1
|
Ding N, Fu L, Qian L, Sun B, Li C, Gao H, Lei T, Ke X. The correlation between brain structure characteristics and emotion regulation ability in children at high risk of autism spectrum disorder. Eur Child Adolesc Psychiatry 2024; 33:3247-3262. [PMID: 38402375 DOI: 10.1007/s00787-024-02369-y] [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: 08/14/2023] [Accepted: 01/08/2024] [Indexed: 02/26/2024]
Abstract
As indicated by longitudinal observation, autism has difficulty controlling emotions to a certain extent in early childhood, and most children's emotional and behavioral problems are further aggravated with the growth of age. This study aimed at exploring the correlation between white matter and white matter fiber bundle connectivity characteristics and their emotional regulation ability in children with autism using machine learning methods, which can lay an empirical basis for early clinical intervention of autism. Fifty-five high risk of autism spectrum disorder (HR-ASD) children and 52 typical development (TD) children were selected to complete the skull 3D-T1 structure and diffusion tensor imaging (DTI). The emotional regulation ability of the two groups was compared using the still-face paradigm (SFP). The classification and regression models of white matter characteristics and white matter fiber bundle connections of emotion regulation ability in the HR-ASD group were built based on the machine learning method. The volume of the right amygdala (R2 = 0.245) and the volume of the right hippocampus (R2 = 0.197) affected constructive emotion regulation strategies. FA (R2 = 0.32) and MD (R2 = 0.34) had the predictive effect on self-stimulating behaviour. White matter fiber bundle connection predicted constructive regulation strategies (positive edging R2 = 0.333, negative edging R2 = 0.334) and mother-seeking behaviors (positive edging R2 = 0.667, negative edging R2 = 0.363). The emotional regulation ability of HR-ASD children is significantly correlated with the connections of multiple white matter fiber bundles, which is a potential neuro-biomarker of emotional regulation ability.
Collapse
Affiliation(s)
- Ning Ding
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
- Qingdao Women and Children' s Hospital, Qingdao University, Qingdao, 266011, China
| | - Linyan Fu
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lu Qian
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bei Sun
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chunyan Li
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huiyun Gao
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Tianyu Lei
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiaoyan Ke
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
| |
Collapse
|
2
|
Sullivan ADW, Roubinov D, Noroña-Zhou AN, Bush NR. Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review. Psychoneuroendocrinology 2024; 162:106949. [PMID: 38295654 DOI: 10.1016/j.psyneuen.2023.106949] [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: 08/30/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 03/04/2024]
Abstract
BACKGROUND Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts. METHODS We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field. RESULTS Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers. CONCLUSIONS We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.
Collapse
Affiliation(s)
- Alexandra D W Sullivan
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA.
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Amanda N Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA.
| |
Collapse
|
3
|
Lynch SF, Perlstein S, Ordway C, Jones C, Lembcke H, Waller R, Wagner NJ. Parasympathetic Nervous System Functioning Moderates the Associations between Callous-Unemotional Traits and Emotion Understanding Difficulties in Late Childhood. CHILDREN (BASEL, SWITZERLAND) 2024; 11:184. [PMID: 38397296 PMCID: PMC10887086 DOI: 10.3390/children11020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Callous-unemotional (CU) traits are characterized by low empathy, guilt, and prosociality, putting children at risk for lifespan antisocial behavior. Elevated CU traits have been linked separately to difficulties with emotion understanding (i.e., identifying emotional states of others) and disrupted parasympathetic nervous system (PNS) functioning. However, no study has investigated how PNS functioning and emotion understanding are jointly related to CU traits. METHOD We explored associations between CU traits, emotion understanding, and PNS functioning (indexed via respiratory sinus arrhythmia [RSA]) among children aged 7-10 years old (n = 55). We also tested whether deficits in emotion understanding differ across specific emotions (i.e., fear, pain, happiness, anger). Each child's RSA was continuously recorded while they watched a film that included emotionally evocative social interactions. To assess emotion understanding, children identified emotions replayed in 1s animations of scenes from the film. Parents reported on child CU traits, conduct problems, and demographic information. RESULTS Higher CU traits were related to lower emotion understanding (β = -0.43, p = 0.03). PNS activity during the film moderated this association (β = -0.47, p < 0.001), such that CU traits were associated with lower emotion understanding among children with mean (B = -0.01, t = -2.46, p = 0.02) or high (i.e., 1 SD > M; B = -0.02, t = -3.00, p < 0.001) RSA levels during the film, but not among children with low RSA levels (i.e., 1 SD < M; B = 0.00, t = -0.53, p = 0.60). Moreover, we found that the observed moderated associations are driven by deficits in fear, specifically. CONCLUSIONS The link between poorer emotion understanding, fear understanding in particular, and CU traits was attenuated for children who demonstrated patterns of PNS functioning consistent with attentional engagement while viewing the emotion stimuli.
Collapse
Affiliation(s)
- Sarah F. Lynch
- Developmental Sciences, Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (S.F.L.); (C.O.)
| | - Samantha Perlstein
- Clinical Psychology, Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.P.); (C.J.)
| | - Cora Ordway
- Developmental Sciences, Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (S.F.L.); (C.O.)
| | - Callie Jones
- Clinical Psychology, Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.P.); (C.J.)
| | - Hanna Lembcke
- Department of General Psychology, University of Hagen, 58097 Hagen, Germany;
| | - Rebecca Waller
- Clinical Psychology, Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA; (S.P.); (C.J.)
| | - Nicholas J. Wagner
- Developmental Sciences, Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA; (S.F.L.); (C.O.)
| |
Collapse
|
4
|
Kolacz J, Chen X, Nix EJ, Roath OK, Holmes LG, Tokash C, Porges SW, Lewis GF. Association of Self-Reported Autonomic Symptoms With Sensor-Based Physiological Measures. Psychosom Med 2023; 85:785-794. [PMID: 37678358 DOI: 10.1097/psy.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Autonomic regulation of organ and tissues may give rise to disruptions of typical functions. The Body Perception Questionnaire Short Form (BPQ-SF) includes items that were developed to assess autonomic symptoms in daily life. This pair of studies aimed to establish previously unexplored psychometric properties of the BPQ-SF autonomic symptoms scale, develop normative values for clinical and research use, and assess the convergence of self-reports with sensor-based measures. METHODS Study 1 reports exploratory and confirmatory factor analysis on BPQ-SF autonomic symptom items from a large US population-based online study ( n = 2048). In study 2, BPQ-SF scores were examined for associations with heart period, respiratory sinus arrhythmia, and skin conductance during seated leg lifts in a community sample ( n = 62). RESULTS Study 1 results supported a two-factor supradiaphragmatic and subdiaphragmatic autonomic symptom solution (confirmatory factor analysis: root mean squared error of approximation = 0.040, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99), although a one-factor solution also fit the data well (root mean squared error of approximation = 0.080, Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99). In study 2, heart period responses to leg lifts and rests were demonstrated at all autonomic symptom levels. However, low autonomic symptoms were associated with optimal autonomic nervous system patterns of activation and recovery to baseline levels. Moderate symptoms were associated with prolonged sympathetic activation. The highest symptom levels were associated with impaired autonomic nervous system coordination across activation and recovery. CONCLUSIONS Results support the utility of self-reports of autonomic symptoms in research and clinical applications, with higher symptoms likely indicating autonomic impairment.
Collapse
Affiliation(s)
- Jacek Kolacz
- From The Ohio State University Wexner Medical Center, Columbus, Ohio (Kolacz, Roath); Traumatic Stress Research Consortium (TSRC), Kinsey Institute, Indiana University-Bloomington, Bloomington, Indiana (Kolacz, Nix, Roath, Holmes, Tokash, Porges, Lewis); Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, Bloomington, Indiana (Chen); Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (Porges); and Intelligent Systems Engineering, Indiana University-Bloomington, Bloomington, Indiana (Lewis)
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Wagner NJ, Shakiba N, Bui HNT, Sem K, Novick DR, Danko CM, Dougherty LR, Chronis-Tuscano A, Rubin KH. Examining the Relations Between Children's Vagal Flexibility Across Social Stressor Tasks and Parent- and Clinician-Rated Anxiety Using Baseline Data from an Early Intervention for Inhibited Preschoolers. Res Child Adolesc Psychopathol 2023; 51:1213-1224. [PMID: 36961596 PMCID: PMC11267580 DOI: 10.1007/s10802-023-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/25/2023]
Abstract
Early behavioral inhibition (BI) is a known risk factor for later anxiety disorder. Variability in children's parasympathetic nervous system (PNS) functioning may provide insight into the substantial heterogeneity in anxiety outcomes for children high in BI. However, gaps persist due to an over-reliance on static measures of functioning, which limits our ability to leverage PNS functioning to identify risk for anxiety. We address these gaps using baseline data from an early intervention study of inhibited preschoolers by characterizing vagal flexibility (VF), an index of non-linear change in PNS functioning, across social stressor tasks and by examining the associations between VF and anxiety. One hundred and fifty-one parents and their 3.5- to 5-year-old children were selected on the basis of BI to participate in an early intervention program (ClinicalTrials.gov registration: NCT02308826). A structural equation modeling framework was used to model children's VF across tasks designed to mimic exposure to novel social interactions and to test the predictive links between VF and anxiety. Children who showed less VF, characterized by less suppression and flatter recovery, were rated by both parents and clinicians as more anxious. Moreover, a multiple group model showed that children meeting diagnostic criteria for social anxiety disorder demonstrated significantly less VF across social stressor tasks. Among inhibited youth, reduced VF is a risk factor for anxiety and may reflect an individual's reduced capacity to actively cope with external demands. Study results contribute to our understanding of the regulatory processes underlying risk for anxiety in early childhood.
Collapse
Affiliation(s)
- Nicholas J Wagner
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA.
| | - Nila Shakiba
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - Hong N T Bui
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Kathy Sem
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02215, USA
| | - Danielle R Novick
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Christina M Danko
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | - Lea R Dougherty
- Department of Psychology, University of Maryland, College Park, MD, 20742, USA
| | | | - Kenneth H Rubin
- Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742, USA
| |
Collapse
|
6
|
Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [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] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
Collapse
Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
| |
Collapse
|
7
|
Oxford ML, Hash JB, Lohr MJ, Fleming CB, Dow-Smith C, Spieker SJ. What works for whom? Mother's psychological distress as a moderator of the effectiveness of a home visiting intervention. Infant Ment Health J 2023; 44:301-318. [PMID: 36917197 DOI: 10.1002/imhj.22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
Attachment-based home visiting programs that serve new mothers experiencing psychological distress may advance health equity by helping families systemically exposed to adversity. This study examined whether one such program (Promoting First Relationships/PFR) had particularly beneficial effects on maternal and child relationship outcomes for mothers reporting the greatest psychological distress. A randomized controlled trial of the PFR program included a low-income sample of 252 Spanish- and English-speaking mother-child dyads referred prenatally for mental health concerns. The sample of mothers was 65.5% White, 17.5% Black, and 17.1% multiracial or other racial groups; 47.2% reported Hispanic ethnicity. The moderating variable of psychological distress was measured using maternal-reported screening tools for symptoms of depression, anxiety, anger, post-traumatic stress, and interpersonal sensitivity. Outcomes included observed parenting sensitivity and self-reported understanding of infants/toddlers, caregiving confidence, and child externalizing behavior. Results showed a significant treatment condition by baseline psychological distress interaction for observed parenting sensitivity such that differences in outcomes favoring the PFR condition were greatest among those with high baseline psychological distress (baseline child age 6-12 weeks). In a low-income sample of new mothers, those with the greatest need, as indicated by high psychological distress, showed greater improvements in their sensitive and responsive caregiving if they were randomized to the PFR treatment condition.
Collapse
Affiliation(s)
- Monica L Oxford
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Jonika B Hash
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Mary Jane Lohr
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, Washington, USA
| | - Carrie Dow-Smith
- WakeMed Children's Hospital, Pediatric Primary Care, Raleigh, North Carolina, USA
| | - Susan J Spieker
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| |
Collapse
|
8
|
Booth-LaForce C, Oxford ML, O’Leary R, Rees J, Petras A, Buchwald DS. Implementation fidelity of the Promoting First Relationships intervention program in a Native community. Transl Behav Med 2023; 13:34-41. [PMID: 36227860 PMCID: PMC9853091 DOI: 10.1093/tbm/ibac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Promoting First Relationship (PFR) is an evidence-based intervention designed to promote positive, supportive relationships between primary caregivers and their young children. Implementing and testing the efficacy of PFR in a remote Native community is especially challenging and requires methods and tools for ensuring implementation fidelity. Tribal members of a Native community were successfully trained and certified to deliver PFR by university-based personnel. During PFR delivery, they achieved very high scores on adherence to intervention content (M = 0.99, SD = 0.02), and their quality of delivery uniformly exceeded established criteria. High attrition occurred before PFR was delivered. However, participants who remained in the study completed all 10 sessions of PFR content. Participants' satisfaction with the program was very high (M = 3.90 [of 4 points], SD = 0.19). High implementation fidelity was attained in the face of many inherent challenges. The suite of methods and tools used for training, monitoring, and evaluating implementation fidelity in this study provides an example that may be useful in the evaluation of evidence-based programs more generally.
Collapse
Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Rae O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD 57625, USA
| | - Jennifer Rees
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Anthippy Petras
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
| |
Collapse
|
9
|
Promoting First Relationships ® for Primary Caregivers and Toddlers in a Native Community: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:39-49. [PMID: 35997845 DOI: 10.1007/s11121-022-01415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 02/03/2023]
Abstract
This study tested the effectiveness of Promoting First Relationships® (PFR), a preventive intervention program aimed at fostering positive caregiver-child relationships in Native families living on a rural reservation. Participants were 162 primary caregivers (96% Native; 93% female) and their Native toddlers (10-31 months old; 50% female). Families were randomized to a PFR group (n = 81) or Resource and Referral (RR) control group (n = 81), after baseline data collection (Time 1) to assess the quality of caregiver-child interaction, caregiver knowledge about children's social-emotional needs, caregiver depressive symptoms, and child externalizing behavior. After delivery of the PFR intervention or the RR service, follow-up assessments were repeated immediately post-intervention (Time 2) and 3 months later (Time 3). After controlling for baseline assessments, multivariate analyses of covariance revealed that caregivers in the PFR group had significantly higher scores on knowledge about children's social-emotional needs at Time 2 (p < .01, η2 = .06) and Time 3 (p < .05, η2 = .04) and less severe depressive symptoms at Times 2 and 3 (both p < .05, η2 = .04). At Time 3, the quality of caregiver-child interaction was better in the PFR group (p < .01, η2 = .06), an effect that was moderated by severity of depressive symptoms (p = .05, η2 = .06), with PFR having the greatest impact at low levels of initial symptoms (p = .02). Results support the positive impact of PFR in a Native community and suggest conditions under which the intervention may be most effective.
Collapse
|
10
|
O'Leary R, Oxford ML, Booth-LaForce C, London S, Buchwald DS. Experiences of Native Participants in the Promoting First Relationships® Intervention: Focus Group Findings. Matern Child Health J 2022; 26:2263-2270. [PMID: 36109420 PMCID: PMC10693919 DOI: 10.1007/s10995-022-03533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES We tested Promoting First Relationships® (PFR), an evidence-based preventive intervention program for caregivers promoting attachment and social and emotional development of infants and toddlers, in a randomized controlled trial in a Native community. Quantitative results yielded evidence of efficacy; but in this report, our objective was to assess the participants' real-life experiences, challenges, and suggested enhancements to further adapt the program. METHODS At the end of the study we conducted three focus groups (N = 17)-two groups for participants who completed the 10-week intervention and one group for those who did not. Focus groups were structured to generate discussion about (1) elements or activities of PFR they enjoyed and others that were challenging, (2) suggested solutions to participant challenges, (3) experiences with video recordings and handouts, and (4) aspects of the program that could be changed to make it more culturally-relevant. RESULTS Qualitative analysis of the focus group transcripts revealed five themes: (1) appreciation for PFR providers and program, (2) personal growth, (3) improved caregiver-child relationships, (4) participant challenges, and (5) participant suggestions to improve the program. CONCLUSIONS These qualitative results complement our quantitative assessment of the positive impact of the PFR program. Additionally, they provide importance guidance for future implementation of PFR in this, and other Native communities, as well as insight into broader issues to consider when adapting intervention programs for Native families.
Collapse
Affiliation(s)
- Rae O'Leary
- Missouri Breaks Industries Research, Inc., 118 S. Willow Street, PO Box 1824, Eagle Butte, SD, 57625, USA.
| | - Monica L Oxford
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Cathryn Booth-LaForce
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Sara London
- College of Education, University of Washington, Seattle, USA
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle and Spokane, USA
| |
Collapse
|
11
|
Tabachnick AR, Eiden RD, Labella MH, Dozier M. Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants. Dev Psychobiol 2022; 64:e22286. [PMID: 35748625 PMCID: PMC9400098 DOI: 10.1002/dev.22286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022]
Abstract
Little is known about whether postnatal intervention enhances autonomic regulation among infants at risk for dysregulation due to prenatal opioid exposure. The present study evaluated the effects of modified Attachment Behavioral Catch-up (mABC) on autonomic regulation for opioid-exposed infants in a pilot randomized clinical trial. We hypothesized that, compared to a control intervention (modified Developmental Education for Families [mDEF]), mABC would be associated with higher resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as well as greater reactivity to and recovery from a social stressor (Still-Face Paradigm). Pregnant or peripartum women receiving opioid agonist therapy (61 mothers of 64 infants; final N = 36 infants) were randomly assigned to mABC or mDEF, 12-session home visiting programs beginning in the third trimester; mABC targets sensitive parenting, and mDEF targets cognitive and motor development. mABC was associated with significantly greater RSA reactivity and marginally greater PEP reactivity. In models accommodating missing data, mABC was additionally associated with significantly greater RSA recovery. In sensitivity analyses removing siblings, mABC predicted significantly enhanced PEP reactivity. Overall, in these preliminary analyses, mABC was associated with healthier autonomic regulation during a social stressor than mDEF. Thus, mABC may be a promising strategy to promote autonomic regulation among opioid-exposed infants through parenting intervention.
Collapse
Affiliation(s)
- Alexandra R. Tabachnick
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Rina Das Eiden
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Madelyn H. Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| |
Collapse
|
12
|
Alen NV, Shields GS, Nemer A, D'Souza IA, Ohlgart MJ, Hostinar CE. A systematic review and meta-analysis of the association between parenting and child autonomic nervous system activity. Neurosci Biobehav Rev 2022; 139:104734. [PMID: 35716874 PMCID: PMC11023739 DOI: 10.1016/j.neubiorev.2022.104734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022]
Abstract
Parental socialization may influence the development of children's autonomic nervous system (ANS), a key stress-response system. However, to date no quantitative synthesis of the literature linking parenting and child ANS physiology has been conducted. To address this gap, we conducted a pre-registered meta-analysis. A systematic review of the literature identified 103 studies (n = 13,044 participants) with available effect sizes describing the association between parenting and either parasympathetic nervous system (PNS) or sympathetic nervous system (SNS) activity in children. The overall analysis revealed non-significant associations between parenting and child ANS physiology on average. However, moderation analyses revealed a positive association between more positive parenting and higher resting PNS activity that was stronger when a study was experimental rather than correlational, and when the sample included children with a clinical condition. In conclusion, well-controlled experimental studies show that positive parenting is associated with the development of higher resting PNS activity, an effect that may be stronger among children who are at elevated developmental risk.
Collapse
Affiliation(s)
- Nicholas V Alen
- Department of Psychology, University of California, Davis, USA; Department of Biological and Clinical Psychology, University of Trier, Germany
| | - Grant S Shields
- Department of Psychology, University of California, Davis, USA; Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701, USA
| | - Adele Nemer
- Department of Psychology, University of California, Davis, USA
| | | | | | | |
Collapse
|
13
|
Oxford ML, Hash JB, Lohr MJ, Bleil ME, Fleming CB, Unützer J, Spieker SJ. Randomized trial of promoting first relationships for new mothers who received community mental health services in pregnancy. Dev Psychol 2021; 57:1228-1241. [PMID: 34591567 DOI: 10.1037/dev0001219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The effectiveness of Promoting First Relationships (PFR), a 10-week home visiting program with video feedback, was tested in a randomized controlled trial involving 252 mothers and their 8- to 12-week-old infants. Mothers were eligible if they initiated treatment after mental health screening (depression, anxiety, posttraumatic stress disorder [PTSD]) at a community or public health primary care center in pregnancy. At baseline, 51% had mild to severe depression symptoms, 54% had mild to severe anxiety, and 35% had PTSD. Their ages ranged from 18 to 42 years. Mothers were 66% White, 18% Black, and 16% other races. Forty-seven percent identified as Hispanic, and 33% preferred to read and speak in Spanish. The median family annual income was less than $20,000. The PFR program or receipt of a resource packet (control condition) followed the baseline assessment and randomization; we assessed outcomes when infants were age 6 and 12 months. Compared to mothers in the control condition, mothers in the PFR condition had significantly (ps < .05) higher observed sensitivity scores at both follow-up time points (d = .25, d = .26), had improved understanding of infant-toddler social-emotional needs at both time points (d = .21, d = .45), and reported less infant externalizing behavior at age 12 months (d = .28). This study is the fourth completed randomized controlled trial of the PFR program, all involving populations experiencing adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Monica L Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Jonika B Hash
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Mary J Lohr
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Maria E Bleil
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Charlie B Fleming
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Jurgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Susan J Spieker
- Department of Child, Family, and Population Health Nursing, University of Washington
| |
Collapse
|
14
|
A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts. Dev Psychopathol 2021; 33:714-726. [PMID: 33517930 DOI: 10.1017/s095457942000156x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
An estimated 12 million girls aged 15-19 years, and 777,000 girls younger than 15 give birth globally each year. Contexts of war and displacement increase the likelihood of early marriage and childbearing. Given the developmentally sensitive periods of early childhood and adolescence, adolescent motherhood in conflict-affected contexts may put a family at risk intergenerationally. We propose that the specifics of normative neuroendocrine development during adolescence, including increased sensitivity to stress, pose additional risks to adolescent girls and their young children in the face of war and displacement, with potential lifelong consequences for health and development. This paper proposes a developmental, dual-generational framework for research and policies to better understand and address the needs of adolescent mothers and their small children. We draw from the literature on developmental stress physiology, adolescent parenthood in contexts of war and displacement internationally, and developmental cultural neurobiology. We also identify culturally meaningful sources of resilience and provide a review of the existing literature on interventions supporting adolescent mothers and their offspring. We aim to honor Edward Zigler's groundbreaking life and career by integrating basic developmental science with applied intervention and policy.
Collapse
|
15
|
Booth-LaForce C, Oxford ML, Barbosa-Leiker C, Burduli E, Buchwald DS. Randomized Controlled Trial of the Promoting First Relationships® Preventive Intervention for Primary Caregivers and Toddlers in an American Indian Community. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:98-108. [PMID: 31754964 DOI: 10.1007/s11121-019-01053-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preventive intervention programs that address parenting practices and children's developmental needs early in life have led to positive changes in caregiving behavior and children's developmental outcomes. However, little is known about the efficacy of such programs among American Indian families. This study tested the efficacy of the strengths-based Promoting First Relationships® (PFR) program in American Indian families living on a rural reservation. Participants were 34 toddlers (10-30 months old) and their primary caregivers. Families were randomized to an Immediate (n = 17) or Waitlist (n = 17) group after a home visit for baseline data collection, which included assessment of observed caregiver-child interactions, caregiver perceptions, and child behavior. After randomization, we delivered the PFR intervention in 10 visits to the Immediate group, with some adaptations based on focus groups with community members and staff input. We analyzed follow-up assessments by implementing multiple regression analyses, controlling for baseline scores and using multiple imputation to handle missing data. Results supported our primary hypotheses: the Immediate group, compared with Waitlist, had significantly higher scores on the quality (p = .011, d = 1.02) and contingent responsiveness (p = .013, d = 1.21) of caregiver-child interactions, as well as on caregiver knowledge of toddlers' social and emotional needs and level of developmentally appropriate expectations (p = .000, d = 0.58). Caregiver stress and caregivers' reports of child behavior did not differ significantly. Our results hold promise for additional PFR research in other Native communities.
Collapse
Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA.
| | - Monica L Oxford
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA
| | | | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| |
Collapse
|
16
|
Holochwost SJ, Kolacz J, Mills-Koonce WR. Towards an understanding of neurophysiological self-regulation in early childhood: A heuristic and a new approach. Dev Psychobiol 2020; 63:734-752. [PMID: 33164204 DOI: 10.1002/dev.22044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022]
Abstract
Self-regulation in early childhood encompasses both "top down," volitional processes, as well as the "bottom up" activity of three neurophysiological systems: the parasympathetic nervous system (PNS), the sympathetic nervous system (SNS), and the hypothalamic-pituitary-adrenal (HPA) axis. In this paper we briefly review the structure, function, and early development of each of these systems and then explain why neurophysiological self-regulation is most accurately defined as a function of their joint activity. We note that while there are a number of predictive models that employ this definition, the field would benefit from a straightforward heuristic and aligned methods of visualization and analysis. We then present one such heuristic, which we call neurophysiological space, and outline how it may facilitate a new, collaborative approach to building a better understanding of self-regulation in early childhood. We conclude with a presentation of early education as one setting in which our heuristic and methods could be applied.
Collapse
Affiliation(s)
- Steven J Holochwost
- Lehman College, City University of New York, 250 Bedford Park Boulevard West, Bronx, NY, 10468, USA
| | - Jacek Kolacz
- Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - W Roger Mills-Koonce
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
17
|
Kolacz J, Dale LP, Nix EJ, Roath OK, Lewis GF, Porges SW. Adversity History Predicts Self-Reported Autonomic Reactivity and Mental Health in US Residents During the COVID-19 Pandemic. Front Psychiatry 2020; 11:577728. [PMID: 33192715 PMCID: PMC7653174 DOI: 10.3389/fpsyt.2020.577728] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The spread of the COVID-19 virus presents an unprecedented event that rapidly introduced widespread life threat, economic destabilization, and social isolation. The human nervous system is tuned to detect safety and danger, integrating body and brain responses via the autonomic nervous system. Shifts in brain-body states toward danger responses can compromise mental health. For those who have experienced prior potentially traumatic events, the autonomic threat response system may be sensitive to new dangers and these threat responses may mediate the association between prior adversity and current mental health. Method: The present study collected survey data from adult U.S. residents (n = 1,666; 68% female; Age M = 46.24, SD = 15.14) recruited through websites, mailing lists, social media, and demographically-targeted sampling collected between March and May 2020. Participants reported on their adversity history, subjective experiences of autonomic reactivity, PTSD and depression symptoms, and intensity of worry related to the COVID-19 pandemic using a combination of standardized questionnaires and questions developed for the study. Formal mediation testing was conducted using path analysis and structural equation modeling. Results: Respondents with prior adversities reported higher levels of destabilized autonomic reactivity, PTSD and depression symptoms, and worry related to COVID-19. Autonomic reactivity mediated the relation between adversity and all mental health variables (standardized indirect effect range for unadjusted models: 0.212-0.340; covariate-adjusted model: 0.183-0.301). Discussion: The data highlight the important role of autonomic regulation as an intervening variable in mediating the impact of adversity on mental health. Because of the important role that autonomic function plays in the expression of mental health vulnerability, brain-body oriented therapies that promote threat response reduction should be investigated as possible therapeutic targets.
Collapse
Affiliation(s)
- Jacek Kolacz
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - Lourdes P. Dale
- Department of Psychiatry, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Evan J. Nix
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - Olivia K. Roath
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States
| | - Gregory F. Lewis
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States
- Intelligent Systems Engineering, Indiana University, Bloomington, IN, United States
| | - Stephen W. Porges
- Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
18
|
Alen NV, Sloan RP, Seeman TE, Hostinar CE. Childhood Parental Warmth and Heart Rate Variability in Midlife: Implications for Health. PERSONAL RELATIONSHIPS 2020; 27:506-525. [PMID: 33244293 PMCID: PMC7685289 DOI: 10.1111/pere.12329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study investigated high-frequency heart rate variability (HF-HRV) as a potential mediator between childhood parental warmth and later health and mortality outcomes. Participants were 1,255 adults (56.9% female). Childhood parental warmth was reported retrospectively at mean age 46; resting HF-HRV was measured at mean age 57; cardiovascular health and self-evaluated health were assessed at mean age 57 and 63, and mortality records extracted at mean age 63. Results revealed a positive association between childhood parental warmth and resting HF-HRV, as well as associations between higher HF-HRV and reduced risk of having a later cardiovascular health problem and of mortality by age 63. Mediation analyses revealed a small significant indirect effect of parental warmth, through HF-HRV, on cardiovascular health.
Collapse
|
19
|
Kuklinski MR, Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Benefit-cost analysis of Promoting First Relationships®: Implications of victim benefits assumptions for return on investment. CHILD ABUSE & NEGLECT 2020; 106:104515. [PMID: 32454356 PMCID: PMC7359609 DOI: 10.1016/j.chiabu.2020.104515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Child abuse and neglect (CAN) cost United States society $136 billion to $428 billion annually. Preventive interventions that reduce CAN may improve people's lives and generate economic benefits to society, but their magnitude is likely to vary greatly with assumptions about victim costs avoided through intervention. OBJECTIVE We examined the implications of different assumptions about avoided victim costs in a benefit-cost analysis of Promoting First Relationships® (PFR), a 10-session attachment and strengths-based home visiting intervention. PARTICIPANTS AND SETTING Participants were 247 child protection-involved but intact families in Washington State randomized to receive PFR (n = 124) or resource and referral (n = 123). METHODS We monetized intervention effects on out-of-home placements and implicit effects on CAN and calculated net present values under three scenarios: (1) benefits from avoided system costs, (2) additional benefits from avoided tangible victim costs, and (3) additional benefits from avoided tangible and intangible quality-of-life victim costs. For scenarios 2 and 3, we varied the CAN effect size and estimated the effect size at which PFR was reliably cost beneficial. RESULTS PFR's societal net benefit ranged from $1 (scenario 1) to $5514 - $25,562 (scenario 2) and $7004 - $32,072 (scenario 3) (2014 USD). In scenarios 2 and 3, PFR was reliably cost beneficial at a CAN effect size of approximately -0.25. CONCLUSIONS PFR is cost beneficial assuming tangible victim costs are avoided by PFR. Research into the long-term health and economic consequences of reducing CAN in at-risk populations would contribute to comprehensive, accurate benefits models.
Collapse
Affiliation(s)
- Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, United States.
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Susan J Spieker
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Mary Jane Lohr
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Charles B Fleming
- Center for The Study of Health and Risk Behavior, Department of Psychiatry, University of Washington, United States.
| |
Collapse
|
20
|
Glackin EB, Hatch V, Drury SS, Gray SAO. Linking preschoolers' parasympathetic activity to maternal early adversity and child behavior: An intergenerational perspective. Dev Psychobiol 2020; 63:338-349. [PMID: 32662198 DOI: 10.1002/dev.22012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/02/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
Increasing evidence suggests intergenerational effects of maternal early adversity on offspring self-regulation. Prior work has demonstrated associations between maternal adverse childhood experiences (ACEs) and infant respiratory sinus arrhythmia (RSA), a parasympathetic biomarker associated with emotional and behavioral self-regulation. The present study examined these associations and additional potential pathways including children's violence exposure and maternal psychopathology among 123 biological mother-child dyads. Families were low-income and oversampled for violence exposure; children were 3-5 years old. RSA was examined during dyadic interaction using latent growth curve modeling (LGCM). On average, females exhibited greater RSA reactivity. Greater RSA withdrawal across the interaction was associated with greater child negative affect during the interaction, linking RSA reactivity to concurrent child behavior. Consistent with previous findings among infants, high maternal ACEs were associated with lower child RSA at task initiation but not with RSA reactivity across the interaction. Findings suggest that the association between high maternal ACEs and a lower set point for offspring RSA persists into the early childhood period, beyond the influence of maternal psychopathology and children's own violence exposure. These data provide further evidence for the biological embedding of maternal early adversity across generations as well as for the relevance of RSA to child behavioral regulation.
Collapse
Affiliation(s)
- Erin B Glackin
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Virginia Hatch
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Stacy S Drury
- Department of Neuroscience, Tulane Brain Institute, Tulane University, New Orleans, LA, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sarah A O Gray
- Department of Psychology, Tulane University, New Orleans, LA, USA
| |
Collapse
|
21
|
Oxford M, Booth-LaForce C, Echo-Hawk A, Madesclaire O, Parrish L, Widner M, Petras A, Abrahamson-Richards T, Nelson K, Buchwald D. Promoting First Relationships®: Implementing a Home Visiting Research Program in Two American Indian Communities. Can J Nurs Res 2020; 52:149-156. [PMID: 32216455 DOI: 10.1177/0844562120914424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few, if any, home visiting programs for children under the age of three have been culturally adapted for American Indian reservation settings. We recently adapted one such program: Promoting First Relationships®. OBJECTIVES To culturally adapt Promoting First Relationships® while maintaining program fidelity, we used a community-based participatory approach to elicit input from two American Indian partners. METHODS University-based researchers, reservation-based Native project staff, and Native tribal liaisons conducted collaborative meetings, conference calls, and focus groups to adapt Promoting First Relationships® to reflect local community needs and values. LESSONS LEARNED Working closely with onsite Native project staff, being flexible and open to suggestions, and attending to the logistical needs of the community are imperative to developing and implementing adaptations. CONCLUSIONS Several adaptations were made based on the collaboration between researchers and Native project staff. Collaboration is critical for adapting programs so they can be tested in ways that respect both American Indian culture and research needs.
Collapse
Affiliation(s)
- Monica Oxford
- Child, Family and Population Health, University of Washington, Seattle, WA, USA
| | | | - Abigail Echo-Hawk
- Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA, USA
| | - Odile Madesclaire
- Elson S. Floyd College of Medicine and Initiative for Research and Education to Advance Community Health, Washington State University, Pullman, WA, USA
| | | | - Mylene Widner
- Health Promotion/Disease Prevention Wellness Program, Fort Peck, MT, USA
| | - Anthippy Petras
- Child, Family and Population Health, University of Washington, Seattle, WA, USA
| | | | - Katie Nelson
- Elson S. Floyd College of Medicine and Initiative for Research and Education to Advance Community Health, Washington State University, Pullman, WA, USA
| | - Dedra Buchwald
- Elson S. Floyd College of Medicine and Initiative for Research and Education to Advance Community Health, Washington State University, Pullman, WA, USA
| | | |
Collapse
|
22
|
Davis EL, Brooker RJ, Kahle S. Considering context in the developmental psychobiology of self‐regulation. Dev Psychobiol 2020; 62:423-435. [DOI: 10.1002/dev.21945] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Elizabeth L. Davis
- Department of Psychology University of California, Riverside Riverside CA USA
| | | | - Sarah Kahle
- University of California, Davis Davis CA USA
| |
Collapse
|
23
|
Kolacz J, Kovacic KK, Porges SW. Traumatic stress and the autonomic brain-gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology. Dev Psychobiol 2019; 61:796-809. [PMID: 30953358 DOI: 10.1002/dev.21852] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 12/14/2022]
Abstract
A range of psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder frequently co-occur with functional gastrointestinal (GI) disorders. Risk of these pathologies is particularly high in those with a history of trauma, abuse, and chronic stress. These scientific findings and rising awareness within the healthcare profession give rise to a need for an integrative framework to understand the developmental mechanisms that give rise to these observations. In this paper, we introduce a plausible explanatory framework, based on the Polyvagal Theory (Porges, Psychophysiology, 32, 301-318, 1995; Porges, International Journal of Psychophysiology, 42, 123-146, 2001; Porges, Biological Psychology, 74, 116-143, 2007), which describes how evolution impacted the structure and function of the autonomic nervous system (ANS). The Polyvagal Theory provides organizing principles for understanding the development of adaptive diversity in homeostatic, threat-response, and psychosocial functions that contribute to pathology. Using these principles, we outline possible mechanisms that promote and maintain socioemotional and GI dysfunction and review their implications for therapeutic targets.
Collapse
Affiliation(s)
- Jacek Kolacz
- Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University, Bloomington, Indiana
| | - Katja K Kovacic
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephen W Porges
- Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University, Bloomington, Indiana.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
24
|
Hash JB, Oxford ML, Fleming CB, Ward TM, Spieker SJ, Lohr MJ. Impact of a home visiting program on sleep problems among young children experiencing adversity. CHILD ABUSE & NEGLECT 2019; 89:143-154. [PMID: 30665020 PMCID: PMC6526956 DOI: 10.1016/j.chiabu.2018.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adversity may negatively impact young children's sleep but receiving home visitation services could buffer children from this potential consequence of adversity. OBJECTIVE This study examined whether young children's adverse experiences increased their risk for sleep problems and if Promoting First Relationships® (PFR), a home visitation program, reduced children's risk for sleep problems both directly and indirectly through increased parenting sensitivity. PARTICIPANTS AND SETTING Participants were 247 parents and their 10- to 24-month-old child recruited from Child Protective Services offices. METHODS A secondary analysis of a randomized controlled trial comparing PFR to a resource and referral control condition was conducted. Four time points of data were collected from baseline to 6 months post-intervention. Parenting sensitivity was measured at all time points using a parent-child interaction tool. Children's adversities were measured at various time points using caregiver report tools and official state records. Children's sleep problems were reported by parents at 6 months post-intervention. RESULTS The likelihood of having a sleep problem increased as children's adversities increased (β = .23, SE = .08, p = .005). There was no effect (direct or indirect) of treatment assignment on children's sleep problems (ps > .05). Post hoc analyses showed a treatment assignment by adversity interaction such that children's odds of having a sleep problem increased as their adversities increased, but only among children in the control condition (b = -0.37, SE = 0.17, p = .030). CONCLUSIONS Experiencing more adversities associated with a greater risk for sleep problems, but PFR buffered children from this risk.
Collapse
Affiliation(s)
- Jonika B Hash
- Department of Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, 98195, USA.
| | - Monica L Oxford
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Charles B Fleming
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Teresa M Ward
- Department of Psychosocial & Community Health, University of Washington, Seattle, WA, 98195, USA
| | - Susan J Spieker
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Mary Jane Lohr
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| |
Collapse
|
25
|
Oxford ML, Spieker SJ, Lohr MJ, Fleming CB, Dillon C, Rees J. Ensuring Implementation Fidelity of a 10-Week Home Visiting Program in Two Randomized Clinical Trials. Matern Child Health J 2018; 22:376-383. [PMID: 29139056 PMCID: PMC5845475 DOI: 10.1007/s10995-017-2387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Implementation fidelity is a challenge for the adoption of evidence-based programs within social service broadly and child welfare specifically. However, implementation fidelity is critical for maintaining the integrity of clinical trials and for ensuring successful delivery of services in public health settings. Methods Promoting First Relationships ® (PFR), a 10-week home visiting parenting intervention, was evaluated in two randomized clinical trials with populations of families in child welfare. Seven providers from community agencies participated in the trials and administered PFR. Fidelity data collected included observational measures of provider behavior, provider records, and input from clients to assess training uptake, adherence to content, quality of delivery, program dosage, and participant satisfaction. Results In mock cases to assess training uptake, providers demonstrated an increase in PFR verbalization strategies and a decrease non-PFR verbalizations from pre to post PFR training, and overall this was maintained a year later (Mann-Whitney U's = 0, p's < .01). Adherence to content in actual cases was high, with M = 97% of the program elements completed. Quality of delivery varied across providers, indicated by PFR consultation strategies (Wilks' Lambda F = 18.24, df = 15, p < .001) and global ratings (F = 13.35, df = 5, p < .001). Program dosage was high in both trials (71 and 86% receiving 10 sessions), and participant satisfaction was high (M = 3.9, SD = 0.2; 4 = greater satisfaction). Discussion This system of training and monitoring provides an example of procedures that can be used effectively to achieve implementation fidelity with evidence-based programs in social service practice.
Collapse
Affiliation(s)
- Monica L Oxford
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA.
| | - Susan J Spieker
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Mary Jane Lohr
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA, 98195-6560, USA
| | - Colleen Dillon
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Jennifer Rees
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| |
Collapse
|