Cardiac complexity and emotional dysregulation in children

Child emotion lability is associated with within-task changes of autonomic activity during a mirror-tracing task

Adaptive biological and emotional stress responding are both critical for healthy human development. However, the complex associations between the two are not fully understood. The current study addresses this gap in research by studying associations of child emotion regulation and lability with within-task changes in the biological stress response during a mirror-tracing task. Participants were 59 families including two parents and a child between 5 and 12 years old (52.2% female). Parents reported on family demographics and completed the Emotion Regulation Checklist. Child skin conductance level (SCL) and respiratory sinus arrhythmia (RSA) were recorded during a baseline task and during a 3-minute mirror-tracing task. Within-task patterns of SCL and RSA during the task were estimated with multilevel modeling (measures within persons). The emotion regulation subscale was unrelated to any facet of SCL/RSA time courses. However, lower emotion lability was related to SCL patterns that changed less during the task and were overall lower. For RSA, lower emotion lability was related to higher initial RSA that significantly decreased during the task. These findings suggest that higher child emotion lability may promote increased physiological arousal of target organs during challenging activities.

Parents’ Experiences of Change in Developmental and Transactional Processes After Time-Limited Intersubjective Child Psychotherapy – A Qualitative Study

Psychopathology in children cannot be understood without considering developmental processes and transactional relationships, particularly the relationship with caregivers. Time-limited intersubjective child psychotherapy (TIC) is a developmental and transactional approach aimed at helping children and caregivers get back on healthier developmental trajectories. Core developmental processes, such as self-other-regulation and affect integration, are considered particularly important for healthy function and transactions with caregivers and contexts. Therefore, TIC seeks to strengthen core developmental processes in the child and the caregivers’ ability to scaffold the child’s development. This is achieved through parallel child therapy and parent sessions. The current study is a qualitative study of parents’ experiences of change after TIC. The study explores parents’ perception of change in their child, themselves, and their transactions, and what they experienced as helpful in therapy.

Materials and Methods

Nine semi-structured qualitative interviews were conducted with parents (n = 13) of nine children aged 9–12 years with internalizing difficulties after completing TIC. The data were analyzed with thematic analysis.

Results

The parents described positive changes in the children’s ability to understand, regulate and express themselves. The parents also described positive changes in their parenting, and for all nine children the parents reported positive changes in the transactions between themselves and the child. Most parents saw the parallel child and parental sessions as particularly important, while several parents mentioned play and the therapeutic focus.

Discussion

Parents’ description of changes after TIC indicate that the parents perceived their children as strengthened in core developmental processes important for intersubjective exchanges such as self-regulation and affect integration. In addition, parents saw their children and their own contributions more clearly, and their transactions were described as more supportive and positive.

Conclusion

The results from this study give support to TIC as a developmentally supportive approach to therapy, with potential effects on children’s core developmental processes, their parents’ ability to both see and scaffold the child’s development and positive effects on the transactions between children and parents. The positive effects likely result from the integration of the different parts of TIC and the synergies taking place between them, rather than any one component by itself.

Differences in affect integration in children with and without internalizing difficulties

Background:

Affect represents an important source of information about our internal state and the external world that can motivate and vitalize us. When affect is poorly integrated, this can lead to problems with self-regulation and psychopathology. Few studies have investigated affect integration in children.

Objective:

This study investigates differences in affect integration in children with and without internalizing difficulties.

Method:

Thirty-three Norwegian children (aged 9–13) with and 24 children without internalizing difficulties were interviewed with the Affect Consciousness Interview (ACI), a measure of affect integration. Data from the ACI was analyzed across nine affective categories (Interest/Excitement, Enjoyment/Joy, Fear/Panic, Anger/Rage, Shame/Humiliation, Sadness/Despair, Envy/Jealousy, Guilt/Remorse, and Tenderness/Care), and four dimensions (Awareness, Tolerance, Emotional, and Conceptual expressivity).

Results:

The children differed significantly in affect integration across all dimensions and all assessed affects, both positive and negative. Emotional Expressivity, Anger/Rage, and Sadness/Despair were particularly less integrated in the children with internalizing problems.

Conclusions:

Assessment of affect integration can provide useful information on possible underlying factors in internalizing problems in children and may help guide and personalize therapeutic interventions. Based on knowledge from empirical infant psychology interventions mimicking rich, early intersubjective experiences are recommended to increase affect integration.

Sex differences in adolescents' cardiac reactivity and recovery under acute stress: The importance of nonlinear measures

How well adolescents can self-regulate in the face of stressors has considerable implications for long-term well-being and risk of psychopathology. This study investigated sex differences in adolescents' cardiac reactivity and recovery during a stressful task. Measures of cardiac variability (linear) and complexity (nonlinear) were obtained from N = 92 adolescents, 41 males (M age = 13.28, SD = 0.69; BMI = 21.9) and 51 females (M age = 13.36, SD = 0.67; BMI = 21.5). The adolescents underwent the Trier Social Stress Test, consisting of five conditions: baseline, anticipation, social exposure, math task, and recovery. Repeated measures ANOVAs revealed that female in comparison to male adolescents showed lower cardiac complexity revealed by higher short-term scaling exponent at baseline (p = .006) and math (p = .013) and lower entropy at exposure (p = .013) and math (p = .012). A marginal between-groups effect was found for Higuchi's fractal dimension, F(1, 90) = 3.67, p = .059, η_p ²  = .041, with females showing lower fractal dimension than males in math (p = .037). Linear measures did not reveal sex-related differences. Results suggest that adolescent females show lower cardiac complexity during stress. These findings support the importance of nonlinear cardiac measures for understanding cardiac reactivity during stress. Further research is needed to test the hypothesis that cardiac complexity is useful to detect an increased risk of emotional disorders, disorders that are more prevalent in women.

Reactive Heart Rate Variability and Cardiac Entropy in Children with Internalizing Disorder and Healthy Controls

Atypical vagal reactivity has been linked to internalizing psychopathology and less adaptive emotion regulation, but reactive cardiac entropy is largely unexplored. Therefore, this study investigated reactive vagally-mediated heart-rate variability (vmHRV) and cardiac entropy in relation to emotion regulation. Electrocardiograms of 32 children (9-13 years) with internalizing difficulties and 25 healthy controls were recorded during a baseline and a sad film. Reactivity-measures were calculated from the root mean square of successive differences (RMSSD) and sample entropy (SampEn). Emotion regulation was assessed using the emotion regulation checklist (ERC). Determinants of reactive SampEn and RMSSD were analyzed with marginal and generalized linear models. The study also modeled the relationship between cardiac reactivity and emotion regulation while controlling for psychopathology. The two groups differed significantly in vmHRV-reactivity, with seemingly higher vagal-withdrawal in the control group. SampEn increased significantly during the film, but less in subjects with higher psychopathology. Higher reactive entropy was a significant predictor of better emotion regulation as measured by the ERC. Internalizing subjects and controls showed significantly different vmHRV-reactivity. Higher reactive cardiac entropy was associated with lower internalizing psychopathology and better emotion regulation and may reflect on organizational features of the neurovisceral system relevant for adaptive emotion regulation.

Negative cognitive emotion regulation as a predictor of adolescent heart rate variability and entropy under social stress

BACKGROUND AND OBJECTIVES

Negative cognitive emotion regulation (ER) strategies are particularly important within the framework of anxiety problems amongst youths and how they cope with stressful events. The aim of this study was to examine the associations between both negative and positive ER style and cardiac regulation under stressful conditions.

DESIGN

Eighty-nine adolescents (M = 13.31 years, SD = 0.68, 44.94% girls) were exposed to a socially relevant stress induction protocol.

METHODS

Participants' emotion regulation strategies were assessed and their cardiac function was recorded.

RESULTS

A negative ER style predicted heart rate (HR) entropy at the stressful stage after controlling for anxiety scores. In addition, heart rate variability reactivity and recovery and HR entropy recovery were larger (p < .05) in the low negative ER style group (n = 16) than in the high negative ER style group (n = 23).

CONCLUSIONS

Results suggest that individuals with a highly negative ER style have diminished autonomic flexibility.

Small intra-individual variability of the pre-ejection period justifies the use of pulse transit time as approximation of the vascular transit

Background

Vascular transit time (VTT) is the propagation time of a pulse wave through an artery; it is a measure for arterial stiffness. Because reliable non-invasive VTT measurements are difficult, as an alternative we measure pulse transit time (PTT). PTT is defined as the time between the R-wave on electrocardiogram and arrival of the resulting pulse wave in a distal location measured with photoplethysmography (PPG). The time between electrical activation of the ventricles and the resulting pulse wave after opening of the aortic valve is called the pre-ejection period (PEP), a component of PTT. The aim of this study was to estimate the variability of PEP at rest, to establish how accurate PTT is as approximation of VTT.

Methods

PTT was measured and PEP was assessed with echocardiography (gold standard) in three groups of 20 volunteers: 1) a control group without cardiovascular disease aged <50 years and 2) aged >50 years, and 3) a group with cardiovascular risk factors, defined as arterial hypertension, dyslipidemia, kidney failure and diabetes mellitus.

Results

Per group, the mean PEP was: 1) 58.5 ± 13.0 ms, 2) 52.4 ± 11.9 ms, and 3) 57.6 ± 11.6 ms. However, per individual the standard deviation was much smaller, i.e. 1) 2.0–5.9 ms, 2) 2.8–5.1 ms, and 3) 1.6–12.0 ms, respectively. There was no significant difference in the mean PEP of the 3 groups (p = 0.236).

Conclusion

In conclusion, the intra-individual variability of PEP is small. A change in PTT in a person at rest is most probably the result of a change in VTT rather than of PEP. Thus, PTT at rest is an easy, non-invasive and accurate approximation of VTT for monitoring arterial stiffness.

Non-linear Heart Rate Variability as a Discriminator of Internalizing Psychopathology and Negative Affect in Children With Internalizing Problems and Healthy Controls

Background: Internalizing psychopathology and dysregulated negative affect are characterized by dysregulation in the autonomic nervous system and reduced heart rate variability (HRV) due to increases in sympathetic activity alongside reduced vagal tone. The neurovisceral system is however, a complex nonlinear system, and nonlinear indices related to psychopathology are so far less studied in children. Essential nonlinear properties of a system can be found in two main domains: the informational domain and the invariant domain. sample entropy (SampEn) is a much-used method from the informational domain, while detrended fluctuation analysis (DFA) represents a widely-used method from the invariant domain. To see if nonlinear HRV can provide information beyond linear indices of autonomic activation, this study investigated SampEn and DFA as discriminators of internalizing psychopathology and negative affect alongside measures of vagally-mediated HRV and sympathetic activation. Material and Methods: Thirty-Two children with internalizing difficulties and 25 healthy controls (aged 9-13) were assessed with the Child Behavior Checklist and the Early Adolescent Temperament Questionnaire, Revised, giving an estimate of internalizing psychopathology, negative affect and effortful control, a protective factor against psychopathology. Five minute electrocardiogram and impedance cardiography recordings were collected during a resting baseline, giving estimates of SampEn, DFA short-term scaling exponent α1, root mean square of successive differences (RMSSD), and pre-ejection period (PEP). Between-group differences and correlations were assessed with parametric and non-parametric tests, and the relationships between cardiac variables, psychopathology and negative affect were assessed using generalized linear modeling. Results: SampEn and DFA were not significantly different between the groups. SampEn was weakly negatively related to heart rate (HR) in the controls, while DFA was moderately negatively related to RMSSD in both groups, and moderately positively related to HR in the clinical sample. SampEn was significantly associated with internalizing psychopathology and negative affect. DFA was significantly related to internalizing psychopathology. Conclusions: Higher invariant self-similarity was linked to less psychopathology. Higher informational entropy was related to less psychopathology and less negative affect, and may provide an index of the organizational flexibility of the neurovisceral system.