiratory sinus arrhythmia (RSA) as a moderator of the link between specific types of media content use, overall media exposure, and the development of internalizing and aggressive symptoms in youth.

METHODS

A sample of 374 adolescents (mean age = 15) reported on their media use, internalizing behavior, and aggressive behavior at time 1 (2011) and 1-year follow-up (2012). RSA reactivity was gathered during a challenging laboratory task. Path analyses were conducted to test the hypothesized three-way interaction model between media use, media content, and RSA reactivity, separately for internalizing and aggressive problems.

RESULTS

Significant interactions were found for aggressive, but not prosocial, media content. For aggressive content, youth exhibiting RSA withdrawal reported significantly greater internalizing and aggressive symptoms when exposed to higher amounts of screen time and aggressive content.

CONCLUSIONS

These findings suggest that profiles of heightened RSA withdrawal may place adolescents at greater risk to the negative impact of violent media, whereas prosocial media content may not significantly impact youth development of psychopathology. Implications for the role of psychophysiology in our understanding of media effects are discussed.

Autonomic nervous system functioning assessed during the Still-Face Paradigm: A meta-analysis and systematic review of methods, approach and findings

Animal and human research suggests that the development of the autonomic nervous system (ANS) is particularly sensitive to early parenting experiences. The Still-Face Paradigm (SFP), one of the most widely used measures to assess infant reactivity and emotional competence, evokes infant self-regulatory responses to parental interaction and disengagement. This systematic review of 33 peer-reviewed studies identifies patterns of parasympathetic (PNS) and sympathetic (SNS) nervous system activity demonstrated by infants under one year of age during the SFP and describes findings within the context of sample demographic characteristics, study methodologies, and analyses conducted. A meta-analysis of a subset of 14 studies with sufficient available respiratory sinus arrhythmia (RSA) data examined whether the SFP reliably elicited PNS withdrawal (RSA decrease) during parental disengagement or PNS recovery (RSA increase) during reunion, and whether results differed by socioeconomic status (SES). Across SES, the meta-analysis confirmed that RSA decreased during the still-face episode and increased during reunion. When studies were stratified by SES, low-SES or high-risk groups also showed RSA decreases during the still face episode but failed to show an increase in RSA during reunion. Few studies have examined SNS activity during the SFP to date, preventing conclusions in that domain. The review also identified multiple qualifications to patterns of SFP ANS findings, including those that differed by ethnicity, infant sex, parental sensitivity, and genetics. Strengths and weaknesses in the extant research that may explain some of the variation in findings across the literature are also discussed, and suggestions for strengthening future research are provided.

A case study of two adolescent-parent pairs describing the association between vagal tone and social-emotional adjustment during a Positive Cognitive Behaviour Therapy Programme

OBJECTIVE

A case study describing the association between vagal tone and social-emotional adaptation in two distressed adolescent-parent (A-P) pairs during a Positive Cognitive Behaviour Therapy Programme (P-CBTP).

METHODS

Two A-P pairs completed a P-CBTP with pre- and post-intervention biosocial-emotional assessments; weekly training sessions over 7 weeks to develop individual strengths, new adaptive cognitions, positive discipline skills, optimism and knowledge on age-appropriate developmental expressions; augmented by moderate physical activity. Resting vagal tone and vagal reactivity were assessed by time-domain measures of vagal activity (RMSSD).

RESULTS

Social-emotional adjustment improved in all A-P pairs. Resting vagal tone increased over the intervention period, from low-to-low-normal towards average-for-normal in three subjects. The fourth individual had excessive pre-intervention resting vagal tone that declined in the direction of normal over the intervention period. Vagal reactivity in response to orthostatic stress remained the same pre- to post-intervention.

CONCLUSIONS

Changes in resting vagal tone demonstrated improvements in psychological functioning in all four subjects over the period of intervention. Results supported the view of the association between vagal tone and mental health not being an absolute positive relationship, but that low, as well as excessive, vagal tone may be maladaptive. Indications are that the same may apply to vagal reactivity to psychological stress. More studies need to examine the association between resting vagal tone and emotion regulation in A-P relationships during P-CBTP, keeping in mind that a linear relationship cannot summarily be expected in population studies.

Children's autonomic functioning moderates links between maternal rejecting attitudes and preschool aggressive behaviors

Substantial theoretical and empirical literature suggests that the extent to which children's early experiences contribute to the development of aggressive behaviors may depend on the psychophysiological regulatory capacities of the child. This study adds to this literature by examining the relations between mothers' rejecting child-rearing attitudes and children's aggressive behaviors, as well as whether children's parasympathetic regulation, both at rest and in response to anger-inducing films, moderate these links. Using the data collected from 88 preschoolers (mage  = 51 months), the results revealed that the positive association between mothers' rejecting child-rearing attitudes and children's aggressive behaviors was moderated by respiratory sinus arrhythmia (RSA) reactivity to anger. More rejecting child-rearing attitudes predicted more aggressive behaviors only for children who showed mild RSA suppression to RSA augmentation. Conversely, and consistent with the differential-susceptibility model, children who showed mild RSA suppression to RSA augmentation had the fewest aggressive behaviors when mothers reported less rejecting child-rearing attitudes.

Vagal Tank Theory: The Three Rs of Cardiac Vagal Control Functioning - Resting, Reactivity, and Recovery

The aim of this paper is to set the stage for the vagal tank theory, showcasing a functional resource account for self-regulation. The vagal tank theory, building on neurophysiological, cognitive and social psychology approaches, will introduce a physiological indicator for self-regulation that has mainly been ignored from cognitive and social psychology, cardiac vagal control (also referred to as cardiac vagal activity). Cardiac vagal control reflects the contribution of the vagus nerve, the main nerve of the parasympathetic nervous system, to cardiac regulation. We propose cardiac vagal control to be an indicator of how efficiently self-regulatory resources are mobilized and used. Three systematic levels of cardiac vagal control analysis are suggested: resting, reactivity, and recovery. Based on this physiological indicator we derive the metaphor of the vagal tank, which can get depleted and replenished. Overall, the vagal tank theory will enable to integrate previous findings from different disciplines and to stimulate new research questions, predictions, and designs regarding self-regulation.

Prenatal exposure to tobacco and cannabis: Effects on autonomic and emotion regulation

Tobacco and cannabis are often used together in pregnancy and both have effects on children's regulatory system. Yet, little is known about the impact of co-use on the development of emotion regulation at the developmentally salient age of 2 years. One pathway linking co-exposure to tobacco and cannabis to toddler regulation may be via poor autonomic regulation in infancy. In addition, substance using mothers may be more dysregulated themselves, which may have direct effects on toddler regulation, but may also affect parenting, particularly maternal sensitivity during mother-child interactions. Thus, a second pathway linking exposure to toddler regulation may be via maternal dysregulation and low maternal sensitivity. We examined a conceptual model linking prenatal exposure to toddler regulation via these two pathways in a prospective sample (N = 247) of mother-child dyads recruited in the first trimester of pregnancy. Results indicated significant effects of co-exposure on poor autonomic regulation in infancy, which in turn predicted poor toddler emotion regulation. Mothers who used both tobacco and cannabis displayed lower sensitivity during play interactions with their infants. Maternal sensitivity was modestly stable from infant to toddler period and was predictive of higher toddler emotion regulation. Continued postnatal exposure to tobacco was also a significant, unique predictor of lower toddler emotion regulation. Results highlight the importance of examining co-exposure effects and suggest that this common pattern of use may be associated with higher infant/toddler risks.

Specificity of Reward Sensitivity and Parasympathetic-Based Regulation among Children with Attention-Deficit/Hyperactivity and Disruptive Behavior Disorders

Attention-deficit/hyperactivity disorder (ADHD) is associated with disruptionsin reward sensitivity and regulatory processes. However, it is unclear whether thesedisruptions are better explained by comorbid disruptive behavior disorder (DBD)symptomology. This study sought to examine this question using multiple levels ofanalysis (i.e., behavior, autonomic reactivity). One hundred seventeen children (aged 6 to 12 years; 72.6% male; 69 with ADHD) completed theBalloon-Analogue Risk Task (BART) to assess external reward sensitivity behaviorally.Sympathetic-based internal reward sensitivity and parasympathetic-based regulationwere indexed via cardiac pre-ejection period (PEP) and respiratory sinus arrhythmia(RSA), respectively. Children with ADHD exhibited reduced internal reward sensitivity (i.e.,lengthened PEP; F(1,112)=4.01, p=0.047) compared to healthy controls and werecharacterized by greater parasympathetic-based dysregulation (i.e., reduced RSAaugmentation F(1,112)=10.12, p=0.002). However, follow-up analyses indicated theADHD effect was better accounted for by comorbid DBD diagnoses; that is, childrenwith ADHD and comorbid ODD were characterized by reduced internal rewardsensitivity (i.e., lengthened PEP; t=2.47, p=0.046) and by parasympathetic-baseddysregulation (i.e., reduced RSA augmentation; t=3.51, p=0.002) in response to rewardwhen compared to typically developing youth. Furthermore, children with ADHD and comorbid CD exhibited greater behaviorally-based external reward sensitivity (i.e.,more total pops; F(3,110)= 5.96, p=0.001) compared to children with ADHD only (t=3.87, p=0.001) and children with ADHD and ODD (t=3.56, p=0.003). Results suggest that disruptions in sensitivity to reward may be betteraccounted for, in part, by comorbid DBD.Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system,disruptive behavior disorders, reward sensitivityPowered.

Respiratory Sinus Arrhythmia in Cognitive Behavioral Therapy for Posttraumatic Stress Symptoms in Children: Preliminary Treatment and Gender Effects

Cognitive behavioral therapy (CBT) is an efficacious treatment for posttraumatic stress disorder (PTSD) symptoms, but the effect of CBT on physiological indicators is largely unknown. Respiratory sinus arrhythmia (RSA) is an established parasympathetic marker of self-regulatory capacity and stress responsivity. The present study tested if and how resting RSA and RSA reactivity changed following treatment among a sample of children (n = 48) who experienced at least one traumatic event and presented with PTSD symptoms. RSA reactivity was measured in response to personalized trauma-related scripts. Results indicated that changes in RSA after treatment were dependent on pretreatment resting levels of RSA, with individuals with high and low pretreatment resting RSA levels appearing to converge over time in both resting RSA and RSA reactivity by the 3-month follow up. Specific to RSA reactivity, a sex difference was evident, as following treatment, females showed less RSA withdrawal whereas males showed more RSA withdrawal. PTSD symptoms were significantly reduced after CBT but symptom change was not associated with pretreatment resting RSA levels. Overall, these results suggest that there may be multiple physiological patterns within children with PTSD and the direction of the physiological changes after CBT may depend on initial differences in resting RSA levels.

Inhibitory control in typically developing preschoolers: Relations among temperament, respiratory sinus arrhythmia, and behavior at age 4

Although inhibitory control (IC) is associated with children's positive adjustment, we know relatively little about factors underlying its development. We examined whether baseline and on-task respiratory sinus arrhythmia [(RSA); a physiological measure of self-regulation] and private speech (a behavioral measure of self-regulation) interacted to confer differences on directly observed IC in 52 typically developing 4-year olds. We found that baseline RSA moderated the association between private speech and IC, such that private speech positively predicted IC in children with relatively higher baseline RSA, but was unrelated to IC in children with relatively lower RSA. We also found that children with a concordant physiological-behavioral pattern (i.e., high RSA and high private speech; low RSA and low private speech) had higher IC, higher effortful control, and lower negative emotionality than those with a discordant physiological-behavioral pattern (i.e., high RSA and low private speech; low RSA and high private speech). Individual differences in physiological and behavioral self-regulation indices may represent distinct regulation pathways that interact to confer differences in IC during the preschool years.

Self-regulation as a predictor of patterns of change in externalizing behaviors from infancy to adolescence

We examined associations between specific self-regulatory mechanisms and externalizing behavior patterns from ages 2 to 15 (N = 443). The relation between multiple self-regulatory indicators across multiple domains (i.e., physiological, attentional, emotional, and behavioral) at age 2 and at age 5 and group membership in four distinct externalizing trajectories was examined. By examining each of these self-regulatory processes in combination with one another, and therefore accounting for their shared variance, we aimed to better understand which specific self-regulatory skills were associated most strongly with externalizing behavioral patterns. Findings suggest that behavioral inhibitory control and emotion regulation are particularly important in distinguishing between children who show normative declines in externalizing behaviors across early childhood and those who demonstrate high levels through adolescence.

Dysregulated Fear, Social Inhibition, and Respiratory Sinus Arrhythmia: A Replication and Extension

Behavioral inhibition indicates increased risk for development of social anxiety. Recent work has identified a pattern of dysregulated fear (DF), characterized by high fear in low-threat situations, that provides a more precise marker of developmental risk through early childhood. This study tested a new longitudinal sample of children (n = 124) from ages 24 to 48 months. Replicating prior findings, at 24 months, we identified a pattern of fearful behavior across contexts marked by higher fear to putatively low-threat situations. DF was associated with higher parental report of social inhibition at 24, 36, and 48 months. Extending prior findings, we observed differences in cardiac physiology during fear-eliciting situations, suggesting that the neurobiological underpinnings of DF relate to difficulty with regulation.

Cumulative risk exposure moderates the association between parasympathetic reactivity and inhibitory control in preschool-age children

A child's cumulative risk for early exposure to stress has been linked to alterations of self-regulation outcomes, including neurobiological correlates of inhibitory control (IC). We examined whether children's ability to engage the parasympathetic nervous system impacts how risk affects IC. Children ages 3-5 years completed two laboratory measures of IC while respiratory sinus arrhythmia (RSA) was measured, indexing parasympathetic activity. Children with greater risk demonstrated lower IC; risk also moderated associations between RSA reactivity and IC. For children with less risk, greater RSA withdrawal during IC tasks was associated with better IC. In contrast, greater risk was associated with poor IC, regardless of RSA withdrawal. Effects of risk were more pronounced for cumulative than individual measures. Results suggest that cumulative risk exposure disrupts connectivity between physiological and behavioral components of self-regulation in early childhood. Parasympathetic withdrawal to cognitive tasks may be less relevant for performance in developmental samples experiencing greater life stress.

Parent emotion regulation socializes children's adaptive physiological regulation

Parenting practices play a major role in socializing children's developing regulatory abilities, but less is known about how parents' regulatory abilities relate to children's healthy functioning. This study examined whether parents' physiological and emotion regulation abilities corresponded to children's physiological and emotional responding to a structured laboratory-based disappointment task. Ninety-seven 3- to 7-year-olds (56 girls; M = 5.79 years) and one parent participated in a multi-method assessment of parents' and children's regulatory functioning. Direct (coaching children to use reappraisal) and indirect (resting physiology, dispositional use of reappraisal) aspects of parents' regulatory abilities were assessed. As expected, an adaptive pattern of parent regulatory abilities composed of higher resting respiratory sinus arrhythmia, use of reappraisal, and coaching reappraisal was associated with children's physiological reactivity after a disappointment indicative of more effective physiological calming in a recovery context (increased parasympathetic activation). In contrast, parents' regulatory abilities did not relate to changes in children's expressions of emotional distress.

Respiratory sinus arrhythmia as a non-invasive index of 'brain-heart' interaction in stress

Respiratory sinus arrhythmia (RSA) is accepted as a peripheral marker of cardiac-linked parasympathetic regulation. According to polyvagal theory, the RSA is also considered as the index of emotion regulation. The neurovisceral integration model posits that parasympathetic modulation of the heart marked by RSA is related to complex nervous regulation associated with emotional and cognitive processing. From this perspective, high resting RSA amplitude associated with a greater withdrawal during stressors and subsequent recovery could represent a flexible and adaptive physiological response system to a challenge. Conversely, low resting RSA accompanied by an inadequate reactivity to stress might reflect maladaptive regulatory mechanisms. The RSA reactivity is different with various types of stressors: while the RSA decreases to cognitive tasks indicating a vagal withdrawal, the RSA magnitude increases to emotional challenge indicating an effective cognitive processing of emotional stimuli. The RSA reactivity to stress could have important implications for several mental disorders, e.g. depressive or anxiety disorder. It seems that the study of the RSA, as a non-invasive index of ‘brain-heart’ communication, could provide important information on the pathway linked to mental and physical health.

Respiratory Sinus Arrhythmia Activity Predicts Internalizing and Externalizing Behaviors in Non-referred Boys

Atypical respiratory sinus arrhythmia (RSA), a biomarker of emotion dysregulation, is associated with both externalizing and internalizing behaviors. In addition, social adversity and gender may moderate this association. In this study, we investigated if RSA (both resting RSA and RSA reactivity in an emotion regulation task) predicts externalizing and/or internalizing behaviors and the extent to which social adversity moderates this relationship. Two hundred and fifty-three children (at Time 1, mean age = 9.05, SD = 0.60, 48% boys) and their caregivers from the community participated in this study. Resting RSA and RSA reactivity were assessed, and caregivers reported children’s externalizing and internalizing behaviors at both Time 1 and Time 2 (1 year later). We found that lower resting RSA (but not RSA reactivity) at Time 1 was associated with increased externalizing and internalizing behaviors at Time 2 in boys, even after controlling for the effects of Time 1 behavioral problems and Time 2 age. Moreover, there was a significant interaction effect between Time 1 resting RSA and social adversity such that lower resting RSA predicted higher externalizing and internalizing behaviors in boys only under conditions of high social adversity. Follow-up analyses revealed that these predictive effects were stronger for externalizing behavior than for internalizing behavior. No significant effects were found for girls. Our findings provide further evidence that low resting RSA may be a transdiagnostic biomarker of emotion dysregulation and a predisposing risk factor for both types of behavior problems, in particular for boys who grow up in adverse environments. We conclude that biosocial interaction effects and gender differences should be considered when examining the etiological mechanisms of child psychopathology.

Parent-child coregulation of parasympathetic processes varies by social context and risk for psychopathology

The parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent-child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent-child interactions showed overall dynamic, positive concordance in mother-child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother-child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent-child physiological coregulation are discussed.

Young adults' internet addiction: Prediction by the interaction of parental marital conflict and respiratory sinus arrhythmia

The aim of the current study was to address the potential moderating roles of respiratory sinus arrhythmia (RSA; baseline and suppression) and participant sex in the relation between parents' marital conflict and young adults' internet addiction. Participants included 105 (65 men) Chinese young adults who reported on their internet addiction and their parents' marital conflict. Marital conflict interacted with RSA suppression to predict internet addiction. Specifically, high RSA suppression was associated with low internet addiction, regardless of parental marital conflict; however, for participants with low RSA suppression, a positive relation between marital conflict and internet addiction was found. Internet addiction also was predicted by a significant three-way interaction among baseline RSA, marital conflict, and participant sex. Specifically, for men, marital conflict positively predicted internet addiction under conditions of low (but not high) baseline RSA. For women, marital conflict positively predicted internet addiction under conditions of high (but not low) baseline RSA. Findings highlight the importance of simultaneous consideration of physiological factors, in conjunction with family factors, in the prediction of young adults' internet addiction.

Quantifying respiratory sinus arrhythmia: Effects of misspecifying breathing frequencies across development

Low resting respiratory sinus arrhythmia (RSA), and to a lesser extent excessive RSA reactivity to emotion evocation, are observed in many psychiatric disorders characterized by emotion dysregulation, including syndromes spanning the internalizing and externalizing spectra, and other conditions such as nonsuicidal self-injury. Nevertheless, some inconsistencies exist. For example, null outcomes in studies of RSA–emotion dysregulation relations are sometimes observed among younger participants. Such findings may derive from use of age inappropriate frequency bands in calculating RSA. We combine data from five published samples (N = 559) spanning ages 4 to 17 years, and reanalyze RSA data using age-appropriate respiratory frequencies. Misspecifying respiratory frequencies results in overestimates of resting RSA and underestimates of RSA reactivity, particularly among young children. Underestimates of developmental shifts in RSA and RSA reactivity from preschool to adolescence were also observed. Although correlational analyses revealed weak negative associations between resting RSA and aggression, those with clinical levels of externalizing exhibited lower resting RSA than their peers. No associations between RSA reactivity and externalizing were observed. Results confirm that age-corrected frequency bands should be used when estimating RSA, and that literature-wide overestimates of resting RSA, underestimates of RSA reactivity, and underestimates of developmental shifts in RSA and RSA reactivity may exist.

Annual Research Review: On the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology

BACKGROUND

Self-regulation (SR) is central to developmental psychopathology, but progress has been impeded by varying terminology and meanings across fields and literatures.

METHODS

The present review attempts to move that discussion forward by noting key sources of prior confusion such as measurement-concept confounding, and then arguing the following major points.

RESULTS

First, the field needs a domain-general construct of SR that encompasses SR of action, emotion, and cognition and involves both top-down and bottom-up regulatory processes. This does not assume a shared core process across emotion, action, and cognition, but is intended to provide clarity on the extent of various claims about kinds of SR. Second, top-down aspects of SR need to be integrated. These include (a) basic processes that develop early and address immediate conflict signals, such as cognitive control and effortful control (EC), and (b) complex cognition and strategies for addressing future conflict, represented by the regulatory application of complex aspects of executive functioning. Executive function (EF) and cognitive control are not identical to SR because they can be used for other activities, but account for top-down aspects of SR at the cognitive level. Third, impulsivity, risk-taking, and disinhibition are distinct although overlapping; a taxonomy of the kinds of breakdowns of SR associated with psychopathology requires their differentiation. Fourth, different aspects of the SR universe can be organized hierarchically in relation to granularity, development, and time. Low-level components assemble into high-level components. This hierarchical perspective is consistent across literatures.

CONCLUSIONS

It is hoped that the framework outlined here will facilitate integration and cross-talk among investigators working from different perspectives, and facilitate individual differences research on how SR relates to developmental psychopathology.

Preschoolers' genetic, physiological, and behavioral sensitivity factors moderate links between parenting stress and child internalizing, externalizing, and sleep problems

This study examined three potential moderators of the relations between maternal parenting stress and preschoolers' adjustment problems: a genetic polymorphism-the short allele of the serotonin transporter (5-HTTLPR, ss/sl allele) gene, a physiological indicator-children's baseline respiratory sinus arrhythmia (RSA), and a behavioral indicator-mothers' reports of children's negative emotionality. A total of 108 mothers (M_age  = 30.68 years, SD_age  = 6.06) reported on their parenting stress as well as their preschoolers' (M_age  = 3.50 years, SD_age  = 0.51, 61% boys) negative emotionality and internalizing, externalizing, and sleep problems. Results indicated that the genetic sensitivity variable functioned according to a differential susceptibility model; however, the results involving physiological and behavioral sensitivity factors were most consistent with a diathesis-stress framework. Implications for prevention and intervention efforts to counter the effects of parenting stress are discussed.

Parasympathetic reactivity and disruptive behavior problems in young children during interactions with their mothers and other adults: A preliminary investigation

Parasympathetic nervous system influences on cardiac functions-commonly indexed via respiratory sinus arrhythmia (RSA)-are central to self-regulation. RSA suppression during challenging emotional and cognitive tasks is often associated with better emotional and behavioral functioning in preschoolers. However, the links between RSA suppression and child behavior across various challenging interpersonal contexts remains unclear. The present study experimentally evaluated the relationship between child RSA reactivity to adult (mother vs. study staff) direction and disruptive behavior problems in children ages 3-8 with varying levels of disruptive behavior problems (N = 43). Reduced RSA suppression in the context of mothers' play-based direction was associated with more severe child behavior problems. In contrast, RSA suppression in the context of staff play-based direction was not associated with behavior problems. Findings suggest that the association between RSA suppression and child behavior problems may vary by social context (i.e., mother vs. other adult direction-givers). Findings are discussed in regard to RSA as an indicator of autonomic self-regulation that has relevance to child disruptive behavior problems.

Emotional Reactivity, Behavior Problems, and Social Adjustment at School Entry in a High-risk Sample

Prior research suggests that heightened emotional reactivity to emotionally distressing stimuli may be associated with elevated internalizing and externalizing behaviors, and contribute to impaired social functioning. These links were explored in a sample of 169 economically-disadvantaged kindergarteners (66 % male; 68 % African American, 22 % Hispanic, 10 % Caucasian) oversampled for elevated aggression. Physiological measures of emotional reactivity (respiratory sinus arrhythmia [RSA], heart rate [HR], and cardiac pre-ejection period [PEP]) were collected, and teachers and peers provided ratings of externalizing and internalizing behavior, prosocial competence, and peer rejection. RSA withdrawal, HR reactivity, and PEP shortening (indicating increased arousal) were correlated with reduced prosocial competence, and RSA withdrawal and HR reactivity were correlated with elevated internalizing problems. HR reactivity was also correlated with elevated externalizing problems and peer rejection. Linear regressions controlling for age, sex, race, verbal proficiency, and resting physiology showed that HR reactivity explained unique variance in both teacher-rated prosocial competence and peer rejection, and contributed indirectly to these outcomes through pathways mediated by internalizing and externalizing problems. A trend also emerged for the unique contribution of PEP reactivity to peer-rated prosocial competence. These findings support the contribution of emotional reactivity to behavior problems and social adjustment among children living in disadvantaged urban contexts, and further suggest that elevated reactivity may confer risk for social difficulties in ways that overlap only partially with internalizing and externalizing behavior problems.

Sex Differences in the Contribution of Respiratory Sinus Arrhythmia and Trauma to Children's Psychopathology

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co-contribution of exposure to potentially traumatic events (PTEs), baseline RSA, and RSA withdrawal to internalizing and externalizing behavior in a sample of primarily African American youth (n = 92) recruited using neighborhood mapping techniques from communities high in epidemiological indicators of adversity. Exposure to PTEs was associated with lower baseline RSA. Complex interactions were observed between sex of the child, baseline RSA and RSA withdrawal, and PTE exposure predicting to internalizing behaviors. Among girls with high (4+) levels of PTEs, high baseline RSA and RSA withdrawal predicted higher internalizing; for RSA withdrawal only, the inverse was observed for girls with low PTE exposure, for whom high RSA withdrawal predicted lower internalizing. No associations were observed from RSA to externalizing, or among boys to internalizing. Findings are consistent with distinct patterns among primarily African American samples and suggest the need for sex-specific conceptualizations of the link between environmental adversity, physiological reactivity, and internalizing behaviors.