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The objective of the current study was to systematically review the literature on caregiver-child biological attunement within distress contexts during the first three years of life. A total of 9932 unique abstracts were identified through Medline, Embase, PsycINFO, CINAHL, and Scopus databases. Thirty-six studies provided data from caregivers and their infants or toddlers within a distress paradigm, used biological indicators of distress, and assessed the relations between caregiver and child biological indicators. Findings were synthesized based on biological indicators, type of analysis, and measurement epochs pre- and post-distress. Most articles examined cortisol. Associations between caregiver and child cortisol indicators were moderate to large, though findings varied depending on the analysis used and measurement epochs examined. Many of the findings examining relations between mother and child cardiac, sAA, and EEG indicators were weak or inconsistent, likely due to the limitations of methodological approaches used to capture the complexity of the caregiver-child attunement process. Gaps in the literature and suggestions for future research are discussed.

The objective of the current study was to systematically review the available literature on the relation between behavioral and cardiac indicators used to measure distress in toddlerhood. After ascertaining the eligibility of 2,424 articles through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO (International Prospective Register of Systematic Reviews) guided search process, 22 articles ( N = 2,504) that investigated associations between behavioral and cardiac indicators of distress in toddlerhood were identified. The narrative synthesis described the overall relation (direction [positive, negative], strength [Cohen’s D]) between behavioral and cardiac indicators and was organized by cardiac indicator (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia, pre-ejection period) and type of behavior measured (i.e., coding for expressed emotion behaviors vs. emotion regulation behaviors). Methodological characteristics (i.e., timing of measurement for behavioral and cardiac indicators [concurrent, predictive], length of measurement epochs, inclusion of covariates and moderators) were also described. HR was consistently positively ( D = .05 to .54) related to expressed emotion behaviors. No other cardiac and behavioral indicators were consistently related. Methodological differences related to behavioral and cardiac indicators utilized, timing of measurement, and length of measurement epochs may be responsible for heterogeneity in findings. The findings suggest that researchers might get divergent results depending on whether distress is measured with cardiac or behavioral indicators of distress in toddlerhood. Suggestions for future psychophysiological research with young children are offered.

There is considerable variability regarding the convergence between behavioral and biological aspects of distress responses in toddlerhood, and little research has investigated the convergence of these measures in high distress. The aim of the current study was to describe patterns of distress responses to vaccinations as indexed by both pain-related behavioral distress and heart rate (HR) at 12 and 18 months. Caregiver-toddler dyads were part of an ongoing longitudinal cohort observed during 12- (N = 158) and 18-month (N = 122) well-baby vaccinations. Parallel-process growth mixture models discerned two distinct groups at 12 months and three distinct groups at 18 months. All groups had comparable pain-related behavioral distress and HR responses post-vaccination, with most participants displaying high arousal and regulation to baseline levels following the vaccination. However, at 18 months, an important minority had a blunted response or did not regulate to a low level of distress by 3 min post-needle. Post hoc analyses revealed that higher baseline pain-related behavioral distress predicted membership in the majority groups at 12 and 18 months. These results highlight the developmental differences and variability in behavioral and cardiac indicators of distress regulation across the second year of life.

The aim of this study was to examine the concurrent and predictive relations between healthy toddlers' pain behavior and cardiac indicators (ie, heart rate [HR] and respiratory sinus arrhythmia [RSA]) during routine vaccinations. Caregiver-infant dyads were part of a longitudinal cohort observed during their 12- and 18-month vaccinations. Behavioral and cardiac data were simultaneously collected for 1-minute preneedle and 3-minutes postneedle. Videotapes were coded for pain behaviors (FLACC; Merkel et al., 1997), and cardiac data were analyzed (HR, RSA) during sequential 30-second epochs. Four separate cross-lagged path models were estimated using data from the 12- (n = 147) and 18-month (n = 122) vaccinations. Across 12- and 18-month vaccinations, predictive within-measure relations were consistent for FLACC, HR, and RSA, reflecting good stability of these pain indicators. Behavioral indicators predicted subsequent HR and RSA within the immediate postneedle period. Both baseline behavior and HR/RSA predicted future pain scores. Concurrent residual relations between behavioral and cardiac indicators were inconsistent across time and indicators. Results suggest that behavioral and cardiac indicators reflect unique aspects of the nociceptive response. As such, multimodal assessment tools should be used and contextualized by child age, cardiac indicator, baseline behavior/physiology, and pain phase.

The current study sets forth to provide descriptive data for preschool vaccination pain responding as well as examine longitudinal relationships over early childhood. Growth mixture modeling was first used to describe stable subgroups of preschoolers on the basis of their pain response patterns over 2-minutes post-needle. Secondly, a parallel-process growth curve model was used to assess the stability of acute pain responding from 12 months of age to preschool age. Specifically, we examined whether preschool pain-related distress or regulation could be predicted from 12-month acute pain responding. Preschool participants were part of a Canadian longitudinal cohort (The Opportunities to Understand Childhood Hurt [OUCH] cohort; N = 302). Growth mixture modeling analyses discerned 3 distinct groups of preschoolers, with an important minority not regulating to low-no pain by 2 minutes post-needle. There were no significant associations between 12-month and preschool pain responding. These results highlight the steep trajectory of development between these different stages of early childhood and the variability of pain responding at the preschool vaccination. Perspective This study provides descriptive data for preschool vaccination pain responding as well as examines longitudinal relationships over early childhood. Demonstrating significantly different pain patterns from infancy, 25% of preschoolers are displaying suboptimal regulation trajectories. This considerable minority poses a significant concern because of the established trajectory of phobia onset in middle childhood.

Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life.Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants.Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review.Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions.Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.

This study examined the effects of comorbid ADHD symptoms, internalizing psychopathology, Callous–Unemotional (CU) Traits, and conduct problem severity on children’s response to an evidence-based psychosocial intervention. Clinic-referred children with DBD ages 8–12 years (N = 76) participated in a 15-week multi-component intervention. Parents provided weekly ratings of children’s oppositionality-defiance, peer problems, and impairment. Oppositionality-defiance, peer problems, and impairment decreased significantly over the course of the intervention; however, there was considerable variability in weekly ratings. Baseline ADHD symptoms, internalizing psychopathology, CU traits, and conduct problem severity were unrelated to rate of change across treatment. However, ADHD symptoms uniquely predicted more oppositionality-defiance, peer problems, and impairment averaged across the 15 weeks of treatment. Follow-up analyses suggested this was driven by hyperactivity-impulsivity rather than inattention. Children with DBD and comorbid symptoms appear to benefit from a multi-component intervention, but those with ADHD symptoms may require additional support to address social and behavioral challenges.

Young adult survivors of extremely low birth weight (ELBW; 2500 g) controls. Using a median split, participants were separated into two groups (high or low afternoon cortisol levels). ELBW survivors with “high” afternoon cortisol levels self-reported significantly higher levels of internalizing behaviors compared to those with “low” afternoon cortisol levels. This association between afternoon cortisol and internalizing symptoms did not exist among NBW controls. These results are suggestive of a differential susceptibility for internalizing behaviors among ELBW survivors, depending on their ability to regulate neuroendocrine responses. © 2015 Wiley Periodicals, Inc. Dev Psychobiol 57: 486–496, 2015.

The focus of this chapter is to draw attention to the need for a relational perspective when understanding infants in pain, due to the unique developmental situation of young infants being wholly dependent on another individual to understand, assess, and manage their pain-related distress signaling. Attachment theory provided a theoretical foundation from which to build a developmentally informed model of understanding infant pain responding that acknowledges the symbiotic nature of infant pain expression and caregiver behavior (the Development of Infant Acute Pain Responding or DIAPR model). Two main areas are presented to support the supposition that to understand the infant in pain, one must also understand the infant’s caregiver and the infant’s relationship with the caregiver. First, research that draws parallels between classic tenets of attachment theory and results from a large longitudinal cohort study following infants and caregivers through routine vaccinations in the first year of life is reviewed. Second, while caregiver pain assessments are a major source for tapping into the subjective experience of the pained infant, these assessments have important challenges regardless of if the caregiver is a parent or health professional. Ultimately, it is recommended that future work in infant pain mechanisms, assessment, and management incorporate a relational lens to more accurately understand the phenomena of infant pain sensation, perception, and expression.

The experience of early adversity can increase one’s risk of psychopathology later in life. Extremely low birth weight (ELBW) provides a unique model of early adversity that affords us the opportunity to understand how prenatal and early postnatal stressors can affect the development of emotional, biological, and behavioural systems. Since the neuroendocrine system and emotion regulation can both be negatively affected by exposure to early adversity, and dysregulation in these regulatory systems has been linked to various forms of psychopathology, it is possible that these systems could mediate and/or moderate associations between early adversity, specifically ELBW, and later internalizing disorders. In this review, we discuss evidence of an early programming hypothesis underlying psychopathology and the identification of neuroendocrine markers of early adversity that may mediate/moderate the development of psychopathology.

Extremely low birth weight survivors (ELBW

To clarify long-standing conceptual and empirical inconsistencies in models describing the relation between frontal brain asymmetry and emotion, we tested a theory of biological sensitivity to context. We examined whether asymmetry of alpha activation in frontal brain regions, as measured by resting electroencephalography, is sensitive to early developmental contexts. Specifically, we investigated whether frontal asymmetry moderates the association between birth weight and adult outcomes. Adults with left frontal asymmetry (LFA) who were born at extremely low birth weight exhibited high levels of attention problems and withdrawn behaviors in their 30s, whereas normal-birth-weight adults with LFA had low levels of these problem behaviors. Adults with right frontal asymmetry (RFA) displayed a relatively moderate amount of problem behavior regardless of birth weight. Our findings suggest that LFA is associated with sensitivity to developmental context and may help explain why LFA is associated with both positive and negative outcomes, whereas RFA seems to be associated with a more canalized process in some contexts.