Darwin's Other Dilemmas and the Theoretical Roots of Emotional Connection

Economic microbiology: exploring microbes as agents in economic systems

Microbial communities exhibit striking parallels with economic markets, resembling intricate ecosystems where microorganisms engage in resource exchange akin to human market transactions. This dynamic network of resource swapping mirrors economic trade in human markets, with microbes specializing in metabolic functions much like businesses specializing in goods and services. Cooperation and competition are central dynamics in microbial communities, with alliances forming for mutual benefit and species vying for dominance, similar to businesses seeking market share. The human microbiome, comprising trillions of microorganisms within and on our bodies, is not only a marker of socioeconomic status but also a critical factor contributing to persistent health inequalities. Social and economic factors shape the composition of the gut microbiota, impacting healthcare access and quality of life. Moreover, these microbes exert indirect influence over human decisions by affecting neurotransmitter production, influencing mood, behavior, and choices related to diet and emotions. Human activities significantly impact microbial communities, from dietary choices and antibiotic use to environmental changes, disrupting these ecosystems. Beyond their natural roles, humans harness microbial communities for various applications, manipulating their interactions and resource exchanges to achieve specific goals in fields like medicine, agriculture, and environmental science. In conclusion, the concept of microbial communities as biological markets offers valuable insights into their intricate functioning and adaptability. It underscores the profound interplay between microbial ecosystems and human health and behavior, with far-reaching implications for multiple disciplines. To paraphrase Alfred Marshall, "the Mecca of the economist lies in economic microbiology."

Qualitative insights from a randomized clinical trial of a mother-child emotional preparation program for preschool-aged children

BACKGROUND

Early life stress and adversity conveys risk for emotional, behavioral, and developmental disorders. To address this risk in the preschool population, Mother-Child Emotional Preparation (MCEP) was tested as an in-school dyadic intervention for facilitating mother-child emotional connection through mother-child calming cycles. In a computer-generated block randomized controlled trial enrolling preschool-aged children and their mothers, in partnership with an early childhood learning center, we at Columbia University Irving Medical Center tested effects of MCEP across multiple domains. Within this RCT we designed a qualitative sub-study to understand how MCEP aligns with calming cycle theory and its impact on mothers and the mother-child relationship.

METHODS

A qualitative researcher observed 14 group MCEP sessions consisting of nurture specialists facilitating reciprocal calming interactions through shared emotional expression between mothers and their preschool-aged children. We conducted two waves of participant interviews in English or Spanish, per participant preference. Participants (n = 8) were majority Hispanic at or below the federal poverty level. Group session observations were coded and analyzed for frequency, co-occurrence, variance by session, and alignment with calming cycle theory, incorporating demographic variables and attendance. Interview transcripts were translated from Spanish to English if needed, then coded and analyzed using thematic analysis.

RESULTS

Qualitative analysis revealed mothers' experiences of MCEP. Data demonstrated that calming position and emotional expression were mutually supportive, and that barriers to connection were calming cycle entry-points, not barriers. At the group level, supported by nurture specialists, fellow participants helped each other progress through calming cycles. Moreover, MCEP adapted to meet individual dyad needs, and mothers described its far-reaching impact.

CONCLUSIONS

Qualitative methods show that MCEP helps mother-child dyads emotionally connect through the calming cycle and fills a gap in early childhood education services. This study generated insights for quantitative studies and suggested implications for MCEP dissemination.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03908268 , Registered April 9, 2019-Retrospectively registered.

Impact of Physical Contact on Preterm Infants' Vital Sign Response to Live Music Therapy

Evidence that music therapy stabilises vital parameters in preterm infants is growing, but the optimal setting for therapy is still under investigation. Our study aimed to quantify the effect of physical contact during live music therapy in preterm infants born < 32 weeks’ gestational age (GA) on post-therapy vital sign values. Live music therapy was delivered twice-weekly until discharge from hospital to 40 stable infants < 32 weeks’ GA. Baseline and post-therapy heart rate, respiratory rate, oxygen saturation and physical contact during each session were recorded. 159 sessions were performed with, and 444 sessions without, physical contact. Descriptive and multivariable regression analyses based on directed acyclic graphs were performed. The mean GA was 28.6 ± 2.6 weeks, and 26 (65%) infants were male. Mean absolute values for heart and respiratory rates lowered during music therapy regardless of physical contact. The mean post-therapy SaO2 was higher compared to baseline values regardless of physical contact (mean differences −8.6 beats/min; −13.3 breaths/min and +2.0%). There were no clinically relevant changes in vital sign responses between therapy sessions, with or without physical contact, or adjusted post-therapy values for any of the studied vital signs. Physical contact caused better baseline and post-therapy vital sign values but did not enhance the vital sign response to music therapy. Thus, the effect of music therapy on preterm infants’ vital signs is independent of physical contact and parents’ presence during music therapy in the neonatal intensive care unit.

Wired to Connect: The Autonomic Socioemotional Reflex Arc

We have previously proposed that mothers and infants co-regulate one another’s autonomic state through an autonomic conditioning mechanism, which starts during gestation and results in the formation of autonomic socioemotional reflexes (ASRs) following birth. Theoretically, autonomic physiology associated with the ASR should correlate concomitantly with behaviors of mother and infant, although the neuronal pathway by which this phenomenon occurs has not been elucidated. In this paper, we consider the neuronal pathway by which sensory stimuli between a mother and her baby/child affect the physiology and emotional behavior of each. We divide our paper into two parts. In the first part, to gain perspective on current theories on the subject, we conduct a 500-year narrative history of scientific investigations into the human nervous system and theories that describe the neuronal pathway between sensory stimulus and emotional behavior. We then review inconsistencies between several currently accepted theories and recent data. In the second part, we lay out a new theory of emotions that describes how sensory stimuli between mother and baby unconsciously control the behavior and physiology of both. We present a theory of mother/infant emotion based on a set of assumptions fundamentally different from current theories. Briefly, we propose that mother/infant sensory stimuli trigger conditional autonomic socioemotional reflexes (ASRs), which drive cardiac function and behavior without the benefit of the thalamus, amygdala or cortex. We hold that the ASR is shaped by an evolutionarily conserved autonomic learning mechanism (i.e., functional Pavlovian conditioning) that forms between mother and fetus during gestation and continues following birth. We highlight our own and others research findings over the past 15 years that support our contention that mother/infant socioemotional behavior is driven by mutual autonomic state plasticity, as opposed to cortical trait plasticity. We review a novel assessment tool designed to measure the behaviors associated with the ASR phenomenon. Finally, we discuss the significance of our theory for the treatment of mothers and infants with socioemotional disorders.

Paths of social-emotional development before 3 years old and child development after 5 years old: Evidence from rural China

BACKGROUND

Social-emotional development during the first three years of life is associated with later social-emotional development and cognitive development. In rural China, research has found large shares of children under age three are developmentally delayed, yet little is known about the paths of social-emotional development before age 3 or how developmental paths predict later social-emotional skills and cognitive skills.

AIMS

To investigate the paths of child social-emotional development during ages 0-3 and examine how different paths predict social-emotional development and cognitive development at preschool age.

METHODS

Three waves of longitudinal panel data from 1245 children in rural Western China was collected. Child social-emotional development was measured by the Ages and Stages Questionnaire: Social-Emotional. Child cognitive development was measured by the Bayley Scales of Infant Development and by the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition. Four paths of child social-emotional development were classified: "never" social-emotionally delayed; "persistently" social-emotionally delayed; "improving," or "deteriorating."

RESULTS

331 (27%) were never social-emotionally delayed; 373 children (30%) were persistently social-emotionally delayed; 149 children (12%) experienced improving social-emotional development; and 392 children (31%) experienced deteriorating social-emotional development. Children who were never social-emotionally delayed or who were on an "improving" path had higher social-emotional development at preschool age (p < .01). Children who were persistently social-emotionally delayed (p < .5) and on a deteriorating path (p < .01) had lower social-emotional development at preschool age. Children on the persistently delay path also were shown to have lower levels of cognitive development at preschool age (p < .01).

CONCLUSIONS

Different paths of child social-emotional development before age 3 are associated with different social-emotional and cognitive development at preschool age.

The Brainstem-Informed Autism Framework: Early Life Neurobehavioral Markers

Autism spectrum disorders (ASD) have long-term implications on functioning at multiple levels. In this perspective, we offer a brainstem-informed autism framework (BIAF) that traces the protracted neurobehavioral manifestations of ASD to early life brainstem dysfunctions. Early life brainstem-mediated markers involving functions of autonomic/arousal regulation, sleep-wake homeostasis, and sensorimotor integration are delineated. Their possible contributions to the early identification of susceptible infants are discussed. We suggest that the BIAF expands our multidimensional understanding of ASD by focusing on the early involvement of brainstem systems. Importantly, we propose an integrated BIAF screener that brings about the prospect of a sensitive and reliable early life diagnostic scheme for weighing the risk for ASD. The BIAF screener could provide clinicians substantial gains in the future and may carve customized interventions long before the current DSM ASD phenotype is manifested using dyadic co-regulation of brainstem-informed autism markers.

Early regulatory problems and parenting: life-long risk, vulnerability or susceptibility for attention, internalizing and externalizing outcomes?

Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems, RPs) predict increased risk for self-regulation difficulties. Sensitive parenting may protect children from trajectories of dysregulation. Considering self-regulation from a life-course perspective, are children with early multiple and/or persistent RPs affected similarly by parenting as those without (main effects model, ME), or are they more vulnerable (diathesis-stress, DIA-S), or more susceptible (differential susceptibility theory, DST) to variations in sensitive parenting at age 6 years? Participants (N = 302) were studied prospectively from birth to 28 years. RPs were assessed from 5 to 56 months. Sensitive parenting was observed at 6 years. Attention regulation was observed at 8 and 28 years. Internalizing and externalizing problems were rated by parents at 8 years, and by adults at 28 years. Confirmatory-comparative modelling tested whether associations of sensitive parenting with outcomes at 8 and 28 years among individuals with early multiple and/or persistent RPs (n = 74) versus those without (n = 228) were best explained by ME, DIA-S, or DST models. Best fitting models differed according to age at assessment. For childhood attention regulation, the statistically parsimonious DIA-S provided the best fit to the data. At age 28, two additive main effects (ME, RP group and sensitive parenting) fit best. DIA-S and ME explained internalizing and externalizing problems. Using a comprehensive life-span approach, DIA-S and ME models but not DST explained how early RPs and sensitive parenting predicted attention, internalizing, and externalizing outcomes. Individuals with early RPs are vulnerable to insensitive parenting.

Preterm infant heart rate is lowered after Family Nurture Intervention in the NICU: Evidence in support of autonomic conditioning

BACKGROUND

Cardiac complications after premature birth are associated with negative long-term consequences to health. The Family Nurture Intervention (FNI) has been designed to support mother-infant parasympathetic calming sessions in the neonatal intensive care unit (NICU). FNI has shown neurodevelopmental and autonomic benefit across infant development.

AIMS

We tested the hypothesis that heart rate (HR) will decrease after FNI over the course of the NICU stay, compared to matched controls.

STUDY DESIGN

We used a case-matched design. The intervention included on average four ~1-hour facilitated mother-infant 'calming' sessions per week. We collected 24/7 real time heart rate data from a central monitoring system and analyzed data from two time-periods.

SUBJECTS

The intervention group comprised 37 infants born ~30 weeks gestational age (GA) in a level IV NICU, treated with FNI. From the same NICU and time-period, we created a contemporaneous comparison group of 32 infants who were case-matched to each intervention infant for sex, age-at-birth, singleton or twin status, month of admission and length of stay.

OUTCOME MEASURES

Using generalized estimating equation (GEE) modeling, we analyzed 24/7 HR data during a 1-hour period between 4:30 and 5:30 am each day in the NICU, when all infants were least disturbed. Using repeated measures ANOVA, we analyzed 24/7 HR data during a 6-week period starting 1 week prior to the start of FNI and ending 5 weeks after start.

RESULTS

GEE modeling of the 1-hour data from all subjects showed significant lower HR in the FNI group, compared with controls. ANOVA modeling on a subset of subjects over the five-week period showed that FNI infant HR decreased in a dose-response manner relative to SC HR.

CONCLUSION

This study suggests FNI may condition lower infant HR in a dose-response manner during the NICU stay.

The safety and efficacy of botulinum toxin A on the treatment of depression

OBJECTIVES

Effective strategy for the treatment of depression is limited. This study was to evaluate the safety and efficacy of botulinum toxin A (BoNT/A) in the treatment of depression.

METHODS

Seventy-six patients were assigned to the BoNT/A group (n = 52) and sertraline control group (n = 24). For the BoNT/A group, BoNT/A was injected into the frowning muscle, depressor muscle, occipital frontalis muscle, lateral canthus, and bilateral temporal region at 20 sites. Five units per site and a total of 100 units of BoNT/A were given. Patients in the sertraline control group were medicated with sertraline 50-200 mg (114.58 ± 52.08 mg) per day. Depression was assessed by the 17-item Hamilton Depression Scale (HAMD-17), 14-item Hamilton Anxiety Scale (HAMA-14), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS). All participants were followed up for 12 weeks.

RESULTS

Scores of HAMD, HAMA, SDS, and SAS decreased significantly in both BoNT/A and sertraline groups after treatment for 12 weeks. Overall, there were no differences in decreased magnitude between the two groups (p > .05). The HAMA, SDS, and SAS results showed that the onset time of BoNT/A was earlier than that of sertraline. Side effects rates were 15.38% for BoNT/A and 33.33% for sertraline.

CONCLUSION

This study demonstrated significant antidepressant effects of BoNT/A. The efficacy of BoNT/A was comparable with established antidepressant sertraline. The onset time of BoNT/A was earlier than sertraline, and the proportion of side effects was less than sertraline. Therefore, BoNT/A could be a safe and effective option for the treatment of depression.

The Welch Emotional Connection Screen: Adapting observational methods to pediatric primary care via resident training

The Welch Emotional Connection Screen (WECS) is a novel instrument that is a brief, practicable, evidenced-based observational screening tool for assessing relationship health between parent and child. The WECS requires observing 2-3 min of face-to-face interactions between parent and child, without toys, prompts, paradigms or technology. Here, we describe a translational project from the coding lab to the primary care provider via a residency training program conducted with 50 residents during a 30-day developmental and behavioral pediatrics medical resident education rotation. The aims of this study were to evaluate the efficacy of WECS pediatric resident training: 1) to improve residents' accuracy in recognizing the dyadic behaviors of emotional connection (EC) via WECS training; and 2) to improve residents' attitudes, self-efficacy, and perceived professional norms (ASPPN) pertaining to Early Relational Health in Pediatrics. Results indicate that using a rapid prototyping approach to training, residents improved in their identification of dyads showing low to midrange levels of emotional connection. As well, resident attitudes about the importance of relationship health in pediatrics and their self-efficacy in identifying emotional connection improved significantly after this brief resident training.

Compassion As an Intervention to Attune to Universal Suffering of Self and Others in Conflicts: A Translational Framework

As interpersonal, racial, social, and international conflicts intensify in the world, it is important to safeguard the mental health of individuals affected by them. According to a Buddhist notion "if you want others to be happy, practice compassion; if you want to be happy, practice compassion," compassion practice is an intervention to cultivate conflict-proof well-being. Here, compassion practice refers to a form of concentrated meditation wherein a practitioner attunes to friend, enemy, and someone in between, thinking, "I'm going to help them (equally)." The compassion meditation is based on Buddhist philosophy that mental suffering is rooted in conceptual thoughts that give rise to generic mental images of self and others and subsequent biases to preserve one's egoism, blocking the ultimate nature of mind. To contextualize compassion meditation scientifically, we adopted a Bayesian active inference framework to incorporate relevant Buddhist concepts, including mind (buddhi), compassion (karuna), aggregates (skandhas), suffering (duhkha), reification (samaropa), conceptual thoughts (vikalpa), and superimposition (prapañca). In this framework, a person is considered a Bayesian Engine that actively constructs phenomena based on the aggregates of forms, sensations, discriminations, actions, and consciousness. When the person embodies rigid beliefs about self and others' identities (identity-grasping beliefs) and the resulting ego-preserving bias, the person's Bayesian Engine malfunctions, failing to use prediction errors to update prior beliefs. To counter this problem, after recognizing the causes of sufferings, a practitioner of the compassion meditation aims to attune to all others equally, friends and enemies alike, suspend identity-based conceptual thoughts, and eventually let go of any identity-grasping belief and ego-preserving bias that obscure reality. We present a brain model for the Bayesian Engine of three components: (a) Relation-Modeling, (b) Reality-Checking, and (c) Conflict-Alarming, which are subserved by (a) the Default-Mode Network (DMN), (b) Frontoparietal Network (FPN) and Ventral Attention Network (VAN), and (c) Salience Network (SN), respectively. Upon perceiving conflicts, the strengthening or weakening of ego-preserving bias will critically depend on whether the SN up-regulates the DMN or FPN/VAN, respectively. We propose that compassion meditation can strengthen brain regions that are conducive for suspending prior beliefs and enhancing the attunements to the counterparts in conflicts.

How babies learn: The autonomic socioemotional reflex

BACKGROUND

Human and animal research has long documented the negative effects of early traumatic events on long-term development and socioemotional behavior. Yet, how and where the body stores these memories remains unclear. Current theories propose that the brain stores such memory in the subcortical limbic system. However, a clear theory of change with testable hypothesis has yet to emerge.

AIMS

In this paper, we review the classical Pavlovian conditioning learning tradition, along with its functional variant. Then, we review calming cycle theory, which builds upon the idea that mother/infant learning is distinct from other types of learning, requiring a new set of assumptions in light of functional Pavlovian conditioning.

CONCLUSION

Calming cycle theory states that learning of behaviors associated with subcortical autonomic physiology is separate and distinct from learning of behaviors associated with cortical physiology. Mother/infant autonomic learning starts in the uterine environment via functional Pavlovian co-conditioning that is stored as conditional reflexes within the dyad's autonomic nervous systems. These reflexes are preserved transnatally as autonomic socioemotional reflexes (ASRs), which can be used to monitor mother-infant relational health. The functional Pavlovian co-conditioning mechanism can be exploited to change the physiological/behavioral reflex response. The theory provides a well established learning mechanism, a theory of change and a method of change, along with a set of hypotheses with which to test the theory. We present evidence from a randomized controlled trial with prematurely born infants and their mothers that supports calming cycle theory.

Effects of Early Intervention on Visual Function in Preterm Infants: A Randomized Controlled Trial

Objectives: To determine the effectiveness of an early intervention program in enhancing visual function in very preterm infants. Methods: We conducted a RCT. We included preterm infants born between 25⁺⁰ and 29⁺⁶ weeks of gestational age (GA), without severe morbidities, and their families. Infants were randomized to either receive Standard Care (SC) or Early Intervention (EI). SC, according to NICU protocols, included Kangaroo Mother Care and minimal handling. EI included, in addition to routine care, parental training according to the PremieStart program, and multisensory stimulation (infant massage and visual interaction) performed by parents. Visual function was assessed at term equivalent age (TEA) using a prevalidated battery evaluating ocular spontaneous motility, ability to fix and follow a target, reaction to color, stripes discrimination and visual attention at distance. Results: Seventy preterm (EI n = 34, SC n = 36) infants were enrolled. Thirteen were excluded according to protocol. Fifty-seven infants (EI = 27, SC = 30) were assessed at TEA. The two groups were comparable for parental and infant characteristics. In total, 59% of infants in the EI group achieved the highest score in all the nine assessed items compared to 17% in the SC group (p = 0.001): all infants in both groups showed complete maturation in four items, but EI infants showed more mature findings in the other five items (ocular motility both spontaneous and with target, tracking arc, stripes discrimination and attention at distance). Conclusions: Our results suggest that EI has a positive effect on visual function maturation in preterm infants at TEA. Trial Registration: clinicalTrial.gov (NCT02983513).

Early Life Maternal Separation and Maternal Behaviour Modulate Acoustic Characteristics of Rat Pup Ultrasonic Vocalizations

Early separation of preterm infants from their mothers has adverse, long-term neurodevelopmental consequences. We investigated the effects of daily maternal separation (MS) of rat pups from postnatal days 2-10 (PND2-10) on neurobehavioural responses to brief isolation at PND12 compared with pups receiving controlled handling without MS. Ultrasonic vocalizations (USV) were measured at PND12 during two, 3-minute isolations occurring immediately before and after a 3-minute maternal reunion. There were no significant differences in acoustic characteristics between MS and control animals in the first isolation. However, in the second isolation, MS pups produced a greater proportion of high (~60 kHz) vs low (~40 kHz) frequency calls. During this isolation, control pups made longer and louder low frequency calls compared to the first isolation, whereas MS pups did the opposite. Maternal behaviour of control and MS mothers modulated pup acoustic characteristics in opposite directions; higher maternal care was associated with more low frequency calls in control pups but more high frequency calls in MS pups. We hypothesize that MS results in USV emission patterns reflective of a greater stress response to isolation. This translational model can be used to identify mechanisms and interventions that may be exploited to overcome the negative, long-term effects of MS.

The practical utility of the Welch Emotional Connection Screen for rating parent-infant relational health

Emotional Connection (EC) measured by the Welch Emotional Connection Screen (WECS) was related to the Parent-Infant Interaction Rating System (PIIRS), a 5-point adaptation of the rating system developed for the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (e.g., NICHD Early Child Care Research Network, 1999, Developmental Psychology, 35, 1399). Parent-infant dyads (n = 49 mothers; 43 fathers) were videotaped during face-to-face interaction at infant age 6 months; interactions were coded with both the WECS and PIIRS. At age 3, mothers completed the Child Behavior Checklist. WECS ratings of EC were associated with PIIRS rating items for both mother-infant and father-infant dyads. Mother-infant EC related positively to maternal sensitivity and positive regard for child, child positive mood and sustained attention, and dyadic mutuality, and negatively with maternal intrusiveness. Father-infant EC related positively to fathers' positive regard for child, child positive mood and sustained attention, and dyadic mutuality. Mother-infant EC predicted child behavior problems at age 3 better than mother-infant PIIRS ratings of dyadic mutuality. With fathers, neither EC nor dyadic mutuality ratings predicted mother-reported child behavior problems. Findings highlight the practical utility of the WECS for identifying potentially at-risk dyads and supporting early relational health.