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Background The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children's posthospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. Method This study used principal components analysis, a panel of experts, Cronbach's alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS). Data from previous investigations (N = 1064, Mage = 5.88) which utilized the PHBQ were combined for the purposes of this paper. Results A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ-AS. The PHBQ-AS demonstrated good internal consistency reliability and concurrent validity with another measure of children's psychosocial and physical functioning. Conclusion Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ-AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes.

Neonatal intensive care unit (NICU) graduates have a higher incidence of attention problems including attention deficit hyperactivity disorder (ADHD). Thus, we examined the effect of risk factors (birth weight (BW), central nervous system (CNS) injury, gender, maternal education) on attention/inhibition during reaction time, continuous performance and Go/No-Go tasks at 42, 51, and 60 months (n = 271). Very low BW NICU graduates (<1,500 g) performed worse than typical BW ones (>2,500 g), displaying poorer target/non-target discrimination. Males responded faster than females, but made more false alarms and random responses. Despite short duration tasks, attention waned. Performance improved with age, but even at 60 months children had difficulty inhibiting random responding. [ABSTRACT FROM AUTHOR]

Objective: One important factor in adolescents' development of problem alcohol use is their family environment. Yet, the mechanisms that relate parenting to youth alcohol use are not well characterized. This study employed a naturalistic laboratory-based approach to observe parenting behaviors (support, structure, criticism) and adolescents' physiological and emotional responses to parent-adolescent interactions to examine associations with adolescent alcohol use.Method: Fifty eight 10-16year olds and their parents completed a 10minute Parent Adolescent Interaction Task (PAIT) in which they discussed a mutually highly-rated conflict topic. Parental support, structure, and criticism were coded from the interaction. Adolescents' heart rate (HR), blood pressure (BP), reported emotions, and salivary cortisol were assessed before, during, and after the interaction.Results: Findings indicated that lower parental structure and support were associated with youth's greater diastolic BP and anger arousal in response to the PAIT. Furthermore, higher HR, systolic BP, and cortisol responses to the interaction were associated with youth's alcohol use.Conclusions: Findings suggest that heightened emotional and physiological responses to parent-adolescent conflict interactions in youth may be one pathway by which parenting is associated with adolescent alcohol use and risk for abuse. [ABSTRACT FROM AUTHOR]

Adolescents are at relatively high-risk for developing anxiety, particularly social anxiety. A primary hallmark of social anxiety is the impulse to avoid situations that introduce risk. Here, we examined the neural and behavioral correlates of risk avoidance in adolescents (N=59) 11 to 19 years of age. The Balloon Risk Avoidance Task was used with concurrent electroencephalography to measure event-related potentials (frontal P2; late slow-wave; N2, feedback-related negativity, FRN; posterior P3) and oscillatory dynamics (midfrontal theta, 4-7 Hz) in response to unsuccessful and successful risk avoidance conditions. Social anxiety was measured using the Social Phobia and Anxiety Inventory for Children. Results indicated that, across the whole sample, youth exhibited smaller P3, larger FRN, and larger theta responses to unsuccessful risk avoidance. Youth reporting high (compared to low) levels of social anxiety exhibited larger P2, slow-wave, and FRN responses to unsuccessful, compared to successful, risk avoidance. Further, greater social anxiety was associated with reduced theta responses to successful avoidance. Youth with higher levels of social anxiety showed smaller theta responses to both conditions compared to those with low levels of social anxiety. Taken together, the ERP-component differences and weakened theta power in socially anxious youth following unsuccessful avoidance are informative neural correlates for socially anxious youth during risk avoidance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Enhanced health literacy in children has been empirically linked to better health outcomes over the long term; however, few interventions have been shown to improve health literacy. In this context, we investigate whether large language models (LLMs) can serve as a medium to improve health literacy in children. We tested pediatric conditions using 26 different prompts in ChatGPT-3.5, ChatGPT-4, Microsoft Bing, and Google Bard (now known as Google Gemini). The primary outcome measurement was the reading grade level (RGL) of output as assessed by Gunning Fog, Flesch-Kincaid Grade Level, Automated Readability Index, and Coleman-Liau indices. Word counts were also assessed. Across all models, output for basic prompts such as "Explain" and "What is (are)," were at, or exceeded, the tenth-grade RGL. When prompts were specified to explain conditions from the first- to twelfth-grade level, we found that LLMs had varying abilities to tailor responses based on grade level. ChatGPT-3.5 provided responses that ranged from the seventh-grade to college freshmen RGL while ChatGPT-4 outputted responses from the tenth-grade to the college senior RGL. Microsoft Bing provided responses from the ninth- to eleventh-grade RGL while Google Bard provided responses from the seventh- to tenth-grade RGL. LLMs face challenges in crafting outputs below a sixth-grade RGL. However, their capability to modify outputs above this threshold, provides a potential mechanism for adolescents to explore, understand, and engage with information regarding their health conditions, spanning from simple to complex terms. Future studies are needed to verify the accuracy and efficacy of these tools., (Copyright ©2024, Yale Journal of Biology and Medicine.)

Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt ('think'-rating), and how intensely they felt in response to each infant stimulus ('feel'-rating). Mothers who used substances had lower 'feel'-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, 'think'-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes., Competing Interests: Declaration of competing interest The authors declare no competing interests with respect to the content of this manuscript. MNP has consulted for Opiant Therapeutics, Game Day Data, Baria-Tek, the Addiction Policy Forum, AXA and Idorsia Pharmaceuticals; has been involved in a patent application with Yale University and Novartis; received research support from the Mohegan Sun Casino and the Connecticut Council on Problem Gambling; and consulted for legal and gambling entities on issues related to impulse-control disorders and addictions. The other authors report no disclosures., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Distracted driving is a primary contributor to for motor vehicle crashes, the leading cause for injuries and fatalities for youth. Although attention and working memory clearly underlie driving abilities, few studies explore these functions on the brain-level under the cognitive load of driving. To understand the load driving has on auditory attention processing, we examined the differences in dynamic brain response to auditory stimuli during LOAD (while driving in a high-fidelity driving simulator) and No-LOAD conditions (seated in simulator, parked on the side of the road)., Methods: Twenty-seven young adult drivers (18-27 y/o; 15 = women) completed a Selective Auditory Attention Task during both a LOAD (driving) and No-LOAD condition in a ½ cab miniSim ® high-fidelity driving simulator. During the task, participants responded by pressing the volume control button on the steering wheel when a target tone was presented to a target ear. Electroencephalography-recorded event-related brain responses to the target tones were evaluated through alpha and theta oscillations for two response windows (early: 150-330ms; late: 350-540ms)., Results: During an early time window, we observed a significant interaction between attended/unattended and LOAD/No-LOAD theta power in the right frontal cortical region ( F (1, 24)= 5.4, p =.03, partial η 2 =.18). During the later window, we observed a significant interaction between attended/unattended and LOAD/No-LOAD alpha response in the posterior cortical region ( F (1, 24)=11.81, p =.002, partial η 2 =.15) and in the right temporal cortical region during the window ( F (1, 24)=4.3, p =.05, partial η 2 =.33)., Conclusions: Our data provide insight into the demand that driving has on cognitive faculties and how dual task engagement may draw resources away from driving. We suggest future research directly incorporate vehicle control abilities into study design to understand how brain-based measures relate to driving behaviors.

Background : Exposure to substances in utero may have significant early-life consequences. Less is known about the effects in emerging adulthood, particularly regarding patterns of substance use and related characteristics. Objectives : In this study, we recruited emerging adults, followed since birth, who had been prenatally exposed, or not, to cocaine. Individuals reported on their cannabis, alcohol, and tobacco use, and measures of impulsivity, anhedonia, emotional regulation, and mental health were obtained. Comparisons were made between emerging adults with prenatal cocaine exposure and those without. Correlations were performed between psychological measures and substance use, and regression analyses were conducted to determine potential pathways by which such measures may relate to prenatal exposure or substance use. Results : Individuals with prenatal cocaine exposure (vs. those without) used cannabis at younger ages, reported greater cannabis-use severity, and demonstrated higher impulsivity, state anxiety, and alexithymia. Earlier age of onset of cannabis use was associated with higher impulsivity, state anxiety, alexithymia, and social and physical anhedonia. Cannabis-use age-of-onset mediated the relationship between prenatal cocaine-exposure status and state anxiety and between prenatal cocaine-exposure status and cannabis-use severity in emerging adulthood but not relationships between prenatal cocaine-exposure status and impulsivity or alexithymia in emerging adulthood. Findings suggest that adults with prenatal cocaine exposure may use cannabis at younger ages, which may relate to increased anxiety and more severe use. Conclusions : These findings suggest both mechanisms and possible intervention targets to improve mental health in emerging adults with prenatal cocaine exposure.

Maternal psychological factors, including anxiety, depression, and substance use, may negatively affect parenting. Previous works with mothers have often assessed each of these factors in isolation despite their frequent co-occurrence. Psychological factors have also been associated with neural processing of facial stimuli, specifically the amplitude (i.e., size) and latency (i.e., timing) of the face-specific N170 event-related potential. In the current study, 106 mothers completed measures assessing maternal psychological factors-anxiety, depression, and substance use. A latent profile analysis was used to identify profiles of psychological factors and assess profile associations with the N170 elicited by infant faces and with parental reflective functioning (PRF) as a measure related to caregiving. Two profiles (termed high and low psychological risk) were identified, with the higher risk profile associated with delayed N170 latency responses to infant faces. An exploratory analysis evidenced an indirect effect between the higher psychological risk profile and lower PRF through delayed N170 latency responses to infant faces. Taken together, maternal psychological risk across multiple indicators may together shape neural processing of infant faces, which may have downstream consequences for caregiving., (© 2023 Wiley Periodicals LLC.)

Objective: Exposure to early childhood adversity is associated with an increased risk for physiological disruption, including increased inflammation. Early interventions that support the mother-child relationship have been shown to potentially buffer negative psychosocial outcomes related to early adversity, but it is unclear whether these interventions have long-term biological effects. We evaluated whether prior participation in Minding the Baby® (MTB), an attachment-based home visiting intervention for young mother-infant dyads living in underserved communities, is associated with lower child salivary inflammatory biomarkers compared with controls at follow-up., Methods: Ninety-seven maternal-child dyads (n = 43 intervention and n = 54 controls) enrolled in a follow-up study of the MTB randomized controlled trial, an average of 4.6 years after RCT completion. Children provided salivary specimens. We used adjusted linear regression to examine the relationship between MTB participation and child salivary inflammatory biomarkers (C-reactive protein [CRP], interleukin [IL]-1β, IL-6, IL-8, and TNF-α)., Results: Children were on average 6.6 years old, 48% female, and identified as non-Hispanic/Latino Black/African American (34%) and Hispanic/Latino (63%). Participation in MTB was associated with lower salivary CRP levels (β = -0.31, SE = 0.28, p = 0.003) compared with controls. Participation in MTB was not associated with salivary cytokine levels., Discussion: Participation in an intensive two-generation home visiting intervention such as MTB may reduce salivary inflammatory biomarkers associated with early childhood adversity. Replication and further research are needed to improve the understanding of the potential for early childhood interventions to buffer the biological embedding of early adversity., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Nancy Suchman and the colleagues she influenced have produced ground-breaking and attitude-challenging work in understanding how parenting and substance use come together. Dr Suchman and her colleagues make the claim that there is nothing about a substance-use disorder that precludes effective and sensitive caring for children especially with interventions that focus on the parent-child relationship. Suchman's legacy is to highlight how substance use as an illness pulls individuals away from important, caring relationships and limits their giving themselves to those relationships. Restoring the salience of caring relationships and of the individual's ability to care may be as impactful on their substance use as a strict focus on the reduction of drug use and achieving abstinence., (© 2023 Michigan Association for Infant Mental Health.)

Background: Tourette syndrome (TS) is a neurodevelopmental disorder involving chronic motor and phonic tics. Most individuals with TS can suppress their tics for at least a short period of time. Yet, the brain correlates of tic suppression are still poorly understood., Methods: In the current study, high-density electroencephalography was recorded during a resting-state and a tic suppression session in 72 children with TS. Functional connectivity between cortical regions was assessed in the alpha band (8-13 Hz) using an electroencephalography source connectivity method. Graph theory and network-based statistics were used to assess the global network topology and to identify brain regions showing increased connectivity during tic suppression., Results: Graph theoretical analyses revealed distinctive global network topology during tic suppression, relative to rest. Using network-based statistics, we found a subnetwork of increased connectivity during tic suppression (p < .001). That subnetwork encompassed many cortical areas, including the right superior frontal gyrus and the left precuneus, which are involved in the default mode network. We also found a condition-by-age interaction, suggesting age-mediated increases in connectivity during tic suppression., Conclusions: These results suggest that children with TS suppress their tics through a brain circuit involving distributed cortical regions, many of which are part of the default mode network. Brain connectivity during tic suppression also increases as youths with TS mature. These results highlight a mechanism by which children with TS may control their tics, which could be relevant for future treatment studies., (Copyright © 2021 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Maternal attachment security is an important predictor of caregiving . However, little is known regarding the neurobiological mechanisms by which attachment influences processing of infant cues, a critical component of caregiving. We examined whether attachment security, measured by the Adult Attachment Interview, might relate to neural responses to infant cues using event-related potentials. Secure ( n =35) and insecure ( n =24) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded. We examined initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Secure mothers were significantly faster than insecure mothers to orient to infant cries (N100), structurally encode their own infant's face (N170), and attend to infant faces (P300). These differences may elucidate mechanisms underlying how attachment may shape neural processing of infant cues and highlight the use ofsocial neuroscientific approaches in examining clinically relevant aspects of attachment.

Objective: The purpose of this study was to examine associations between maternal trauma exposure, posttraumatic stress symptoms, and directly observed maternal-child interactions among a diverse cohort of mother-preterm infant dyads at 12-month corrected age., Methods: We conducted a retrospective cohort study. Maternal trauma exposure and posttraumatic stress symptoms were measured using the Modified Posttraumatic Stress Disorder Symptom Scale at baseline and 6 and 12 months. The primary outcome was directly observed maternal-child interactions at 12-month corrected age using the Coding Interactive Behavior Manual. We used linear regression models to estimate the associations between trauma exposure, posttraumatic stress symptoms (and symptom clusters), and observer-rated maternal-child interactions., Results: Among the 236 participants, 89 (37.7%) self-reported as Black and 98 (41.5%) as Latina; mean gestational age of the infants was 31.6 weeks (SD 2.6). Mothers with posttraumatic stress symptoms demonstrated greater maternal sensitivity (β = 0.32; 95% confidence interval [CI], 0.06-0.58; standardized effect size = 0.39) and greater dyadic reciprocity (β = 0.39; 95% CI, 0.04-0.73; standardized effect size = 0.36) compared with those not exposed to trauma; however, we did not observe significant differences between trauma-exposed but asymptomatic women and those not exposed to trauma. Across symptom clusters, differences in maternal sensitivity and dyadic reciprocity were most pronounced for mothers with avoidance and re-experiencing symptoms, but not hyperarousal symptoms., Conclusion: Maternal posttraumatic stress symptoms seem to be associated with the quality of maternal-child interactions at age 1 year among a cohort of urban, mother-preterm infant dyads. These findings have implications for strength-based intervention development., Competing Interests: M. Silverstein is a member of the US Preventive Services Task Force. This article does not necessarily represent the views and policies of the US Preventive Services Task Force. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Prenatal substance exposure has the potential to impact a variety of domains, with neurobiological effects that last throughout the lifespan. Different substances may impact the brain in both specific and diffuse ways; however, the aberrant neural outcomes following exposure tend to coalesce in three areas: (1) sensorimotor development; (2) arousal, motivation, and reward; and (3) executive functioning, impulse control, and emotion regulation. This manuscript represents a summary and update of a previous review (Morie et al., 2019). We organize this piece by domain and summarize data from published neuroimaging studies that examine the neural correlates of prenatal exposure across developmental stages. While the published neuroimaging literature in the area of prenatal exposure has a range of sampling concerns that may limit generalizability as well as longitudinal prediction, the findings to date do point to domains of interest warranting further study. With this caveat, we synthesize the extant findings to describe ways in which prenatal substance exposure is associated with developmental psychopathology and implicated in potentially aberrant behavioral patterns beginning in infancy and persisting through childhood, adolescence, adulthood, and even parenthood. We also examine how substance abuse may impact parenting behaviors that in turn influences infant and child behavior in ways that may be additive or obscure the direct teratological effects of prenatal exposure. Given this observation, we offer an additional intergenerational lens through which prenatal substance exposure should be studied., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Maternal substance use is associated with altered neural activity and poor offspring outcomes, which may be facilitated by suboptimal caregiving in the form of impaired parental reflective functioning (PRF). To investigate these associations, the resting-state frontal electroencephalography (EEG) power of 48 substance-using mothers and 37 non-substance-using mothers were examined, specifying seven frequency bands: delta, theta, alpha, alpha1, alpha2, beta, and gamma. Substance-using mothers exhibited enhanced beta and gamma spectral power compared to non-substance-using mothers, potentially reflecting higher arousal states in substance-using mothers. There were no between-group differences in any component of PRF (i.e., levels of pre-mentalizing, certainty, and interest and curiosity). Whole-sample analyses revealed significant positive correlations between pre-mentalizing and delta spectral power. Taken together, these findings suggest potential neural correlates of maternal substance use and PRF, providing an important next step into examining associations between maternal substance use and poor child outcomes., (© 2022 Michigan Association for Infant Mental Health.)

Emotional regulation is important for mental health and behavioral regulation. A relevant precursor to emotional regulation may involve identification of one's emotions. Here, we propose a model of seven components that may provide a foundation for emotion identification. These factors include baseline mood, monitoring, physiological responses, interoception, past personal experiences regarding emotions/metacognition, context, and labeling. We additionally examine how deficits in different components may contribute to the concept of alexithymia, which is defined by difficulty identifying and describing one's own emotions. Ultimately, we explore how the model may support a relationship between specific psychiatric disorders and alexithymia. The proposed model may help explain emotional identification impairment in multiple psychiatric disorders and guide future research and treatment development efforts., (Copyright © 2022. Published by Elsevier Ltd.)

Background: The proportion of motor vehicle crash fatalities involving alcohol-impaired drivers declined substantially between 1982 and 1997, but progress stopped after 1997. The systemic complexity of alcohol-impaired driving contributes to the persistence of this problem. This study aims to identify and map key feedback mechanisms that affect alcohol-impaired driving among adolescents and young adults in the U.S., Methods: We apply the system dynamics approach to the problem of alcohol-impaired driving and bring a feedback perspective for understanding drivers and inhibitors of the problem. The causal loop diagram (i.e., map of dynamic hypotheses about the structure of the system producing observed behaviors over time) developed in this study is based on the output of two group model building sessions conducted with multidisciplinary subject-matter experts bolstered with extensive literature review., Results: The causal loop diagram depicts diverse influences on youth impaired driving including parents, peers, policies, law enforcement, and the alcohol industry. Embedded in these feedback loops are the physical flow of youth between the categories of abstainers, drinkers who do not drive after drinking, and drinkers who drive after drinking. We identify key inertial factors, discuss how delay and feedback processes affect observed behaviors over time, and suggest strategies to reduce youth impaired driving., Conclusion: This review presents the first causal loop diagram of alcohol-impaired driving among adolescents and it is a vital first step toward quantitative simulation modeling of the problem. Through continued research, this model could provide a powerful tool for understanding the systemic complexity of impaired driving among adolescents, and identifying effective prevention practices and policies to reduce youth impaired driving., (Copyright © 2022. Published by Elsevier Ltd.)

Multiple interventions have been developed to improve the caregiver-child relationship as a buffer to the effects of early life adversity and toxic stress. However, relatively few studies have evaluated the long-term effects of these early childhood interventions, particularly on parenting and childhood behaviors. Here we describe the early school-age follow-up results of a randomized controlled trial of Minding the Baby ® (MTB), a reflective, attachment-based, trauma-informed, preventive home-visiting intervention for first-time mothers and their infants. Results indicate that mothers who participated in MTB are less likely to show impaired mentalizing compared to control mothers two to eight years after the intervention ended. Additionally, MTB mothers have lower levels of hostile and coercive parenting, and their children have lower total and externalizing problem behavior scores when compared to controls at follow-up. We discuss our findings in terms of their contribution to understanding the long-term parenting and childhood socio-emotional developmental effects of early preventive interventions for stressed populations.

Cannabis and tobacco use and related disorders have been separately associated with sensitivity to reward (SR), sensitivity to punishment (SP), and impulsivity. Given the frequent co-occurrence of cannabis and tobacco consumption in adolescents, it is important to understand how SR, SP and impulsivity may relate to both cannabis-use and tobacco-use co-occurrences and problem severities. Presently, sixty-five adolescents (14-21 years, 65% male), including 36 adolescents with daily tobacco smoking and regular cannabis use and 29 non-smoking healthy controls (HCs), completed self-report questionnaires assessing substance use, addiction severity, SR, SP, and impulsivity. Adolescent smokers had decreased SP and increased impulsivity compared to HCs. SR and impulsivity were independent predictors of concurrent cannabis-related problem severity among smokers. These findings suggest that specific approach/avoidance motives and impulsivity warrant further investigation as potential treatment targets in adolescents who consume both tobacco and cannabis., Competing Interests: Conflict of Interest and Financial Disclosures: None of the authors have any conflicts of interest. Dr. Hammond serves as a scientific advisor for the National Courts and Science Institute and as a subject matter expert for the Substance Abuse Mental Health Services Administration (SAMHSA) related to co-occurring substance use disorders and severe emotional disturbance in youth. Dr. Krishnan-Sarin has received investigational medications from Astra Zeneca and Novartis for studies on alcohol drinking behaviors. Dr. Potenza has consulted for Rivermend Health, Opiant Therapeutics, Addiction Policy Forum, Game Day Data and AXA; has received research support (to Yale) from Mohegan Sun Casino and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse-control disorders or other health topics; has consulted for and/or advised gambling and legal entities on issues related to impulse-control/addictive disorders; has provided clinical care in a problem gambling services program; has performed grant reviews for research-funding agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts. Dr. Mayes reports no disclosures. Dr. Crowley received grant funding from the NIH (T32 MH018268).

Purpose: A growing body of human research has documented associations between the maternal brain and maternal substance use and addictions. This neuroscience-informed approach affords the opportunity to unpack potential neurobiological mechanisms that may underscore challenges in maternal caregiving behavior among mothers with addictions and provide new directions for parenting interventions., Findings: Consistent with theoretical models of parenting and addictions, five studies evidence both hypo- and hyper-reactivity to infant affective cues across neuroimaging methods and tasks that incorporate both infant face and cry stimuli. Three structural and resting-state brain studies as a function of maternal substance use are also reported., Conclusions: While human neuroimaging research converges in showing that maternal substance use is associated with differential reactivity to infant affective cues, further multi-level/multi-modal, longitudinal, and dimensional research is critically needed to advance this area of investigation.

The COVID-19 pandemic is an unanticipated and uncontrollable chronic stressor that is detrimental to the mental and behavioral health of children and families, particularly those from disadvantaged and marginalized backgrounds. Chronic stress impairs a myriad of prefrontal cortical functions, important for coping with the COVID-19 pandemic, and has consequences on dyadic parent-child functioning. Informed by neuroscience and clinical evidence, sensitive parenting is a vital avenue of intervention that buffers against the toxic effects of COVID-19 on parent-child mental health. In the context of the COVID-19 pandemic, we first discuss the neurobiological, psychological, and behavioral mechanisms behind exacerbated mental health risks in families. We then highlight the role of sensitive parenting as a buffer against stress-related mental health problems, and conclude with recommendations for systemic-, family-, and individual-interventions to most effectively address stress-related mental health problems and their impact on children and families during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impairments in feedback processing, often associated with risk-taking behavior, may have implications for development of substance abuse in adolescents. The most commonly used substances by adolescents include tobacco and cannabis, with some individuals using both substances, potentially heightening risk. Our objective was to examine feedback processing and impulsivity in adolescents who smoke cigarettes and use cannabis daily (N = 21), comparing them with adolescents who smoke cigarettes daily and use cannabis occasionally (N = 18) and non-smoking (N = 27) adolescents. To do this, the Balloon Analog Risk Task (BART) with concurrent EEG was used to measure risk-related feedback processing, and impulsivity was measured using the Barratt's impulsiveness scale (BIS-11). It was found that adolescent daily tobacco/cannabis smoking was associated with higher BIS-11 scores, shortened feedback-related-negativity (FRN) latencies and reduced P300 amplitudes. In addition, FRN latencies during win conditions were inversely associated with tobacco-use severity, indicated by scores on the Fagerstrom Test for Nicotine Dependence (FTND), and with BIS-11 scores. Adolescents with concurrent tobacco and cannabis use show altered feedback processing and higher impulsivity. Future work should disentangle whether the effect reflects risk, consequences of use or both., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: Optimal age at surgery in nonsyndromic sagittal craniosynostosis continues to be debated. Previous reports suggest that earlier age at whole vault cranioplasty more frequently requires reoperation. It is unknown, however, whether reoperation affects neurocognitive outcome. This study examined the impact of reoperation on neurocognitive outcome in children with nonsyndromic sagittal craniosynostosis using comprehensive neurocognitive testing., Methods: Forty-seven school-age children (age 5-16 years) with nonsyndromic sagittal craniosynostosis who underwent whole-vault cranioplasty were included in this analysis. Participants were administered a battery of standardized neuropsychological testing to measure neurocognitive outcomes., Results: Thirteen of the 47 participants underwent reoperation (27.7%); 11 out of the 13 reoperations were minor revisions while 2 reoperations were cranioplasties. Reoperation rate was not statistically different between patients who had earlier surgery (at age ≤6 months) versus later surgery (at age >6 months) (P > 0.05). Nonreoperated patients who had only one later-in-life surgery did not perform statistically better than reoperated patients on any outcome measure of neurocognitive function, including IQ, academic achievement, visuomotor integration, executive function, and behavior. Comparing reoperated earlier surgery patients with nonreoperated later surgery patients, reoperated earlier surgery patients had higher full-scale and verbal IQ (P < 0.05), scored higher on word reading, reading comprehension, spelling, numerical operations, and visuomotor integration (P < 0.05), and had fewer indicators of suspected learning disabilities (P < 0.01) compared to nonreoperated later surgery patients., Conclusion: Reoperation rate after whole vault cranioplasty was 27.7%, with few cases of repeat cranioplasty (4.2% of all patients). Reoperation was not associated with worse neurocognitive outcome. Reoperated earlier surgery patients in fact performed better in IQ, academic achievement and visuomotor integration when compared to nonreoperated later surgery patients., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 by Mutaz B. Habal, MD.)

The burden of the COVID-19 pandemic upon healthcare workers necessitates a systematic effort to support their resilience. This article describes the Yale University and Yale New Haven Health System effort to unite several independent initiatives into a coherent integrated model for institutional support for healthcare workers. Here, we highlight both opportunities and challenges faced in attempting to support healthcare workers during this pandemic., (Published by Elsevier Inc.)

Differences in corticostriatal neural activity during feedback processing of rewards and losses have been separately related to cannabis and tobacco use but remain understudied relative to co-use in adolescents. Using high-density EEG (128 electrode system, 1000 Hz sampling), we examined event-related potentials (ERPs) elicited by monetary reward, neutral, and loss feedback during performance on a non-learning four-choice guessing task in a sample of non-deprived daily-cigarette-smoking adolescents (n = 36) who used tobacco and cannabis regularly (TC adolescents), and non-smoking healthy control adolescents (HCs) (n = 29). Peak amplitudes and latencies of mediofrontal ERPs indexing feedback-related negativities (FRNs) were used as outcomes in repeated-measures ANOVAs. No differences in FRNs were observed between TC and HC adolescents. Within TC adolescents, cannabis-use and tobacco-use variables had distinct relationships with the FRN, with cannabis-related problem severity being positively correlated with FRN amplitude during reward feedback and tobacco-related problem severity being negatively correlated with FRN latency during non-loss feedback (i.e., reward and neutral). These findings suggest that co-occurring cannabis and tobacco use may have dissociable relationships with feedback processing relating to each drug and support an incentive salience model of addiction severity related to cannabis use in adolescents., (Copyright © 2021. Published by Elsevier Inc.)

Infant-cue processing facilitates sensitive maternal care, which is necessary in the formation of healthy mother-infant attachment. Mothers may be particularly focused on cue processing early postpartum, contributing to intense preoccupation with their infant's well-being. Prior reproductive experience, or parity, may also impact the intensity of infant-cue processing and has been found to influence P300 neural responses to infant faces during pregnancy and at 2 months postpartum. However, we do not know whether this parity effect persists. Thus, we examined the P300 to infant faces in 59 mothers at 2 and 7 months postpartum. Our main finding was that primiparous, as compared to multiparous, women showed a significantly higher P300 to infant faces across the postpartum period. Findings further emphasize the importance of studying parity and its impact on the neural processing of infant faces.

Background: There is an epidemic of obesity in children and adolescents. Research into the self-regulatory factors that drive eating behavior is of critical importance. Food craving contributes to overeating and difficulty with weight loss and is strongly correlated with self-regulation. High-frequency heart rate variability (HF HRV) reflects parasympathetic activity and is positively associated with self-regulation. Few studies of HF HRV and food craving have been conducted in adolescents. The current study examined the association between HF HRV and food craving in a large-scale sample of healthy adolescents., Method: Electrocardiogram (ECG) was recorded in 134 healthy adolescents aged 10-17 during a 7-min resting state. Participants also completed the Food Craving Questionnaire-Trait (FCQ-T). The relative power of HF HRV was calculated. Association between HF HRV and food craving was examined in the context of sex and age. Next, the relative significance of all food craving subscales was considered in relation to HF HRV., Results: HF HRV was inversely correlated with food craving, taking into account sex and age. Considering all the subscales of FCQ-T in relation to HF HRV, the "lack of control over eating" subscale accounted for the most significant variance., Conclusion: This was the first study to evaluate resting HRV and eating behaviors in a large-scale adolescent sample. HF HRV was negatively associated with food craving, with lower HF HRV correlating with higher food craving, especially in the context of diminished control over eating. HF HRV could be a potential biomarker for food craving and food-related self-regulation capacity, and therefore may aid weight management interventions., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Objectives: Exposure to early-life trauma may lead to maladaptive characteristics such as alexithymia, and thus to poorer emotional regulation. This relationship may also be influenced by exposure to substances prenatally. We hypothesized that increased alexithymia would be seen in those with prenatal cocaine exposure (PCE). Additionally, we hypothesized that early-life trauma would be associated with alexithymia, and that alexithymia would be associated with poor emotional reappraisal and emotional suppression., Methods: A moderated mediation model was developed to examine whether the hypothesized indirect relationship between trauma and emotional reappraisal through alexithymia was different in young adults with and without PCE (Total N = 57). Thirty-seven young adults with PCE and 20 with no such exposure, all of whom were members of a longitudinal cohort, were recruited for the study, and data concerning childhood trauma, alexithymia, and emotional regulation were collected. Intercorrelations were performed between the scores on each measure and moderated mediation models were constructed separately with emotional neglect or emotional abuse as the independent variable and emotional reappraisal or emotional suppression as the dependent variable., Results: PCE status was associated with alexithymia, and alexithymia mediated the relationship between emotional neglect and emotional reappraisal in individuals with PCE but not those without., Discussion and Conclusions: The data suggest that alexithymia is a mechanism underlying poor use of emotional reappraisal in PCE individuals., Scientific Significance: Individuals with early-life trauma and substance exposure may represent a vulnerable population, and alexithymia may play a key role in the development of emotional regulation skills in this population. (Am J Addict 2020;29:492-499)., (© 2020 American Academy of Addiction Psychiatry.)

Converging evidence demonstrates increased levels of sensitivity to infant faces in mothers. This may be reflective of a series of psychological and neurobiological changes that occur in the transition to, and during early, parenthood for the purpose of appropriate caregiving; however, this enhanced infant facial recognition is in contrast with the general adult literature regarding facial processing. In the current study, we aimed to replicate a prior study of emotion facial recognition in pregnant women in a sample of mothers with children under a year old, utilizing a paradigm in which adult and infant faces gradually changed from neutral expressions to either happy or sad expressions. Mothers were faster at the recognition of adult faces in comparison to infant faces, and were also faster at happy faces in comparison to sad faces. Results are discussed in context of the current processing literature regarding the perinatal period, and implications for the persistence of the own-age bias and happy face advantage are considered., (Copyright © 2020. Published by Elsevier B.V.)

Objective: As noninvasive biological markers gain increasing popularity in pediatric research, it is critical to understand how study participants perceive these measures, especially among groups underrepresented in biobehavioral research, like children and people of color. The purpose of this study was to examine acceptability and feasibility of hair and salivary biomarker collection in an urban community sample of ethnically diverse children (age 4 to 10 years)., Methods: Ninety-seven mother-child dyads were recruited for a cross-sectional follow up study of the Minding the Baby® home visiting intervention. Children were Hispanic (63%), Black (34%), and multi-racial (3.1%). A conventional content analysis was conducted using two sources of data: (1) mothers' responses to open-ended interview questions on their views and suggestions regarding biomarker collection, and (2) field notes recorded by investigators., Results: Forty-four percent of mothers reported biomarker-related questions or concerns, including questions about the purpose of biomarker testing, and concerns about cosmetic issues, child discomfort, and future use of biomarker data. Mothers also offered positive feedback and advice for collection. Issues affecting feasibility included children's hair length and style, refusal to participate, and behavioral or developmental issues., Conclusions: Hair and salivary biomarker collection was largely acceptable and feasible in this sample. Strategies for promoting ethical and sensitive biomarker collection include respectful explanations and parental involvement, creating a comfortable and safe environment for the child, flexible collection strategies, and attention to development, cultural preferences and perspectives.

Distracted driving remains a leading factor in fatal motor vehicle crashes, particularly in young drivers. Due to ongoing neuromaturation, attention capabilities are changing and improving throughout young adulthood. Here, we sought to bridge neuroscience with driving simulation by evaluating the effects of driving on attention processing through a selective auditory attention task. Participants (18-25 years old) engaged in an auditory attention task during LOAD (driving a high-fidelity simulator) and No-LOAD conditions (sitting in the parked simulator). For the auditory task, participants responded to a target auditory tone in a target ear. The event-related potential components, collected from frontal and posterior regions, P2 and P3, were used to evaluate attention processing across LOAD and No-LOAD conditions for attended and unattended stimuli. Data from 24 participants were evaluated in repeated measures ANOVAs, considering interactions between load and attention conditions for the P2 and P3 components of the cortical region. We observed a significant difference between response to attended and unattended stimuli for posterior P2 and P3 responses at the frontal and posterior midline sites. Comparing LOAD and No-LOAD conditions, there was a significant difference for P2 response at the posterior site and P3 response at the frontal site. A significant interaction between load and attended stimuli was found for P3 response at the posterior site. These data document differences in neural processing of auditory stimuli during high-fidelity simulated driving versus sitting parked in the simulator. Findings suggest the cognitive load of driving affects auditory attention.

Objective: Infant crying can lead to parental frustration and is the most common trigger for abusive head trauma (AHT). We used qualitative methodology with an activating stimulus (an audiotape of an infant crying) to prime the participants to engage in open dialogue for the purpose of understanding their perceptions of infant crying and its association with AHT, with the aim that information from these interviews and the impact of hearing the activating stimulus could be used to inform interventions to prevent AHT that would resonate with parents., Methods: We conducted 25 initial qualitative interviews and 16 subsequent interviews with mothers and fathers of newborns. Before the initial interview, parents listened to a 1-minute audio clip of a crying infant, followed by a preventive message regarding AHT. The transcribed data were analyzed, and themes were developed using the constant comparative method of grounded theory. Data collection and analysis continued past the point of thematic saturation., Results: Four themes emerged from the initial interviews: 1) previous experience is helpful to manage infant crying, 2) babies cry for a reason, 3) shaking an infant is incomprehensible to parents, and 4) the role of safety planning to manage frustration with crying. Analysis of the subsequent interviews revealed 2 additional themes: 1) use of supports for infant crying (eg, technology and physician advice) and 2) effects of the audio clip on caregiving practices., Conclusion: Previous experiences and beliefs about crying affect parents' perceptions of infant crying and AHT. After discharge, parents reported using technology for information and support and thinking about the audio clip when caring for their infant. These experiences, beliefs, and practices may aid in shaping effective prevention strategies to prevent AHT., (Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Maternal bonding early postpartum lays an important foundation for child development. Changing brain structure and function during pregnancy and postpartum may underscore maternal bonding. We employed connectome-based predictive modeling (CPM) to measure brain functional connectivity and predict self-reported maternal bonding in mothers at 2 and 8 months postpartum. At 2 months, CPM predicted maternal anxiety in the bonding relationship: Greater integration between cerebellar and motor-sensory-auditory networks and between frontoparietal and motor-sensory-auditory networks were associated with more maternal anxiety toward their infant. Furthermore, greater segregation between the cerebellar and frontoparietal, and within the motor-sensory-auditory networks, was associated with more maternal anxiety regarding their infant. We did not observe CPM prediction of maternal bonding impairments or rejection/anger toward the infant. Finally, considering 2 and 8 months of data, changes in network connectivity were associated with changes in maternal anxiety in the bonding relationship. Our results suggest that changing connectivity among maternal brain networks may provide insight into the mother-infant bond, specifically in the context of anxiety and the representation of the infant in the mother's mind. These findings provide an opportunity to mechanistically investigate approaches to enhance the connectivity of these networks to optimize the representational and behavioral quality of the caregiving relationship., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Substance use may influence mothers' responsiveness to their infants and negatively impact the parent-infant relationship. Maternal substance use may co-opt neural circuitry involved in caregiving, thus reducing the salience of infant cues and diminishing the sense of reward experienced by caring for infants. Gaps in understanding exist with regard to the mechanisms by which substance use operates to influence mothers' processing of infant cues and how this translates to caregiving. Therefore, we examined how substance use might relate to maternal neural responses to infant cues using event-related potentials (ERPs). Substance-using (n = 29) and nonsubstance-using (n = 29) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded simultaneously. Three specific ERP components were used to examine initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Substance-using mothers did not discriminate facial affect at early encoding stages (N170), were generally slower to orient to infant cries (N100), showed heightened responses to neutral faces (P300), and failed to adaptively differentiate between high-distress versus low-distress cries (P300). These differences may be important to caregiving behaviors associated with the formation of mother-child attachment. Implications are discussed, as are limitations and future directions., (© 2020 Michigan Association for Infant Mental Health.)