Self-regulation and emotion in infancy

Parent's use of coercive control practices with food is associated with poorer emotion regulation and increased emotional overeating in preschoolers

Emotional overeating is defined as eating in response to emotions. Around the preschool years, there is a shift from emotional undereating to overeating, which suggests environmental influences in the development of overeating. The use of food by parents to control their child's emotions, rather than to teach them appropriate emotion regulation strategies, may impact the child's ability to regulate their own emotions, resulting in emotional overeating. We hypothesized that such coercive control practices with food by parents would be associated with poorer ability of the child to regulate their own emotions, which in turn would lead to increased emotional overeating, but not emotional undereating. Mothers of four- and five-year-olds (N = 221) were recruited through MTurk and Prolific to complete online questionnaires measuring food parenting practices (Comprehensive Feeding Style Questionnaire and Parent Feeding Style Questionnaire), child emotion regulation (Emotion Regulation Checklist), and child emotional eating (Child Eating Behavior Questionnaire). Several mediation models were tested. Parent's use of food to control emotions and behavior was associated with higher levels of emotional overeating, which was mediated by poorer child emotion regulation. However, child emotion regulation did not mediate the association between parent's use of food to control emotions and behavior and the child's emotional undereating. Taken together, these models suggest that parent's use of coercive control with food may lead to child emotional overeating, but not emotional undereating, by teaching children to regulate their emotions through eating rather than more adaptive regulation strategies. Future experimental and longitudinal studies are needed to directly test the nature and direction of these associations and whether coercive control with food teaches children to overeat in response to their emotions in lieu of using appropriate emotion regulation strategies.

The effectiveness of maternal regulatory attempts in the development of infant emotion regulation

Caregivers are instrumental in the development of infant emotion regulation; however, few studies have focused on delineating the real-time effectiveness of strategies that caregivers use to reduce infant distress. It is also unclear whether certain caregiver traits facilitate engagement in more successful regulation strategies. This study addressed these gaps by: (1) examining the differential effectiveness of maternal regulatory attempts (MRAs; behavioral strategies initiated by mothers to assist infants with regulating emotional states) in reducing 12- to 24-month-old infants' frustration during a toy removal task; and (2) assessing whether maternal mind-mindedness (mothers' attunement to their infant's mental state) predicted mothers' selection of MRAs. Multilevel modeling revealed that distraction and control were the most effective MRAs in reducing infant negative affect across 5-s intervals (N = 82 dyads; M infant age = 18 months; 45 females). Greater use of non-attuned mind-related speech predicted less engagement in effective MRAs, supporting a link between caregivers' socio-cognitive skills and provision of in-the-moment regulation support. These findings highlight the value of considering caregiver regulatory behaviors as a target for elucidating how maternal socialization of emotion regulation occurs in real-time. They also underscore mothers' important role as socializing agents in the development of this foundational developmental ability.

Psychological and social impacts of frontotemporal dementia on caregivers and family members - A systematic review

INTRODUCTION

Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigated these impacts on caregivers and family members.

METHODS

A systematic search was conducted in the PubMed, Cochrane Library and Embase databases for relevant articles published from database inception to 23 March 2023. The methodological quality of the articles was evaluated using a checklist.

RESULTS

Thirty-six articles (six qualitative and thirty quantitative), including 5129 participants, were included in this review. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. Caregiver burden was associated with behavioural symptoms (e.g., apathy and disinhibition) and motor symptoms. The costs of caring for a patient with FTD were found to be higher than those for Alzheimer's disease. FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses. Healthcare professionals may also be less familiar with FTD than with Alzheimer's, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention.

CONCLUSION

FTD is associated with significant costs and caregiver burden levels, and the difficulties faced by caregivers and family members can be unique and challenging in different aspects when compared to other forms of dementia. Better education about FTD for family members and healthcare professionals is required to improve the quality of life for both patients and caregivers, and more support needs to be provided at all stages of the disease.

Fetal heart rate variability and infant self-regulation: the impact of mother's prenatal depressive symptoms

BACKGROUND

Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother's prenatal depressive symptoms on infant self-regulation.

OBJECTIVE

This study analysed the mediator role of FHR variability in the association between mother's prenatal depressive symptoms and infant self-regulation at three months.

METHODS

The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother's postnatal depressive symptoms.

RESULTS

Higher levels of mother's prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother's prenatal depressive symptoms and infant self-regulation at three months.

CONCLUSION

Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother's prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.

Topography and relationship-specific social touching in individuals displaying body image disturbances

Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the 'imagined' experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to 'social' body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.

Early antecedents of emotion differentiation and regulation: Experience tunes the appraisal thresholds of emotional development in infancy

In this review, we synthesize evidence to highlight cognitive appraisal as an important developmental antecedent of individual differences in emotion differentiation and adept emotion regulation. Emotion differentiation is the degree to which emotions are experienced in a nuanced or "granular" way-as specific and separable phenomena. More extensive differentiation is related to positive wellbeing and has emerged as a correlate of emotion regulation skill among adults. We argue that the cognitive appraisal processes that underlie these facets of emotional development are instantiated early in the first year of life and tuned by environmental input and experience. Powerful socializing input in the form of caregivers' contingent and selective responding to infants' emotional signals carves and calibrates the infant's appraisal thresholds for what in their world ought to be noticed, deemed as important or personally meaningful, and responded to (whether and how). These appraisal thresholds are thus unique to the individual child despite the ubiquity of the appraisal process in emotional responding. This appraisal infrastructure, while plastic and continually informed by experience across the lifespan, likely tunes subsequent emotion differentiation, with implications for children's emotion regulatory choices and skills. We end with recommendations for future research in this area, including the urgent need for developmental emotion science to investigate the diverse sociocultural contexts in which children's cognitive appraisals, differentiation of emotions, and regulatory responses are being built across childhood.

Infant temperamental fear, pupil dilation, and gaze aversion from smiling strangers

In childhood, higher levels of temperamental fear-an early-emerging proclivity to distress in the face of novelty-are associated with lower social responsivity and greater social anxiety. While the early emergence of temperamental fear in infancy is poorly understood, it is theorized to be driven by individual differences in reactivity and self-regulation to novel stimuli. The current study used eye tracking to capture infants' (N = 124) reactions to a video of a smiling stranger-a common social encounter-including infant gaze aversions from the stranger's face (indexing arousal regulation) and pupil dilation (indexing physiological reactivity), longitudinally at 2, 4, 6, and 8 months of age. Multilevel mixed-effects models indicated that more fearful infants took more time to look away from a smiling stranger's face than less fearful infants, suggesting that high-fear infants may have slower arousal regulation. At 2 and 4 months, more fearful infants also exhibited greater and faster pupil dilation before gaze aversions, consistent with greater physiological reactivity. Together, these findings suggest that individual differences in infants' gaze aversions and pupil dilation can index the development of fearful temperament in early infancy, facilitating the identification of, and interventions for, risk factors to social disruptions.

Association of parental characteristics and emotion regulation in children and adolescents with and without psychopathology: A case-control study

This study explores the difference in child emotion regulation (ER) and parenting between a heterogeneous clinical sample (ClinS) and a community sample (ComS). We hypothesized that parents of the ClinS would report more dysfunctional child ER and more dysfunctional parenting regarding the child’s negative emotions than parents of the ComS. Further, we aimed to predict child ER by parenting behavior, parents’ ER, and mental health. Parents of children and adolescents (aged 6–18 years) seeking treatment at an outpatient clinic were compared to a matched sample of parents in a ComS (n = 57 each group). As predicted, the children in the clinical group were reported to use less reappraisal and more suppression than ComS children. No difference was found in dysfunctional emotion parenting between the groups. Reappraisal in parents and supportive reactions to negative emotions predicted reappraisal in children. No predictor was found for child suppression. Child emotion regulation and parents’ psychopathology were not associated. These results could suggest new elements for prevention and intervention programs with parents concerning their own emotion regulation and their reaction to negative emotions in children.

The Effectiveness of Sleep Training: Fact or Fiction?

Introduction

In Western cultures, parents often view infant sleep as problematic. Family, friends, and doctors may advise parents to “sleep train” assuming it is safe and effective, without considering its possible side effects, including its impact on breastfeeding. Unfortunately, it may reduce night feeds and result in earlier supplementation or weaning. The larger question is whether sleep training is worth the risk (i.e., does it improve infant sleep?). Our goal was to examine the data on the effectiveness of sleep training interventions on infant/toddler sleep.

Methods

PubMed and Google Scholar were searched for specific terms to identify articles that included behavioral sleep interventions and objective measures of sleep pre-and postntervention. Two objective infant sleep measures were examined: Night wakings and total sleep duration. Articles were then reviewed for evidence of the effectiveness of these interventions to reduce night wakings and increase total sleep duration.

Results

Five articles were identified that met the criteria for inclusion. Overall, there was no evidence that sleep training improves infant sleep.

Applications for Practice

The claim that sleep training is effective in changing infant sleep is not warranted. Given the potential side effects on breastfeeding, parents should be cautioned about engaging these behavioral sleep interventions if they have breastfeeding goals they want to achieve.

Inhibitory control, dyadic social behavior, and mental health difficulties in preschoolers

Although inhibitory control is typically associated with positive outcomes, several theoretical frameworks suggest that too little and too much inhibitory control may be problematic. Using a longitudinal, latent variable approach, we examined whether a multi-method index of inhibitory control at Time 1 (N = 105, 52 girls, M_age  = 3.50 years, 87% White) predicted observed social behavior with an unfamiliar peer and maternal report of preschoolers' mental health difficulties at Time 2 (M_age  = 4.76 years). Data collection occurred between 2017 and 2019. Inhibitory control displayed a U-shaped relation with prospective outcomes, where high and low levels of inhibitory control were associated with higher levels of avoidant social behaviors and mental health difficulties. The results are discussed in the context of under- and over-regulation in understanding individual differences in children's social behavior and mental health difficulties.

Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients

Emotion regulation has been specifically linked to both non-suicidal self-injury (NSSI) and attempted suicide. It is also known that self-harm is disproportionally higher (30–68.4%) in forensic samples than in the general population, yet knowledge about the association between emotion regulation and self-harm in forensic settings is scarce. The purpose of this study was to describe emotion regulation in a sample of forensic psychiatric patients, to explore dimensions and levels of emotion regulation between forensic psychiatric patients with and without self-harm, and to explore associations between forensic psychiatric patients’ self-reported emotion regulation and self-reported functions of NSSI. A cohort of forensic psychiatric inpatients (N=98) was consecutively recruited during 2016–2020 from a high-security forensic psychiatric clinic in Sweden. Data were collected through the self-report measures Difficulties in Emotion Regulation Scale (DERS) and Inventory of Statements About Self-injury (ISAS). In relation to the first aim, median total and subscales scores for DERS were reported. Results showed a statistically significant difference in emotion regulation between participants with and without self-harm (p=0.004), with a medium effect size (Cohen’s d=0.65) for the DERS total scale. The DERS subscales returned large differences for Impulse (p=0.001, d=0.86), Goals (p=0.014, d=0.58), and Strategies (p=0.012, d=0.54) between participants with and without self-harm. Finally, DERS scores were correlated with both the interpersonal (r_s=0.531, p<0.001, n=43) and intrapersonal factors (r_s=0.503, p<0.001, n=43) of NSSI as reported on the ISAS. Participants with self-harm (NSSI and/or suicide attempts) demonstrated significantly more difficulties with emotion regulation than those without self-harm. Emotion dysregulation was associated with both interpersonal and intrapersonal functions of NSSI in the participants. We suggest further studies on forensic psychiatric patients’ maladaptive behaviors that focus on substance abuse, self-harm, and aggressive behaviors in relation to the regulation and expression of emotion.

A Person- and Time-Varying Vector Autoregressive Model to Capture Interactive Infant-Mother Head Movement Dynamics

Head movement is an important but often overlooked component of emotion and social interaction. Examination of regularity and differences in head movements of infant-mother dyads over time and across dyads can shed light on whether and how mothers and infants alter their dynamics over the course of an interaction to adapt to each others. One way to study these emergent differences in dynamics is to allow parameters that govern the patterns of interactions to change over time, and according to person- and dyad-specific characteristics. Using two estimation approaches to implement variations of a vector-autoregressive model with time-varying coefficients, we investigated the dynamics of automatically-tracked head movements in mothers and infants during the Face-Face/Still-Face Procedure (SFP) with 24 infant-mother dyads. The first approach requires specification of a confirmatory model for the time-varying parameters as part of a state-space model, whereas the second approach handles the time-varying parameters in a semi-parametric ("mostly" model-free) fashion within a generalized additive modeling framework. Results suggested that infant-mother head movement dynamics varied in time both within and across episodes of the SFP, and varied based on infants' subsequently-assessed attachment security. Code for implementing the time-varying vector-autoregressive model using two R packages, dynr and mgcv, is provided.

The Neuropsychology of Emotion and Emotion Regulation: The Role of Laterality and Hierarchy

Over the last few decades, work in affective neuroscience has increasingly investigated the neural basis of emotion. A central debate in the field, when studying individuals with brain damage, has been whether emotional processes are lateralized or not. This review aims to expand this debate, by considering the need to include a hierarchical dimension to the problem. The historical journey of the diverse literature is presented, particularly focusing on the need to develop a research program that explores the neural basis of a wide range of emotional processes (perception, expression, experience, regulation, decision making, etc.), and also its relation to lateralized cortical and deep-subcortical brain structures. Of especial interest is the study of the interaction between emotional components; for example, between emotion generation and emotion regulation. Finally, emerging evidence from lesion studies is presented regarding the neural basis of emotion-regulation strategies, for which the issue of laterality seems most relevant. It is proposed that, because emotion-regulation strategies are complex higher-order cognitive processes, the question appears to be not the lateralization of the entire emotional process, but the lateralization of the specific cognitive tools we use to manage our feelings, in a range of different ways.

Emotion regulation from infancy to toddlerhood: Individual and group trajectories of full-term and very-low-birthweight preterm infants

Adaptive emotion regulation begins with infants operating jointly with their parents to regulate their emotions, which fosters the development of independent regulation. Little is known about when or how this transition occurs, or the impact of factors such as parental availability or premature birth status. The current study examined the use of self-soothing, attentional distraction, and dyadic regulation in full-term and healthy very-low-birthweight (VLBW) preterm infant-mother dyads at 5 ½, 12, and 18 months of age. At 5 ½ months, dyads participated in the Still-Face procedure. At 12 and 18 months, dyads participated in two free-play interactions, a puzzle task, and an interference task. Emotion regulation behaviors were coded using two systematic, observational systems. Results indicated that infants used less self-soothing and attentional distraction and more dyadic regulation as they aged. Increased use of self-soothing at earlier ages predicted increased use of dyadic regulation at subsequent ages. Toddlers used more independent, attention-seeking, and escape behavior during periods of maternal unavailability. There were no significant differences between full-term and VLBW/preterm toddlers' emotion regulation behaviors. Results from the current study contribute to the understanding of normative development of emotion regulation and the risk associated with prematurity.

Confirmatory factor analysis and psychometric properties of the Emotion Regulation Questionnaire in participants with personality disorders

Emotional dysregulation is a key symptom in participants with personality disorders. The Emotional Regulation Questionnaire (ERQ) has been studied with nonclinical samples; however, it is necessary to confirm the factorial structure of the ERQ in participants with personality disorders. The aims of the present study were to confirm the factorial structure of the Spanish version of the ERQ and analyse its psychometric properties as well as the association between the ERQ and the Borderline Symptoms List (BSL-23) and the Difficulties in Emotion Regulation Scale (DERS). The overall sample was composed of 250 patients with personality disorders, of whom 195 met the criteria for borderline personality disorder. Confirmatory factor analysis was conducted. The two-factor model showed an acceptable fit, similar to the original structure, in the participants with personality disorders and with borderline personality disorder. Cognitive reappraisal was negatively correlated with the DERS and BSL-23, and expressive suppression was positively correlated with the BSL-23. The ERQ is a reliable and valid instrument to evaluate emotional dysregulation in participants with personality disorders and participants with borderline personality disorder.

Biological signatures of emotion regulation flexibility in children: Parenting context and links with child adjustment

Emotion regulation (ER) is a key facet of positive adjustment throughout the lifespan. Recent theoretical and empirical innovations suggest that current methods for assessing ER are limited, because they measure discrete strategy use instead of ER flexibility and are insensitive to ecologically valid social contexts that influence ER. This is particularly important for studying the impact of parenting on ER development during childhood. The current study (N = 93; 47 females; M_age = 6.98, SD = 1.12) examined child ER flexibility during a directed reappraisal task (DRT) with two parenting contexts: passive parent presence or active scaffolding. Two biological signatures of ER flexibility were measured: respiratory sinus arrhythmia (RSA), an index of physiological flexibility; and the late positive potential (LPP), an index of neurocognitive flexibility. Emotion regulation behavior was observed during a frustrating wait, and parents reported on child ER and adjustment. Greater ER flexibility indexed via the LPP and RSA both predicted observed ER during the frustrating wait, but only RSA predicted parent-reported trait ER and fewer adjustment problems. Emotion regulation flexibility indexed by the LPP was bolstered by parent presence and scaffolding of child ER during the DRT, but RSA measures were not sensitive to parenting context. Taken together, the results provide converging evidence for the conceptualization of ER in terms of physiological and neurocognitive flexibility in childhood. Furthermore, among school-aged children, while physiological flexibility broadly predicted parent-reported child adjustment, neurocognitive flexibility may be context-sensitive and predictive of concurrent observed ER.

Rationale and design of the Baylor Infant Twin Study-A study assessing obesity-related risk factors from infancy

BACKGROUND

Early childhood (0-3 years) is a critical period for obesity prevention, when tendencies in eating behaviors and physical activity are established. Yet, little is understood about how the environment shapes children's genetic predisposition for these behaviors during this time. The Baylor Infant Twin Study (BITS) is a two phase study, initiated to study obesity risk factors from infancy. Data collection has been completed for Phase 1 in which three sub-studies pilot central measures for Phase 2. A novel infant temperament assessment, based on observations made by trained researchers was piloted in Behavior Observation Pilot Protocol (BOPP) study, a new device for measuring infant feeding parameters (the "orometer") in the Baylor Infant Orometer (BIO), and methods for analyzing DNA methylation in twins of unknown chorionicity in EpiTwin.

METHODS

EpiTwin was a cross-sectional study of neonatal twins, while up to three study visits occurred for the other studies, at 4- (BOPP, BIO), 6- (BOPP), and 12- (BOPP, BIO) of age. Measurements for BOPP and BIO included temperament observations, feeding observations, and body composition assessments while EpiTwin focused on collecting samples of hair, urine, nails, and blood for quantifying methylation levels at 10 metastable epialleles. Additional data collected include demographic information, zygosity, chorionicity, and questionnaire-based measures of infant behaviors.

RESULTS

Recruitment for all three studies was completed in early 2020. EpiTwin recruited 80 twin pairs (50% monochorionic), 31 twin pairs completed the BOPP protocol, and 68 singleton infants participated in BIO.

CONCLUSIONS

The psychometric properties of the data from all three studies are being analyzed currently. The resulting findings will inform the development of the full BITS protocol, with the goal of completing assessments at 4-, 6-, 12-, and 14-month of age for 400 twin pairs.

Parental internalizing disorder and the developmental trajectory of infant self-regulation: The moderating role of positive parental behaviors

Child self-regulation (SR), a key indicator for later optimal developmental outcomes, may be compromised in the presence of parental mental disorders, especially those characterized by affective dysregulation. However, positive parental behaviors have been shown to buffer against such negative effects, especially during infancy when SR shows great plasticity to environmental inputs. The current study investigated the effect of maternal and paternal lifetime and current internalizing disorders on the developmental trajectory of infant SR from 3 to 24 months, and the potential moderating role of positive parental behaviors. A latent growth model revealed that SR increased overall from 3 to 24 months. Mothers' positive parental behaviors demonstrated significant moderation effects, such that maternal lifetime internalizing disorder was associated with higher SR intercept only among those with low levels of positive parental behavior. Mothers' lifetime internalizing disorder was also associated with a lower linear slope in SR development with a moderate effect size. Fathers' current internalizing disorder was significantly associated with a higher intercept and lower linear slope of the SR trajectory. The current study expands the infant SR literature by describing its early developmental trajectory as well as early risk and protective factors within the parent-infant environment, taking into consideration developmental inputs from both parents.

Latent Growth in Self-Regulatory Subdimensions in Relation to Adjustment Outcomes in Youth Aged 12-19

This study assessed latent growth in behavioral inhibition, anger regulation, and goal-setting from ages 12 to 18, as well as links between latent growth and depression, externalizing behavior, and prosocial behavior at age 19. A second goal included examining whether latent growth in these constructs and associations with distal outcomes varied by sex. Generally speaking, self-regulatory subdimensions displayed distinct patterns of developmental growth from ages 12 to 18. Growth in self-regulatory subdimensions did not vary by sex, though initial levels of anger regulation and goal-setting did vary by sex. In addition, self-regulatory subdimensions from ages 12 to 18 were differentially related to adjustment outcomes at age 19. However, sex did not moderate associations between growth in self-regulatory subdimensions and distal outcomes.

Dissociated deficits in attentional networks in social anxiety and depression

A critical cognitive symptom that is commonly involved in social anxiety and depression is attentional deficit. However, the functional relationship between attentional deficit and these two disorders remains poorly understood. Here, we behaviorally disentangled the three key attentional components (alerting, orienting, and executive control) using the established attentional network task (ANT) to investigate how social anxiety and depression are related to deficits in these attention components. We identified a double dissociation between the symptoms of social anxiety and depression and the attentional component deficits when processing non-emotional stimuli. While individuals vulnerable to social anxiety exhibited deficits in the orienting component, individuals vulnerable to depression were impaired in the executive control component. Our findings showed that social anxiety and depression were associated with deficits in different attentional components, which are not specific to emotional information.

Convergence of behavioral and cardiac indicators of distress in toddlerhood: A systematic review and narrative synthesis

The objective of the current study was to systematically review the available literature on the relation between behavioral and cardiac indicators used to measure distress in toddlerhood. After ascertaining the eligibility of 2,424 articles through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO (International Prospective Register of Systematic Reviews) guided search process, 22 articles ( N = 2,504) that investigated associations between behavioral and cardiac indicators of distress in toddlerhood were identified. The narrative synthesis described the overall relation (direction [positive, negative], strength [Cohen’s D]) between behavioral and cardiac indicators and was organized by cardiac indicator (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia, pre-ejection period) and type of behavior measured (i.e., coding for expressed emotion behaviors vs. emotion regulation behaviors). Methodological characteristics (i.e., timing of measurement for behavioral and cardiac indicators [concurrent, predictive], length of measurement epochs, inclusion of covariates and moderators) were also described. HR was consistently positively ( D = .05 to .54) related to expressed emotion behaviors. No other cardiac and behavioral indicators were consistently related. Methodological differences related to behavioral and cardiac indicators utilized, timing of measurement, and length of measurement epochs may be responsible for heterogeneity in findings. The findings suggest that researchers might get divergent results depending on whether distress is measured with cardiac or behavioral indicators of distress in toddlerhood. Suggestions for future psychophysiological research with young children are offered.

Revisiting the double-edged sword of self-regulation: Linking shyness, attentional shifting, and social behavior in preschoolers

Although children's self-regulation has been conceptualized positively, there may be individual differences in self-regulatory processes, some of which might not be adaptive depending on temperamental factors. We examined whether individual differences in children's self-regulation (i.e., inhibitory control and attentional shifting) moderated the association between shyness and social behavior in multiple social contexts (N = 156 children, 74 girls; M_age = 4.06 years, SD = 0.78). Only in children with high attentional shifting was shyness associated with lower levels of social support seeking during a frustration task and with lower levels of social engagement during a stranger approach task. These results were not attributable to differences in baseline physiological arousal indexed by respiratory sinus arrhythmia. These findings suggest that for some shy children, high levels of self-regulation may be less adaptive, leading to rigidity or over-control in some social contexts, possibly hindering social interaction.

Development of Emotion Regulation Dynamics Across Early Childhood: a Multiple Time-Scale Approach

Children should become more effective at regulating emotion as they age. Longitudinal evidence of such change, however, is scarce. This study uses a multiple-time scale approach to test the hypothesis that the self-regulation of emotion-the engagement of executive processes to influence the dynamics of prepotent emotional responses-becomes more effective as children move through early childhood. Second-by-second time-series data obtained from behavioral observation of 120 children (46% female) during an 8-min frustration-eliciting wait task completed at four ages (24 months, 36 months, 48 months, 5 years) were modeled using bivariate coupled differential equation models designed to capture age-related changes in the intrinsic dynamics and bidirectional coupling of prepotent and executive processes. Results revealed indirect influences of executive processes on the intrinsic dynamics of children's desire and frustration increased with age but also revealed complex and non-linear age-related changes in how specific aspects of the dynamic interplay between prepotent responses and executive processes influence the effectiveness of regulation at different ages. The findings illustrate the utility of using a dynamics system approach to articulate and study how specific aspects of emotion regulation change with age.

Emotion regulation: A treatment target for autism spectrum disorder

Individuals with autism spectrum disorder (ASD) tend to experience difficulties with emotion regulation (ER). Treatments designed to address ER difficulties in individuals with ASD are emerging. The authors review cognitive-behavioral therapy (CBT) and mindfulness-based treatments that have focused on ER difficulties in youth and young adults with ASD. In general, these treatments addressing ER skills have included awareness of emotions/psychoeducation about emotions, frustration tolerance, and ER skills, as well as practice and use of these skills during group therapy that sometimes includes caregivers. The results from these interventions are encouraging for individuals with high-functioning ASD because ER skills tend to improve following treatment. The inclusion of ER in other ASD treatments is discussed.

Does Maternal Warmth Moderate Longitudinal Associations Between Infant Attention Control and Children's Inhibitory Control?

Attention control (AC) is thought to play an important role in the development of inhibitory control (IC) in children, yet there are few longitudinal studies of this association. This study used a prospective parent-child adoption design (N = 361 children) to examine whether maternal warmth at child age 27 months moderated the link between AC during infancy and IC during childhood. Tobit regression analyses indicated that low levels of infant AC at 9 months predicted low levels of IC at 6 years, controlling for birth parent IC, prenatal risk, infant distress to limitations, child sex, and openness of adoption. Adoptive mother warmth at 27 months moderated this association. In the context of higher levels of maternal warmth, the longitudinal association between low AC and low IC was attenuated. Thus, high levels of early maternal warmth may help diminish the effects of extant risk for IC deficits.

Maternal positive responses to a distressed infant simulator predict subsequent negative affect in infants

Existing evidence indicates that maternal responses to infant distress, specifically more sensitive and less inconsistent/rejecting responses, are associated with lower infant negative affect (NA). However, due to ethical and methodological constraints, most existing studies do not employ methods that guarantee each mother will be observed responding to infant distress. To address such limitations, in the current study, a distressed infant simulator (SIM), programmed to be inconsolable, was employed to ensure that mothers (N = 150; 4 months postpartum) were observed responding to infant distress. Subsequently, maternal report of infant NA and an early aspect of regulatory capacity, sootheability, were collected at eight-months postpartum, and observational assessments of infant fear and frustration, fine-grained aspects of NA, were collected at 12-months of age. After controlling for infant sex, the proportion of time mothers spent using soothing touch during the SIM task was related to less overall maternal reported NA and sadness at eight-months postpartum. Similarly, greater use of touch was associated with less fear reactivity, and greater maternal use of vocalizations was related to lower infant frustration, at 12-months postpartum. Specific maternal soothing behaviors were not related to infant soothability at 8 months postpartum. Total time spent interacting with the SIM was not related to infant temperament, suggesting that type of soothing, not quantity of interactions with distressed infants, is important for reducing infant NA. The implications of these findings and important future directions are discussed.

Neurohormones and temperament interact during infant development

The infant's psycho-physiological regulatory system begins to develop prenatally and continues to mature during the postnatal period. Temperament is a construct comprising tonic individual differences in dispositional physiological and behavioural reactions as well as an evolving ability to regulate to environmental conditions. Theoretical models and research have shown that neurohormonal and -physiological factors contribute to individual development and impact infant behaviours as well as the developing regulatory system. Moreover, prenatal maternal risks such as stress and depression are thought to programme fetal regulatory tendencies and that influences neural and behavioural functioning in infancy. The purpose of this review is to examine the theories and research that link infant temperament to neurohormonal and -physiological development in typically developing infants and in those exposed to environmental risk. Research has demonstrated associations between individual variation in physiological stress responses and regulation (measured with cortisol). Moreover, studies have noted an association with physiological regulation and socio-emotional interaction (as measured by the touch-oxytocin link) that may buffer emotional dysregulation. The interaction between individual differences in temperamental tendencies, neurohormonal and -physiological patterns will be discussed by presenting data from studies that have shown that infant neurohormonal and -physiological functioning sets an important trajectory for the development of the individual.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.

Age-related changes in the dynamics of fear-related regulation in early childhood

Self-regulation is a dynamic process wherein executive processes (EP) delay, minimize or desist prepotent responses (PR) that arise in situations that threaten well-being. It is generally assumed that, over the course of early childhood, children expand and more effectively deploy their repertoire of EP-related strategies to regulate PR. However, longitudinal tests of these assumptions are scarce in part because self-regulation has been mostly studied as a static construct. This study engages dynamic systems modeling to examine developmental changes in self-regulation between ages 2 and 5 years. Second-by-second time-series data derived from behavioral observations of 112 children (63 boys) faced with novel laboratory-based situations designed to elicit wariness, hesitation, and fear were modeled using differential equation models designed to capture age-related changes in the intrinsic dynamics and bidirectional coupling of PR (fear/wariness) and EP (strategy use). Results revealed that dynamic models allow for the conceptualization and measurement of fear regulation as intrinsic processes as well as direct and indirect coupling between PR and EP. Several patterns of age-related changes were in line with developmental theory suggesting that PR weakened and was regulated more quickly and efficiently by EP at age 5 than at age 2. However, most findings were in the intrinsic dynamics and moderating influences between PR and EP rather than direct influences. The findings illustrate the precision with which specific aspects of self-regulation can be articulated using dynamic systems models, and how such models can be used to describe the development of self-regulation in nuanced and theoretically meaningful ways.

Dysregulation in children: Origins and implications from age 5 to age 28

Research shows that childhood dysregulation is associated with later psychiatric disorders. It does not yet resolve discrepancies in the operationalization of dysregulation. It is also far from settled on the origins and implications of individual differences in dysregulation. This study tested several operational definitions of dysregulation using Achenbach attention, anxious/depressed, and aggression subscales. Individual growth curves of dysregulation were computed, and predictors of growth differences were considered. The study also compared the predictive utility of the dysregulation indexes to standard externalizing and internalizing indexes. Dysregulation was indexed annually for 24 years in a community sample (n = 585). Hierarchical linear models considered changes in dysregulation in relation to possible influences from parenting, family stress, child temperament, language, and peer relations. In a test of the meaning of dysregulation, it was related to functional and psychiatric outcomes in adulthood. Dysregulation predictions were further compared to those of the more standard internalizing and externalizing indexes. Growth curve analyses showed strong stability of dysregulation. Initial levels of dysregulation were predicted by temperamental resistance to control, and change in dysregulation was predicted by poor language ability and peer relations. Dysregulation and externalizing problems were associated with negative adult outcomes to a similar extent.

Digital disruption? Maternal mobile device use is related to infant social-emotional functioning

Mobile device use has become increasingly prevalent, yet its impact on infant development remains largely unknown. When parents use mobile devices in front of infants, the parent is physically present but most likely distracted and unresponsive. Research using the classic Still Face Paradigm (SFP) suggests that parental withdrawal and unresponsiveness may have negative consequences for children's social-emotional development. In the present study, 50 infants aged 7.20 to 23.60 months (M = 15.40, SD = 4.74) and their mothers completed a modified SFP. The SFP consisted of three phases: free play (FP; parent and infant play and interact), still face (SF; parent withdraws attention and becomes unresponsive), and reunion (RU; parent resumes normal interaction). The modified SFP incorporated mobile device use in the SF phase. Parents reported on their typical mobile device use and infant temperament. Consistent with the standard SFP, infants showed more negative affect and less positive affect during SF versus FP. Infants also showed more toy engagement and more engagement with mother during FP versus SF and RU. Infants showed the most social bids during SF and more room exploration in SF than RU. More frequent reported mobile device use was associated with less room exploration and positive affect during SF, and less recovery (i.e., engagement with mother, room exploration positive affect) during RU, even when controlling for individual differences in temperament. Findings suggest that the SFP represents a promising theoretical framework for understanding the impact of parent's mobile device use on infant social-emotional functioning and parent-infant interactions.

Impaired disengagement of attention and its relationship to emotional distress in infants at high-risk for autism spectrum disorder

INTRODUCTION

We provide data on visual orienting and emotional distress in infants at high and low risk for autism spectrum disorder (ASD).

METHOD

Participants included 83 high-risk (HR) infants with an older sibling with ASD and 53 low-risk (LR) control infants with no family history of ASD. Infants were assessed on the gap-overlap task and a parent-completed temperament questionnaire at 6 and 12 months of age. At 36 months of age, an independent, gold standard diagnostic assessment for ASD was conducted.

RESULTS

HR infants subsequently diagnosed with ASD were distinguished at 12 months by an asymmetric disengage impairment (for left- vs. right-sided stimuli) that was associated with an increase in latencies between 6 and 12 months. Across groups, prolonged left-directed disengage latencies at 12 months were associated with emotional distress (high irritability and difficult to soothe).

CONCLUSIONS

The asymmetry in our findings raises the question of whether the disengage problem in ASD is at base one of orienting or alerting attention. Our findings also raise the question of whether attention training might be a critical ingredient in the early treatment of ASD.

Disruptive Mood Dysregulation Disorder (DMDD): An RDoC perspective

In recent years, there has been much debate regarding the most appropriate diagnostic classification of children exhibiting emotion dysregulation in the form of irritability and severe temper outbursts. Most recently, this has resulted in the addition of a new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD) in the DSM 5. The impetus for including this new disorder was to reduce the number of diagnoses that these children would typically receive; however, there is concern that it has only complicated matters rather than simplifying them. For example, a recent epidemiologic study shows that DMDD cannot be differentiated from oppositional defiant disorder (ODD) based on symptoms alone. Thus, these children are an ideal population in which to apply RDoC constructs in order to obtain greater clarity in terms of underlying processes and ultimately, inform nosology and appropriate interventions. The aim of this article is to provide a foundation for future research by examining extant theoretical and empirical evidence for the role of four key RDoC constructs in DMDD.

Lower Visual Avoidance in Dementia Patients Is Associated with Greater Psychological Distress in Caregivers

Caring for a spouse with dementia can lead to increased health problems in caregivers. The present study examined whether patient deficits in visual avoidance, a common form of emotion regulation, are related to greater psychological distress in caregivers. Participants were 43 Alzheimer disease (AD) patients, 43 behavioral variant frontotemporal dementia (bvFTD) patients, and their spousal caregivers. Patient visual avoidance (e.g., gaze aversion) was measured using behavioral coding of head, body, and eye position while viewing a disgusting film. Caregiver psychological distress was measured using a standard self-report symptom inventory. Lower use of visual avoidance by patients was associated with greater psychological distress in their caregivers. This relationship was partially mediated by patient overall emotional functioning (as reported by caregivers), such that patients with less visual avoidance were seen as having worse emotional functioning, which in turn related to greater caregiver psychological distress. Dementia diagnosis moderated this effect, with diminished patient visual avoidance particularly detrimental to psychological distress of bvFTD caregivers. Findings suggest that the use of visual avoidance may serve as a marker of overall emotional functioning in patients and that preservation of this emotion regulatory behavior may help reduce the negative effects of caregiving.

Associations between childhood adversity and daily suppression and avoidance in response to stress in adulthood: can neurobiological sensitivity help explain this relationship?

BACKGROUND AND OBJECTIVES

Although it has been postulated that psychological responses to stress in adulthood are grounded in childhood experiences in the family environment, evidence has been inconsistent. This study tested whether two putative measures of neurobiological sensitivity (vagal flexibility and attentional capacity) moderated the relation between women's reported exposure to a risky childhood environment and current engagement in suppressive or avoidant coping in response to daily stress.

DESIGN AND METHODS

Adult women (N = 158) recruited for a study of stress, coping, and aging reported on early adversity (EA) in their childhood family environment and completed a week-long daily diary in which they described their most stressful event of the day and indicated the degree to which they used suppression or avoidance in response to that event. In addition, women completed a visual tracking task during which heart rate variability and attentional capacity were assessed.

RESULTS

Multilevel mixed modeling analyses revealed that greater EA predicted greater suppression and avoidance only among women with higher attentional capacity. Similarly, greater EA predicted greater use of suppression, but only among women with greater vagal flexibility.

CONCLUSION

Childhood adversity may predispose individuals with high neurobiological sensitivity to a lifetime of maladaptive coping.

Expression and Regulation of Attachment-Related Emotions in Children with Conduct Problems and Callous-Unemotional Traits

Callous-unemotional traits (CU) are defined by low responsiveness to, and unfeeling disregard for the emotions of others. There is controversial evidence, however, that children with high CU traits can demonstrate affective responsiveness under certain conditions, namely those associated with attachment threat. We tested this using 'fear + amusing' and 'attachment rich' stimuli from the Lion King film. Of N = 76, 4-14 years old children, 56 were clinic-referred children divided into high and low CU traits groups, and 20 children were drawn from the community. Participants watched film sequences of fearful, attachment-related and neutral stimuli and their affective responses and emotion-regulation strategies were coded by independent observers. Children in the high CU traits group were able to disengage from the fear stimuli by showing more 'happiness' to a brief slapstick interlude. In the attachment scenario, high CU children expressed similar or trends toward higher emotional responses and emotion regulation strategies, compared to low-CU children and control children. The results support the idea that high CU children may have the potential for emotional responsiveness to complex emotional stimuli in attachment contexts. Implications of these results for the development of interventions are discussed.

Emotion Regulation in Early Childhood

The purpose of this study is to analyze toddlers’ regulation of negative emotions in two cultures. A general sequential model of emotion regulation is specified that takes emotional reaction, goal-directed behavior strategies, and the interactive process between child and mother into account. Two-year-old Japanese ( n = 20) and German ( n = 20) girls and their mothers were observed in a quasi-natural interaction in which the girls experienced a playmate’s distress (the mothers were present). The features of the sequential model were measured. Mothers’ sensitivity was assessed in a structured mother-child interaction. The sequential model was confirmed for the German sample and modified in regard to the regulation of distance for the Japanese sample. The Japanese mothers displayed more sensitive and contingent behavior. Culture-specific differences in regard to the distribution of children’s regulation patterns and qualities of mother-child interactions demonstrate the effects of different socialization practices with respect to socioemotional development.

Individual differences in infant attention skills, joint attention, and emotion regulation behaviour

This study examined the concurrent and predictive relations between infant attention skills, joint attention, and emotion regulation. Infants' gaze following skills and duration of orienting were assessed at 6 months of age, and collaborative joint attention and emotion regulation skills were assessed at 24 months of age. The results indicated that infants' ability to follow direction of gaze at 6 months was significantly correlated with emotion regulation strategy use at 24 months of age, and that collaborative joint attention at 24 months was significantly correlated with emotion regulation strategy use at 24 months of age. The results of this study are consistent with previous research finding associations between collaborative joint attention and children's emotion regulation behaviour. These data also suggest that children's preexisting visual attention skills may contribute to their ability to regulate emotion.

Early attention and negative emotionality predict later cognitive and behavioural function

Negative emotionality and poor attention may combine or interact as risk factors in development. Negative emotionality is considered a challenge for self-regulation, whereas good attention is a potential means of self-regulation. In the current study, composites of 1- and 2-year maternal ratings of negative emotionality and global ratings of observed attentiveness were predictors for 3.5-year cognitive and behavioural outcome for 75 children. Results of variable-based regression analyses indicated that early negativity and attentiveness predicted IQ and scores on a hyperactivity index; only negativity predicted a global measure of behaviour problems. Results of person-based analyses for groups formed by median splits on negativity and attention suggested that the More Negative/Less Attentive group had significantly poorer outcome than the other three groups combined (those with one or none of the two risk factors). Comparisons of mean differences also suggested a protective effect of greater attentiveness for more negative as opposed to less negative children for all outcomes. The results extend prior work in providing longitudinal data over the first 3 years and including both cognitive and behavioural outcomes.

Developmental Issues in the Study of Coping

Developmental issues generally have been ignored in the study of coping. Thus, the goals of this paper were threefold: (1) to summarise theory in which coping is placed in the larger context of emotion regulation; (2) to review brie‘y existing literature related to consistency and change in coping, interrelations among coping strategies at different ages, and the relation of coping to the quality of social functioning at different ages; and (3) to summarise data from a longitudinal study pertaining to the aforementioned issues. Coping was relatively consistent across time (over a six-year period); there were some age-related changes in mean levels of children’s adult-reported coping; and there was considerable consistency in interrelations of coping strategies at different ages. In general, relations of coping to social functioning were similar across age, although some age-related changes in patterns were noted.

Gaze Synchrony between Mothers with Mood Disorders and Their Infants: Maternal Emotion Dysregulation Matters

A lowered and heightened synchrony between the mother's and infant's nonverbal behavior predicts adverse infant development. We know that maternal depressive symptoms predict lowered and heightened mother-infant gaze synchrony, but it is unclear whether maternal emotion dysregulation is related to mother-infant gaze synchrony. This cross-sectional study examined whether maternal emotion dysregulation in mothers with mood disorders is significantly related to mother-infant gaze synchrony. We also tested whether maternal emotion dysregulation is relatively more important than maternal depressive symptoms in predicting mother-infant gaze synchrony, and whether maternal emotion dysregulation mediates the relation between maternal depressive symptoms and mother-infant gaze synchrony. We observed 68 mothers and their 4- to 9-month-old infants in the Still-Face paradigm during two play interactions, before and after social stress was induced. The mothers' and infants' gaze behaviors were coded using microanalysis with the Maternal Regulatory Scoring System and Infant Regulatory Scoring System, respectively. The degree of mother-infant gaze synchrony was computed using time-series analysis. Maternal emotion dysregulation was measured by the Difficulties in Emotion Regulation Scale; depressive symptoms were assessed using the Beck Depression Inventory. Greater maternal emotion dysregulation was significantly related to heightened mother-infant gaze synchrony. The overall effect of maternal emotion dysregulation on mother-infant gaze synchrony was relatively more important than the effect of maternal depressive symptoms in the five tested models. Maternal emotion dysregulation fully mediated the relation between maternal depressive symptoms and mother-infant gaze synchrony. Our findings suggest that the effect of the mother's depressive symptoms on the mother-infant gaze synchrony may be mediated by the mother's emotion dysregulation.

Infant negative reactivity defines the effects of parent–child synchrony on physiological and behavioral regulation of social stress

How infants shape their own development has puzzled developmentalists for decades. Recent models suggest that infant dispositions, particularly negative reactivity and regulation, affect outcome by determining the extent of parental effects. Here, we used a microanalytic experimental approach and proposed that infants with varying levels of negative reactivity will be differentially impacted by parent–infant synchrony in predicting physiological and behavioral regulation of increasing social stress during an experimental paradigm. One hundred and twenty-two mother–infant dyads (4–6 months) were observed in the face-to-face still face (SF) paradigm and randomly assigned to three experimental conditions: SF with touch, standard SF, and SF with arms’ restraint. Mother–infant synchrony and infant negative reactivity were observed at baseline, and three mechanisms of behavior regulation were microcoded; distress, disengagement, and social regulation. Respiratory sinus arrhythmia baseline, reactivity, and recovery were quantified. Structural equation modeling provided support for our hypothesis. For physiological regulation, infants high in negative reactivity receiving high mother–infant synchrony showed greater vagal withdrawal, which in turn predicted comparable levels of vagal recovery to that of nonreactive infants. In behavioral regulation, only infants low in negative reactivity who received high synchrony were able to regulate stress by employing social engagement cues during the SF phase. Distress was reduced only among calm infants to highly synchronous mothers, and disengagement was lowest among highly reactive infants experiencing high mother–infant synchrony. Findings chart two pathways by which synchrony may bolster regulation in infants of high and low reactivity. Among low reactive infants, synchrony builds a social repertoire for handling interpersonal stress, whereas in highly reactive infants, it constructs a platform for repeated reparation of momentary interactive “failures” and reduces the natural tendency of stressed infants to disengage from source of distress. Implications for the construction of synchrony-focused interventions targeting infants of varying dispositions are discussed.

Trajectories of regulatory behaviors in early infancy: Determinants of infant self-distraction and self-comforting

The ability to effectively regulate emotions is an important marker for early socioemotional development. The uses of self-comforting behaviors and self-distraction have been empirically supported as effective regulatory strategies for infants, though research on determinants of such behaviors is scarce. Thus, a more thorough examination of the development of regulatory behaviors is needed. For the current study, 135 mothers, fathers, and their infants participated in laboratory visits at 3-, 5-, and 7-months of age where parent sensitivity and infant regulatory strategies were coded from the Still Face Paradigm. Parents also filled out questionnaires about infant temperament and parental involvement. Using multi-level modeling to examine levels and trajectories of self-comforting and self-distraction, the current study found: 1) infants higher in temperamental surgency used more self-distraction and self-comforting, 2) infants lower in surgency with highly involved parents increased in self-distraction at a faster rate, particularly with highly involved fathers, and 3) infants used self-comforting more than average with fathers when the infant was also lower in temperamental regulation. In addition, we examined trajectories of parent involvement and temperament in relation to infant regulatory strategy.

Maternal prenatal stress and infant regulatory capacity in Mexican Americans

The early postpartum period lays important groundwork for later self-regulation as infants' dispositional traits interact with caregivers' co-regulatory behaviors to produce the earliest forms of self-regulation. Although emerging literature suggests that fetal exposure to maternal stress may be integral in determining child self-regulatory capacity, the complex pathways that characterize these early developmental processes remain unclear. The current study considers these complex, transactional processes in a low income, Mexican American sample. Data were collected from 295 Mexican American infants and their mothers during prenatal, 6- and 12-week postpartum home interviews. Mother reports of stress were obtained prenatally, and mother reports of infant temperament were obtained at 6 weeks. Observer ratings of maternal sensitivity and infant regulatory behaviors were obtained at the 6- and 12-week time points. Study results indicate that prenatal stress predicts higher levels of infant negativity and surgency, both of which directly or interactively predict later engagement in regulatory behaviors. Unexpectedly, prenatal stress also predicted more engagement in orienting, but not self-comforting behaviors. Advancing understandings about the nature of these developmental pathways may have significant implications for targets of early intervention in this high risk population.