Specification of Change Mechanisms in Pregnant Smokers for Malleable Target Identification: A Novel Approach to a Tenacious Public Health Problem

Maternal smoking during pregnancy (MSDP) continues to be a leading modifiable risk factor for perinatal complications and a range of neurodevelopmental and cardio-metabolic outcomes across the lifespan. Despite 40 years of intervention research less than one in five pregnant smokers who receive an intervention quit by delivery. Within this context, recognition of pregnancy is commonly associated with abrupt suspension or reduction of smoking in the absence of intervention, yet has not been investigated as a volitional target. The goal of this article is to provide the empirical foundation for a novel direction of research aimed at identifying malleable targets for intervention through the specification of behavior change mechanisms specific to pregnant women. To do so, we: (1) summarize progress on MSDP in the United States generated from conventional empirical approaches to health behavior change; (2) discuss the phenomenon of spontaneous change in the absence of intervention among pregnant smokers to illustrate the need for mechanistic specification of behavior change motivated by concern for fetal well-being; (3) summarize component processes in neurobiological models of parental and non-parental social behaviors as a conceptual framework for understanding change mechanisms during pregnancy; (4) discuss the evidence for the malleability of these processes to support their translational relevance for preventive interventions; and (5) propose a roadmap for validating the proposed change mechanism using an experimental medicine approach. A greater understanding of social and interpersonal processes that facilitate health behavior change among expectant mothers and how these processes differ interindividually could yield novel volitional targets for prenatal interventions. More broadly, explicating other-oriented mechanisms of behavior change during pregnancy could serve as a paradigm for understanding how social and interpersonal processes positively influence health behaviors across the lifespan

Neural correlates of early deliberate emotion regulation: Young children\u27s responses to interpersonal scaffolding.

Deliberate emotion regulation, the ability to willfully modulate emotional experiences, is shaped through interpersonal scaffolding and forecasts later functioning in multiple domains. However, nascent deliberate emotion regulation in early childhood is poorly understood due to a paucity of studies that simulate interpersonal scaffolding of this skill and measure its occurrence in multiple modalities. Our goal was to identify neural and behavioral components of early deliberate emotion regulation to identify patterns of competent and deficient responses. A novel probe was developed to assess deliberate emotion regulation in young children. Sixty children (age 4-6 years) were randomly assigned to deliberate emotion regulation or control conditions. Children completed a frustration task while lateral prefrontal cortex (LPFC) activation was recorded via functional near-infrared spectroscopy (fNIRS). Facial expressions were video recorded and children self-rated their emotions. Parents rated their child\u27s temperamental emotion regulation. Deliberate emotion regulation interpersonal scaffolding predicted a significant increase in frustration-related LPFC activation not seen in controls. Better temperamental emotion regulation predicted larger LPFC activation increases post- scaffolding among children who engaged in deliberate emotion regulation interpersonal scaffolding. A capacity to increase LPFC activation in response to interpersonal scaffolding may be a crucial neural correlate of early deliberate emotion regulation

Parenting practices in pregnancy smokers compared to non smokers

BACKGROUND: The present investigation compared parenting practices in a sample of preschoolers whose mothers reported smoking during pregnancy versus those who did not. METHODS: A sample of n = 216, 3.0- to 5.11-year-old children, participants in an ongoing longitudinal study, was separated into those reportedly exposed to smoking in utero and those who were not. Parenting practices were compared between the two groups, using T-tests and exact logistic regressions. Multiple linear regressions and multivariate logistic regressions were used to examine the association between smoking status and parenting, controlling for variables also known to be associated with parenting practices. RESULTS: Current study findings suggest that smoking during pregnancy is associated with harsh parenting practices. CONCLUSIONS: Study results highlight the possible role of parenting in disruptive outcomes well-known in toddlers exposed to nicotine in utero and have implications for targeting early interventions in these populations

Attention bias and anxiety in young children exposed to family violence

Background—Attention bias towards threat is associated with anxiety in older youth and adults and has been linked with violence exposure. Attention bias may moderate the relationship between violence exposure and anxiety in young children. Capitalizing on measurement advances, the current study examines these relationships at a younger age than previously possible. Methods—Young children (mean age 4.7, ±0.8) from a cross-sectional sample oversampled for violence exposure (N = 218) completed the dot-probe task to assess their attention biases. Observed fear/anxiety was characterized with a novel observational paradigm, the Anxiety Diagnostic Observation Schedule. Mother-reported symptoms were assessed with the Preschool-Age Psychiatric Assessment and Trauma Symptom Checklist for Young Children. Violence exposure was characterized with dimensional scores reflecting probability of membership in two classes derived via latent class analysis from the Conflict Tactics Scales: Abuse and Harsh Parenting. Results—Family violence predicted greater child anxiety and trauma symptoms. Attention bias moderated the relationship between violence and anxiety

Who Underreports Smoking on Birth Records: A Monte Carlo Predictive Model with Validation

Research has shown that self-reports of smoking during pregnancy may underestimate true prevalence. However, little is known about which populations have higher rates of underreporting. Availability of more accurate measures of smoking during pregnancy could greatly enhance the usefulness of existing studies on the effects of maternal smoking offspring, especially in those populations where underreporting may lead to underestimation of the impact of smoking during pregnancy.In this paper, we develop a statistical Monte Carlo model to estimate patterns of underreporting of smoking during pregnancy, and apply it to analyze the smoking self-report data from birth certificates in the state of Massachusetts. Our results illustrate non-uniform patterns of underreporting of smoking during pregnancy among different populations. Estimates of likely underreporting of smoking during pregnancy were highest among mothers who were college-educated, married, aged 30 years or older, employed full-time, and planning to breastfeed. The model's findings are validated and compared to an existing underreporting adjustment approach in the Maternal and Infant Smoking Study of East Boston (MISSEB).The validation results show that when biological assays are not available, the Monte Carlo method proposed can provide a more accurate estimate of the smoking status during pregnancy than self-reports alone. Such methods hold promise for providing a better assessment of the impact of smoking during pregnancy

Linking informant discrepancies to observed variations in young children’s disruptive behavior

Article in press in the Journal of Abnormal Child PsychologyPrior work has not tested the basic theoretical notion that informant discrepancies in reports of children’s behavior exist, in part, because different informants observe children’s behavior in different settings. We examined patterns of observed preschool disruptive behavior across varying social contexts in the laboratory and whether they related to parent-teacher rating discrepancies of disruptive behavior in a sample of 327 preschoolers. Observed disruptive behavior was assessed with a lab-based developmentally sensitive diagnostic observation paradigm that assesses disruptive behavior across three interactions with the child with parent and examiner. Latent class analysis identified four patterns of disruptive behavior: (a) low across parent and examiner contexts, (b) high with parent only, (c) high with examiner only, and (d) high with parent and examiner. Observed disruptive behavior specific to the parent and examiner contexts were uniquely related to parent-identified and teacher-identified disruptive behavior, respectively. Further, observed disruptive behavior across both parent and examiner contexts was associated with disruptive behavior as identified by both informants. Links between observed behavior and informant discrepancies were not explained by child impairment or observed problematic parenting. Findings provide the first laboratory-based support for the Attribution Bias Context Model, which posits that informant discrepancies are indicative of cross-contextual variability in children’s behavior and informants’ perspectives on this behavior. These findings have important implications for clinical assessment, treatment outcomes, and developmental psychopathology research.Lauren S. Wakschlag: NIMH grants R01 MH68455 and MH62437, National 0-3, and Shaw and Children’s Brain Research Foundations; Patrick H. Tolan and David B. Henry: CDC grant U49/CE 000732, NICHD grant R01 HD042030, and NIDA grant R01 DA02082

Dimension- and Context-Specific Expression of Preschoolers’ Disruptive Behaviors Associated with Prenatal Tobacco Exposure

Objective—Precise phenotypic characterization of prenatal tobacco exposure (PTE) −related disruptive behavior (DB) that integrates nuanced measures of both exposures and outcomes is optimal for elucidating underlying mechanisms. Using this approach, our goals were to identify dimensions of DB most sensitive to PTE prior to school entry and assess contextual variation in these dimensions. Methods—A community obstetric sample of N=369 women (79.2% lifetime smokers; 70.2% pregnancy smokers) from two Midwestern cities were assessed for PTE using cotinine-calibrated interview-based reports at 16, 28, and 40 weeks of gestation. A subset of n=244 who completed observational assessments with their 5-year-old children in a subsequent preschool follow-up study constitute the analytic sample. Using two developmentally-meaningful dimensions previously associated with emergent clinical risk for DB—irritability and noncompliance—we assessed children with 2 parent-report scales: the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB) and the Early Childhood Inventory (ECI). We also assessed children by direct observation across 3 interactional contexts with the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS). We used generalized linear models to examine between-child variability across behavioral dimensions, and mixed effects models to examine directly observed within-child variability by interactional context. Results—Increasing PTE predicted increasing impairment in preschoolers’ modulation of negative affect (irritability), but not negative behavior (noncompliance) across reported (MAP-DB) and observed (DB-DOS) dimensional measures. Moreover, children’s PTE-related irritability was more pronounced when observed with parents than with the examiner. The ECI did not detect PTE-related irritability nor noncompliance. Conclusions—Nuanced, dimension- and context-specific characterization of PTE-related DB described can optimize early identification of at-risk children

Adversity is linked with decreased parent-child behavioral and neural synchrony

Parent-child synchrony-parent-child interaction patterns characterized by contingent social responding, mutual responsivity, and co-regulation-has been robustly associated with adaptive child outcomes. Synchrony has been investigated in both behavioral and biological frameworks. While it has been demonstrated that adversity can influence behavioral parent-child synchrony, the neural mechanisms by which this disruption occurs are understudied. The current study examined the association between adversity, parent-child behavioral synchrony, and parent-child neural synchrony across lateral prefrontal cortical regions using functional near-infrared spectroscopy hyperscanning during a parent-child interaction task that included a mild stress induction followed by a recovery period. Participants included 115 children (ages 4-5) and their primary caregivers. Parent-child behavioral synchrony was quantified as the amount time the dyad was synchronous (e.g., reciprocal communication, coordinated behaviors) during the interaction task. Parent-child neural synchrony was examined as the hemodynamic concordance between parent and child lateral PFC activation. Adversity was examined across two, empirically-derived domains: sociodemographic risk (e.g., family income) and familial risk (e.g., household chaos). Adversity, across domains, was associated with decreased parent-child behavioral synchrony across task conditions. Sociodemographic risk was associated with decreased parent-child neural synchrony in the context of experimentally-induced stress. These findings link adversity to decreased parent-child behavioral and neural synchrony

Specific and social fears in children and adolescents : separating normative fears from problem indicators and phobias

Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears

How penalizing substance use in pregnancy affects treatment and research: A qualitative examination of researchers\u27 perspectives

INTRODUCTION: Laws regulating substance use in pregnancy are changing and may have unintended consequences on scientific efforts to address the opioid epidemic. Yet, how these laws affect care and research is poorly understood. METHODS: We conducted semi-structured qualitative interviews using purposive and snowball sampling of researchers who have engaged pregnant people experiencing substance use. We explored views on laws governing substance use in pregnancy and legal reform possibilities. Interviews were double coded. Data were examined using thematic analysis. RESULTS: We interviewed 22 researchers (response rate: 71 per cent) and identified four themes: (i) harms of punitive laws, (ii) negative legal impacts on research, (iii) proposals for legal reform, and (iv) activism over time. DISCUSSION: Researchers view laws penalizing substance use during pregnancy as failing to treat addiction as a disease and harming pregnant people and families. Respondents routinely made scientific compromises to protect participants. While some have successfully advocated for legal reform, ongoing advocacy is needed. CONCLUSION: Adverse impacts from criminalizing substance use during pregnancy extend to research on this common and stigmatized problem. Rather than penalizing substance use in pregnancy, laws should approach addiction as a medical issue and support scientific efforts to improve outcomes for affected families