Paulo A. Graziano

Cardiac vagal regulation differentiates among children at risk for behavior problems.

A sample of 335 five-year-old children participating in an ongoing longitudinal study was the focus of a study on the effects of emotional and behavioral challenge on cardiac activity in children with different patterns of early childhood behavior problems. The children were placed in one of three behavior problem groups (low behavior problems, risk for externalizing problems, risk for mixed externalizing/internalizing problems) based on their scores on the Child Behavior Checklist for 4-18-year-olds [Achenbach, T.M., 1991. Integrative guide for the 1991 CBCL/4-18, YSR & TRF profiles. University of Vermont Department of Psychiatry, Burlington, VT], completed by their mothers. To assess cardiac vagal regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA change (vagal withdrawal) to five emotionally and behaviorally challenging tasks were derived. In addition, heart period (HP) and heart period change (HR acceleration) was examined. Results indicated that the behavior problem groups did not differ in terms of resting measures of either RSA or HP. Analyses of the challenge tasks indicated that the children at risk for mixed problems displayed greater cardiac vagal withdrawal across the five tasks than did the other two groups of children. There was a trend for the children at risk for externalizing problems to display less vagal withdrawal than the control group. In addition, the children at risk for mixed problems displayed greater heart rate acceleration to the tasks than did the other two groups of children. Follow-up analyses indicated that the greater cardiac acceleration observed in the mixed group was largely a function of greater vagal withdrawal. These findings are discussed in terms of the emotion regulatory function of cardiac vagal regulation, and its implications for patterns of risk for behavior problems in young children.

Cardiac vagal control and children's adaptive functioning: a meta-analysis.

Polyvagal theory has influenced research on the role of cardiac vagal control, indexed by respiratory sinus arrhythmia withdrawal (RSA-W) during challenging states, in childrens self-regulation. However, it remains unclear how well RSA-W predicts adaptive functioning (AF) outcomes and whether certain caveats of measuring RSA (e.g., respiration) significantly impact these associations. A meta-analysis of 44 studies (n=4996 children) revealed small effect sizes such that greater levels of RSA-W were related to fewer externalizing, internalizing, and cognitive/academic problems. In contrast, RSA-W was differentially related to childrens social problems according to sample type (community vs. clinical/at-risk). The relations between RSA-W and childrens AF outcomes were stronger among studies that co-varied baseline RSA and in Caucasian children (no effect was found for respiration). Children from clinical/at-risk samples displayed lower levels of baseline RSA and RSA-W compared to children from community samples. Theoretical/practical implications for the study of cardiac vagal control are discussed.

Toddler self-regulation skills predict risk for pediatric obesity.

Objective:To investigate the role of early self-regulation skills, including emotion regulation, sustained attention and inhibitory control/reward sensitivity, in predicting pediatric obesity in early childhood.Method:Participants for this study included 57 children (25 girls) obtained from three different cohorts participating in a larger ongoing longitudinal study. At 2 years of age, participants participated in several laboratory tasks designed to assess their self-regulation skills. Height and weight measures were collected when children were 2 and 5.5 years of age.Results:Self-regulation skills in toddlerhood were predictive of both normal variations in body mass index (BMI) development and pediatric obesity. Specifically, emotion regulation was the primary self-regulation skill involved in predicting normative changes in BMI as no effects were found for sustained attention or inhibitory control/reward sensitivity. However, both emotion regulation and inhibitory control/reward sensitivity predicted more extreme weight problems (that is, pediatric obesity), even after controlling for 2-year BMI. Thus, toddlers with poor emotion regulation skills and lower inhibitory control skills/higher reward sensitivity were more likely to be classified as overweight/at risk at 5.5 years of age.Conclusion:Early self-regulation difficulties across domains (that is, behavioral and emotional) represent significant individual risk factors for the development of pediatric obesity. Mechanisms by which early self-regulation skills may contribute to the development of pediatric obesity are discussed.

Predicting Cardiac Vagal Regulation in Early Childhood from Maternal–Child Relationship Quality during Toddlerhood

The aim of this study was to examine the influence of maternal-child relationship quality during toddlerhood on early childhood physiological regulation. A community sample of 447 children (215 males) was recruited at age 2 for participation in the study using the Child Behavior Checklist [Achenbach [1992] Manual for the child behavior checklist/2-3 & 1992 profile. Burlington, VT: University of VT Department of Psychiatry]. Mothers and children were observed across several interactions in the laboratory at age 2 and mothers completed the Parenting Stress Index [Abidin [1995] Manual for the parenting stress index. Odessa, FL: Psychological Assessment Resources]. Relationship quality was assessed using laboratory measures of hostility, positive guidance, and stress related to the quality of the relationship as reported by mothers. Cardiac vagal regulation at age 2 was assessed across six challenge tasks, three in which the child and mother worked together and three in which the child worked independently, and was indexed by the magnitude of vagal withdrawal (decrease in respiratory sinus arrhythmia, RSA) to challenge. Results indicated that children displayed greater cardiac vagal regulation and heart rate acceleration during collaborative tasks versus independent tasks. In addition, maternal-child relationship quality predicted the degree of vagal regulation in children at age 5, even after controlling for early and concurrent level of behavior problems as well as 2-year cardiac vagal regulation. Children with poorer quality relationships displayed significantly poorer vagal regulation and lower heart rate acceleration (p < .01). These findings are discussed in terms of the implications of environmental factors for the acquisition of fundamental self-regulatory skills.

Attention-deficit hyperactivity disorder and children's emotion dysregulation: A meta-analysis

While executive functioning deficits have been central to cognitive theories of Attention-Deficit Hyperactivity Disorder (ADHD), recent work has suggested that emotion dysregulation may also play a key role in understanding the impairments suffered by youth with ADHD. However, given the multiple processes involved in emotion dysregulation, the extent to which youth with ADHD are impaired across multiple domains of emotion dysregulation including: emotion recognition/understanding (ERU), emotion reactivity/negativity/lability (ERNL), emotion regulation (EREG), and empathy/callous-unemotional traits (ECUT) remains unclear. A meta-analysis of 77 studies (n=32,044 youths) revealed that youth with ADHD have the greatest impairment on ERNL (weighted ES d=.95) followed by EREG (weighted ES d=.80). Significantly smaller effects were observed for ECUT (weighted ES d=.68) and ERU (weighted ES d=.64). Moderation analyses indicated that the association between ADHD and ERNL was stronger among studies that had a sample containing older youth (no other demographic factors were significant). Additionally, the association between ADHD and ECUT was significantly weaker among studies that controlled for co-occurring conduct problems. Co-occurring conduct problems did not moderate the link between ADHD and any other emotion dysregulation domain. Lastly, the association between ADHD and ERNL was significantly weaker when controlling for youths cognitive functioning. Cognitive functioning did not moderate the link between ADHD and ERU, EREG, or ECUT, respectively. Theoretical/practical implications for the study of emotional dysregulation in youth with ADHD are discussed.

Barriers to Success in Parent Training for Young Children With Developmental Delay The Role of Cumulative Risk

The purpose of this study was to examine the effect of cumulative risk on dropout and treatment outcome in parent training. Participants were 44 families of young children (mean age of 49.59 months) who presented with elevated externalizing behavior problems and developmental delay or borderline developmental delay. All families were offered to receive Parent–Child Interaction Therapy (PCIT), an evidence-based, behavioral parent-training intervention, at a hospital-based outpatient clinic. Cumulative risk was calculated as a sum of risk variables, including socioeconomic disadvantage (poverty, low maternal education), family structure (single-parent household), and maternal risk characteristics (minority status, lower intelligence, and parental distress). Families with higher cumulative risk scores, especially those with three or more risks, were more likely to drop out of treatment and display diminished treatment response in child behavior and parenting skills compared with families with lower cumulative risk scores. However, only two individual risk factors (i.e., minority status and family structure) predicted dropout, and one individual risk factor (i.e., maternal education) predicted outcome. These findings suggest that it can be useful to conceptualize risk factors as having a cumulative, in addition to individual, influence on parent-training interventions for children with developmental delay and have significant implications for clinical practice. It is important for clinicians to regularly assess for risk factors, and future research should examine ways in which clinicians can improve retention and outcome of parent training in the presence of multiple risk factors.

Predicting weight outcomes in preadolescence: the role of toddlers’ self-regulation skills and the temperament dimension of pleasure

Objectives:To investigate the role of toddlers’ self-regulation skills and temperament in predicting weight outcomes in preadolescence.Methods:Participants for this study included 195 children (114 girls) obtained from three different cohorts participating in a larger ongoing longitudinal study. At 2 years of age, participants participated in several laboratory tasks designed to assess their self-regulation abilities, including emotion regulation, sustained attention and delay of gratification, whereas parents filled out a temperament questionnaire to assess toddlers’ pleasure expression. Height and weight measures were collected when children were 4, 5, 7 and 10 years of age. Children also filled out a body image and eating questionnaire at the 10-year visit.Results:Self-regulation skills in toddlers were associated with body mass index (BMI) development and pediatric obesity as well as body image/eating concerns. The temperament dimension of pleasure was also associated with BMI development and pediatric obesity but not body image/eating concerns.Conclusions:Self-regulation difficulties across domains as well as temperament-based pleasure in toddlers represented significant individual risk factors for the development of pediatric obesity 8 years later. Early self-regulation difficulties also contributed to body image and eating concerns that typically accompanied overweight children. The mechanisms by which early self-regulation skills and temperament-based pleasure may contribute to the development of pediatric obesity and associated weight concerns are discussed.

Co-occurring weight problems among children with attention deficit/hyperactivity disorder: the role of executive functioning

OBJECTIVE:To explore the link between pediatric obesity and attention deficit/hyperactivity disorder (ADHD) by examining whether executive functioning (EF) and medication status are associated with body mass index (BMI) and weight status in children with ADHD.METHOD:Participants for this study included 80 children (mean age=10 years, 9 months) with a DSM-IV diagnosis of ADHD, confirmed by a comprehensive clinical diagnostic assessment. Childrens EF was measured using three neuropsychological tests, and severity of ADHD symptoms and medication status were obtained from parent report. Childrens height and weight were also measured during the visit using a wall-mounted stadiometer and a balance beam scale.RESULTS:Children with ADHD who performed poorly on the neuropsychological battery had greater BMI z-scores, and were more likely to be classified as overweight/obese compared with children with ADHD who performed better on the neuropsychological battery. In addition, children with ADHD who were taking a stimulant medication had significantly lower BMI z-scores compared with children with ADHD who were not taking medication or who were taking a non-stimulant medication.CONCLUSION:EF is more impaired among children with ADHD and co-occurring weight problems, highlighting the importance of self-regulation as a link between pediatric obesity and ADHD.

An initial investigation of baseline respiratory sinus arrhythmia as a moderator of treatment outcome for young children born premature with externalizing behavior problems.

The aim of the current study was to examine the moderating effect of baseline respiratory sinus arrhythmia (RSA) on Parent-Child Interaction Therapy (PCIT), a behavioral parent-training intervention, for young children born premature. In this pilot randomized controlled trial, 28 young children (mean age of 37.79 months), who were born <37 weeks gestation and presented with elevated externalizing behavior problems, were randomly assigned to an immediate treatment or waitlist control group. RSA, which provides an approximate marker of individual differences in cardiac vagal tone, was measured during a baseline period. Past research has generally shown that higher levels of baseline RSA correlate with various positive psychological states (e.g., empathy, sustained attention), whereas lower levels of baseline RSA correlate with less optimal psychological states (e.g., higher externalizing behavior problems). Results indicated that baseline RSA significantly interacted with treatment condition in predicting changes in child disruptive behavior. Specifically, low levels of baseline RSA were associated with greater improvements in child disruptive behavior following PCIT. While acknowledging the caveats of measuring and interpreting RSA and the need to include a sympathetic-linked cardiac measure in future research, these findings provide preliminary evidence that children with lower capacity for emotion regulation receive even greater treatment gains. Future research should also examine the moderating effect of RSA in larger samples and explore the potential mediating role of RSA on behavioral parenting interventions.

ADHD symptomatology and risky health, driving, and financial behaviors in college: the mediating role of sensation seeking and effortful control

Objective: To examine the extent to which effortful control (EC) and sensation seeking (SS) tendencies explain the association between the severity of ADHD symptoms and risky behaviors. Method: Participants included 555 college students (66% females) who completed self-report measures assessing their ADHD symptoms, EC abilities, SS tendencies, and risky health (e.g., substance use) and driving/financial behaviors (e.g., misuse of credit cards). Results: Severity of college students’ ADHD symptoms, EC abilities, and SS tendencies were related to all risky behaviors. Multiple mediational analyses further indicated that students’ SS tendencies significantly mediated the association between ADHD symptoms and the risky health factor but not the risky driving/financial factor. EC, however, significantly mediated the association between ADHD symptoms and both the risky health and driving/financial factors. Conclusion: The current study provides initial data showing potentially different mechanisms that explain the link between college students’ severity of ADHD symptoms and risky behaviors.