The Role of Oxytocin in Parenting and as Augmentative Pharmacotherapy: Critical Issues and Bold Conjectures

Oxytocin and state attachment responses to secure base support after stress in middle childhood

We tried to replicate the finding that receiving care increases children's oxytocin and secure state attachment levels, and tested whether secure trait attachment moderates the oxytocin and state attachment response to care. 109 children (9-11 years old; M = 9.59; SD = 0.63; 34.9% boys) participated in a within-subject experiment. After stress induction (Trier Social Stress Test), children first remained alone and then received maternal secure base support. Salivary oxytocin was measured eight times. Secure trait and state attachment were measured with questionnaires, and Secure Base Script knowledge was assessed. Oxytocin levels increased after receiving secure base support from mother after having been alone. Secure state attachment changed less. Trait attachment and Secure Base Script knowledge did not moderate oxytocin or state attachment responses to support. This might mean that, regardless of the attachment history, in-the-moment positive attachment experiences might have a beneficial effect on trait attachment development in middle childhood.

Enhancing precision in human neuroscience

Human neuroscience has always been pushing the boundary of what is measurable. During the last decade, concerns about statistical power and replicability - in science in general, but also specifically in human neuroscience - have fueled an extensive debate. One important insight from this discourse is the need for larger samples, which naturally increases statistical power. An alternative is to increase the precision of measurements, which is the focus of this review. This option is often overlooked, even though statistical power benefits from increasing precision as much as from increasing sample size. Nonetheless, precision has always been at the heart of good scientific practice in human neuroscience, with researchers relying on lab traditions or rules of thumb to ensure sufficient precision for their studies. In this review, we encourage a more systematic approach to precision. We start by introducing measurement precision and its importance for well-powered studies in human neuroscience. Then, determinants for precision in a range of neuroscientific methods (MRI, M/EEG, EDA, Eye-Tracking, and Endocrinology) are elaborated. We end by discussing how a more systematic evaluation of precision and the application of respective insights can lead to an increase in reproducibility in human neuroscience.

Oxytocin Reactivity during a Wilderness Program without Parents in Adolescents

While wilderness programs are recognized as a feasible intervention to promote psychological independence in adolescence, little is known about physiological changes. The present study focused on oxytocin, a key hormone for social cognition and behavior, and investigated changes in OT concentrations during a wilderness program among adolescents. Twenty-one 4th-7th graders were separated from parents and immersed with adventures and challenges in the woodlands of Motegi, Tochigi Prefecture, Japan for 31 days, and dataset of 20 boys aged 9-13 years-old were used for analysis. OT concentrations in early morning saliva samples on days 2, 5, 8, 13, 18, 20, 21, 22 and 30 were determined using ELIZA. We performed multi-level regression analyses to compare the OT concentrations before and after solo and team-based survival challenges, and across the nine observational points, adjusting for potential covariates. We found that adolescents increased OT level in a situation where they needed others' cooperation and support for survival (coefficient: 2.86, SE: 1.34, p = 0.033). Further, we found that adolescents gradually decreased their basal OT level during a long separation from parents (coefficient: -0.083, SE: 0.034, p = 0.016). A combination of these findings suggest the OT level may be a marker for psychological independence.

Does neural face processing explain effects of an attachment-based intervention on maternal sensitivity? A randomized controlled study including pre- and postintervention measures

BACKGROUND

Although there is a large body of literature highlighting the behavioral effects of parenting interventions, studies on the neurocognitive mechanisms involved in such intervention effects remain scarce.

PURPOSE

The aim of the current study was to test whether changes in neural face processing (as reflected in N170 amplitudes) would act as a mediator in the association between the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and maternal sensitivity.

METHODS

A total of 66 mothers of whom a random 33% received the VIPP-SD and the others a "dummy" intervention participated in pre- and postintervention assessments. We recorded mothers' electroencephalographic (EEG) activity in response to photographs of children's neutral, happy, and angry facial expressions. Maternal sensitivity was observed while mothers interacted with their offspring in a semi-structured play situation.

RESULTS

In contrast with our expectations, we did not find evidence for mediation of intervention effects on maternal sensitivity by the N170.

CONCLUSION

We discuss that parenting support programs may yield different effects on neurocognitive processes depending on the population and provide recommendations for future research. Our study underscores the importance of reporting null findings and preregistering studies in the field of neurocognitive research.

Practitioner's review: medication for children and adolescents with autism spectrum disorder (ASD) and comorbid conditions

Alleviating the multiple problems of children with autism spectrum disorder (ASD) and its comorbid conditions presents major challenges for the affected children, parents, and therapists. Because of a complex psychopathology, structured therapy and parent training are not always sufficient, especially for those patients with intellectual disability (ID) and multiple comorbidities. Moreover, structured therapy is not available for a large number of patients, and pharmacological support is often needed, especially in those children with additional attention deficit/hyperactivity and oppositional defiant, conduct, and sleep disorders.

Advances in the field of intranasal oxytocin research: lessons learned and future directions for clinical research

Reports on the modulatory role of the neuropeptide oxytocin on social cognition and behavior have steadily increased over the last two decades, stimulating considerable interest in its psychiatric application. Basic and clinical research in humans primarily employs intranasal application protocols. This approach assumes that intranasal administration increases oxytocin levels in the central nervous system via a direct nose-to-brain route, which in turn acts upon centrally-located oxytocin receptors to exert its behavioral effects. However, debates have emerged on whether intranasally administered oxytocin enters the brain via the nose-to-brain route and whether this route leads to functionally relevant increases in central oxytocin levels. In this review we outline recent advances from human and animal research that provide converging evidence for functionally relevant effects of the intranasal oxytocin administration route, suggesting that direct nose-to-brain delivery underlies the behavioral effects of oxytocin on social cognition and behavior. Moreover, advances in previously debated methodological issues, such as pre-registration, reproducibility, statistical power, interpretation of non-significant results, dosage, and sex differences are discussed and integrated with suggestions for the next steps in translating intranasal oxytocin into psychiatric applications.

A registered replication study on oxytocin and trust

In an influential paper, Kosfeld et al. (2005) showed that intranasal administration of oxytocin (OT) increases the transfers made by investors in the trust game-suggesting that OT increases trust in strangers. Subsequent studies investigating the role of OT in the trust game found inconclusive effects on the trusting behaviour of investors but these studies deviated from the Kosfeld et al. study in an important way-they did not implement minimal social contact (MSC) between the investors and the trustees in the trust game. Here, we performed a large double-blind and placebo-controlled replication study of the effects of OT on trusting behaviour that yields a power of more than 95% and implements an MSC condition as well as a no-social-contact (NoC) condition. We find no effect of OT on trusting behaviour in the MSC condition. Exploratory post hoc analyses suggest that OT may increase trust in individuals with a low disposition to trust in the NoC condition, but this finding requires confirmation in future research. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 19 October 2018. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.11980368.

The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period

Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.

Combining oxytocin and cognitive bias modification training in a randomized controlled trial: Effects on trust in maternal support

BACKGROUND AND OBJECTIVES

Research on the social effects of intranasal oxytocin in children is scarce. Oxytocin has been proposed to have clearer beneficial effects when added to social learning paradigms. The current study tested this proposition in middle childhood by assessing effects of cognitive bias modification (CBM) training and oxytocin on trust in maternal support.

METHODS

Children (N = 100, 8-12 years) were randomly assigned to one of two training conditions: CBM training aimed at increasing trust or neutral placebo training. Within each training condition, half the participants received oxytocin and half a placebo. Main and interaction effects were assessed on measures of trust-related interpretation bias and trust. We explored whether child characteristics moderated intervention effects.

RESULTS

Children in the CBM training were faster to interpret maternal behaviour securely versus insecurely. Effects did not generalize to interpretation bias measures or trust. There were no main or interaction effects of oxytocin. Exploratory moderation analyses indicated that combining CBM training with oxytocin had less positive effects on trust for children with more internalizing problems.

LIMITATIONS

As this was the first study combining CBM and oxytocin, replication of the results is needed.

CONCLUSIONS

This study combined a social learning paradigm with oxytocin in children. CBM training was effective at an automatic level of processing. Oxytocin did not enhance CBM effects or independently exert effects. Research in larger samples specifying when oxytocin might have beneficial effects is necessary before oxytocin can be used as intervention option in children.

Challenging the challenge hypothesis on testosterone in fathers: Limited meta-analytic support

In fathers testosterone levels are suggested to decrease in the context of caregiving, but results seem inconsistent. In a meta-analysis including 50 study outcomes with N = 7,080 male participants we distinguished three domains of research, relating testosterone levels to parental status (Hedges' g = 0.22, 95% CI: 0.09 to 0.35; N = 4,150), parenting quality (Hedges' g = 0.14, 95% CI: 0.03 to 0.24; N = 2,164), and reactivity after exposure to child stimuli (Hedges' g = 0.19, 95% CI: -0.03 to 0.42; N = 766). The sets of study outcomes on reactivity and on parenting quality were both homogeneous. Parental status and (higher) parenting quality were related to lower levels of testosterone, but according to conventional criteria combined effect sizes were small. Moderators did not significantly modify combined effect sizes. Results suggest that publication bias might have inflated the meta-analytic results, and the large effects of pioneering but small and underpowered studies in the domains of males' parental status and parenting quality have not been consistently replicated. Large studies with sufficient statistical power to detect small testosterone effects and, in particular, the moderating effects of the interplay with other endocrine systems and with contextual determinants are required.

Effects of the Video-feedback intervention to promote positive parenting and sensitive discipline on mothers' neural responses to child faces: A randomized controlled ERP study including pre- and post-intervention measures

Parenting interventions have proven to be effective in enhancing positive parenting behavior and child outcomes. However, the neurocognitive mechanisms explaining the efficacy remain largely unknown. We tested effects of the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) on mothers' neural processing of child faces. Our primary focus was on the N170 and the secondary focus on the LPP. We expected the intervention to enhance the amplitudes of both ERP components in response to emotional compared to neutral faces. A total of 66 mothers visited the lab for two identical sessions separated by 4.28 months (SD = 0.86) during which a random 33% of the mothers received the VIPP-SD. During both pre- and post-intervention sessions, mothers' electroencephalographic (EEG) activity in response to photographs of children's neutral, happy and angry facial expressions were acquired. In contrast to our expectations, we found smaller (less negative) N170 amplitudes at post-test in the intervention group. There was no intervention effect on the LPP, although overall LPP amplitudes were more positive for neutral and angry compared to happy faces. Our study shows that the N170 is affected by the VIPP-SD, suggesting that the intervention promotes efficient, less effortful face processing.Trial registration: Dutch Trial Register: NTR5312; Date registered: 3 January 2017.

Intrapartum ultrasound monitoring of malposition and malrotation during labor neuraxial analgesia: maternal outcomes

Objective: This study analyzes the important role of ultrasonography (IUS) related to the maternal outcomes in women with fetal persistent occiput posterior position (POPP) and asynclitism (A) in labor neuraxial analgesia (LNA).Study design: Prospective assessment of 148 primiparous women diagnosed with the prolonged second stage of labor. Transabdominal and transperineal IUS were used to detect fetal head position and to evaluate the angle of progression (AOP) and pubic arch angle (PAA). Statistical data about maternal aspects, modalities of delivery and maternal outcomes were observed.Results: In all parturients included in the study, the operative delivery rate was 73%. In patients delivered via cesarean section, the PAA was ≤ of 96.5°. There was statistical correlation between doses of LNA and Apgar score at first minute (r0.8).Conclusions: There is a greater frequency of Fetal POPP and asynclitism related with maternal complications. The results of our study confirmed the importance of determination of angle of progression (AoP) and PAA in the prolonged second stage of labor. Unfavorable AoP and PAA, in presence of POPP and A, are related with high percentage of operative delivery. If the prolonged labor and delivery in these patients exceed time limit proposed by American College of Obstetricians and Gynecologists guidelines, it may be viewed as a possible malpractice. In cases of POPP with asynclitism, in the second stage of labor detected by IUS it is advisable to discontinue the anesthetic drugs administration in LNA; because the labor pain is related to the dystocia, an operative delivery is necessary to avoid maternal and fetal complications.

Effects of Oxytocin on Emotional and Physiological Responses to Conflict in Couples with Substance Misuse

Social stress, especially dyadic conflict among couples, is an important correlate of addiction. Several authors have suggested that the neuropeptide oxytocin (OT) may be useful in the treatment of couples with substance misuse. However, the literature examining OT among couples is scant and has yielded mixed findings. The current study examined the effects of OT versus placebo on emotional (e.g., warmth and anger) and physiological (e.g., skin conductance and heart rate) reactivity to a conflict resolution task in 30 heterosexual couples (N=60) in which one or both members misused substances. Using a randomized, double-blind, placebo-controlled design, both partners within each dyad were randomized to the same treatment condition. Participants completed a standardized conflict resolution task at baseline and 45 minutes following drug self-administration. Physiological measures were examined continuously during the laboratory tasks and emotional reactivity was self-reported at baseline and at 5 time points over the course of 1 hour following the second conflict resolution task. Results of a multi-level growth curve model accounting for baseline scores, gender and drug condition indicate that positive emotional experiences and skin conductance measures increased over the 5 time points. Neither drug condition nor gender was significantly related to outcomes, and no interaction effects were observed. These findings highlight the complexities involved in translational OT research and suggest that the impact of OT on key outcomes requires further exploration in regards to OT's potential therapeutic benefit.

A walk on the dark side: TMS over the right inferior frontal gyrus (rIFG) disrupts behavioral responses to infant stimuli

Infant signals, including infant sounds and facial expressions, play a critical role in eliciting parental proximity and care. Processing of infant signals in the adulthood brain is likely to recruit emotional empathy neural circuits, including the inferior frontal gyrus (IFG). Here, we used transcranial magnetic stimulation (TMS) to test the role of right IFG (rIFG) in behavioral responses to infant signals. Specifically, a group of nulliparous women were asked to perform a handgrip dynamometer task and an Approach-Avoidance Task (AAT) after receiving TMS over the right IFG or over a control site (vertex). Suppressing activity in the rIFG affected the modulation of handgrip force in response to infant crying. Moreover, the AAT showed that participants tend to avoid the sad infant face after Vertex stimulation, and this bias was counteracted by rIFG stimulation. Our results suggest a causal role of rIFG in sensitive responding towards sad infants and point to the rIFG as a critical node in the neural network underlying the innate releasing mechanism for feelings of love, affection and caring of sad infants.

No side-effects of single intranasal oxytocin administration in middle childhood

BACKGROUND

Despite growing interest in the (therapeutic) use of intranasal oxytocin administration in children, the potential side-effects of intranasal oxytocin have remained largely unclear to date. The current study is the first double-blind randomized controlled trial to examine side-effects following single administration of oxytocin nasal spray in elementary school-aged children.

METHODS

One hundred children (8-12 years old) were randomly assigned to receive oxytocin or placebo nasal spray. We assessed side-effects by means of a standardized, drug-specific questionnaire and an open-ended question at two time points: 90 min after nasal spray administration and 24 h after administration.

RESULTS

There were no significant associations between nasal spray condition and total frequency of reported side-effects or reports of specific side-effects. Children and their mothers were unable to correctly guess nasal spray allocation, further supporting that the subjective experience of oxytocin versus placebo nasal spray effects was similar. Moreover, the majority of reported side-effects were classified as mild and ceased within 24 h after the procedure, indicating that the nasal sprays were well tolerated.

CONCLUSION

In all, this study is the first randomized controlled trial to provide information on the safety of intranasal oxytocin administration in middle childhood. The current study suggests that single administration of intranasal oxytocin is likely safe in elementary school-aged children.

Effects of vasopressin on neural processing of infant crying in expectant fathers

In a randomized, double blind, placebo-controlled, within-subject magnetic resonance imaging study, we examined the effect of 20 IU intranasal vasopressin on the neural processing of infant crying in 25 fathers-to-be. We explored whether familial background modulates vasopressin effects, and whether vasopressin differentially affects cry processing coupled with neutral or emotional contextual information. Participants listened to cries accompanied by neutral ('this is an infant') or emotional ('this infant is sick/bored') contextual information, and neutral control sounds ('this is a saw'). Additionally, participants reported on their childhood experiences of parental love-withdrawal and abuse. Infant crying (vs control sounds) was associated with increased activation in the bilateral auditory cortex and posterior medial cortex. No effects of vasopressin were found in this 'cry network'. Exploratory whole-brain analyses suggested that effects of vasopressin in the anterior cingulate cortex, paracingulate gyrus and supplemental motor area were stronger in fathers who experienced lower (vs higher) levels of love-withdrawal. No interaction was observed for abuse. Vasopressin increased activation in response to cries accompanied by emotional vs neutral contextual information in several brain regions, e.g. the cerebellum, brainstem (midbrain), posterior medial cortex, hippocampus, putamen, and insula. Our results suggest that the experience of love-withdrawal may modulate the vasopressin system, influencing effects of vasopressin administration on cry processing. Results further suggest a role for vasopressin in the processing of cry sounds with emotional contextual information.

Oxytocin promotes face-sensitive neural responses to infant and adult faces in mothers

Research utilizing intranasal oxytocin (OT) administration has shown that OT may increase attention and sensitivity to social cues, such as faces. Given the pivotal role of OT in parental behaviors across mammals, the paucity of intranasal OT research investigating responses to social cues in parents and particularly mothers of young children is a critical limitation. In the current study, we recorded cortical event-related potentials (ERPs) to investigate whether intranasal OT affects the early neural responses to emotional faces in mothers of 1-year-old infants. Using a double-blind, within-subjects design, mothers (n = 38) were administered intranasal OT and placebo on separate sessions and presented with happy and sad infant and adult faces while ERP components reflecting face-sensitive brain activation and attention allocation were measured. We hypothesized that ERP responses to faces would be larger in the OT condition and that the effects of OT on ERP responses would be more pronounced for infant faces. The amplitudes of the face-sensitive N170 ERP component were larger in the OT condition to infant and adult faces, but no clear support was found for the hypothesis that the responses to infant faces would be more susceptible to OT effects than the responses to adult faces. The attention-sensitive late positive potential (LPP) component was not modulated by intranasal substance condition. The results are in line with the view that OT acts to enhance the perceptual salience of social and emotional stimuli. Demonstrating such effects in mothers of young children encourages further investigation of the potential of intranasal OT to affect the perception of social cues relevant for parent-child interaction.

Oxytocin and Human Sensitive and Protective Parenting

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

The effects of Cognitive Bias Modification training and oxytocin administration on trust in maternal support: study protocol for a randomized controlled trial

BACKGROUND

Lack of trust in parental support is a transdiagnostic risk factor for the development of psychological problems throughout the lifespan. Research suggests that children's cognitive attachment representations and related information processing biases could be an important target for interventions aiming to build trust in the parent-child relationship. A paradigm that can alter these biases and increase trust is that of Cognitive Bias Modification (CBM), during which a target processing bias is systematically trained. Trust-related CBM training effects could possibly be enhanced by oxytocin, a neuropeptide that has been proposed to play an important role in social information processing and social relationships. The present article describes the study protocol for a double-blind randomized controlled trial (RCT) aimed at testing the individual and combined effects of CBM training and oxytocin administration on trust in maternal support.

METHODS/DESIGN

One hundred children (aged 8-12 years) are randomly assigned to one of four intervention conditions. Participants inhale a nasal spray that either contains oxytocin (OT) or a placebo. Additionally, they receive either a CBM training aimed at positively modifying trust-related information processing bias or a neutral placebo training aimed to have no trust-related effects. Main and interaction effects of the interventions are assessed on three levels of trust-related outcome measures: trust-related interpretation bias; self-reported trust; and mother-child interactional behavior. Importantly, side-effects of a single administration of OT in middle childhood are monitored closely to provide further information on the safety of OT administration in this age group.

DISCUSSION

The present RCT is the first study to combine CBM training with oxytocin to test for individual and combined effects on trust in mother. If effective, CBM training and oxytocin could be easily applicable and nonintrusive additions to interventions that target trust in the context of the parent-child relationship.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02737254 . Registered on 23 March 2016.

Identification and Treatment of Pathophysiological Comorbidities of Autism Spectrum Disorder to Achieve Optimal Outcomes

Despite the fact that the prevalence of autism spectrum disorder (ASD) continues to rise, no effective medical treatments have become standard of care. In this paper we review some of the pathophysiological abnormalities associated with ASD and their potential associated treatments. Overall, there is evidence for some children with ASD being affected by seizure and epilepsy, neurotransmitter dysfunction, sleep disorders, metabolic abnormalities, including abnormalities in folate, cobalamin, tetrahydrobiopterin, carnitine, redox and mitochondrial metabolism, and immune and gastrointestinal disorders. Although evidence for an association between these pathophysiological abnormalities and ASD exists, the exact relationship to the etiology of ASD and its associated symptoms remains to be further defined in many cases. Despite these limitations, treatments targeting some of these pathophysiological abnormalities have been studied in some cases with high-quality studies, whereas treatments for other pathophysiological abnormalities have not been well studied in many cases. There are some areas of more promising treatments specific for ASD including neurotransmitter abnormalities, particularly imbalances in glutamate and acetylcholine, sleep onset disorder (with behavioral therapy and melatonin), and metabolic abnormalities in folate, cobalamin, tetrahydrobiopterin, carnitine, and redox pathways. There is some evidence for treatments of epilepsy and seizures, mitochondrial and immune disorders, and gastrointestinal abnormalities, particularly imbalances in the enteric microbiome, but further clinical studies are needed in these areas to better define treatments specific to children with ASD. Clearly, there are some promising areas of ASD research that could lead to novel treatments that could become standard of care in the future, but more research is needed to better define subgroups of children with ASD who are affected by specific pathophysiological abnormalities and the optimal treatments for these abnormalities.