Hanna C. Gustafsson

Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study.

BACKGROUND Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance. METHODS 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review. RESULTS Two distinct factors of PrA were identified, indexing specific concerns about the childs health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood. LIMITATIONS The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples. CONCLUSIONS PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention.

Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change.

The role of cognitive mechanisms in the clinical course of neurodevelopmental disorders is poorly understood. Attention Deficit Hyperactivity Disorder (ADHD) is emblematic in that numerous alterations in cognitive development are apparent, yet how they relate to changes in symptom expression with age is unclear. To resolve the role of cognitive mechanisms in ADHD, a developmental perspective that takes into account expected within-group heterogeneity is needed. Method: The current study uses an accelerated longitudinal design and latent trajectory growth mixture models in a sample of children ages 7–13 years carefully characterized as with (n = 437) and without (n = 297) ADHD to (a) identify heterogeneous developmental trajectories for response inhibition, visual spatial working memory maintenance, and delayed reward discounting and (b) to assess the relationships between these cognitive trajectories and ADHD symptom change. Results: Best-fitting models indicated multiple trajectory classes in both the ADHD and typically developing samples, as well as distinct relationships between each cognitive process and ADHD symptom change. Developmental change in response inhibition and delayed reward discounting were unrelated to ADHD symptom change, while individual differences in the rate of visual spatial working memory maintenance improvement predicted symptom remission in ADHD. Conclusion: Characterizing heterogeneity in cognitive development will be crucial for clarifying mechanisms of symptom persistence and recovery. Results here suggest working memory maintenance may be uniquely related to ADHD symptom improvement.

Maternal diet, metabolic state, and inflammatory response exert unique and long-lasting influences on offspring behavior in non-human primates

Nutritional status influences brain health and gestational exposure to metabolic disorders (e.g. obesity and diabetes) increases the risk of neuropsychiatric disorders. The aim of the present study was to further investigate the role of maternal Western-style diet (WSD), metabolic state, and inflammatory factors in the programming of Japanese macaque offspring behavior. Utilizing structural equation modeling, we investigated the relationships between maternal diet, prepregnancy adiposity, third trimester insulin response, and plasma cytokine levels on 11-month-old offspring behavior. Maternal WSD was associated with greater reactive and ritualized anxiety in offspring. Maternal adiposity and third trimester macrophage-derived chemokine (MDC) exerted opposing effects on offspring high-energy outbursts. Elevated levels of this behavior were associated with low maternal MDC and increased prepregnancy adiposity. This is the first study to show that maternal MDC levels influence offspring behavior. We found no evidence suggesting maternal peripheral inflammatory response mediated the effect of maternal diet and metabolic state on aberrant offspring behavior. Additionally, the extent of maternal metabolic impairment differentially influenced chemokine response. Elevated prepregnancy adiposity suppressed third trimester chemokines, while obesity-induced insulin resistance augmented peripheral chemokine levels. WSD also directly increased maternal interleukin-12. This is the first non-human primate study to delineate the effects of maternal diet and metabolic state on gestational inflammatory environment and subsequent offspring behavior. Our findings give insight to the complex mechanisms by which diet, metabolic state, and inflammation during pregnancy exert unique influences on offspring behavioral regulation.

The relationship between early and late event-related potentials and temperament in adolescents with and without ADHD

Differences in emotional processing are prevalent in adolescents with attention deficit/hyperactivity disorder (ADHD) and are related to clinical impairment, but substantial heterogeneity exists. Within ADHD, some individuals experience difficulty with positive/approach emotions, negative/withdrawal emotions, or both. These problems may reflect differences in emotional reactivity, emotion regulation, or a combination, and the neurophysiological correlates remain unclear. Event-related potentials were collected from 109 adolescents (49 with ADHD) while they completed an emotional go/no-go task with three conditions: happy (positive/approach), fear (negative/withdrawal), and neutral. The P1 and N170 were used as a marker of early emotional processing and the P3b and late positive potential (LPP) were used as markers of later elaborative emotional processing. Emotional response style was assessed with parent and adolescent report on the Early Adolescent Temperament Questionnaire. There were no effects of emotion or group for the P1. Typically-developing adolescents exhibited a larger N170 to emotional vs. neutral faces while adolescents with ADHD showed the opposite pattern. All adolescents exhibited a larger P3b to fearful versus other faces and a larger LPP to emotional vs. non-emotional faces. Within the ADHD group, N170 responses to happy faces predicted parent ratings of positive/approach emotions. Findings highlight the importance of considering within-group heterogeneity when studying clinical populations and help clarify the time-locked neurophysiological correlates of emotion dysregulation.

Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping.

Attention deficit hyperactivity disorder (ADHD) is emblematic of unresolved heterogeneity in psychiatric disorders— the variation in biological, clinical, and psychological correlates that impedes progress on etiology. One approach to this problem is to characterize subgroups using measures rooted in biological or psychological theory, consistent with the National Institute of Mental Health’s research domain criteria initiative. Within ADHD, a promising application involves using emotion trait profiles that can address the role of irritability as a complicating feature for ADHD. Here, a new sample of 186 children with ADHD was evaluated using community detection analysis to determine if meaningful subprofiles existed and if they replicated those previously identified. The new sample and a prior sample were pooled for evaluation of (a) method dependence, (b) longitudinal assessment of the stability of classifications, and (c) clinical prediction 2 years later. Three temperament profiles were confirmed within the ADHD group: one with normative emotional functioning (“mild”), one with high surgency (“surgent”), and one with high negative affect (“irritable”). Profiles were similar across statistical clustering approaches. The irritable group had the highest external validity: It was moderately stable over time and it enhanced prospective prediction of clinical outcomes beyond standard baseline indicators. The irritable group was not reducible to ADHD + oppositional defiant disorder, ADHD + disruptive mood dysregulation disorder, or other patterns of comorbidity. Among the negative affect domains studied, trait proneness to anger uniquely contributed to clinical prediction. Results extend our understanding of chronic irritability in psychiatric disorders and provide prospects for a fresh approach to assessing ADHD heterogeneity focused on the distinction between ADHD with and without anger/irritability.

Extracurricular Activities are Associated with Lower Suicidality through Decreased Thwarted Belongingness in Young Adults

Research has shown a negative association between extracurricular activities (ECAs) and suicidality. This study builds upon past research by using the interpersonal psychological theory of suicide to better understand the mechanisms involved in the relationship between ECAs and suicide risk. A total of 121 community and online-recruited adults ages 18 to 24-years-old participated. Self-report measures of suicidality, thwarted belongingness, and perceived burdensomeness were collected. Duration and breadth of participation in ECAs were assessed. ECA involvement was negatively associated with thwarted belongingness and perceived burdensomeness. An indirect effect of ECAs on suicidality through thwarted belongingness was statistically significant, but not for perceived burdensomeness. ECA involvement was associated with decreased suicidality through lower levels of thwarted belongingness. Interventions utilizing ECAs may be a low-cost, high-access option for decreasing suicide risk.

Intimate Partner Violence and Children's Attachment Representations During Middle Childhood

Despite long-standing hypotheses that intimate partner violence (IPV) may undermine childrens ability to form secure attachment representations, few studies have empirically investigated this association. Particularly lacking is research that examines IPV and attachment during middle childhood, a time when the way that children understand, represent, and process the behavior of others becomes particularly important. Using data from a sample of African American children living in rural, low-income communities (n = 98), the current study sought to address this gap by examining the association between physical IPV occurring early in childrens lives and their attachment security during the first grade. Results indicate that, even after controlling for child- and family-level covariates, physical IPV was associated with a greater likelihood of being rated insecurely attached. This effect was above and beyond the influence of maternal parenting behaviors, demonstrating a unique effect of physical IPV on childrens attachment representations during middle childhood.

Maternal prenatal depression predicts infant negative affect via maternal inflammatory cytokine levels

Maternal depressive symptoms during pregnancy are associated with risk for offspring emotional and behavioral problems, but the mechanisms by which this association occurs are not known. Infant elevated negative affect (increased crying, irritability, fearfulness, etc.) is a key risk factor for future psychopathology, so understanding its determinants has prevention and early intervention potential. An understudied yet promising hypothesis is that maternal mood affects infant mood via maternal prenatal inflammatory mechanisms, but this has not been prospectively examined in humans. Using data from a pilot study of women followed from the second trimester of pregnancy through six months postpartum (N = 68) our goal was to initiate a prospective study as to whether maternal inflammatory cytokines mediate the association between maternal depressive symptoms and infant offspring negative affect. The study sample was designed to examine a broad range of likely self-regulation and mood-regulation problems in offspring; to that end we over-selected women with a family history or their own history of elevated symptoms of attention-deficit/hyperactivity disorder. Results supported the hypothesis: maternal pro-inflammatory cytokines during the third trimester (indexed using a latent variable that included plasma interleukin-6, tumor necrosis factor-alpha and monocyte chemoattractant protein-1 concentrations as indicators) mediated the effect, such that higher maternal depressive symptoms were associated with higher maternal inflammation, and this mediated the effect on maternal report of infant negative affect (controlling for maternal affect during the infant period). This is the first human study to demonstrate that maternal inflammatory cytokines mediate the association between prenatal depression and infant outcomes, and the first to demonstrate a biological mechanism through which depressive symptoms impact infant temperament.

Associations between early caregiving and rural, low-SES, African-American children’s representations of attachment relationships

ABSTRACT Little research has examined the legacy of early maternal care for later attachment representations among low-income and ethnic minority school-aged children. Using data from a sample of 276 rural, low-income, African-American families, this study examined associations between maternal care in infancy and children’s representations of attachment figures in middle childhood. Maternal care was coded from 10-min home-based observations at 6, 15, and 24 months of age. Representations of attachment figures were assessed using the Manchester Child Attachment Story Task at 6 years of age. Sensitive maternal care in infancy was not significantly related to attachment security or episodic disorganized behaviors in children’s representations. However, children exposed to more harsh–intrusive parenting during infancy displayed less secure representations of attachment figures in middle childhood and more episodic disorganized behaviors, even after controlling for numerous child and family contextual covariates. Findings inform conceptualizations of attachment formation among rural, low-income, African-American parent–child dyads.