Parental responses to infant crying: the influence of child physical abuse risk and hostile priming

Prolonged Infant Crying: Caregiving Quality and Child Physical Abuse Risk

Research suggests that prolonged infant crying may increase risk for child physical abuse (CPA). However, few studies have examined behavioral responses to infant crying among parents at risk for CPA. The present study sought to fill this gap by using a simulated infant to examine how mothers and fathers with varying degrees of CPA risk respond to prolonged infant crying. Specifically, a sample of 184 general population caregivers (107 mothers and 77 fathers) participated in a task that involved attempting to soothe a simulated infant that cried continuously for 30 min. The simulated infant sessions were video-recorded, and quality of caregiving behavior was coded in 5-min segments. Participants rated their negative affect (feelings of upset, distress, irritability) at the outset of the data collection session, before beginning the simulated infant task, and after the simulated infant task concluded. It was predicted that high-risk caregivers, compared to low-risk caregivers, would display lower quality caregiving, higher levels of negative affect, and that CPA risk group differences would increase over time. Gender differences were explored in relation to the aforementioned hypotheses. Over the course of the 30-min simulated infant task, the quality of caregiving behavior diminished among both high- and low-risk caregivers. As expected, high-risk caregivers, compared to low-risk caregivers, exhibited lower quality caregiving behaviors and were more likely to discontinue the simulated infant task early. In addition, high-risk, compared to low-risk, caregivers reported higher levels of negative affect throughout the data collection session, with the highest level of negative affect reported by high-risk caregivers after completing the simulated infant task. Overall, the quality of caregiving exhibited by men and women did not significantly differ. The present findings highlight the importance of early intervention designed to support caregivers' abilities to respond effectively to prolonged infant crying.

Motivational increase of androgens and behavior by infant distress calls in highly responsive common marmoset fathers, Callithrix jacchus

Common marmoset fathers are highly involved in care of their infants. However, variability exists in their response to infant behavior even in paternally experienced fathers. Using infant distress cries as a motivation test, we investigated: 1. the differences in paternally experienced fathers' motivation to search for the infant vocalization stimuli; 2. the relationship between a father's motivation to search for the source of the infant cries and testosterone levels; and 3. if there is a rapid steroidogenesis pathway leading to increased testosterone and estradiol in the peripheral circulation. Only 44% of the paternally experienced fathers showed a high frequency of searching for the source of the infant distress cries. Through the use of multisteroid analysis, we found high responsive fathers had significantly higher levels of progesterone and testosterone in response to infant distress cries compared to a control stimulus with progesterone and androstenedione correlating with testosterone, while no differences were seen in low responders. The frequency to search for the infant stimuli was positively correlated with higher testosterone compared to control vocal levels. These results suggest that searching for the source of infant cries represents a motivation behavior for fathers that is activated by testosterone and reflects rapid circulating testosterone.

Child maltreatment affects fathers’ response to infant crying, not mediated by cortisol or testosterone

Parents' ability to appropriately respond to infant crying is essential for parental care and has been found to relate to parents' own childhood experiences. Additionally, childhood experiences can affect endocrine factors, which may subsequently affect behavior. In the current study, preregistered on https://osf.io/hwgtu, we examined in expectant and new fathers (N = 152) associations between experiences of maltreatment in their own childhood, hair cortisol and testosterone concentrations and their ability to modulate handgrip force when exposed to infant crying. Cortisol and testosterone were quantified from the 1 cm of hair most proximal to the scalp using Liquid chromatography-tandem mass spectrometry. Participants were asked to squeeze a handgrip dynamometer at full and half strength while listening to infant cries and control sounds. Results indicated that fathers who experienced more childhood maltreatment used more excessive handgrip force during infant cry sounds. Hair cortisol and testosterone were not related to either experienced childhood maltreatment or handgrip strength modulation. These findings confirm that fathers’ early experiences of maltreatment reduce their ability to modulate their behavioral responses during infant cries, but suggest that hair cortisol and testosterone concentrations do not identify the underlying mechanism of this association.

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Childhood maltreatment relates to fathers' behavioural responses to infant crying.

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Childhood maltreatment is unrelated to fathers' hair cortisol and testosterone.

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Cortisol and testosterone are unrelated to behavioural responses to infant cries.

White matter integrity moderates the relation between experienced childhood maltreatment and fathers' behavioral response to infant crying

The ability to provide appropriate responses to infant distress is vital to paternal care, but may be affected by fathers' experiences of childhood maltreatment. Detrimental effects of childhood maltreatment have been found in the adult brain's white matter fibers, accompanied with impaired emotional and cognitive functioning. In the current study (N = 121), we examined new and expectant fathers' childhood maltreatment experiences (i.e. emotional and physical abuse and neglect), current behavioral responses (i.e. handgrip force) to infant cry sounds, and white matter integrity using diffusion tensor imaging. First, more exposure to childhood maltreatment was associated with more use of excessive handgrip force in response to infant crying by fathers. Second, the association between experienced childhood maltreatment and white matter integrity was not significant in whole-brain analyses. Lastly, we found that the association between maltreatment exposure and excessive handgrip force during infant crying was absent in fathers with high tract integrity in the bilateral uncinate fasciculus. These findings possibly point to insufficient behavioral inhibition or emotional dysregulation in fathers who experienced childhood maltreatment, but buffering for this effect in those with larger integrity in brain fibers connecting the amygdala and prefrontal cortex.

How do expectant fathers respond to infant cry? Examining brain and behavioral responses and the moderating role of testosterone

Expectant parents’ responses to infant cry may indicate future risk and resiliency in the parent-child relationship. Most studies of parental reactivity to infant cry have focused on mothers, and few studies have focused on expectant fathers, although fathers make important contributions to parenting. Additionally, although different responses to infant cry (behavioral, psychological and neural) are hypothesized to track together, few studies have analyzed them concurrently. The current investigation aimed to address these gaps by characterizing multimodal responses to infant cry within expectant fathers and testing whether prenatal testosterone moderates these responses. Expectant fathers responded to infant cry vs frequency-matched white noise with increased activation in bilateral areas of the temporal lobe involved in processing speech sounds and social and emotional stimuli. Handgrip force, which has been used to measure parents’ reactivity to cry sounds in previous studies, did not differentiate cry from white noise within this sample. Expectant fathers with higher prenatal testosterone showed greater activation in the supramarginal gyrus, left occipital lobe and precuneus cortex to cry sounds. Expectant fathers appear to interpret and process infant cry as a meaningful speech sound and social cue, and testosterone may play a role in expectant fathers’ response to infant cry.

Incidence of nonaccidental head trauma in infants: a call to revisit prevention strategies

OBJECTIVE

Traumatic brain injury is a major sequela of nonaccidental trauma (NAT) that disproportionately affects young children and can have lasting sequelae. Considering the potentially devastating effects, many hospitals develop parent education programs to prevent NAT. Despite these efforts, NAT is still common in Western New York. The authors studied the incidence of NAT following the implementation of the Western New York Shaken Baby Syndrome Education Program in 1998.

METHODS

The authors performed a retrospective chart review of children admitted to our pediatric hospital between 1999 and 2016 with ICD-9-CM and ICD-10-CM codes for types of child abuse and intracranial hemorrhage. Data were also provided by the Safe Babies New York program, which tracks NAT in Western New York. Children with a diagnosis of abuse at 0-24 months old were included in the study. Children who suffered a genuine accidental trauma or those with insufficient corroborating evidence to support the NAT diagnosis were excluded.

RESULTS

A total of 107 children were included in the study. There was a statistically significant rise in both the incidence of NAT (p = 0.0086) and the incidence rate of NAT (p = 0.0235) during the study period. There was no significant difference in trendlines for annual NAT incidence between sexes (y-intercept p = 0.5270, slope p = 0.5263). When stratified by age and sex, each age group had a distinct and statistically significant incidence of NAT (y-intercept p = 0.0069, slope p = 0.0374).

CONCLUSIONS

Despite educational interventions targeted at preventing NAT, there is a significant rise in the trend of newly reported cases of NAT, indicating a great need for better injury prevention programming.

Less efficient detection of positive facial expressions in parents at risk of engaging in child physical abuse

Background

Parental physical punishment (e.g., spanking) of children can gradually escalate into child physical abuse (CPA). According to social-information processing (SIP) models of aggressive behaviors, distorted social cognitive mechanisms can increase the risk of maladaptive parenting behaviors by changing how parents detect, recognize, and act on information from their social environments. In this study, we aimed to identify differences between mothers with a low and high risk of CPA regarding how quickly they detect positive facial expressions.

Methods

Based on their use of spanking to discipline children, 52 mothers were assigned to a low- (n = 39) or high-CPA-risk group (n = 13). A single-target facial emotional search (face-in-the-crowd) task was used, which required participants to search through an array of faces to determine whether a target emotional face was present in a crowd of non-target neutral faces. Search efficiency index was computed by subtracting the search time for target-present trials from that for target-absent trials.

Results

The high-CPA-risk group searched significantly less efficiently for the happy, but not sad, faces, than did the low-CPA-risk group; meanwhile, self-reported emotional ratings (i.e., valence and arousal) of the faces did not differ between the groups.

Conclusions

Consistent with the SIP models, our findings suggest that low- and high-CPA-risk mothers differ in how they rapidly detect positive facial expressions, but not in how they explicitly evaluate them. On a CPA-risk continuum, less efficient detection of positive facial expressions in the initial processes of the SIP system may begin to occur in the physical-discipline stage, and decrease the likelihood of positive interpersonal experiences, consequently leading to an increased risk of CPA.

Maternal childhood adversity, OXTR genotype and cognitive load impact on perceptual and behavioral responses to infant crying

The crying of infants elicits aversive feelings and poses a risk for child abuse. Maternal childhood maltreatment can have negative parenting ability consequences and interact with the oxytocin receptor (OXTR) single nucleotide polymorphism (rs53576) to predict maternal response to infant distress stimuli. Recent studies have highlighted the importance of individual vulnerability differences to situational cognitive load in parenting situations. The current study, in which 124 mothers participated in a standardized infant vocalization paradigm, examined three-way interaction on subjective empathy, behavior intention, and handgrip force response to a crying infant. Participants were asked to squeeze a handgrip dynamometer at maximal and half strength while memorizing a meaningless alphabet syllable as the cognitive load manipulation. Significant interactions were also observed between OXTR rs53576, childhood adversity, and cognitive load when predicting excessive force and harsh response intention on hearing a crying infant. These findings suggested that, as the G allele carriers of OXTR rs53576 appear to be susceptible to the effects of severe childhood adversity, inter- and intra-individual approaches are needed when assessing maternal responses to infant stimuli.

Vasopressin Differentially Affects Handgrip Force of Expectant Fathers in Reaction to Own and Unknown Infant Faces

The underlying mechanisms of paternal responses to infant signals are poorly understood. Vasopressin has previously been proposed to affect these responses. Using a double-blind, placebo-controlled, within-subject design (N = 25 expectant fathers), we examined the effect of vasopressin administration on the use of excessive handgrip force during exposure to infant crying versus matched control sounds, while participants saw morphed images representing their own infant versus an unknown infant. We found that, compared to placebo, AVP administration elicited more excessive force while viewing an unknown infant image compared to viewing the image representing one’s own infant, while the reverse was true under placebo. The results are discussed in light of vasopressin’s role in parenting and parental protection among human fathers.

Registered Replication Report on Srull and Wyer (1979)

Srull and Wyer (1979) demonstrated that exposing participants to more hostility-related stimuli caused them subsequently to interpret ambiguous behaviors as more hostile. In their Experiment 1, participants descrambled sets of words to form sentences. In one condition, 80% of the descrambled sentences described hostile behaviors, and in another condition, 20% described hostile behaviors. Following the descrambling task, all participants read a vignette about a man named Donald who behaved in an ambiguously hostile manner and then rated him on a set of personality traits. Next, participants rated the hostility of various ambiguously hostile behaviors (all ratings on scales from 0 to 10). Participants who descrambled mostly hostile sentences rated Donald and the ambiguous behaviors as approximately 3 scale points more hostile than did those who descrambled mostly neutral sentences. This Registered Replication Report describes the results of 26 independent replications ( N = 7,373 in the total sample; k = 22 labs and N = 5,610 in the primary analyses) of Srull and Wyer’s Experiment 1, each of which followed a preregistered and vetted protocol. A random-effects meta-analysis showed that the protagonist was seen as 0.08 scale points more hostile when participants were primed with 80% hostile sentences than when they were primed with 20% hostile sentences (95% confidence interval, CI = [0.004, 0.16]). The ambiguously hostile behaviors were seen as 0.08 points less hostile when participants were primed with 80% hostile sentences than when they were primed with 20% hostile sentences (95% CI = [−0.18, 0.01]). Although the confidence interval for one outcome excluded zero and the observed effect was in the predicted direction, these results suggest that the currently used methods do not produce an assimilative priming effect that is practically and routinely detectable.

Oxytocin and Human Sensitive and Protective Parenting

In this chapter we review the evidence for the role of oxytocin in parenting, and discuss some crucial but outstanding questions. This is not meant to be a comprehensive review of all studies on oxytocin and parenting in general. Instead, special attention will be paid to a dimension of parenting that has been largely neglected in behavioral and neurobiological research on parental caregiving, namely protection. Parental protection has received considerable attention in animal research but, despite its evolutionary importance, not in studies on humans. It is argued that oxytocin may have specific significance for the protective dimension of parenting. The effects of exogenous oxytocin may be dependent not only on contextual factors, but also on personal characteristics, most notably gender, on endogenous levels of oxytocin, and on early childhood experiences. Examining the contextual, personal, hormonal, neural, genetic, and behavioral mechanisms of protective parenting in tandem is essential for the development of a comprehensive theory of protective parenting, and for the identification of "biomarkers" for insensitive and unprotective parenting that should be taken into account in preventive parenting interventions.

Parenting the Crying Infant

Crying conveys evidence about an infant's state and neurological health which, when carefully assessed, can provide diagnostic information for parents and clinicians. When crying is inconsolable or judged to be excessive, it can stress parents, disrupt parenting and, in rare cases, place an infant at risk for abuse. Research has revealed physiological and neural responses to crying that may predispose some adults to maltreat infants. Although this work suggests that parental vulnerabilities contribute to insensitive or aggressive reactions, there is a growing recognition that exposure to large doses of crying may be a challenge for all adults. Support programmes that inform parents about infant crying, enhance parenting, and improve parental wellbeing and coping, are under development with promising initial findings.

Management of musculoskeletal dysfunction in infants

Excessive crying (or infant colic) is a common pain syndrome of infancy without any specific known aetiology or effective management. Many cases result in long-term poor sleep, behavioral problems and parental stress. The biomechanical aspects of this condition lack adequate investigation despite its strong link with assisted and/or difficult births. The present review focused on the current trends in the management of this mal-musculoskeletal health of infants associated with the condition of excessive crying. In addition, the risk factors associated with therapeutic procedures used to manage the above conditions were also discussed.

Weakened Resilience in Parenting Self-Efficacy in Pregnant Women Who Were Abused in Childhood: An Experimental Test

This study tested experimentally whether the combination of a history of childhood abuse and confrontation with difficult infant temperament is associated with negative changes in parenting self-efficacy. First-time pregnant women (N = 243) participated in the Adult Attachment Interview, which was used to assess the occurrence of abuse by parents in childhood and unresolved representations, and completed a task asking them to respond to infant cries. Sixty of the 243 participants (25%) experienced childhood abuse, mostly physical or sexual. The task simulated infant temperamental difficulty by manipulating soothing success in order to reflect an easy-to-soothe (80% soothing success) and a difficult-to-soothe infant (20% soothing success). Both after baseline and after each of the two stimulus series women assessed their parenting self-efficacy. Women who reported childhood abuse did not differ from women who reported no childhood abuse in parenting self-efficacy at baseline or in response to the easy-to-soothe infant (relative to baseline), but decreased more in parenting self-efficacy following the difficult-to-soothe infant. Effects did not vary according to resolution of trauma. These findings suggest that in response to infant temperamental difficulty, women who experienced childhood abuse may more easily lose confidence in their parenting abilities, which underlines the importance of preparing at-risk women for the possible challenges that come along with parenthood.

Sex-Specific Automatic Responses to Infant Cries: TMS Reveals Greater Excitability in Females than Males in Motor Evoked Potentials

Neuroimaging reveals that infant cries activate parts of the premotor cortical system. To validate this effect in a more direct way, we used event-related transcranial magnetic stimulation (TMS). Here, we investigated the presence and the time course of modulation of motor cortex excitability in young adults who listened to infant cries. Specifically, we recorded motor evoked potentials (MEPs) from the biceps brachii (BB) and interosseus dorsalis primus (ID1) muscles as produced by TMS delivered from 0 to 250 ms after sound onset in six steps of 50 ms in 10 females and 10 males. We observed an excitatory modulation of MEPs at 100 ms from the onset of infant cry specific to females and to the ID1 muscle. We regard this modulation as a response to natural cry sounds because it was attenuated to stimuli increasingly different from natural cry and absent in a separate group of females who listened to non-cry stimuli physically matched to natural infant cries. Furthermore, the 100-ms latency of this response is not compatible with a voluntary reaction to the stimulus but suggests an automatic, bottom-up audiomotor association. The brains of adult females appear to be tuned to respond to infant cries with automatic motor excitation.

Analog assessment of frustration tolerance: association with self-reported child abuse risk and physiological reactivity

Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants' persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent-child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse.

Handgrip force of maltreating mothers in reaction to infant signals

Handgrip force responses to infant signals were examined in a sample of 43 maltreating and 40 non-maltreating mothers. During a standardized handgrip paradigm, mothers were asked to squeeze a handgrip dynamometer at maximal and at half of their maximal handgrip strength while listening to infant crying and laughter sounds. Maltreating mothers used excessive force more often while listening to infant crying and laughter than non-maltreating mothers. Of the maltreating mothers, only neglectful mothers (n=20) tended to use excessive force more often during crying than non-maltreating mothers. Participants did not rate the sounds differently, indicating that maltreating mothers cannot be differentiated from non-maltreating mothers based on their perception of infant signals, but show different behavioral responses to the signals. Results imply that, in response to infant signals (i.e., crying or laughing), maltreating mothers may be insufficiently able to regulate the exertion of physical force.

Pain tolerance, pain sensitivity, and accessibility of aggression-related schemata in parents at-risk for child physical abuse

This study examined whether parents with varying degrees of child physical abuse (CPA) risk differed in pain tolerance, pain sensitivity, and accessibility of aggression-related schemata. Participants included 91 (51 low CPA risk and 40 high CPA risk) general population parents. Participants were randomly assigned to complete either an easy or a difficult anagram task. Pain tolerance and pain sensitivity were assessed using a cold pressor task. Accessibility of aggression-related schemata was assessed at the outset of the data collection session and at the end of the session using a word completion task. Parents' self-reported negative affect was assessed three times over the course of the study: baseline, after the anagram task, and after the cold pressor task. As expected, high-risk (compared to low-risk) parents reported higher levels of negative affect at each time point. Moreover, after completing the difficult anagram task, high-risk (compared to low-risk) parents exhibited higher pain sensitivity during the cold pressor task. Following completion of the cold pressor task, high-risk (compared to low-risk) parents exhibited greater accessibility of aggression-related schemata. Collectively, these findings indicate that under certain conditions, high-risk parents experience a confluence of aggression-related risk factors (i.e., negative affect, pain sensitivity, and aggression-related information processes) that may predispose them to aggressive behavior.

Cortisol administration increases hippocampal activation to infant crying in males depending on childhood neglect

Animal studies show that exposure to parental neglect alters stress regulation and can lead to neural hyposensitivity or hypersensitivity in response to cortisol, most pronounced in the hippocampus. Cortisol, the end product of the hypothalamic-pituitary-adrenal (HPA) axis, has also been related to parenting more directly, for example, in both sexes, cortisol levels increase when listening to infants crying, possibly to activate and facilitate effective care behavior. Severe trauma is known to negatively affect the HPA-axis in humans; however, it is unknown whether normal variation in parental care in the healthy population can alter sensitivity of the hippocampus to cortisol. Here, we investigate whether variation in experienced neglect changes neural sensitivity to cortisol when humans listen to infant crying, which is an unequivocal signal relevant for care behavior. In a placebo-controlled, within-subject neuroimaging study, we administered 40 mg cortisol to 21 healthy young males without children and used a validated task for measuring neural responses to infant crying. The Dutch version of the Childhood Trauma Questionnaire was used to index participants' early exposure to abuse and neglect. The data show that cortisol markedly increased hippocampal activation toward crying infants, and this effect varied significantly with parental neglect, even in our nonclinical subject sample. Without exposure to severe trauma or neglect, reduced self-experienced quality of parental care in the normal range already substantially increased hippocampal responsivity to cortisol. Altered hippocampal sensitivity to cortisol might be a cross-species marker for the risk of developing later life psychopathology.

Frustration influences impact of history and disciplinary attitudes on physical discipline decision making

Although intergenerational patterns of punitive physical punishment garner considerable research attention, the mechanisms by which historical, cognitive, and contextual factors interplay to influence disciplinary responding remains poorly understood. Disciplinary attitudes have been shown to mediate the association between disciplinary history and disciplinary responding. The present study investigated whether frustration influences these mediation effects. Half of a sample of 330 undergraduates was randomly assigned to frustration induction. Structural equation modeling confirmed that, for participants in the frustration condition, the relation between disciplinary history and physical discipline decision-making was fully mediated by attitudes approving physical discipline. In contrast, for respondents in the no-frustration condition, the pathway from disciplinary history to discipline decision-making was only partially mediated by attitudes. Under conditions of frustration, attitudes may become a more central means by which personal disciplinary history is associated with disciplinary decision-making.

Salivary α-amylase and intended harsh caregiving in response to infant crying: evidence for physiological hyperreactivity

This is the first study on adults' physiological reactivity to infant cry sounds and the association with intended harsh parenting using salivary α-amylase (sAA) as a novel and noninvasive marker of autonomic nervous system activity. The sample consisted of 184 adult twin pairs. In an experimental design, cry sounds were presented and adults' perception and their intended caregiving responses were measured. Saliva samples were collected after each cry sound. For the majority of the sample, a decrease in sAA across the cry paradigm was observed. However, adults who indicated that they would respond in a harsh way to the crying infant were significantly less likely to show a decrease in sAA. Consistent with previous studies on physiological hyperreactivity in abusive parents, these findings suggest that failure to habituate to repeated infant crying may be one of the mediating mechanisms through which excessive, inconsolable, and high-pitched infant crying triggers less optimal caregiving.

The Word Game: an innovative strategy for assessing implicit processes in parents at risk for child physical abuse

OBJECTIVE

Contemporary theories of child physical abuse (CPA) emphasize the proximal role of social cognitive processes (many of which are implicit in nature) in the occurrence of parental aggression. However, methods that allow for the systematic examination of implicit cognitive processes during the course of aggressive interactions are needed. To address this need, the present study was designed to examine the utility of the Word Game, an innovative procedure designed to assess implicit changes in schema accessibility during the course of an interpersonal exchange involving aggressive response options.

METHODS

The game involves a series of competitive reaction time trials which are actually lexical decision making trials designed to determine the accessibility of schema throughout the game. Each parent was led to believe that they were competing against another player with whom they exchanged sound blasts of varying intensities. Participants in the present study were parents who were either low (n=50) or high (n=20) risk for CPA.

RESULTS

Results revealed that high CPA risk parents behaved more aggressively than low CPA risk parents and that provocation augmented the aggressiveness of all participants. Among high CPA risk parents, positive schema became less accessible (whereas negative schema became more accessible) following lost rounds. At the conclusion of the game, high CPA risk parents reported more aggressive motives than low CPA risk parents. Further, aggressive motives significantly mediated the association between CPA risk status and aggressiveness (i.e., mean sound blast selections).

CONCLUSIONS

Collectively, results support the potential utility of the Word Game as a means of advancing the study of social cognitive processes involved in parental aggression.

Incidence of hospitalization due to child maltreatment in Taiwan, 1996-2007: a nationwide population-based study

OBJECTIVES

Little is known regarding the epidemiology of child maltreatment in Asian countries. This study aimed to examine the incidence of hospitalization coded as due to child maltreatment in Taiwan.

METHODS

We used inpatient claims data of the National Health Insurance for the years 1996 through 2007 for estimation. Hospitalization of children aged 0-12 years with an ICD-9-CM code 995.5 "maltreatment syndrome" or E960-E969 "assault" in the main or secondary discharge diagnosis in claims data was defined as hospitalization due to child maltreatment. Poisson regression was used to examine the trends.

RESULTS

A total of 1,726 children with 1,780 hospitalizations due to child maltreatment were identified during 1996-2007. The averaged annual incidence over 1996-2007 was 13.2/100,000 for infants, 3.5/100,000 for children aged 1-3 years, 2.1/100,000 for children aged 4-6 years and 3.3/100,000 for children aged 7-12 years. The incidence increased most among the infant group, from 4.8/100,000 in 1996-1997 to 25.4/100,000 in 2006-2007, a greater than 5-fold increase. The magnitude of the increase in incidence decreased with age, and no change in incidence was noted among children aged 7-12 years. The drastic increase in incidence in infants since 2003 corresponds with the introduction of use of ICD-9-CM code 995.55 "shaken infant syndrome" in Taiwan since 2003. Head injury was the main type of injury in all age groups.

CONCLUSIONS

The incidence of hospitalization coded as due to child maltreatment in Taiwan differed by age group. Infants had the highest and the largest increase in incidence during the past decade. The increase might be due to improvement in awareness, competence and willingness to diagnose child maltreatment of medical staff in hospitals during the past decade after the revision of Child Welfare Law in 1993 and the new ICD-9-CM code for "shaken infant syndrome" being used since 2003.

PRACTICE IMPLICATIONS

Physicians and nursing staff should be aware of and provide the detailed and specific information needed for proper discharge diagnosis coding, from which valid estimation of the incidence of hospitalization due to child maltreatment can be made. Administrative data should include both the N-code and E-code for each case of child maltreatment hospitalization to provide more complete information.

Oxytocin decreases handgrip force in reaction to infant crying in females without harsh parenting experiences

Infant crying can elicit sensitive caregiving as well as hostility and harsh parenting responses. In the current study (N = 42 females) with a double-blind experimental design, we tested the effect of intranasal oxytocin administration on the use of excessive force using a hand-grip dynamometer during listening to infant cry sounds. Participants' experiences with harsh parental discipline during childhood were found to moderate the effect of oxytocin administration on the use of excessive force. Participants' whose parents did not discipline them harshly used less excessive force in the oxytocin condition, but for participants who were disciplined harshly there was no difference between the oxytocin and placebo condition. Such effects were not found during listening to infant laughter. We conclude that early caregiving experiences constitute an important moderator of the prosocial and/or stress-reducing effects of oxytocin. Oxytocin administration may increase trust and cooperation in individuals with supportive backgrounds, but not generate this effect in individuals who as a consequence of unfavorable early caregiving experiences may have a bias toward negative interpretation of social cues.

Children's perceptions and comforting strategies to infant crying: relations to age, sex, and empathy-related responding

This study aimed to examine child characteristics associated with the understanding of and responses to infant crying. Seven hundred and twenty-four 1st to 7th grade children (383 boys, 341 girls) were shown a picture depicting a crying infant, whereupon they were asked to generate the potential causes for infant crying along with the action responses that they might utilize to assist a crying baby. Self-reports of children's empathy-related responding were also obtained. As hypothesized, an age-related increase in the number, variety, and quality for causes for infant crying and strategies to help a crying infant were observed. Girls generated a higher mean number and variety of causes compared to boys. For older children (grades 4-7), dimensions of empathy-related responding, namely sympathy and perspective taking, were significantly associated with the number and variety of causes for infant crying and caregiving strategies. The findings support the conclusion for a developmental progression of understanding of facial expressions of infant crying across middle childhood.