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Allbaugh LJ, George G, Klengel T, Profetto A, Marinack L, O'Malley F, Ressler KJ. Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting. J Affect Disord 2024; 354:224-231. [PMID: 38490588 DOI: 10.1016/j.jad.2024.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Research has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk. METHOD This study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS. RESULTS We found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS. LIMITATIONS The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms. DISCUSSION Limitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.
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Affiliation(s)
- Lucy J Allbaugh
- Department of Psychology, University of Dayton, Dayton, OH, United States of America.
| | - Grace George
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Klengel
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Alex Profetto
- McLean Hospital, Boston, MA, United States of America
| | - Lucas Marinack
- Department of Psychology, University of Wyoming, Laramie, WY, United States of America
| | - Fiona O'Malley
- Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kerry J Ressler
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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2
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Li Q, Zhang X, Yang X, Pan N, He M, Suo X, Li X, Gong Q, Wang S. Pre-COVID resting-state brain activity in the fusiform gyrus prospectively predicts social anxiety alterations during the pandemic. J Affect Disord 2024; 344:380-388. [PMID: 37838273 DOI: 10.1016/j.jad.2023.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Social anxiety (SA) has been linked to the coronavirus disease 2019 (COVID-19) pandemic, but the neurobiopsychological mechanisms underlying this relationship remain unclear. This study aimed to elucidate the neurofunctional markers for COVID-induced SA development and the potential role of COVID-related posttraumatic stress symptoms (PTSS) in the brain-SA alterations link. METHODS Before the COVID-19 pandemic (T1), 100 general college students underwent resting-state magnetic resonance imaging and behavioral tests. During the period of community-level outbreaks (T2), these students were re-contacted to undergo follow-up behavioral assessments. RESULTS Whole-brain correlation and prediction analyses found that pre-pandemic spontaneous neural activity (measured by fractional amplitude of low-frequency fluctuations) in the right fusiform gyrus (FG) was positively correlated to SA alterations (T2 - T1). Mediation analyses revealed that COVID-specific PTSS mediated the effects of right FG on SA alterations. LIMITATIONS The results should be interpreted carefully because only one-session neuroimaging data in a sample of normal adults were included. CONCLUSIONS The results provide evidence for neurofunctional markers of COVID-induced SA and may help develop targeted brain-based interventions that reduce SA.
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Affiliation(s)
- Qingyuan Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xun Zhang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing, China
| | - Nanfang Pan
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Min He
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xueling Suo
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
| | - Song Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
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3
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Bremner JD, Ortego RA, Campanella C, Nye JA, Davis LL, Fani N, Vaccarino V. Neural correlates of PTSD in women with childhood sexual abuse with and without PTSD and response to paroxetine treatment: A placebo-controlled, double-blind trial. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 14:100615. [PMID: 38088987 PMCID: PMC10715797 DOI: 10.1016/j.jadr.2023.100615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Objective Childhood sexual abuse is the leading cause of posttraumatic stress disorder (PTSD) in women, and is a prominent cause of morbidity and loss of function for which limited treatments are available. Understanding the neurobiology of treatment response is important for developing new treatments. The purpose of this study was to assess neural correlates of personalized traumatic memories in women with childhood sexual abuse with and without PTSD, and to assess response to treatment. Methods Women with childhood sexual abuse with (N = 28) and without (N = 17) PTSD underwent brain imaging with High-Resolution Positron Emission Tomography scanning with radiolabeled water for brain blood flow measurements during exposure to personalized traumatic scripts and memory encoding tasks. Women with PTSD were randomized to paroxetine or placebo followed by three months of double-blind treatment and repeat imaging with the same protocol. Results Women with PTSD showed decreases in areas involved in the Default Mode Network (DMN), a network of brain areas usually active when the brain is at rest, hippocampus and visual processing areas with exposure to traumatic scripts at baseline while women without PTSD showed increased activation in superior frontal gyrus and other areas (p < 0.005). Treatment of women with PTSD with paroxetine resulted in increased anterior cingulate activation and brain areas involved in the DMN and visual processing with scripts compared to placebo (p < 0.005). Conclusion PTSD related to childhood sexual abuse in women is associated with alterations in brain areas involved in memory and the stress response and treatment with paroxetine results in modulation of these areas.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
| | - Rebeca Alvarado Ortego
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Carolina Campanella
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lori L. Davis
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham, AL
- Tuscaloosa VA Medical Center, Tuscaloosa AL
| | - Negar Fani
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta GA
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
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4
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Meijer L, Franz MR, Deković M, van Ee E, Finkenauer C, Kleber RJ, van de Putte EM, Thomaes K. Towards a more comprehensive understanding of PTSD and parenting. Compr Psychiatry 2023; 127:152423. [PMID: 37722204 DOI: 10.1016/j.comppsych.2023.152423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain. PROCEDURE We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting. FINDINGS We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account. CONCLUSION With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.
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Affiliation(s)
- Laurien Meijer
- Sinai Centrum Arkin Mental Health Care, Amstelveen, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands; Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands.
| | - Molly R Franz
- Department of Psychology, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Maja Deković
- Department of Clinical Child and Family Studies, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elisa van Ee
- Psychotraumacentrum Zuid Nederland, Den Bosch, Bethaniestraat 10, 5211 LJ 's Hertogenbosch, the Netherlands; Behavioural Science Institute, Radboud University, Thomas Van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Diemen, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elise M van de Putte
- Wilhelmina Children's Hospital / University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam University Medical Centre/VUmc, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands
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5
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Orchard ER, Voigt K, Chopra S, Thapa T, Ward PGD, Egan GF, Jamadar SD. The maternal brain is more flexible and responsive at rest: effective connectivity of the parental caregiving network in postpartum mothers. Sci Rep 2023; 13:4719. [PMID: 36959247 PMCID: PMC10036465 DOI: 10.1038/s41598-023-31696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
The field of neuroscience has largely overlooked the impact of motherhood on brain function outside the context of responses to infant stimuli. Here, we apply spectral dynamic causal modelling (spDCM) to resting-state fMRI data to investigate differences in brain function between a group of 40 first-time mothers at 1-year postpartum and 39 age- and education-matched women who have never been pregnant. Using spDCM, we investigate the directionality (top-down vs. bottom-up) and valence (inhibition vs excitation) of functional connections between six key left hemisphere brain regions implicated in motherhood: the dorsomedial prefrontal cortex, ventromedial prefrontal cortex, posterior cingulate cortex, parahippocampal gyrus, amygdala, and nucleus accumbens. We show a selective modulation of inhibitory pathways related to differences between (1) mothers and non-mothers, (2) the interactions between group and cognitive performance and (3) group and social cognition, and (4) differences related to maternal caregiving behaviour. Across analyses, we show consistent disinhibition between cognitive and affective regions suggesting more efficient, flexible, and responsive behaviour, subserving cognitive performance, social cognition, and maternal caregiving. Together our results support the interpretation of these key regions as constituting a parental caregiving network. The nucleus accumbens and the parahippocampal gyrus emerging as 'hub' regions of this network, highlighting the global importance of the affective limbic network for maternal caregiving, social cognition, and cognitive performance in the postpartum period.
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Affiliation(s)
- Edwina R Orchard
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
- Department of Psychology, Yale University, New Haven, CT, USA
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - Katharina Voigt
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
| | - Sidhant Chopra
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Tribikram Thapa
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
| | - Phillip G D Ward
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Gary F Egan
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia
| | - Sharna D Jamadar
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia.
- Monash Biomedical Imaging, Monash University, Melbourne, VIC, 3800, Australia.
- Australian Research Council Centre of Excellence for Integrative Brain Function, Melbourne, Australia.
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Zablocki-Thomas PB, Rogers FD, Bales KL. Neuroimaging of human and non-human animal emotion and affect in the context of social relationships. Front Behav Neurosci 2022; 16:994504. [PMID: 36338883 PMCID: PMC9633678 DOI: 10.3389/fnbeh.2022.994504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
Long-term relationships are essential for the psychological wellbeing of humans and many animals. Positive emotions and affective experiences (e.g., romantic or platonic love) seem to be closely related to the creation and maintenance of social bonds. When relationships are threatened or terminated, other emotions generally considered to be negative can arise (e.g., jealousy or loneliness). Because humans and animals share (to varying degrees) common evolutionary histories, researchers have attempted to explain the evolution of affect and emotion through the comparative approach. Now brain imaging techniques allow the comparison of the neurobiological substrates of affective states and emotion in human and animal brains using a common methodology. Here, we review brain imaging studies that feature emotions characterized by the context of social bonding. We compare imaging findings associated with affective and emotional states elicited by similar social situations between humans and animal models. We also highlight the role of key neurohormones (i.e., oxytocin, vasopressin, and dopamine) that jointly support the occurrence of socially contextualized emotions and affect across species. In doing so, we seek to explore and clarify if and how humans and animals might similarly experience social emotion and affect in the context of social relationships.
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Affiliation(s)
| | - Forrest D. Rogers
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
- Psychology Graduate Group, University of California, Davis, Davis, CA, United States
| | - Karen L. Bales
- California National Primate Research Center, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, Davis, CA, United States
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7
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Lemus A, Vogel SC, Greaves AN, Brito NH. Maternal anxiety symptoms associated with increased behavioral synchrony in the early postnatal period. INFANCY 2022; 27:821-835. [PMID: 35524642 PMCID: PMC9887273 DOI: 10.1111/infa.12473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 02/02/2023]
Abstract
The presence of perinatal mood and anxiety disorders has typically been associated with decreases in the quality of mother-infant interactions. However, maternal anxiety symptoms during the postpartum period have been less studied than other mental health disorders like depression. In the current study, we examined associations among symptoms of maternal anxiety, maternal perceived stress, and mother-infant behavioral synchrony in the early postnatal period. Eighty-one mother-infant dyads participated in this study when the infants were 3 months old. Surveys were given to obtain demographic information and current maternal mental health symptoms, and dyads completed a 5-min free-play task to measure behavioral synchrony. Results indicated that maternal anxiety symptoms were positively associated with behavioral synchrony, but only for mothers reporting moderate levels of perceived stress. These findings highlight the differential impact of maternal postpartum mental health on behavioral synchrony and suggest that higher maternal anxiety symptoms during the postnatal period may play an adaptive role in fostering more dynamic mother-infant interactions.
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Affiliation(s)
- Alejandra Lemus
- Department of Applied Psychology New York University New York New York USA
| | - Sarah C. Vogel
- Department of Applied Psychology New York University New York New York USA
| | - Ashley N. Greaves
- Department of Applied Psychology New York University New York New York USA
| | - Natalie H. Brito
- Department of Applied Psychology New York University New York New York USA
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8
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Wu Y, Veerareddy A, Lee MR, Bellucci G, Camilleri JA, Eickhoff SB, Krueger F. Understanding identification-based trust in the light of affiliative bonding: Meta-analytic neuroimaging evidence. Neurosci Biobehav Rev 2021; 131:627-641. [PMID: 34606821 DOI: 10.1016/j.neubiorev.2021.09.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
Trust is vital for establishing social relationships and is a crucial precursor for affiliative bonds. Investigations explored the neuropsychological bases of trust separately (e.g., measured by the trust game) and affiliative bonding (e.g., measured by parental care, pair-bonding, or friendship). However, direct empirical support for the shared neural mechanisms between trust and affiliative bonding is missing. Here, we conducted a coordinate-based meta-analysis on functional magnetic resonance imaging studies on interpersonal trust and affiliative bonding using the activation likelihood estimation method. Our results demonstrated that decisions to trust strangers in repeated interactions (i.e., identification-based trust) engaged the ventral striatum (vSTR, part of the mesolimbic dopaminergic pathway), likely signaling the reward anticipation. Further, both feedbacks in repeated interactions and affiliative bonding engaged the dorsal striatum (dSTR, part of the nigrostriatal dopaminergic pathway), likely encoding learning dynamics. Our findings suggest that identification-based trust can be understood in the light of affiliative bonding, involving the mesocorticolimbic "reward" pathway (vSTR) and nigrostriatal "habit formation" pathway (dSTR) in building and sustaining social relationships.
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Affiliation(s)
- Yan Wu
- Department of Psychology, College of Education, Hangzhou Normal University, Hangzhou, 311121, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, 311121, China
| | | | - Mary R Lee
- US Department of Veteran Affairs, Washington, DC, USA
| | - Gabriele Bellucci
- Department of Computational Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Julia A Camilleri
- Institute for Neuroscience and Medicine (INM-7), Research Center Jülich, Germany; Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute for Neuroscience and Medicine (INM-7), Research Center Jülich, Germany; Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA; Department of Psychology, University of Mannheim, Mannheim, Germany.
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9
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Lee MS, Anumagalla P, Pavuluri MN. Individuals with the post-traumatic stress disorder process emotions in subcortical regions irrespective of cognitive engagement: a meta-analysis of cognitive and emotional interface. Brain Imaging Behav 2021; 15:941-957. [PMID: 32710332 DOI: 10.1007/s11682-020-00303-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Post-traumatic stress disorder (PTSD) manifests as emotional suffering and problem-solving impairments under extreme stress. This meta-analysis aimed to pool the findings from all the studies examining emotion and cognition in individuals with PTSD to develop a robust mechanistic understanding of the related brain dysfunction. We identified primary studies through a comprehensive literature search of the MEDLINE and PsychINFO databases. The GingerALE software (version 2.3.6) from the BrainMap Project was used to conduct activation likelihood estimation meta-analyses of the eligible studies for cognition, emotion and interface of both. Relative to the non-clinical (NC) group, the PTSD group showed greater activation during emotional tasks in the amygdala and parahippocampal gyrus. In contrast, the NC group showed significantly greater activation in the bilateral anterior cingulate cortex (ACC) than did the PTSD group in the emotional tasks. When both emotional and cognitive processing were evaluated, the PTSD group showed significantly greater activation in the striatum than did the NC group. No differences in activation between the PTSD and NC groups were noted when only the cognitive systems were examined. Individuals with PTSD exhibited overactivity in the subcortical regions, i.e., amygdala and striatum, when processing emotions. Underactivity in the emotional and cognitive processing intermediary cortex, i.e., the ACC, was especially prominent in individuals with PTSD relative to the NC population following exposure to emotional stimuli. These findings may explain the trauma-related fear, irritability, and negative effects as well as the concentration difficulties during cognitive distress associated with emotional arousal, that are commonly observed in individuals with PTSD.
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Affiliation(s)
- Moon-Soo Lee
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.,Department of Psychiatry, Korea University Guro hospital, Guro-gu, Seoul, 08308, Republic of Korea
| | - Purnima Anumagalla
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA
| | - Mani N Pavuluri
- Department of adult, adolescent and child psychiatry, Brain and Wellness Institute, 1500 N. Halsted St, Chicago, IL, 60642, USA.
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10
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Finnegan MK, Kane S, Heller W, Laurent H. Mothers' neural response to valenced infant interactions predicts postpartum depression and anxiety. PLoS One 2021; 16:e0250487. [PMID: 33905457 PMCID: PMC8078806 DOI: 10.1371/journal.pone.0250487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
It is currently unknown whether differences in neural responsiveness to infant cues observed in postpartum affective disturbance are specific to depression/anxiety or are better attributed to a common component of internalizing distress. It is also unknown whether differences in mothers’ brain response can be accounted for by effects of past episodes, or if current neural processing of her child may serve as a risk factor for development of future symptoms. Twenty-four mothers from a community-based sample participated in an fMRI session viewing their 3-month- old infant during tasks evoking positive or negative emotion. They were tracked across the ensuing 15 months to monitor changes in affective symptoms. Past and current episodes of depression and anxiety, as well as future symptoms, were used to predict differences in mothers’ hemodynamic response to their infant in positive compared to negative emotion contexts. Lower relative activation in largely overlapping brain regions involving frontal lobe structures to own infant positive vs. negative emotion was associated with concurrent (3-month) depression diagnosis and prospective (3–18 month) depression and anxiety symptoms. There was little evidence for impacts of past psychopathology (more limited effect of past anxiety and nonsignificant effect of past depression). Results suggest biased maternal processing of infant emotions during postpartum depression and anxiety is largely accounted for by a shared source of variance (internalizing distress). Furthermore, differential maternal responsiveness to her infant’s emotional cues is specifically associated with the perpetuation of postpartum symptoms, as opposed to more general phenotypic or scarring effects of past psychopathology.
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Affiliation(s)
- Megan Kate Finnegan
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
- * E-mail:
| | - Stephanie Kane
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States of America
| | - Wendy Heller
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
| | - Heidemarie Laurent
- Psychology Department, University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America
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11
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Kim P. How stress can influence brain adaptations to motherhood. Front Neuroendocrinol 2021; 60:100875. [PMID: 33038383 PMCID: PMC7539902 DOI: 10.1016/j.yfrne.2020.100875] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Research shows that a woman's brain and body undergo drastic changes to support her transition to parenthood during the perinatal period. The presence of this plasticity suggests that mothers' brains may be changed by their experiences. Exposure to severe stress may disrupt adaptive changes in the maternal brain and further impact the neural circuits of stress regulation and maternal motivation. Emerging literature of human mothers provides evidence that stressful experience, whether from the past or present environment, is associated with altered responses to infant cues in brain circuits that support maternal motivation, emotion regulation, and empathy. Interventions that reduce stress levels in mothers may reverse the negative impact of stress exposure on the maternal brain. Finally, outstanding questions regarding the timing, chronicity, types, and severity of stress exposure, as well as study design to identify the causal impact of stress, and the role of race/ethnicity are discussed.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, CO, United States.
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12
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Abstract
At least one in seven pregnant or recently postpartum women will experience a mental illness such as an anxiety disorder, depressive disorder, or substance use disorder. These mental illnesses have detrimental effects on the health of the mother, child, and family, but little is known about the hypothalamic and other neural correlates of maternal mental health concerns. The transition to parenthood alone is a time of remarkable neural plasticity, so it is perhaps not surprising that current research is showing that maternal mental illness has unique neural profiles. Furthermore, the neural systems affected by peripartum mental illness overlap and interact with the systems involved in maternal caregiving behaviors, and mother-infant interactions are, therefore, highly susceptible to disruption. This review discusses what we know about the unique neural changes occurring during peripartum mental illness and the role of the hypothalamus in these illnesses. With an improved understanding of the neural correlates of maternal mental health and disease, we will be better equipped to predict risk, develop effective treatments, and ultimately prevent suffering for millions of parents during this critical time in life.
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Affiliation(s)
- Jodi L Pawluski
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR S 1085, Rennes, France.
| | - James E Swain
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI, United States
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13
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Bunston W, Frederico M, Whiteside M. The Experience of the Infant Entering Refuge (Shelter) Setting with Their Mothers After Fleeing Family Violence. JOURNAL OF FAMILY VIOLENCE 2020; 36:953-965. [PMID: 33262557 PMCID: PMC7689642 DOI: 10.1007/s10896-020-00226-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
Almost nothing is known about how the infant may experience being in a women's Refuge (Shelter) setting with their mother after fleeing family violence, despite the high numbers of infants and young children in Refuges or Shelters. This research was concerned with exploring how the infant experienced refuge within a Refuge setting post family violence. Using a non-intrusive, ethically informed, 'infant led' approach, this research involved ten infants (aged 3 weeks to 16 months), ten mothers, and 13 staff in eight Refuges from three countries: Australia, Scotland and England. Data was collected through infant observation, interviews with mothers and then staff. Presented is a synthesis of a research methodology which was led by the infant, drew on concepts of 'inter-subjectivity' and used a constructivist grounded theory method. Infants were often lost from view within the Refuge setting. The mother, herself traumatised, was expected to be the refuge for her infant. Only the obviously distressed infant was assisted, and where available, from outside specialist workers. It was often too painful for the adults, both mothers and staff, to see or reflect on the infant's possible trauma. Significantly, in all cases the motivation for each mother to enter Refuge was ensuring their infant's safety. Concern for their infant or young child can be a powerful catalyst for women leaving a violent relationship. Refuges (Shelters) are in a unique position to respond to the infant in their own right whilst helping to heal and grow the infant/mother relationship.
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Affiliation(s)
- Wendy Bunston
- wb Training & Consultancy, La Trobe University, Bundoora, Victoria Australia
- School of Allied Health, Human Services and Health, La Trobe University, Bundoora, Australia
| | - Margarita Frederico
- School of Allied Health, Human Services and Health, La Trobe University, Bundoora, Australia
| | - Mary Whiteside
- School of Allied Health, Human Services and Health, La Trobe University, Bundoora, Australia
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14
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Kim P, Tribble R, Olsavsky AK, Dufford AJ, Erhart A, Hansen M, Grande L, Gonzalez DM. Associations between stress exposure and new mothers' brain responses to infant cry sounds. Neuroimage 2020; 223:117360. [PMID: 32927083 PMCID: PMC8291268 DOI: 10.1016/j.neuroimage.2020.117360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Exposure to severe stress has been linked to negative postpartum outcomes among new mothers including mood disorders and harsh parenting. Non-human animal studies show that stress exposure disrupts the normative adaptation of the maternal brain, thus identifying a neurobiological mechanism by which stress can lead to negative maternal outcomes. However, little is known about the impact of stress exposure on the maternal brain response to infant cues in human mothers. We examined the association of stress exposure with brain response to infant cries and maternal behaviors, in a socioeconomically diverse (low- and middle-income) sample of first-time mothers (N=53). Exposure to stress across socioeconomic, environmental, and psychosocial domains was associated with reduced brain response to infant cry sounds in several regions, including the right insula/inferior frontal gyrus and superior temporal gyrus. Reduced activation in these regions was further associated with lower maternal sensitivity observed during a mother-infant interaction. The findings demonstrate that higher levels of stress exposure may be associated with reduced brain response to an infant’s cry in regions that are important for emotional and social information processing, and that reduced brain responses may further be associated with increased difficulties in developing positive mother-infant relationships.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Rebekah Tribble
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Aviva K Olsavsky
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; University of Colorado Anschutz School of Medicine/Children's Hospital Colorado, 13123 E. 16th Avenue, CO 80045, United States
| | - Alexander J Dufford
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Andrew Erhart
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Melissa Hansen
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Leah Grande
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Daniel M Gonzalez
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; Harvard Medical School, Boston, 25 Shattuck St, Boston, MA 02115, United States
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15
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Olsavsky AK, Stoddard J, Erhart A, Tribble R, Kim P. Neural processing of infant and adult face emotion and maternal exposure to childhood maltreatment. Soc Cogn Affect Neurosci 2020; 14:997-1008. [PMID: 31680141 PMCID: PMC7058929 DOI: 10.1093/scan/nsz069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 01/26/2023] Open
Abstract
Face processing in mothers is linked to mother–infant social communication, which is critical for parenting and in turn for child development. Neuroimaging studies of child maltreatment-exposed (CME) mothers are sparse compared to studies of mothers with postpartum depression, which have suggested blunted amygdala reactivity to infant stimuli. We expected to see a similar pattern in CME mothers. Based on broader studies in trauma-exposed populations, we anticipated increased amygdala reactivity to negative adult face stimuli in a comparison task in CME mothers given heightened evaluation of potential threat. We examined Neuroimaging studies of mothers with childhood maltreatment exposure (CME) (18–37 years old), who performed infant (N = 45) and/or adult (N = 46) face processing tasks. CME mothers exhibited blunted bilateral amygdala reactivity to infant faces. There was no between-group difference in amygdala reactivity to adult faces. In infant and adult face processing tasks regardless of CME, superior temporal gyrus activation was increased for negative-valence stimuli. Our preliminary findings suggest that childhood maltreatment alters maternal processing of infant social cues, a critical skill impacting infant socioemotional development.
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Affiliation(s)
- Aviva K Olsavsky
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Pediatric Mental Health Institute, Children's Hospital Colorado
| | - Joel Stoddard
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Pediatric Mental Health Institute, Children's Hospital Colorado
| | | | | | - Pilyoung Kim
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Department of Psychology, University of Denver
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Moser DA, Suardi F, Rossignol AS, Vital M, Manini A, Serpa SR, Schechter DS. Parental Reflective Functioning correlates to brain activation in response to video-stimuli of mother-child dyads: Links to maternal trauma history and PTSD. Psychiatry Res Neuroimaging 2019; 293:110985. [PMID: 31627112 DOI: 10.1016/j.pscychresns.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/10/2023]
Abstract
Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse. Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother-child separation and play. Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories. Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.
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Affiliation(s)
- Dominik Andreas Moser
- Institute of Psychology, University of Bern, Rue de Lyon 38, 1203 Bern, Switzerland.
| | - Francesca Suardi
- Service of Child and Adolescent Psychiatry (SPEA), University of Geneva Hospitals, Geneva, Switzerland
| | - Ana Sancho Rossignol
- Service of Child and Adolescent Psychiatry (SPEA), University of Geneva Hospitals, Geneva, Switzerland
| | - Marylène Vital
- Service of Child and Adolescent Psychiatry (SPEA), University of Geneva Hospitals, Geneva, Switzerland
| | - Aurélia Manini
- Service of Child and Adolescent Psychiatry (SPEA), University of Geneva Hospitals, Geneva, Switzerland
| | - Sandra Rusconi Serpa
- Service of Child and Adolescent Psychiatry (SPEA), University of Geneva Hospitals, Geneva, Switzerland
| | - Daniel Scott Schechter
- University Service of Child and Adolescent Psychiatry (SUPEA), Lausanne University Hospital (CHUV), Lausanne, Switzerland; Department of Psychiatry, University of Geneva Faculty of Medicine, Geneva, Switzerland; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY USA
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17
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Orem TR, Wheelock MD, Goodman AM, Harnett NG, Wood KH, Gossett EW, Granger DA, Mrug S, Knight DC. Amygdala and prefrontal cortex activity varies with individual differences in the emotional response to psychosocial stress. Behav Neurosci 2019; 133:203-211. [PMID: 30907618 PMCID: PMC6435298 DOI: 10.1037/bne0000305] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stress elicits a variety of psychophysiological responses that show large interindividual variability. Determining the neural mechanisms that mediate individual differences in the emotional response to stress would provide new insight that would have important implications for understanding stress-related disorders. Therefore, the present study examined individual differences in the relationship between brain activity and the emotional response to stress. In the largest stress study to date, 239 participants completed the Montreal Imaging Stress Task (MIST) while heart rate, skin conductance response (SCR), cortisol, self-reported stress, and blood oxygen level dependent (BOLD) functional MRI (fMRI) signal responses were measured. The relationship between differential responses (heart rate, SCR, cortisol, and self-reported stress) and differential BOLD fMRI data was analyzed. Dorsolateral prefrontal cortex (PFC), dorsomedial PFC, ventromedial PFC, and amygdala activity varied with the behavioral response (i.e., SCR and self-reported stress). These results suggest the PFC and amygdala support processes that are important for the expression and regulation of the emotional response to stress, and that stress-related PFC and amygdala activity underlie interindividual variability in peripheral physiologic measures of the stress response. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Tyler R. Orem
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muriah D. Wheelock
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam M. Goodman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathaniel G. Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimberly H. Wood
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ethan W. Gossett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, USA
- UCI Center for the Neurobiology of Learning and Memory, University of California at Irvine, Irvine, CA, USA
- Johns Hopkins University School of Medicine, School of Nursing, and Bloomberg School of Public Health, Baltimore, MD USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C. Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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Neukel C, Herpertz SC, Hinid-Attar C, Zietlow AL, Fuchs A, Moehler E, Bermpohl F, Bertsch K. Neural processing of the own child's facial emotions in mothers with a history of early life maltreatment. Eur Arch Psychiatry Clin Neurosci 2019; 269:171-181. [PMID: 30056560 DOI: 10.1007/s00406-018-0929-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/16/2018] [Indexed: 01/02/2023]
Abstract
Early life maltreatment (ELM) has long-lasting effects on social interaction. When interacting with their own child, women with ELM often report difficulties in parenting and show reduced maternal sensitivity. Sensitive maternal behavior requires the recognition of the child's emotional state depicted in its facial emotions. Based on previous studies, it can be expected that ELM affects the neural processing of facial emotions by altering activation patterns in parts of the brain's empathy and mentalizing networks. However, so far studies have focused on the processing of standardized, adult facial emotions. Therefore, the current study investigated the impact of ELM on the processing of one's own child's facial emotions using functional magnetic resonance imaging. To achieve this, 27 mothers with and 26 mothers without a history of ELM (all without current mental disorders and psychopharmacological treatment) took part in an emotional face recognition paradigm with happy, sad, and neutral faces of their own and an unknown primary school-aged child of the same age and sex. We found elevated activations in regions of the mentalizing (superior temporal sulcus, precuneus) and mirror neuron (inferior parietal lobule) networks as well as in the visual face processing network (cuneus, middle temporal gyrus) in mothers with ELM compared to the non-maltreated mothers in response to happy faces of their own child. This suggests a more effortful processing and cognitive empathic mentalizing of the own child's facial happiness in mothers with ELM. Future research should address whether this might indicate a compensatory recruitment of mentalizing capacities to maintain maternal sensitivity.
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Affiliation(s)
- Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Germany
| | - Catherine Hinid-Attar
- Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany
| | - Anna-Lena Zietlow
- Institute of Medical Psychology, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Eva Moehler
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, 69115, Heidelberg, Germany
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19
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Rigo P, Kim P, Esposito G, Putnick DL, Venuti P, Bornstein MH. Specific maternal brain responses to their own child's face: An fMRI meta-analysis. DEVELOPMENTAL REVIEW 2019; 51:58-69. [PMID: 30872887 PMCID: PMC6411077 DOI: 10.1016/j.dr.2018.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Paola Rigo
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
- Division of Psychology, Nanyang Technological University, Singapore, Singapore
| | - Pilyoung Kim
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO 80208-3500
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
- Division of Psychology, Nanyang Technological University, Singapore, Singapore
| | - Diane L. Putnick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - Paola Venuti
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Marc H. Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
- Institute for Fiscal Studies, London, UK
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20
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Schechter DS. And Then There Was Intersubjectivity: Addressing Child Self and Mutual Dysregulation During Traumatic Play. PSYCHOANALYTIC INQUIRY 2019. [DOI: 10.1080/07351690.2019.1549911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Torrisi R, Arnautovic E, Pointet Perizzolo VC, Vital M, Manini A, Suardi F, Gex-Fabry M, Rusconi Serpa S, Schechter DS. Developmental delay in communication among toddlers and its relationship to caregiving behavior among violence-exposed, posttraumatically stressed mothers. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 82:67-78. [PMID: 29754762 DOI: 10.1016/j.ridd.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/16/2018] [Accepted: 04/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to understand if maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) is associated with delayed language development among very young children ("toddlers"). METHODS Data were collected from 61 mothers and toddlers (ages 12-42 months, mean age = 25.6 months SD = 8.70). Child expressive and receptive language development was assessed by the Ages and Stages Questionnaire (ASQ) communication subscale (ASQCS) that measures language acquisition. Observed maternal caregiving behavior was coded from videos of 10-min free-play interactions via the CARE-Index. Correlations, Mann-Whitney tests, and multiple linear regression were performed. RESULTS There was no significant association between maternal IPV-PTSD severity and the ASQCS. Maternal IPV-PTSD severity was associated with continuous maternal behavior variables (i.e. sensitive and controlling behavior on the CARE-Index) across the entire sample and regardless of child gender. Maternal sensitivity was positively and significantly associated with the ASQCS. Controlling behavior was negatively and significantly associated with the ASQCS. CONCLUSIONS Results are consistent with the literature that while maternal IPV-PTSD severity is not associated with child language delays, the quality of maternal interactive behavior is associated both with child language development and with maternal IPV-PTSD severity. Further study is needed to understand if the level of child language development contributes to intergenerational risk or resilience for relational violence and/or victimization.
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Affiliation(s)
- R Torrisi
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - E Arnautovic
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - V C Pointet Perizzolo
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - M Vital
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - A Manini
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - F Suardi
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - M Gex-Fabry
- Department of Psychiatry, University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - S Rusconi Serpa
- Child and Adolescent Psychiatry Service, Geneva University Hospitals, Geneva, Switzerland
| | - D S Schechter
- Department of Psychiatry, University of Geneva Faculty of Medicine, Geneva, Switzerland; Department of Child and Adolescent Psychiatry, New York Langone University School of Medicine, New York, NY, USA.
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22
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Neukel C, Bertsch K, Fuchs A, Zietlow AL, Reck C, Moehler E, Brunner R, Bermpohl F, Herpertz SC. The maternal brain in women with a history of early-life maltreatment: an imagination-based fMRI study of conflictual versus pleasant interactions with children. J Psychiatry Neurosci 2018; 43:273-282. [PMID: 29947610 PMCID: PMC6019349 DOI: 10.1503/jpn.170026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/07/2017] [Accepted: 10/07/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Early-life maltreatment has severe consequences for the affected individual, and it has an impact on the next generation. To improve understanding of the intergenerational effects of abuse, we investigated the consequences of early-life maltreatment on maternal sensitivity and associated brain mechanisms during mother-child interactions. METHODS In total, 47 mothers (22 with a history of physical and/or sexual childhood abuse and 25 without, all without current mental disorders) took part in a standardized real-life interaction with their 7- to 11-year-old child (not abused) and a subsequent functional imaging script-driven imagery task. RESULTS Mothers with early-life maltreatment were less sensitive in real-life mother-child interactions, but while imagining conflictual interactions with their child, they showed increased activation in regions of the salience and emotion-processing network, such as the amygdala, insula and hippocampus. This activation pattern was in contrast to that of mothers without early-life maltreatment, who showed higher activations in those regions in response to pleasant mother-child interactions. Mothers with early-life maltreatment also showed reduced functional connectivity between regions of the salience and the mentalizing networks. LIMITATIONS Region-of-interest analyses, which were performed in addition to whole-brain analyses, were exploratory in nature, because they were not further controlled for multiple comparisons. CONCLUSION Results suggest that for mothers with early-life maltreatment, conflictual interactions with their child may be more salient and behaviourally relevant than pleasant interactions, and that their salience network is poorly modulated by the brain regions involved in mentalizing processes. This activation pattern offers new insights into the mechanisms behind the intergenerational effects of maltreatment and into options for reducing these effects.
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Affiliation(s)
- Corinne Neukel
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Katja Bertsch
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Anna Fuchs
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Anna-Lena Zietlow
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Corinna Reck
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Eva Moehler
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Romuald Brunner
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Felix Bermpohl
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
| | - Sabine C Herpertz
- From the Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Neukel, Zietlow, Reck, Herpertz); the Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany (Fuchs, Brunner); the Department of Psychology, Faculty of Psychology and Educational Science, Ludwig-Maximilian University of Munich, Germany (Reck); the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, SHG Hospital, Kleinblittersdorf, Germany (Moehler); and the Department of Psychiatry and Psychotherapy, University Medicine Berlin, Charité Campus Mitte, Berlin, Germany (Bermpohl)
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Bernard K, Kuzava S, Simons R, Dozier M. CPS-referred mothers' psychophysiological responses to own versus other child predict sensitivity to child distress. Dev Psychol 2018; 54:1255-1264. [PMID: 29595312 PMCID: PMC6019158 DOI: 10.1037/dev0000508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Maltreating mothers often struggle to respond sensitively to their children's distress. Examining psychophysiological processing of own child cues may offer insight into neurobiological mechanisms that promote sensitive parenting among high-risk mothers. The current study used event-related potential (ERP) methodology to examine associations between mothers' neural responses to their own child versus other children and observed sensitivity to distress. Participants included 73 mothers: 42 with histories of child protective services (CPS) involvement and 31 low-risk comparison mothers. Maternal sensitivity to child distress was coded from observations of children's blood sample collection. Late positive potential (LPP) ERP responses, which reflect sustained attention to emotionally salient stimuli, were measured when mothers viewed photos of their own child and other children. An own-other LPP difference score (own-other LPP) was computed by regressing the mean amplitude of mothers' LPP to their own child on the mean amplitude of mothers' LPP to other children. CPS-referred mothers and low-risk mothers did not differ in their LPP responses to own child, other children, or the own-other LPP. However, there was a significant interaction between group (CPS-referred vs. low-risk) and own-other LPP in predicting maternal sensitivity. Among the CPS-referred mothers, own-other LPP was significantly correlated with maternal sensitivity, with greater LPP amplitude to own versus other child associated with higher maternal sensitivity. In contrast, among the low-risk group, own-other LPP was not significantly correlated with maternal sensitivity. Findings add to our understanding of the neurobiology of sensitive parenting among high-risk mothers. (PsycINFO Database Record
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Affiliation(s)
| | | | - Robert Simons
- Department of Psychological and Brain Sciences, University of Delaware
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware
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Nephew BC, Febo M, Huang W, Colon-Perez LM, Payne L, Poirier GL, Greene O, King JA. Early life social stress and resting state functional connectivity in postpartum rat anterior cingulate circuits. J Affect Disord 2018; 229:213-223. [PMID: 29324369 PMCID: PMC5807174 DOI: 10.1016/j.jad.2017.12.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/22/2017] [Accepted: 12/31/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Continued development and refinement of resting state functional connectivity (RSFC) fMRI techniques in both animal and clinical studies has enhanced our comprehension of the adverse effects of stress on psychiatric health. The objective of the current study was to assess both maternal behavior and resting state functional connectivity (RSFC) changes in these animals when they were dams caring for their own young. It was hypothesized that ECSS exposed dams would express depressed maternal care and exhibit similar (same networks), yet different specific changes in RSFC (different individual nuclei) than reported when they were adult females. METHODS We have developed an ethologically relevant transgenerational model of the role of chronic social stress (CSS) in the etiology of postpartum depression and anxiety. Initial fMRI investigation of the CSS model indicates that early life exposure to CSS (ECSS) induces long term changes in functional connectivity in adult nulliparous female F1 offspring. RESULTS ECSS in F1 dams resulted in depressed maternal care specifically during early lactation, consistent with previous CSS studies, and induced changes in functional connectivity in regions associated with sensory processing, maternal and emotional responsiveness, memory, and the reward pathway, with robust changes in anterior cingulate circuits. LIMITATIONS The sample sizes for the fMRI groups were low, limiting statistical power. CONCLUSION This behavioral and functional neuroanatomical foundation can now be used to enhance our understanding of the neural etiology of early life stress associated disorders and test preventative measures and treatments for stress related disorders.
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Affiliation(s)
- Benjamin C Nephew
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA.
| | - Marcelo Febo
- Department of Psychiatry, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Wei Huang
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Luis M Colon-Perez
- Department of Psychiatry, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32611, USA
| | - Laurellee Payne
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Guillaume L Poirier
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Owen Greene
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, 200 Westborough Road, North Grafton, MA 01536, USA
| | - Jean A King
- Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA
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25
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Lang AJ, Gartstein MA. Intergenerational transmission of traumatization: Theoretical framework and implications for prevention. J Trauma Dissociation 2018; 19:162-175. [PMID: 28509617 DOI: 10.1080/15299732.2017.1329773] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intergenerational transmission of traumatization (ITT) occurs when traumatized parents have offspring with increased risk for emotional and behavioral problems. Although fetal exposure to the maternal biological milieu is known to be one factor in ITT, PTSD-driven parent-child interactions represent an additional important and potentially modifiable contributor. The Perinatal Interactional Model of ITT presented herein proposes that PTSD leads to social learning and suboptimal parent-child interactions, which undermine child regulatory capacity and increase distress, largely explaining poor social-emotional outcomes for offspring of parents with PTSD. Psychosocial intervention, particularly when delivered early in pregnancy, holds the possibility of disrupting ITT.
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Affiliation(s)
- Ariel J Lang
- a VA San Diego Center of Excellence for Stress and Mental Health (CESAMH) , University of California San Diego , San Diego , California , USA
| | - Maria A Gartstein
- b Department of Psychology , Washington State University , Pullman , Washington , USA
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26
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Sancho-Rossignol A, Schilliger Z, Cordero MI, Rusconi Serpa S, Epiney M, Hüppi P, Ansermet F, Schechter DS. The Association of Maternal Exposure to Domestic Violence During Childhood With Prenatal Attachment, Maternal-Fetal Heart Rate, and Infant Behavioral Regulation. Front Psychiatry 2018; 9:358. [PMID: 30131731 PMCID: PMC6090178 DOI: 10.3389/fpsyt.2018.00358] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022] Open
Abstract
Human and animal models suggest that maternal hormonal and physiological adaptations during pregnancy shape maternal brain functioning and behavior crucial for offspring care and survival. Less sensitive maternal behavior, often associated with psychobiological dysregulation and the offspring's behavioral and emotional disorders, has been observed in mothers who have experienced adverse childhood experiences. Strong evidence shows that children who are exposed to domestic violence (DV) are at risk of being abused or becoming abusive in adulthood. Yet little is known about the effect of childhood exposure to DV on the expecting mother, her subsequent caregiving behavior and related effects on her infant. Thus, the present study examined the association of maternal exposure to DV during childhood on prenatal maternal attachment, maternal heart rate reactivity to an infant-crying stimulus and post-natal infant emotional regulation. Thirty-three women with and without exposure to DV during childhood were recruited during the first trimester of pregnancy and followed until 6-month after birth. The Maternal Antenatal Attachment Scale (MAAS) was used to measure prenatal attachment of the mother to her fetus during the second trimester of pregnancy, maternal and fetal heart rate reactivity to an infant-crying stimulus was assessed at the third trimester of pregnancy, and the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess infant emotional regulation at 6-months. Results showed that pregnant women that were exposed to DV during childhood had a poorer quality of prenatal attachment of mother to fetus, regardless of whether they also experienced DV during adulthood. In addition, maternal exposure to DV during childhood was associated with increased maternal heart rate to infant-crying stimulus and worse infant emotional regulation. These findings highlight the importance of prenatal screening for maternal exposure to DV during childhood as a risk factor for disturbances in the development of maternal attachment, dysfunctional maternal behavior and emotion dysregulation.
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Affiliation(s)
- Ana Sancho-Rossignol
- Child & Adolescent Psychiatry Service, University of Geneva Hospitals, Geneva, Switzerland
| | - Zoe Schilliger
- Child & Adolescent Psychiatry Service, University of Geneva Hospitals, Geneva, Switzerland
| | - María I Cordero
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Sandra Rusconi Serpa
- Child & Adolescent Psychiatry Service, University of Geneva Hospitals, Geneva, Switzerland
| | - Manuella Epiney
- Department of Obstetrics & Gynecology, University of Geneva Hospitals, Geneva, Switzerland
| | - Petra Hüppi
- Developmental Pediatrics Service, University of Geneva Hospitals, Geneva, Switzerland
| | - François Ansermet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel S Schechter
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Child & Adolescent Psychiatry, New York University Langone Medical Center and School of Medicine, New York, NY, United States
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Bunston W, Franich-Ray C, Tatlow S. A Diagnosis of Denial: How Mental Health Classification Systems Have Struggled to Recognise Family Violence as a Serious Risk Factor in the Development of Mental Health Issues for Infants, Children, Adolescents and Adults. Brain Sci 2017; 7:E133. [PMID: 29039808 PMCID: PMC5664060 DOI: 10.3390/brainsci7100133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022] Open
Abstract
Child and adolescent mental health services (CAMHS) routinely overlook assessing for, and providing treatment to, infants and children living with family violence, despite family violence being declared endemic across the globe. As contemporary neuro-developmental research recognises the harm of being exposed to early relational trauma, key international diagnostic texts such as the DSM-5 and ICD-10 struggle to acknowledge or appreciate the relational complexities inherent in addressing family violence and its impacts during childhood. These key texts directly influence thinking, funding and research imperatives in adult services as well as CAMHS, however, they rarely reference family violence. Their emphasis is to pathologise conditions over exploring causality which may be attributable to relational violence. Consequently, CAMHS can miss important indicators of family violence, misdiagnose disorders and unwittingly, not address unacceptable risks in the child's caregiving environment. Notwithstanding urgent safety concerns, ongoing exposure to family violence significantly heightens the development of mental illness amongst children. CAMHS providers cannot and should not rely on current diagnostic manuals alone. They need to act now to see family violence as a significant and important risk factor to mental health and to treat its impacts on children before these develop into enduring neurological difficulties.
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Affiliation(s)
- Wendy Bunston
- wb Training and Consultancy, PO Box 750, Moonee Ponds, Victoria, Australia, 3039; La Trobe University, Bundoora 3086, Victoria, Australia.
| | - Candice Franich-Ray
- Mental Health, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia.
- The Murdoch Childrens Research Institute, Flemington Road, Parkville 3052, Victoria, Australia.
- Department of Paediatrics, The University of Melbourne; Level 2 West Building, The Royal Children's Hospital, 50 Flemington Street, Parkville 3052, Victoria, Australia.
| | - Sara Tatlow
- Mental Health, The Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia.
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Brefczynski-Lewis JA, Lewis JW. Auditory object perception: A neurobiological model and prospective review. Neuropsychologia 2017; 105:223-242. [PMID: 28467888 PMCID: PMC5662485 DOI: 10.1016/j.neuropsychologia.2017.04.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 12/15/2022]
Abstract
Interaction with the world is a multisensory experience, but most of what is known about the neural correlates of perception comes from studying vision. Auditory inputs enter cortex with its own set of unique qualities, and leads to use in oral communication, speech, music, and the understanding of emotional and intentional states of others, all of which are central to the human experience. To better understand how the auditory system develops, recovers after injury, and how it may have transitioned in its functions over the course of hominin evolution, advances are needed in models of how the human brain is organized to process real-world natural sounds and "auditory objects". This review presents a simple fundamental neurobiological model of hearing perception at a category level that incorporates principles of bottom-up signal processing together with top-down constraints of grounded cognition theories of knowledge representation. Though mostly derived from human neuroimaging literature, this theoretical framework highlights rudimentary principles of real-world sound processing that may apply to most if not all mammalian species with hearing and acoustic communication abilities. The model encompasses three basic categories of sound-source: (1) action sounds (non-vocalizations) produced by 'living things', with human (conspecific) and non-human animal sources representing two subcategories; (2) action sounds produced by 'non-living things', including environmental sources and human-made machinery; and (3) vocalizations ('living things'), with human versus non-human animals as two subcategories therein. The model is presented in the context of cognitive architectures relating to multisensory, sensory-motor, and spoken language organizations. The models' predictive values are further discussed in the context of anthropological theories of oral communication evolution and the neurodevelopment of spoken language proto-networks in infants/toddlers. These phylogenetic and ontogenetic frameworks both entail cortical network maturations that are proposed to at least in part be organized around a number of universal acoustic-semantic signal attributes of natural sounds, which are addressed herein.
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Affiliation(s)
- Julie A Brefczynski-Lewis
- Blanchette Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA; Department of Physiology, Pharmacology, & Neuroscience, West Virginia University, PO Box 9229, Morgantown, WV 26506, USA
| | - James W Lewis
- Blanchette Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA; Department of Physiology, Pharmacology, & Neuroscience, West Virginia University, PO Box 9229, Morgantown, WV 26506, USA.
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29
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Maternal PTSD and corresponding neural activity mediate effects of child exposure to violence on child PTSD symptoms. PLoS One 2017; 12:e0181066. [PMID: 28767657 PMCID: PMC5540394 DOI: 10.1371/journal.pone.0181066] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/26/2017] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to examine the relationship of maternal interpersonal violence-related posttraumatic stress disorder (IPV-PTSD), associated neural activity in response to mother-child relational stimuli, and child psychopathology indicators at child ages 12-42 months and one year later. The study tested the hypothesis that decreased maternal neural activity in regions that subserve emotion regulation would be associated with child symptoms associated with emotional dysregulation at both time points. Functional magnetic resonance imaging of 42 mothers with or without violence-exposure and associated IPV-PTSD were assessed. Their child's life-events and symptoms/behaviors indicative of high-risk subsequent PTSD diagnosis on a maternal-report questionnaire were measured one year later. Maternal IPV-PTSD severity was significantly associated with decreased ventromedial prefrontal cortex (vmPFC) activation in response to mother-child relational stimuli. Maternal IPV-PTSD severity and decreased vmPFC activation were then significantly associated with a child attachment disturbance at 12-42 months and symptoms/behaviors one year later, that were correlated with emotional dysregulation and risk for child PTSD. Maternal IPV-PTSD and child exposure to IPV were both predictive of child PTSD symptoms with maternal IPV-PTSD likely mediating the effects of child IPV exposure on child PTSD symptoms. These findings suggest that maternal IPV-PTSD severity and associated decreased vmPFC activity in response to mother-child relational stimuli are predictors of child psychopathology by age 12-42 months and one-year later. Significant findings in this paper may well be useful in understanding how maternal top-down cortico-limbic dysregulation promotes intergenerational transmission of IPV and related psychopathology and, thus should be targeted in treatment.
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30
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Leppanen J, Cardi V, Paloyelis Y, Simmons A, Tchanturia K, Treasure J. FMRI Study of Neural Responses to Implicit Infant Emotion in Anorexia Nervosa. Front Psychol 2017; 8:780. [PMID: 28567026 PMCID: PMC5434152 DOI: 10.3389/fpsyg.2017.00780] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/26/2017] [Indexed: 12/29/2022] Open
Abstract
Difficulties in social–emotional processing have been proposed to play an important role in the development and maintenance of anorexia nervosa (AN). Few studies, thus far, have investigated neural processes that underlie these difficulties, including processing emotional facial expressions. However, the majority of these studies have investigated neural responses to adult emotional display, which may be confounded by elevated sensitivity to social rank and threat in AN. Therefore, the aim of this study was to investigate the neural processes underlying implicit processing of positively and negatively valenced infant emotional display in AN. Twenty-one adult women with AN and twenty-six healthy comparison (HC) women were presented with images of positively valenced, negatively valenced, and neutral infant faces during a fMRI scan. Significant differences between the groups in positive > neutral and negative > neutral contrasts were investigated in a priori regions of interest, including the bilateral amygdala, insula, and lateral prefrontal cortex (PFC). The findings revealed that the AN participants showed relatively increased recruitment while the HC participants showed relatively reduced recruitment of the bilateral amygdala and the right dorsolateral PFC in the positive > neutral contrast. In the negative > neutral contrast, the AN group showed relatively increased recruitment of the left posterior insula while the HC groups showed relatively reduced recruitment of this region. These findings suggest that people with AN may engage in implicit prefrontal down-regulation of elevated limbic reactivity to positively social–emotional stimuli.
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Affiliation(s)
- Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
| | - Andy Simmons
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK.,Department of Psychology, Ilia State UniversityTbilisi, Georgia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
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32
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The association of serotonin receptor 3A methylation with maternal violence exposure, neural activity, and child aggression. Behav Brain Res 2017; 325:268-277. [DOI: 10.1016/j.bbr.2016.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 01/05/2023]
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Wright DB, Laurent HK, Ablow JC. Mothers Who Were Neglected in Childhood Show Differences in Neural Response to Their Infant's Cry. CHILD MALTREATMENT 2017; 22:158-166. [PMID: 28413918 DOI: 10.1177/1077559516683503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study used functional magnetic resonance imaging to investigate how a mother's experience of neglect in her own childhood is associated with her neural response to her infant's distress cues. During scanning, 22 high-risk primiparous mothers were exposed to both their own 18-month-old infant's cry sound and a control sound. Mothers' continuous Neglect subscale scores from the Childhood Trauma Questionnaire were examined as a predictor of their neural response to own infant cry > control sound. Mothers who reported high levels of neglect from childhood showed regions of hyperactivation to their infant's cry (relative to control sound) in the anterior and posterior cingulate cortices and insula as well as specific prefrontal (precentral gyrus) and parietal (posterior supramarginal gyrus) areas. These results may suggest how important early life experiences are for future parenting responses and behaviors.
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Abstract
New mothers undergo dynamic neural changes that support positive adaptation to parenting and the development of mother-infant relationships. In this article, I review important psychological adaptations that mothers experience during pregnancy and the early postpartum period. I then review evidence of structural and functional plasticity in human mothers' brains, and explore how such plasticity supports mothers' psychological adaptation to parenting and sensitive maternal behaviors. Last, I discuss pregnancy and the early postpartum period as a window of vulnerabilities and opportunities when the human maternal brain is influenced by stress and psychopathology, but also receptive to interventions.
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Schechter DS. Witch-mother is which? The potential role of the analyst in facilitating authentic motherhood. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2016. [DOI: 10.1080/0803706x.2016.1195511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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van Ee E, Kleber RJ, Jongmans MJ. Relational Patterns Between Caregivers With PTSD and Their Nonexposed Children: A Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:186-203. [PMID: 25964276 DOI: 10.1177/1524838015584355] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The question as to whether or not children can be affected by the traumatization of their parents has been the topic of a long-standing debate. This article provides a critical review of 72 research studies on traumatized parents with symptoms of posttraumatic stress disorder (PTSD), the parent-child interaction, and the impact on their nonexposed child (0-18 years). The evidence suggests that traumatization can cause parenting limitations, and these limitations can disrupt the development of the young child. From the studies reviewed several patterns emerged: Relational patterns of traumatized parents who are observed to be emotionally less available and who perceive their children more negatively than parents without symptoms of PTSD; relational patterns of children who at a young age are easily deregulated or distressed and at an older age are reported to face more difficulties in their psychosocial development than children of parents without symptoms of PTSD; and relational patterns that show remarkable similarities to relational patterns between depressed or anxious parents and their children. Mechanisms such as mentalization, attachment, physiological factors, and the cycle of abuse offer a valuable perspective to further our understanding of the relational patterns. This article builds on previous work by discussing the emerged patterns between traumatized parents and their nonexposed children from a relational and transactional perspective.
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Affiliation(s)
- Elisa van Ee
- Reinier van Arkel, Psychotraumacentrum Zuid Nederland, Den Bosch, the Netherlands
| | - Rolf J Kleber
- Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
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Kunseler FC, Oosterman M, de Moor MHM, Verhage ML, Schuengel C. Weakened Resilience in Parenting Self-Efficacy in Pregnant Women Who Were Abused in Childhood: An Experimental Test. PLoS One 2016; 11:e0141801. [PMID: 26848573 PMCID: PMC4744056 DOI: 10.1371/journal.pone.0141801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/13/2015] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Florentina C. Kunseler
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, The Netherlands
| | - Mirjam Oosterman
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, The Netherlands
| | - Marleen H. M. de Moor
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, The Netherlands
| | - Marije L. Verhage
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, The Netherlands
| | - Carlo Schuengel
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Vrije Universiteit Amsterdam, The Netherlands
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Kim P, Strathearn L, Swain JE. The maternal brain and its plasticity in humans. Horm Behav 2016; 77:113-23. [PMID: 26268151 PMCID: PMC4724473 DOI: 10.1016/j.yhbeh.2015.08.001] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023]
Abstract
This article is part of a Special Issue "Parental Care". Early mother-infant relationships play important roles in infants' optimal development. New mothers undergo neurobiological changes that support developing mother-infant relationships regardless of great individual differences in those relationships. In this article, we review the neural plasticity in human mothers' brains based on functional magnetic resonance imaging (fMRI) studies. First, we review the neural circuits that are involved in establishing and maintaining mother-infant relationships. Second, we discuss early postpartum factors (e.g., birth and feeding methods, hormones, and parental sensitivity) that are associated with individual differences in maternal brain neuroplasticity. Third, we discuss abnormal changes in the maternal brain related to psychopathology (i.e., postpartum depression, posttraumatic stress disorder, substance abuse) and potential brain remodeling associated with interventions. Last, we highlight potentially important future research directions to better understand normative changes in the maternal brain and risks for abnormal changes that may disrupt early mother-infant relationships.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Lane Strathearn
- Department of Pediatrics, University of Iowa, Center for Disabilities and Development, 100 Hawkins Drive 213F CDD, Iowa City, IA 52246-1011, United States.
| | - James E Swain
- Department of Psychiatry, Psychology and Center for Human Growth and Development, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109-2700, United States.
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Feldman R. The neurobiology of mammalian parenting and the biosocial context of human caregiving. Horm Behav 2016; 77:3-17. [PMID: 26453928 DOI: 10.1016/j.yhbeh.2015.10.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/29/2015] [Accepted: 10/06/2015] [Indexed: 02/05/2023]
Abstract
This article is part of a Special Issue "Parental Care". Research on the neurobiology of attachment, pioneered by scholars in the generation that followed the discovery of social bonding, examined the biological basis of mammalian parenting through systematic experiments in animal models and their application to theories on human attachment. This paper argues for the need to construct a theory on the neurobiology of human attachment that integrates findings in animal models with human neuroscience research to formulate concepts based on experimental, not only extrapolative data. Rosenblatt's (2003) three characteristics of mammalian parenting - rapid formation of attachment, behavioral synchrony, and mother-offspring attachment as basis of social organization - are used to guide discussion on mammalian-general versus human-specific attributes of parental care. These highlight specific components of attachment in rodents, primates, and humans that chart the evolution from promiscuous, nest-bound, olfactory-based bonds to exclusive, multi-sensory, and representation-based attachments. Following, three continua are outlined in parental behavior, hormones, and brain, each detailing the evolution from rodents to humans. Parental behavior is defined as a process of trophallaxis - the reciprocal multisensory exchange that supports approach orientation and enables collaboration in social species - and includes human-specific features that enable behavioral synchrony independent of tactile contact. The oxytocin system incorporates conserved and human-specific components and is marked by pulsatile activity and dendritic release that reorganize neural networks on the basis of species-specific attachment experiences. Finally, the subcortical limbic circuit underpinning mammalian mothering extends in humans to include multiple cortical networks implicated in empathy, mentalizing, and emotion regulation that enable flexible, goal-directed caregiving. I conclude by presenting a philosophical continuum from Hobbes to Lorenz, which illustrates how research on the neurobiology of attachment can put in the forefront the social-collaborative elements in human nature and afford a new perspective on the mind-brain polarity.
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Affiliation(s)
- Ruth Feldman
- Department of Psychology and the Gonda Brain Sciences Center, Bar-Ilan University, Ramat-Gan 52900, Israel.
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Moser DA, Paoloni-Giacobino A, Stenz L, Adouan W, Manini A, Suardi F, Cordero MI, Vital M, Sancho Rossignol A, Rusconi-Serpa S, Ansermet F, Dayer AG, Schechter DS. BDNF Methylation and Maternal Brain Activity in a Violence-Related Sample. PLoS One 2015; 10:e0143427. [PMID: 26649946 PMCID: PMC4674054 DOI: 10.1371/journal.pone.0143427] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/04/2015] [Indexed: 11/18/2022] Open
Abstract
It is known that increased circulating glucocorticoids in the wake of excessive, chronic, repetitive stress increases anxiety and impairs Brain-Derived Neurotrophic Factor (BDNF) signaling. Recent studies of BDNF gene methylation in relation to maternal care have linked high BDNF methylation levels in the blood of adults to lower quality of received maternal care measured via self-report. Yet the specific mechanisms by which these phenomena occur remain to be established. The present study examines the link between methylation of the BDNF gene promoter region and patterns of neural activity that are associated with maternal response to stressful versus non-stressful child stimuli within a sample that includes mothers with interpersonal violence-related PTSD (IPV-PTSD). 46 mothers underwent fMRI. The contrast of neural activity when watching children—including their own—was then correlated to BDNF methylation. Consistent with the existing literature, the present study found that maternal BDNF methylation was associated with higher levels of maternal anxiety and greater childhood exposure to domestic violence. fMRI results showed a positive correlation of BDNF methylation with maternal brain activity in the anterior cingulate (ACC), and ventromedial prefrontal cortex (vmPFC), regions generally credited with a regulatory function toward brain areas that are generating emotions. Furthermore we found a negative correlation of BDNF methylation with the activity of the right hippocampus. Since our stimuli focus on stressful parenting conditions, these data suggest that the correlation between vmPFC/ACC activity and BDNF methylation may be linked to mothers who are at a disadvantage with respect to emotion regulation when facing stressful parenting situations. Overall, this study provides evidence that epigenetic signatures of stress-related genes can be linked to functional brain regions regulating parenting stress, thus advancing our understanding of mothers at risk for stress-related psychopathology.
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Affiliation(s)
- Dominik A. Moser
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Ariane Paoloni-Giacobino
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Ludwig Stenz
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Wafae Adouan
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Aurélia Manini
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Francesca Suardi
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Maria I. Cordero
- Faculty of Health, Psychology and Social care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Marylene Vital
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Ana Sancho Rossignol
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Sandra Rusconi-Serpa
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - François Ansermet
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Alexandre G. Dayer
- Faculty of Health, Psychology and Social care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Daniel S. Schechter
- Department of Child & Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
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Moser DA, Aue T, Suardi F, Manini A, Sancho Rossignol A, Cordero MI, Merminod G, Ansermet F, Rusconi Serpa S, Favez N, Schechter DS. The relation of general socio-emotional processing to parenting specific behavior: a study of mothers with and without posttraumatic stress disorder. Front Psychol 2015; 6:1575. [PMID: 26578996 PMCID: PMC4625041 DOI: 10.3389/fpsyg.2015.01575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/29/2015] [Indexed: 01/27/2023] Open
Abstract
Socio-emotional information processing during everyday human interactions has been assumed to translate to social-emotional information processing when parenting a child. Yet, few studies have examined whether this is indeed the case. This study aimed to improve on this by connecting the functional neuroimaging data when seeing socio-emotional interactions that are not parenting specific to observed maternal sensitivity. The current study considered 45 mothers of small children (12-42 months of age). It included healthy controls (HC) and mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD), as well as mothers without PTSD, both with and without IPV exposure. We found that anterior cingulate cortex (ACC) and ventromedial prefrontal cortex (vmPFC) activity correlated negatively with observed maternal sensitivity when mothers watched videos of menacing vs. prosocial adult male-female interactions. This relationship was independent of whether mothers were HC or had IPV-PTSD. We also found dorsolateral prefrontal cortex (dlPFC) activity to be correlated negatively with maternal sensitivity when mothers watched any kind of arousing adult interactions. With regards to ACC and vmPFC activity, we interpret our results to mean that the ease of general emotional information integration translates to parenting-specific behavior. Our dlPFC activity findings support the idea that the efficiency of top-down control of socio-emotional processing in non-parenting specific contexts may be predictive of parenting behavior.
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Affiliation(s)
- Dominik A Moser
- Faculty of Psychology and Education Sciences, University of Geneva Geneva, Switzerland ; Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - Tatjana Aue
- Institute of Psychology, University of Bern Bern, Switzerland
| | - Francesca Suardi
- Faculty of Psychology and Education Sciences, University of Geneva Geneva, Switzerland ; Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - Aurélia Manini
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - Ana Sancho Rossignol
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - Maria I Cordero
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland ; Faculty of Health, Psychology and Social Care, Manchester Metropolitan University Manchester, UK
| | - Gaëlle Merminod
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - François Ansermet
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland ; Faculty of Medicine, University of Geneva Geneva, Switzerland
| | - Sandra Rusconi Serpa
- Faculty of Psychology and Education Sciences, University of Geneva Geneva, Switzerland ; Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland
| | - Nicolas Favez
- Faculty of Psychology and Education Sciences, University of Geneva Geneva, Switzerland
| | - Daniel S Schechter
- Research Unit, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals Geneva, Switzerland ; Faculty of Medicine, University of Geneva Geneva, Switzerland
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42
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Impact du stress post-traumatique lié à la violence domestique sur la parentalité : Données empiriques et applications cliniques. ENFANCE 2015. [DOI: 10.4074/s0013754515003110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Rusconi-Serpa S, Suardi F, Moser D, Schechter DS. Impact du stress post-traumatique lié à la violence domestique sur la parentalité : Données empiriques et applications cliniques. ENFANCE 2015. [DOI: 10.3917/enf1.153.0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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44
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Stark EA, Parsons CE, Van Hartevelt TJ, Charquero-Ballester M, McManners H, Ehlers A, Stein A, Kringelbach ML. Post-traumatic stress influences the brain even in the absence of symptoms: A systematic, quantitative meta-analysis of neuroimaging studies. Neurosci Biobehav Rev 2015; 56:207-21. [PMID: 26192104 DOI: 10.1016/j.neubiorev.2015.07.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
Stress affects brain function, and may lead to post-traumatic stress disorder (PTSD). Considerable empirical data for the neurobiology of PTSD has been derived from neuroimaging studies, although findings have proven inconsistent. We used an activation likelihood estimation analysis to explore differences in brain activity between adults with and without PTSD in response to affective stimuli. We separated studies by type of control group: trauma-exposed and trauma-naïve. This revealed distinct patterns of differences in functional activity. Compared to trauma-exposed controls, regions of the basal ganglia were differentially active in PTSD; whereas the comparison with trauma-naïve controls revealed differential involvement in the right anterior insula, precuneus, cingulate and orbitofrontal cortices known to be involved in emotional regulation. Changes in activity in the amygdala and parahippocampal cortex distinguished PTSD from both control groups. Results suggest that trauma has a measurable, enduring effect upon the functional dynamics of the brain, even in individuals who experience trauma but do not develop PTSD. These findings contribute to the understanding of whole-brain network activity following trauma, and its transition to clinical PTSD.
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Affiliation(s)
- E A Stark
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - C E Parsons
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark
| | - T J Van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - M Charquero-Ballester
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - H McManners
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom
| | - A Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - A Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - M L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark.
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45
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Feldman R. The adaptive human parental brain: implications for children's social development. Trends Neurosci 2015; 38:387-99. [DOI: 10.1016/j.tins.2015.04.004] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
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Schechter DS, Moser DA, Paoloni-Giacobino A, Stenz L, Gex-Fabry M, Aue T, Adouan W, Cordero MI, Suardi F, Manini A, Sancho Rossignol A, Merminod G, Ansermet F, Dayer AG, Rusconi Serpa S. Methylation of NR3C1 is related to maternal PTSD, parenting stress and maternal medial prefrontal cortical activity in response to child separation among mothers with histories of violence exposure. Front Psychol 2015; 6:690. [PMID: 26074844 PMCID: PMC4447998 DOI: 10.3389/fpsyg.2015.00690] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/10/2015] [Indexed: 02/05/2023] Open
Abstract
Prior research has shown that mothers with Interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) report greater difficulty in parenting their toddlers. Relative to their frequent early exposure to violence and maltreatment, these mothers display dysregulation of their hypothalamic pituitary adrenal axis (HPA-axis), characterized by hypocortisolism. Considering methylation of the promoter region of the glucocorticoid receptor gene NR3C1 as a marker for HPA-axis functioning, with less methylation likely being associated with less circulating cortisol, the present study tested the hypothesis that the degree of methylation of this gene would be negatively correlated with maternal IPV-PTSD severity and parenting stress, and positively correlated with medial prefrontal cortical (mPFC) activity in response to video-stimuli of stressful versus non-stressful mother–child interactions. Following a mental health assessment, 45 mothers and their children (ages 12–42 months) participated in a behavioral protocol involving free-play and laboratory stressors such as mother–child separation. Maternal DNA was extracted from saliva. Interactive behavior was rated on the CARE-Index. During subsequent fMRI scanning, mothers were shown films of free-play and separation drawn from this protocol. Maternal PTSD severity and parenting stress were negatively correlated with the mean percentage of methylation of NR3C1. Maternal mPFC activity in response to video-stimuli of mother–child separation versus play correlated positively to NR3C1 methylation, and negatively to maternal IPV-PTSD and parenting stress. Among interactive behavior variables, child cooperativeness in play was positively correlated with NR3C1 methylation. Thus, the present study is the first published report to our knowledge, suggesting convergence of behavioral, epigenetic, and neuroimaging data that form a psychobiological signature of parenting-risk in the context of early life stress and PTSD.
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Affiliation(s)
- Daniel S Schechter
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland ; Division of Developmental Neuroscience, Department of Psychiatry, Columbia University College of Physicians and Surgeons New York, NY, USA
| | - Dominik A Moser
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Ariane Paoloni-Giacobino
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Geneva, Switzerland
| | - Ludwig Stenz
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Geneva, Switzerland
| | - Marianne Gex-Fabry
- Department of Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Tatjana Aue
- Swiss Center for Affective Sciences, University of Geneva Geneva, Switzerland ; Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern Bern, Switzerland
| | - Wafae Adouan
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva Geneva, Switzerland
| | - María I Cordero
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland ; Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern Bern, Switzerland ; Faculty of Health, Psychology and Social Care, Manchester Metropolitan University Manchester, UK
| | - Francesca Suardi
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Aurelia Manini
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Ana Sancho Rossignol
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Gaëlle Merminod
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Francois Ansermet
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Alexandre G Dayer
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland ; Department of Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
| | - Sandra Rusconi Serpa
- Geneva Early Childhood Stress Project, Department of Child and Adolescent Psychiatry, Faculty of Medicine, University of Geneva Hospitals Geneva, Switzerland
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Steele M, Steele H, Bate J, Knafo H, Kinsey M, Bonuck K, Meisner P, Murphy A. Looking from the outside in: the use of video in attachment-based interventions. Attach Hum Dev 2015; 16:402-15. [PMID: 24972107 DOI: 10.1080/14616734.2014.912491] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper provides an account of multiple potential benefits of using video in clinical interventions designed to promote change in parent-child attachment relationships. The power of video to provide a unique perspective on parents' ways of thinking and feeling about their own behavior and that of their child will be discussed in terms of current attachment-based interventions using video either as the main component of the treatment or in addition to a more comprehensive treatment protocol. Interventions also range from those that use micro-analytic as compared to more global units of analyses, and there are potential bridges to be made with neuro-scientific research findings. In addition, this paper provides a clinical illustration of the utility of showing parents vignettes of video-filmed observations of parent-child interactions from the Group Attachment Based Intervention (GABI) for vulnerable families. Emphasis is placed on the motivational force arising from seeing (and hearing) oneself in interaction with one's child on video, thus serving as a powerful catalyst for reflective functioning and updating one's frame of reference for how to think, feel and behave with one's child.
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Affiliation(s)
- Miriam Steele
- a Psychology Department , New School for Social Research , New York , USA
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48
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Schechter DS, Moser DA, Reliford A, McCaw JE, Coates SW, Turner JB, Serpa SR, Willheim E. Negative and distorted attributions towards child, self, and primary attachment figure among posttraumatically stressed mothers: what changes with Clinician Assisted Videofeedback Exposure Sessions (CAVES). Child Psychiatry Hum Dev 2015; 46:10-20. [PMID: 24553738 PMCID: PMC4139484 DOI: 10.1007/s10578-014-0447-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the "Clinician Assisted Videofeedback Exposure Session(s)" (CAVES), for mothers with IPV-PTSD as compared to control-subjects.
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Affiliation(s)
- Daniel S Schechter
- Unité de Recherche, Department of Child and Adolescent Psychiatry, University of Geneva Hospitals, Rue Verte 2, 1205, Geneva, Switzerland,
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49
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Maupin AN, Hayes NJ, Mayes LC, Rutherford HJ. The Application of Electroencephalography to Investigate the Neural Bases of Parenting: A Review. PARENTING, SCIENCE AND PRACTICE 2015; 15:9-23. [PMID: 26120286 PMCID: PMC4477836 DOI: 10.1080/15295192.2015.992735] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Angela N. Maupin
- Yale Child Study Center, Yale University, 230 South Frontage Road, New Haven, CT 06520
| | - Nathan J. Hayes
- Yale Child Study Center, Yale University, 230 South Frontage Road, New Haven, CT 06520
| | - Linda C. Mayes
- Yale Child Study Center, Yale University, 230 South Frontage Road, New Haven, CT 06520
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50
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Kim P, Rigo P, Leckman JF, Mayes LC, Cole PM, Feldman R, Swain JE. A Prospective Longitudinal Study of Perceived Infant Outcomes at 18-24 Months: Neural and Psychological Correlates of Parental Thoughts and Actions Assessed during the First Month Postpartum. Front Psychol 2015; 6:1772. [PMID: 26635679 PMCID: PMC4654106 DOI: 10.3389/fpsyg.2015.01772] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/04/2015] [Indexed: 01/12/2023] Open
Abstract
The first postpartum months constitute a critical period for parents to establish an emotional bond with their infants. Neural responses to infant-related stimuli have been associated with parental sensitivity. However, the associations among these neural responses, parenting, and later infant outcomes for mothers and fathers are unknown. In the current longitudinal study, we investigated the relationships between parental thoughts/actions and neural activation in mothers and fathers in the neonatal period with infant outcomes at the toddler stage. At the first month postpartum, mothers (n = 21) and fathers (n = 19) underwent a neuroimaging session during which they listened to their own and unfamiliar baby's cry. Parenting-related thoughts/behaviors were assessed by interview twice at the first month and 3-4 months postpartum and infants' socioemotional outcomes were reported by mothers and fathers at 18-24 months postpartum. In mothers, higher levels of anxious thoughts/actions about parenting at the first month postpartum, but not at 3-4 months postpartum, were associated with infant's low socioemotional competencies at 18-24 months. Anxious thoughts/actions were also associated with heightened responses in the motor cortex and reduced responses in the substantia nigra to own infant cry sounds. On the other hand, in fathers, higher levels of positive perception of being a parent at the first month postpartum, but not at 3-4 months postpartum, were associated with higher infant socioemotional competencies at 18-24 months. Positive thoughts were associated with heightened responses in the auditory cortex and caudate to own infant cry sounds. The current study provides evidence that parental thoughts are related to concurrent neural responses to their infants at the first month postpartum as well as their infant's future socioemotional outcome at 18-24 months. Parent differences suggest that anxious thoughts in mothers and positive thoughts in fathers may be the targets for parenting-focused interventions very early postpartum.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of DenverDenver, CO, USA
- *Correspondence: Pilyoung Kim,
| | - Paola Rigo
- Department of Psychology and Cognitive Science, University of TrentoTrento, Italy
| | - James F. Leckman
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
| | - Linda C. Mayes
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
| | - Pamela M. Cole
- Department of Psychology, The Pennsylvania State UniversityUniversity Park, PA, USA
| | - Ruth Feldman
- Department of Psychology, Bar-Ilan UniversityRamat Gan, Israel
| | - James E. Swain
- Child Study Center, Yale University School of MedicineNew Haven, CT, USA
- Department of Psychiatry, Psychology, Center for Human Growth and Development, Women and Infants Mental Health Program, University of MichiganAnn Arbor, MI, USA
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