Ed Tronick

Healthy Newborns' Neurobehavior: Norms and Relations to Medical and Demographic Factors

OBJECTIVE To generate neurobehavioral norms for an unselected random sample of clinically healthy newborns by examining the newborns with use of the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). STUDY DESIGN We recruited 344 healthy mothers and newborns from a well-child nursery. The NNNS, a 128-item assessment of infant neurobehavior, was used to examine newborn performance. Associations between 11 NNNS summary scales and the stress/abstinence scale, as well as medical and demographic variables, were evaluated. Mean, SD, and 5th and 95th percentile values for the summary scores of the NNNS are presented. RESULTS NNNS scores from the 10th to the 90th percentile represent a range of normative performance. Performance on different neurobehavioral domains was related to marital status, ethnicity, prenatal, intrapartum and neonatal risk factors, complications during labor/delivery, cesarean delivery, gestational age, the age of the newborn at testing, and infant sex. CONCLUSION These data provide clinicians and researchers with normative data for evaluation of newborn neurobehavior. Even in a low-risk sample, medical and demographic factors below clinical cut-offs were related to newborn performance. Infants with scores outside the ranges for the 11 NNNS summary scores and the stress/abstinence scale may need further observation and, if necessary, early intervention.

Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions

Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring.

Re‐conceptualising Prenatal Life Stressors in Predicting Post‐partum Depression: Cumulative‐, Specific‐, and Domain‐specific Approaches to Calculating Risk

BACKGROUND Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health. METHODS The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women. RESULTS Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5). CONCLUSIONS In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.

Differential distribution and lateralization of infant gestures and their relation to maternal gestures in the Face-to-Face Still-Face paradigm.

We examined whether there are differences in the lateralization of expressive gestures in infants during normal and stressful interactions with their mothers and the relations between their gestures. Thirty full-term 6-12 month-old infants were videotaped during the Face-to-Face Still-Face paradigm. We coded the occurrence and lateralization of infant self-directed and other-directed gestures and maternal proximal and distal gestures. Infant self-directed gestures increased from the Play to Still-Face episode and decreased from the Still-Face to Reunion episode. Other-directed gestures decreased from the Play to Still-Face and increased from the Still-Face to Reunion episode. During the Still-Face, self-directed gestures were predominantly performed with the left side of the body. Maternal gestures were not lateralized, but there was a prevalence of distal gestures in the Play and Reunion episodes of the paradigm. Left-sided infant other-directed gestures and left-sided maternal gestures were associated with each other. The findings highlight a differential utilization and lateralization of self- and other-directed gestures related to context and the stress experienced by the infant as well as to maternal gestures. These results are suggestive of a brain asymmetry, but an asymmetry related to emotional engagement and stress regulation.

Intra-individual stability and developmental change in hair cortisol among postpartum mothers and infants: Implications for understanding chronic stress.

The study goal was to determine the intra-individual stability, developmental change, and maternal-reported correlates (socio-demographic, stress experiences, hair characteristics, and care) of hair cortisol in mothers and their infants. To assess cortisol deposition in hair during the periods of 6-to-9 months and 9-to-12 months of age, 3 cm segments of hair samples deemed to represent approximately 3 months of retrospective hair cortisol were sampled longitudinally at 9- and 12-months in 41 mothers and infants. Bivariate correlations and mean level comparisons of log-transformed hair cortisol levels at 9- (T1) and 12-months (T2) in mothers and infants were examined. Hair cortisol values were positively correlated from T1 to T2 for mothers (r = .41, p < .05) and infants (r = .39, p < .05). Hair cortisol values did not significantly differ from T1 to T2 in infants but decreased for mothers (F(1,34) = 9.2, p < .01). Maternal and infant hair cortisol was not associated with each other at either time point. Self-reported measures of stress, and hair characteristics and care were not associated with hair cortisol. This is the first study to obtain hair cortisol from more than one time point within the first year after birth in mothers and infants. The intra-individual stability of hair cortisol suggests that it may be a possible biomarker for detecting change in chronic stress experiences within the first year of life and in the postpartum period.

Relational Psychophysiology and Mutual Regulation During Dyadic Therapeutic and Developmental Relating

Human experiences of empathy and presence are quintessential in therapeutic as well as intimate relationships. The work on relational psychophysiology has informed psychotherapeutic research by illustrating how early life physiological concordance between mother and infant is critical in mutual dyadic regulation. These processes cross several developmental domains, including biological, affective, social, and self-identity. By examining physiological concordance, this research has propelled our understanding of mutual regulation into the more expansive understanding of dyadically expanded states of consciousness. The core of the therapeutic relationship inherently engenders expanded opportunities and reorganization of the client, as well as the therapist. By incorporating the views of nonlinear dynamic systems theory, this model views the human as an open dynamic system, consisting of interrelated domains of functioning (i.e., physiological, emotional, cognitive/symbolic, and social/behavioral), where each is an agent in mutual regulation and growth. Fine-tuning the mutual regulation model by bringing in relational psychophysiology and dynamic systems theory offers an expanded understanding of intimate human relationships, including early systemic development between mother and infant, as well as therapist–client effectiveness.

Maternal Lifestyle Study (MLS): Relationship of Neurologic Exam to Neurobehavior following Cocaine-Opiate Exposure

Maternal Lifestyle Study (MLS): Relationship of Neurologic Exam to Neurobehavior following Cocaine-Opiate Exposure