Interventions for Transition-Age Youth With Disabilities: A Meta-Analysis of Group Design Studies.

This meta-analytic review investigated interventions for transition-age youth diagnosed with autism, intellectual disability, or extensive support needs. Nineteen group design studies with 215 effect sizes met inclusion criteria. A robust variance estimation procedure that accounts for the clustering effect sizes within studies was used to synthesize effect sizes within each intervention and outcome type. Occupational Therapy/Physical Therapy interventions have significant and positive effects on gross motor outcomes (g = 0.73, p < 0.01). All remaining interventions and outcomes could not be synthesized due to a limited number of studies, but are further described in a narrative manner. Recommendations for future research include improving the methodological quality of intervention studies and further analyzing the effects of interventions for transition-age youth.

Mechanisms by which Early Eye Gaze to the Mouth During Multisensory Speech Influences Expressive Communication Development in Infant Siblings of Children with and without Autism.

Looking to the mouth of a talker early in life predicts expressive communication. We hypothesized that looking at a talker's mouth may signal that infants are ready for increased supported joint engagement and that it subsequently facilitates prelinguistic vocal development and translates to broader gains in expressive communication. We tested this hypothesis in 50 infants aged 6-18 months with heightened and general population-level likelihood of autism diagnosis (Sibs-autism and Sibs-NA; respectively). We measured infants' gaze to a speaker's face using an eye tracking task, supported joint engagement during parent-child free play sessions, vocal complexity during a communication sample, and broader expressive communication. Looking at the mouth was indirectly associated with expressive communication via increased higher-order supported joint engagement and vocal complexity. This indirect effect did not vary according to sibling status. This study provides preliminary insights into the mechanisms by which looking at the mouth may influence expressive communication development.

Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial.

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity. MATERIALS AND METHODS: A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy. RESULTS: Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity. CONCLUSIONS: The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.

Sequence organization of autistic children's play with caregivers: Rethinking follow-in directives.

LAY ABSTRACT: In this article we use a qualitative method, conversation analysis, to examine videos of caregivers interacting with their young autistic children who are in the early phases of language learning. Conversation analysis involves preparation of detailed transcripts of video data, which are then analyzed together to understand how interactional moves (e.g. talk, gestures, and physical conduct) are linked with prior and subsequent interactional moves. We analyzed data from 15 participants, and focused on instances when caregivers made a proposal about something the child was playing with. In previous research, similar instances have been referred to as "follow-in directives." We found that these proposals were embedded in sequences that had a similar structure, and were prefaced with a 'pre-proposal'; where the caregiver established the child's interest in a joint activity and signaled the upcoming proposal. The caregiver's talk was also provided in such a way that there was a clear "slot" for the child's turn, which made it easy for the child's actions to become part of an interactional sequence. In addition, proposal sequences were very negotiable-the caregivers do not usually insist that the child follow through on the proposal, only that they produce an action that could be taken as a response. Finally, there were some instances where the child's turn was very precisely timed to occur right at the end of a caregiver's proposal; this precise timing could signal the child's understanding of how interactional turn-taking works. We suggest that this method of examining caregiver-child interactions provides new insights into how interactions proceed, which could be useful for future intervention research.

Pervasive Undisclosed Conflicts of Interest in Applied Behavior Analysis Autism Literature.

Many autistic people (including researchers and non-researchers) are becoming increasingly involved in, and increasingly critical of, autism intervention research. They have expressed concerns regarding applied behavior analysis (ABA) interventions on a number of grounds, one of which is the prevalence of conflicts of interests (COIs) among autism intervention researchers. These concerns are now also being addressed by non-autistic researchers. COIs can introduce bias into the research process, and allow researchers to demonstrate positive effects for interventions that are not actually effective. Despite these concerns, there are no studies to date that examine the prevalence of COIs in behavioral journals. Because ABA services are routinely provided to autistic people in the United States as a means to address difficulties experienced by autistic people, this is an important area of investigation. We tallied author COIs in articles published over a 1-year period that tested, commented on, or reviewed ABA autism intervention strategies, extracted from eight journals devoted to publishing behavioral research. We coded included studies for COIs related to researcher employment as an ABA clinical provider or a training consultant to ABA clinical providers. We found that 84% of studies had at least one author with this type of COI, but they were only disclosed as COIs in 2% of studies. Additionally, 87% of studies with statements claiming the authors did not have COIs, were authored by researchers found to have clinical/training consultancy COIs. Pervasive, undisclosed COIs likely lead to researcher bias, and could at least partially account for persistent poor quality research in this area. The high prevalence of COIs among this research corroborates the concerns expressed by many autistic people. The autism community - including autistic people, autism researchers, and other stakeholders - should be aware of the prevalence of undisclosed COIs in this literature and take this into account when using, providing, or recommending ABA services.

Understanding perceptions and experiences of autistic undergraduate students toward disability support offices of their higher education institutions.

BACKGROUND: Autistic undergraduate students are experiencing considerable difficulties on their college campuses. Yet, disability support offices (DSOs), which assume the responsibility of providing support to students with disabilities, often lack the resources to cater to the varied needs of autistic students. AIM: To understand autistic students' perspectives and experiences with DSOs and the range of support services available from DSOs of higher education institutions in the United States. METHODS: Semi-structured interviews with 27 autistic undergraduate students were conducted to solicit their perceptions about their DSOs. A generic inductive approach was used to qualitatively analyze the participants' responses. RESULTS: Students expressed both positive and negative experiences with academic and non-academic support, and perceived that DSO staff lacked specific autism knowledge and were often inaccessible. Some students initially decided not to receive DSO accommodations, but many chose to reach out to their DSOs after experiencing academic difficulties. Finally, students' perceptions of ways for DSOs to support them better highlighted the need for institution-wide efforts to make a cultural shift about disability and acceptance and the need for more individualized services. CONCLUSIONS: Appropriate resources for DSOs and institution-wide efforts are needed to make college campuses both physically and emotionally accessible to autistic students.

Understanding the Effects of Naturalistic Developmental Behavioral Interventions: A Project AIM Meta-analysis.

We examined the quality of evidence supporting the effects of Naturalistic Developmental Behavioral Interventions (NBDIs) for facilitating change in young children with autism. We also investigated whether effects varied as a function of specific features of the intervention, samples, and outcomes measured. Twenty-seven studies testing the effects of NDBIs were extracted from data collected for the Autism Intervention Meta-analysis (Project AIM), a comprehensive meta-analysis of group design, nonpharmacological intervention studies for children with autism aged 0-8 years. We extracted effect sizes for 454 outcomes from these studies for use in meta-regression analyses testing associations between intervention effects and mean participant chronological age, language age, autism symptomatology, percentage of sample reported as male, cumulative intervention intensity, interventionist, outcome boundedness, outcome proximity, and risk of parent/teacher training correlated measurement error. The extant literature on NDBIs documents effects on social communication, language, play, and cognitive outcomes. However, our confidence in the positive and significant summary effects for these domains is somewhat limited by methodological concerns. Intervention effects were larger for context-bound outcomes (relative to generalized), and for proximal outcomes (relative to distal). Our results indicate that NDBIs have promise as an approach for supporting development for some, but not all of the core and related features of autism in early childhood. Confidence in summary effect estimates is limited by study quality concerns, particularly an overreliance on measures subject to high detection bias. The results of this review support the use of proximity and boundedness as indicators of the limits of intervention effects. LAY SUMMARY: Naturalistic Developmental Behavioral Interventions may increase language, social communication, play skills, and cognition in young children with autism, but these increases are largest for skills directly targeted by the intervention, and in contexts that are similar to that of the intervention. These conclusions are tempered by some concerns regarding research design across the studies that have been conducted to date. Autism Res 2021, 14: 817-834. © 2021 International Society for Autism Research and Wiley Periodicals LLC.

Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects.

BACKGROUND: The presence, types, disclosure rates, and effects of conflicts of interest (COIs) on autism early intervention research have not previously been studied. The purpose of this study was to examine these issues. METHODS: This study is a secondary analysis of a comprehensive meta-analysis of all group-design, nonpharmacological early intervention autism research conducted between 1970 and 2018. We coded reports for the presence/absence of COI statements, the types of COIs that were disclosed, and for 8 types of COIs, including (a) the author developed the intervention, (b) the author is affiliated with a clinical provider, (c) the author is employed by a clinical provider, (d) the author is affiliated with an institution that trains others to use the intervention, (e) the author receives payment or royalties related to the intervention, (f) the study was funded by an intervention provider, (g) the study used a commercially available measure developed by the author, and (h) proceeds of the intervention fund the author's research. Frequencies and proportions were calculated to determine prevalence of COIs and COI disclosures. Meta-analysis was used to estimate summary effects by COI type and to determine if they were larger than for reports with no coded COIs. RESULTS: Seventy percent of reports were coded for ≥ 1 COI, but only ~ 6% of reports contained COI statements fully accounting for all coded COIs. Metaregressions did not detect significant influences of any COI type on summary effects; however, point estimates for each COI type were larger than for reports with no coded COIs. CONCLUSIONS: Conflicts of interest are prevalent but under-reported in autism early intervention research. Improved reporting practices are necessary for researcher transparency and would enable more robust examination of the effects of COIs on research outcomes.

Adverse event reporting in intervention research for young autistic children.

LAY ABSTRACT: In this study, we looked at published research on interventions for young autistic children that did not involve administering medication. We were interested in determining how often studies reported on whether adverse events (i.e. physical or psychological distress to the participants) or adverse effects (i.e. adverse events that are thought to be caused by the intervention) had occurred. We found that of the 150 reports we examined, only 11 mentioned adverse events. One of these studies reported adverse events occurred, and three reported that adverse effects occurred. We also reviewed the studies to examine the reasons that were given to explain why any participants dropped out of the intervention (termed "withdrawal"), to determine if any of these reasons could be considered adverse events or adverse effects. Fifty-four studies described reasons for withdrawal, and 10 of these studies had reasons that could be categorized as an adverse event, 8 studies had reasons that could be categorized as an adverse effect, and an additional 12 studies had reasons that were too vaguely described to determine whether they were adverse events or not. We recommend that autism intervention researchers develop more systematic methods of looking for and reporting adverse events and effects, so that professionals and families can be better informed when choosing to enroll their autistic children in interventions.

Sex-Based Performance Responses to an Acute Sprint Interval Cycling Training Session in Collegiate Athletes.

There are limited data pertaining to the effects of sex on sprint interval cycling (SIC) training session performance. Purpose: We investigated sex-based differences on sprint interval cycling (SIC) performance in collegiate soccer players. Methods: Twelve men and twelve women completed two identical lab trials, 7-14 days apart. The first lab session served as familiarization, "dry run," trial. Reported data were collected and analyzed during the second, "testing" SIC training trial. Each SIC training session was comprised of a warm-up, at 50 revolutions per min (RPM) with no resistance, and six repeated 30-s Wingate Anaerobic Tests (WAnT) separated by a 4-min recovery period between each sprint. Results: Significant (P ≤ .05) sex differences were observed in peak power (PP), peak power relative to body mass (RPP), mean power (MP), mean power relative to body mass (RMP) but not in peak power relative to fat free mass (FFMPP). When WAnT bouts 2-6 were expressed as %Δ of WAnT1, there were no significant (P > .05) differences between the sexes across all performance variables. Further, Cohen's d statistics demonstrated only trivial and small effect size between the groups. Average HR and RPE were not significantly (P > .05) different between the sexes. Correlational analysis revealed a significant (P ≤ .05) relationship between FFM, and PP and MP. Conclusion: Although overall performance may be affected by a number of physiological mechanisms, the results of the current study indicate that differences between men and women soccer players performing SIC training, are likely attributed to differences in body composition.

Developmental associations between joint engagement and autistic children's vocabulary: A cross-lagged panel analysis.

LAY ABSTRACT: In this study, we used a cross-lagged panel analysis to examine correlations over time between two types of engagement between children and their parents and children's later expressive and receptive vocabularies. This kind of design can help researchers understand which early developmental achievements "drive" later developmental achievements. It is important for intervention researchers to know which developmental achievements happen first, so that they can set intervention goals appropriately. The two joint engagement variables we examined were (a) higher order supported joint engagement, which occurs when caregivers influence their child's play with toys and the child reciprocally responds to the caregiver, but does not manage the interaction by shifting gaze between the toys and the caregiver, and (b) higher order supported joint engagement that co-occurs with caregiver's follow-in talk (higher order supported joint engagement + follow-in). Follow-in talk occurs when the caregiver talks about objects and events that the child is focused on. Ninety-one autistic children (n = 91) with language delay (mean chronological age = 39 months) participated, along with their primary caregivers. Each of the four variables was measured twice, 8 months apart. Our statistical procedures showed that early higher order supported joint engagement and early higher order supported joint engagement + follow-in were significantly associated with later expressive and receptive vocabulary. In contrast, associations between early vocabulary variables and later joint engagement variables were not significant. Our results suggest that higher order supported joint engagement and higher order supported joint engagement + follow-in may be useful initial intervention targets, for developmental interventions aimed at promoting language development in autistic children who are initially language delayed.

Intervention Effects on Language in Children With Autism: A Project AIM Meta-Analysis.

Purpose This study synthesized effects of interventions on language outcomes of young children (ages 0-8 years) with autism and evaluated the extent to which summary effects varied by intervention, participant, and outcome characteristics. Method A subset of effect sizes gathered for a larger meta-analysis (the Autism Intervention Meta-analysis or Project AIM) examining the effects of interventions for young children with autism, which were specific to language outcomes, was analyzed. Robust variance estimation and metaregression were used to calculate summary and moderated effects while controlling for intercorrelation among outcomes within studies. Results A total of 221 outcomes were gathered from 60 studies. The summary effect of intervention on language outcomes was small but significant. Summary effects were larger for expressive and composite language outcomes compared to receptive language outcomes. Interventions implemented by clinicians, or by clinicians and caregivers together, had summary effects that were significantly larger than interventions implemented by caregivers alone. Participants' pretreatment language age equivalent scores positively and significantly moderated intervention effects, such that effects were significantly larger on average when samples of children had higher pretreatment language levels. Effects were not moderated by cumulative intervention intensity, intervention type, autism symptomatology, chronological age, or the proximity or boundedness of outcomes. Study quality concerns were apparent for a majority of included outcomes. Conclusions We found evidence that intervention can facilitate improvements in language outcomes for young children with autism. Effects were largest for expressive and composite language outcomes, for children with initially higher language abilities, and for interventions implemented by clinicians or by caregivers and clinicians combined. However, quality concerns of included studies and borderline significance of some results temper our conclusions regarding intervention effectiveness and corresponding moderators.

Cardiorespiratory fitness, sleep, and physiological responses to stress in women.

Epidemiological studies suggest that cardiorespiratory fitness (CRfitness) is associated with reduced risk of depression and anxiety in women, however, the mechanisms by which CRfitness may be protective against the development of these disorders are less clear. Because sleep problems are associated with both a higher risk for mental illness and altered physiological responses to stress, this study investigated whether sleep quality might influence the relationship between CRfitness and physiological stress responses in women. Thirty healthy women (18-45 y) who were medication-free, with regular menstrual cycles completed: (1) enrolment visit [including the assessment of CRfitness via maximal oxygen consumption during exercise]; (2) one-week sleep monitoring period including subjective (daily sleep diaries) and objective (wrist actigraphy) sleep measures; and (3) psychosocial stressor protocol (the Trier Social Stress Test; TSST) for the collection of heart rate (HR), blood pressure (BP), and salivary cortisol stress responses. Higher CRfitness was associated with reduced wake after sleep onset (WASO) duration (r = -.38, p = 0.04), higher self-reported sleep quality (higher scores reflect poorer sleep quality; r = -.37, p = 0.05), and lower HR (r = -.43, p = 0.02) during the stressor. Higher sleep quality was associated with a lower HR during the stressor (r = .44, p = 0.01). Increased WASO duration and WASO number were associated with blunted cortisol output during the stressor (r = -.44, p = 0.02, and r = -.46, p = 0.02, respectively). Results suggest that, in women, CRfitness may be protective against the deleterious effects of stress via improved sleep quality.

High School Experiences and Support Recommendations of Autistic Youth.

We used an online survey to gather perspectives of autistic youth (n = 248) on the impacts of autism, school professionals, family members, and peers on their high school experiences; what each stakeholder group could have done better; and what future high school professionals and autistic youth should know. Two-thirds of participants viewed autism as negatively impacting their school experience, and this was more prevalent in women. The majority viewed impacts of school professionals, family, and peers as positive. Women were more likely to view school professional contributions as positive than men, and LGBT youth were more likely to view school professional and peer contributions as negative than non-LGBT youth. Suggestions for stakeholders included providing more help, care, and quality time.

Project AIM: Autism intervention meta-analysis for studies of young children.

In this comprehensive systematic review and meta-analysis of group design studies of nonpharmacological early interventions designed for young children with autism spectrum disorder (ASD), we report summary effects across 7 early intervention types (behavioral, developmental, naturalistic developmental behavioral intervention [NDBI], TEACCH, sensory-based, animal-assisted, and technology-based), and 15 outcome categories indexing core and related ASD symptoms. A total of 1,615 effect sizes were gathered from 130 independent participant samples. A total of 6,240 participants, who ranged in age from 0-8 years, are represented across the studies. We synthesized effects within intervention and outcome type using a robust variance estimation approach to account for the nesting of effect sizes within studies. We also tracked study quality indicators, and report an additional set of summary effect sizes that restrict included studies to those meeting prespecified quality indicators. Finally, we conducted moderator analyses to evaluate whether summary effects across intervention types were larger for proximal as compared with distal effects, and for context-bound as compared to generalized effects. We found that when study quality indicators were not taken into account, significant positive effects were found for behavioral, developmental, and NDBI intervention types. When effect size estimation was limited to studies with randomized controlled trial (RCT) designs, evidence of positive summary effects existed only for developmental and NDBI intervention types. This was also the case when outcomes measured by parent report were excluded. Finally, when effect estimation was limited to RCT designs and to outcomes for which there was no risk of detection bias, no intervention types showed significant effects on any outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Factors influencing exposure of North American river otter (Lontra canadensis) and American mink (Neovison vison) to mercury relative to a large-scale reservoir in northern British Columbia, Canada.

Although reservoir creation increases fish mercury (Hg) concentrations, little information exists on its effects on Hg concentrations in aquatic mammals. River otters (Lontra canadensis) and American mink (Neovison vison) are two aquatic mammals that have been used as model species for assessing Hg bioaccumulation in aquatic systems. We assessed Hg and selenium (Se) concentrations in these two species within and outside of the Williston Reservoir (Peace-Williston (PW) watershed) in northern British Columbia (BC) and used these data to investigate potential explanatory factors (i.e., watershed, gender, trophic level (δ15N), and regional geology) influencing Hg concentrations. Hg concentrations in otter and mink inhabiting the Mackenzie watershed (outside the PW) were significantly lower than other watersheds in Northern BC. The general trend was the same for both species; the Peace-Williston having the highest and Mackenzie having the lowest Hg concentrations. For mink, the Peace-Williston watershed, higher trophic levels, and higher proportions of igneous/metamorphic bedrock were all significant influences on higher Hg concentrations (logistic regression). Higher trophic levels or proportions of of igneous/metamorphic bedrock, however, were not directly associated with the PW watershed suggesting there may be an impoundment effect. Baseline data on natural Hg inputs before planned anthropogenic changes occur is a critical first step to aiding interpretations of Hg-related effects on wildlife populations and their related ecosystems.

The stability of joint engagement states in infant siblings of children with and without ASD: Implications for measurement practices.

Obtaining stable estimates of caregiver-child joint engagement states is of interest for researchers who study development and early intervention in young children with autism spectrum disorder (ASD). However, studies to date have offered little guidance on the numbers of sessions and coders necessary to obtain sufficiently stable estimates of these constructs. We used procedures derived from G theory to carry out a generalizability study, in which we partitioned error variance between two facets of our system for measuring joint engagement states: session and coder. A decision study was then conducted to determine the number of sessions and coders required to obtain g coefficients of 0.80, an a priori threshold set for acceptable stability. This process was conducted separately for 10 infant siblings of children with ASD (Sibs-ASD) and 10 infants whose older sibling did not have ASD (Sibs-TD), and for two different joint engagement states; lower- and higher-order supported joint engagement (LSJE and HSJE, respectively). Results indicated that, in the Sibs-ASD group, four sessions and one coder was required to obtain acceptably stable estimates for HSJE; only one session and one coder were required for LSJE. In the Sibs-TD group, two sessions and one coder were required for HSJE; seven sessions and two coders were required for LSJE. Implications for measurement in future research are discussed. Autism Res 2019, 12: 495-504 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study offers guidance for researchers who measure joint engagement between caregivers and infants who have an older sibling with ASD, and who have older siblings who are TD.

A systematic review and meta-regression analysis of social functioning correlates in autism and typical development.

Differences in social functioning are a hallmark feature of autism spectrum disorder (ASD), and much research has been devoted to locating cognitive and developmental explanations for this domain. To sort through this literature, we conducted a systematic review and meta-analysis that quantifies the extent to which several of these candidate constructs are associated with social functioning. We gathered 881 effect sizes calculated from 133 unique participant samples, and synthesized Pearson's r correlations between social functioning and three cognitive constructs; (a) theory of mind (ToM), (b) executive function, and (c) central coherence, and five developmental constructs: (d) initiating joint attention, (e) responding to joint attention, (f) imitation, (g) pretend play, and (h) visual fixation to social stimuli. We synthesized effect sizes using robust variance estimation for each putative correlate, for populations with ASD and typical development (TD) separately. We also conducted a series of meta-regressions to determine if sample and study features moderated effect sizes. We found that, in the ASD group, effect size estimates were significant and small (<0.30) for ToM, executive function, and initiating joint attention. Effect size estimates were significant and moderate (0.30 < r < 0.50) for imitation and response to joint attention. In the TD group, effect size estimates for ToM, executive function, and initiating joint attention were significant and small. In a meta-regression collapsed across correlates, we found that effect sizes were significantly larger in the ASD group (P < 0.05) and decreased as mental age increased (P < 0.001). Autism Res 2019, 12: 152-175 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this meta-analysis, we found that correlations between social functioning and several constructs used to explain the developmental or cognitive origins of social functioning were quite low. This could mean that researchers will need to develop new theories about social functioning in ASD.

Blunted neuroactive steroid and HPA axis responses to stress are associated with reduced sleep quality and negative affect in pregnancy: a pilot study.

RATIONALE: Anxiety during pregnancy has been linked to adverse maternal health outcomes, including postpartum depression (PPD). However, there has been limited study of biological mechanisms underlying behavioral predictors of PPD during pregnancy. OBJECTIVES: Considering the shared etiology of chronic stress amongst antenatal behavioral predictors, the primary goal of this pilot study was to examine associations among stress-related physiological factors (including GABA-ergic neurosteroids) and stress-related behavioral indices of anxiety during pregnancy. METHODS: Fourteen nulliparous women in their second trimester of a singleton pregnancy underwent speech and mental arithmetic stress, following a 2-week subjective and objective recording of sleep-wake behavior. RESULTS: Lower cortisol, progesterone, and a combined measure of ALLO + pregnanolone throughout the entire stressor protocol (area under the curve, AUC) were associated with greater negative emotional responses to stress, and lower cortisol AUC was associated with worse sleep quality. Lower adrenocorticotropic hormone was associated with greater anxious and depressive symptoms. Stress produced paradoxical reductions in cortisol, progesterone, and a combined measure of allopregnanolone + pregnanolone, while tetrahydrodeoxycorticosterone levels were elevated. CONCLUSIONS: These data suggest that cortisol, progesterone, and ALLO + pregnanolone levels in the second trimester of pregnancy are inversely related to negative emotional symptoms, and the negative impact of acute stress challenge appears to exert its effects by reducing these steroids to further promote negative emotional responses.

The influence of early life sexual abuse on oxytocin concentrations and premenstrual symptomatology in women with a menstrually related mood disorder.

Oxytocin (OT), associated with affiliation and social bonding, social salience, and stress/pain regulation, may play a role in the pathophysiology of stress-related disorders, including menstrually-related mood disorders (MRMD's). Adverse impacts of early life sexual abuse (ESA) on adult attachment, affective regulation, and pain sensitivity suggest ESA-related OT dysregulation in MRMD pathophysiology. We investigated the influence of ESA on plasma OT, and the relationship of OT to the clinical phenomenology of MRMD's. Compared to MRMD women without ESA (n=40), those with ESA (n=20) displayed significantly greater OT [5.39pg/mL (SD, 2.4) vs. 4.36pg/mL (SD, 1.1); t (58)=-2.26, p=0.03]. In women with ESA, OT was significantly, inversely correlated with premenstrual psychological and somatic symptoms (r's=-0.45 to -0.64, p's<0.05). The relationship between OT and premenstrual symptomatology was uniformly low and non-significant in women without ESA. In women with ESA, OT may positively modulate MRMD symptomatology.