Infant Attachment Insecurity and Baseline Physiological Activity and Physiological Reactivity to Interpersonal Stress: A Meta-Analytic Review.

This meta-analytic review (k = 5-10; N = 258-895) examined links between attachment insecurity and physiological activity at baseline and in response to interpersonal stress elicited by separation-reunion procedures in the early life course (1-5 years). Insecurity was trivially, nonsignificantly associated with baseline physiological activity (heart rate [HR]: g = -.06; respiratory sinus arrhythmia [RSA]: g = -.06; cortisol: g = .01) and nonsignificantly associated with physiological reactivity to separation from parents (HR: g = -.001; RSA: g = .24). However, insecurity was moderately associated with heightened RSA (g = .26) and cortisol (g = .27) reactivity upon reunion with parents. Findings provide insight into the biobehavioral organization of attachment, suggesting that early insecurity is associated with heightened physiological reactivity to interpersonal stress.

Aberrant parasympathetic reactivity to acute psychosocial stress in male patients with schizophrenia spectrum disorders.

Autonomic dysfunction represents a core domain of the pathophysiology of schizophrenia spectrum disorders (SCZ), with aberrant physiologic arousal underlying maladaptive social and cognitive behaviors. Antagonistic parasympathetic and sympathetic systems support autonomic flexibility to appropriately regulate arousal and respond to environmental challenges, which can be modeled using physiologic measures. SCZ patients consistently show heightened basal stress, however, their parasympathetic reactivity to an acute psychosocial stressor is poorly understood. Heart period (HP-arousal), respiratory sinus arrhythmia (RSA-parasympathetic vagal activity), and their relationship were measured in SCZ patients (n = 19) and healthy controls (n = 20) at baseline and during psychosocial stress exposure. Parasympathetic vagal control of arousal, reflected in RSA-HP coupling, was assessed for the first time in SCZ. Patients demonstrated blunted physiologic reactivity (less change in heart period and respiratory sinus arrhythmia), a unique increase in respiratory sinus arrhythmia relative to baseline during recovery, and elevated arousal was associated with poor cognitive performance and greater positive symptoms. Arousal regulation was tightly controlled by parasympathetic activity in controls only, indicated by a strong association between changes in heart period and respiratory sinus arrhythmia. Results are the first to demonstrate maladaptive, inefficient parasympathetic arousal regulation (RSA-HP decoupling) in reaction to psychosocial stress in SCZ, representing an autonomic profile incompatible with appropriate social and emotional functioning.

Dynamic changes in parent affect and adolescent cardiac vagal regulation: a real-time analysis.

The current study explored the role of parents' negative and positive affect in adolescent respiratory sinus arrhythmia (RSA) reactivity during a parent-adolescent conflict discussion task and the moderating effects of adolescent sex and age. Questionnaire data were collected from 206 adolescents (10-18 years of age; M = 13.37 years) and their primary caregivers (83.3% biological mothers). Electrocardiogram and respiration data were collected from adolescents, and RSA variables were computed. Parent affect was coded during the conflict discussion task. Multilevel modeling was used to distinguish the between- and within-individual effects of parent affect on adolescent RSA. Results indicated that observed within-parent-teen dyad anger was negatively associated with adolescent RSA, controlling for previous-minute RSA level, particularly among adolescents 13 years and older. In addition, observed between-dyad positive affect was positively linked to RSA for both boys and girls when previous-minute RSA level was controlled. Within-dyad positive affect was positively related to girl's RSA only. These findings suggest that expressions of positive affect may be related to better vagal regulation (RSA increases), whereas expressions of anger may be related to poor vagal regulation (RSA decreases) during social engagement.

Children's parasympathetic reactivity to specific emotions moderates response to intervention for early-onset aggression.

Following theories that individual differences in respiratory sinus arrhythmia (RSA) denote differential sensitivity to environmental influences, this study examines whether differences in RSA reactivity to specific emotional challenges predict differential response to intervention. We present data from a randomized clinical trial of a targeted intervention for early onset aggression. In collaboration with a high-risk urban school district, 207 kindergarten children (73% African American, 66% male), identified by their teachers as having high levels of aggressive and disruptive behavior, were recruited. All children received a universal social-emotional curriculum. One hundred children were randomly assigned to an additional intervention consisting of weekly peer-based social skills training. Complete RSA data were available for 139 of the children. Teacher-reported externalizing symptoms and emotion regulation in 1st grade (post intervention) were examined controlling for baseline levels. First-grade peer nominations of aggressive behavior, controlling for baseline nominations, were also examined as outcomes. No effect of resting RSA was found. However, greater reactivity to anger was associated with higher externalizing symptoms and lower emotion regulation skills in 1st grade relative to low reactive children. Lower reactivity to fear was associated with greater improvement over time, an effect that was enhanced in the targeted intervention condition. Results suggest that measures of affective reactivity may provide insight into children's capacity to benefit from different types of interventions.

Do you hear the same? Cardiorespiratory responses between mothers and infants during tonal and atonal music.

This study examined the effects of tonal and atonal music on respiratory sinus arrhythmia (RSA) in 40 mothers and their 3-month-old infants. The tonal music fragment was composed using the structure of a harmonic series that corresponds with the pitch ratio characteristics of mother-infant vocal dialogues. The atonal fragment did not correspond with a tonal structure. Mother-infant ECG and respiration were registered along with simultaneous video recordings. RR-interval, respiration rate, and RSA were calculated. RSA was corrected for any confounding respiratory and motor activities. The results showed that the infants' and the mothers' RSA-responses to the tonal and atonal music differed. The infants showed significantly higher RSA-levels during the tonal fragment than during the atonal fragment and baseline, suggesting increased vagal activity during tonal music. The mothers showed RSA-responses that were equal to their infants only when the infants were lying close to their bodies and when they heard the difference between the two fragments, preferring the tonal above the atonal fragment. The results are discussed with regard to music-related topics, psychophysiological integration and mother-infant vocal interaction processes.

Sympathetic- and parasympathetic-linked cardiac function and prediction of externalizing behavior, emotion regulation, and prosocial behavior among preschoolers treated for ADHD.

OBJECTIVE: To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). METHOD: Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4-6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. RESULTS: Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. CONCLUSIONS: We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.

Does respiratory sinus arrhythmia (RSA) predict anxiety reduction during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD)?

Modifying dysfunctional emotion regulation is an important goal in psychological treatments for social anxiety disorder (SAD). Antecedent-focused strategies learned in cognitive behavioral therapy (CBT), such as cognitive reappraisal, have proven more effective in reducing social anxiety than response-focused strategies, such as expressive suppression. Still, not all patients with SAD respond well to CBT. Medications and physiological factors may also influence the clinical response. The purpose of the present study was to examine the role that these factors play in determining treatment response following CBT for SAD. Using multilevel modeling, we examined associations across four separate laboratory visits between change in self-reported anxiety and indices of reappraisal, suppression, medication status, and resting respiratory sinus arrhythmia (RSA), a proxy measure of self-regulatory capacity, in 23 socially anxious adults during a 12-week program of CBT. Most participants were ultimately classified as responders to CBT (n=15), but in some, anxiety levels remained unchanged (n=8). Medication use explained substantial variance related to individual differences in anxiety among participants. When modeled separately, reappraisal, suppression, and RSA each accounted for significant variance related to anxiety. However, the best-fitting model included reappraisal and RSA. Moreover, RSA reactivity (change in RSA levels over time) was more important for predicting anxiety reduction than were baseline levels of RSA. These findings suggest that reappraisal and parasympathetic responsiveness may be important in reducing anxiety in adults with SAD who respond well to CBT.

Marital conflict, allostatic load, and the development of children's fluid cognitive performance.

Relations between marital conflict, children's respiratory sinus arrhythmia (RSA), and fluid cognitive performance were examined over 3 years to assess allostatic processes. Participants were 251 children reporting on marital conflict, baseline RSA, and RSA reactivity (RSA-R) to a lab challenge were recorded, and fluid cognitive performance was measured using the Woodcock-Johnson III. A cross-lagged model showed that higher levels of marital conflict at age 8 predicted weaker RSA-R at age 9 for children with lower baseline RSA. A growth model showed that lower baseline RSA in conjunction with weaker RSA-R predicted the slowest development of fluid cognitive performance. Findings suggest that stress may affect development of physiological systems regulating attention, which are tied to the development of fluid cognitive performance.

Poverty, problem behavior, and promise: differential susceptibility among infants reared in poverty.

Do infants reared in poverty exhibit certain physiological traits that make them susceptible to the positive and negative features of their caregiving environment? Guided by theories of differential susceptibility and biological sensitivity to context, we evaluated whether high baseline respiratory sinus arrhythmia (RSA) operates as a susceptibility factor among infants reared in poverty (N = 73). Baseline RSA at 5 months, the quality of the attachment relationship at 17 months, and the interaction of these two factors were included in our models as predictors of problem behavior at 17 months. Consistent with theory, results showed no significant differences in problem behavior among infants with low baseline RSA; however, infants with high baseline RSA exhibited the lowest levels of problem behavior if reared in an environment that fostered security, and they exhibited the highest levels of problem behavior if reared in an environment that fostered disorganization. These results have important implications for the psychological health of infants living in poverty.

The relation between maternal emotional support and child physiological regulation across the preschool years.

Trajectories of baseline RSA (respiratory sinus arrhythmia), an index of reactivity, and vagal withdrawal, an index of regulation, across the preschool period were examined. In addition, maternal emotional support was investigated as a potential time-varying predictor of these trajectories. Physiological measures were obtained during frustration tasks, and a maternal emotional support measure was assessed via maternal report and direct observation. Children's baseline RSA and vagal withdrawal scores were moderately stable across the preschool period. Growth models indicated that children's baseline RSA scores changed linearly over the preschool years, and there was significant variability in withdrawal trajectories. Greater maternal emotional support predicted higher initial withdrawal levels and lower emotional support was associated with the greatest increase in withdrawal over time. This suggests that children of higher emotionally supportive mothers reached higher levels of physiological regulation earlier in development and therefore did not show the same increase across preschool as children of less supportive mothers. Maternal emotional support was not significantly related to trajectories of baseline RSA.

Respiratory sinus arrhythmia and auditory processing in autism: modifiable deficits of an integrated social engagement system?

The current study evaluated processes underlying two common symptoms (i.e., state regulation problems and deficits in auditory processing) associated with a diagnosis of autism spectrum disorders. Although these symptoms have been treated in the literature as unrelated, when informed by the Polyvagal Theory, these symptoms may be viewed as the predictable consequences of depressed neural regulation of an integrated social engagement system, in which there is down regulation of neural influences to the heart (i.e., via the vagus) and to the middle ear muscles (i.e., via the facial and trigeminal cranial nerves). Respiratory sinus arrhythmia (RSA) and heart period were monitored to evaluate state regulation during a baseline and two auditory processing tasks (i.e., the SCAN tests for Filtered Words and Competing Words), which were used to evaluate auditory processing performance. Children with a diagnosis of autism spectrum disorders (ASD) were contrasted with aged matched typically developing children. The current study identified three features that distinguished the ASD group from a group of typically developing children: 1) baseline RSA, 2) direction of RSA reactivity, and 3) auditory processing performance. In the ASD group, the pattern of change in RSA during the attention demanding SCAN tests moderated the relation between performance on the Competing Words test and IQ. In addition, in a subset of ASD participants, auditory processing performance improved and RSA increased following an intervention designed to improve auditory processing.

Associations between respiratory sinus arrhythmia reactivity and internalizing and externalizing symptoms are emotion specific.

Internalizing and externalizing disorders are often, though inconsistently in studies of young children, associated with low baseline levels of respiratory sinus arrhythmia (RSA). RSA is thus considered to reflect the capacity for flexible and regulated affective reactivity and a general propensity for psychopathology. However, studies assessing RSA reactivity to emotional challenges tend to report more consistent associations with internalizing than with externalizing disorders, although it is unclear whether this is a function of the type of emotion challenges used. In the present study, we examined whether baseline RSA was associated with internalizing and/or externalizing severity in a sample of 273 young children (ages 5-6) with elevated symptoms of psychopathology. Following motivation-based models of emotion, we also tested whether RSA reactivity during withdrawal-based (fear, sadness) and approach-based (happiness, anger) emotion inductions was differentially associated with internalizing and externalizing symptoms, respectively. Baseline RSA was not associated with externalizing or internalizing symptom severity. However, RSA reactivity to specific emotional challenges was associated differentially with each symptom domain. As expected, internalizing symptom severity was associated with greater RSA withdrawal (increased arousal) during fearful and sad film segments. Conversely, externalizing symptom severity was related to blunted RSA withdrawal during a happy film segment. The use of theoretically derived stimuli may be important in characterizing the nature of the deficits in emotion processing that differentiate the internalizing and externalizing domains of psychopathology.

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.

Adolescent attachment insecurity and parasympathetic functioning predict future loss adjustment.

Losing a close relationship is highly stressful and a robust predictor of major depression in adolescents. The current study examined relationships between attachment insecurity, parasympathetic nervous system activity, indexed by respiratory sinus arrhythmia (RSA), and adolescent adjustment to the loss of a close social partner. Adolescents with more attachment anxiety to their mother at age 14 were more likely to report poorer adjustment to a subsequent loss than adolescents with less attachment anxiety. Attachment avoidance interacted with stress-induced changes in RSA to predict loss adjustment. Among adolescents with higher RSA in response to the stressor, those with more attachment avoidance reported better loss adjustment, whereas among adolescents with lower RSA in response to the stressor, those with more attachment avoidance reported poorer loss adjustment. In sum, the combination of attachment insecurity and stress-induced changes in RSA predicted how well adolescents adjusted to a loss.

Trajectories of children's internalizing symptoms: the role of maternal internalizing symptoms, respiratory sinus arrhythmia and child sex.

BACKGROUND: We assessed trajectories of children's internalizing symptoms as predicted by interactions among maternal internalizing symptoms, respiratory sinus arrhythmia (RSA) and child sex. METHOD: An ethnically and socioeconomically diverse sample of children (n = 251) participated during three study waves. Children's mean ages were 8.23 years (SD = 0.72) at T1, 9.31 years (SD = 0.79) at T2 and 10.28 years (SD = 0.99) at T3. RESULTS: Multiple-indicator multilevel latent growth analyses showed maternal internalizing symptoms interacted with child RSA and sex to predict children's internalizing symptoms. Girls with higher RSA whose mothers had lower levels of internalizing symptoms showed the steepest decline in internalizing symptoms across time. Girls with lower RSA whose mothers had higher levels of internalizing symptoms showed the highest levels of internalizing symptoms at T3, whereas boys with higher RSA whose mothers had higher levels of internalizing symptoms showed the highest levels of internalizing symptoms at T3. CONCLUSIONS: Findings build on this scant literature and support the importance of individual differences in children's physiological regulation in the prediction of psychopathology otherwise associated with familial risk.

Atypical development of resting respiratory sinus arrhythmia in children at high risk for depression.

Compromised respiratory sinus arrhythmia (RSA, i.e., low cardiac vagal control) frequently characterizes clinically depressed adults and also has been detected in infants of depressed mothers; however, its existence has not been established in older at-risk offspring. We investigated developmental patterns of RSA in a sample of 163 5- to 14-year-old children, who were either at high risk for depression (due to having a parent with a childhood-onset mood disorder) or low-risk for depression. We hypothesized that high-risk children have lower resting RSA than do low-risk children, which could reflect atypical developmental trajectories. Children's RSA was assessed during resting baseline periods on multiple occasions, typically 1-year apart. Linear growth modeling indicated a group by age interaction. Low-risk children (but not the high-risk children) exhibited a significantly increasing trajectory in resting RSA with age. Mood disorders in offspring did not account for the Group X Age interaction effect. Our study provides new evidence that children at high risk for depression have an atypical developmental trajectory of RSA across late childhood.

Developmental changes in autonomic nervous system resting and reactivity measures in Latino children from 6 to 60 months of age.

OBJECTIVE: : This study describes the developmental changes and individual stability in autonomic nervous system (ANS) resting and challenge responses for a cohort of primarily Latino, low-income children during the first 5 years of life. METHODS: : ANS measures of the parasympathetic nervous system (respiratory sinus arrhythmia [RSA]) and sympathetic nervous system (preejection period [PEP]) were collected on a representative sample of the full cohort at 6, 12, 42, and 60 months of age (N = 378). The children participated in a standardized protocol to elicit ANS responses during resting and challenging states. Reactivity profiles were created to summarize each child's combined RSA and PEP reactivity (i.e., change in response to challenges compared to a resting state). RESULTS: : Results showed developmental changes in ANS measures from 6 to 60 months: heart rate decreased, RSA increased, PEP increased, and frequency of classic reactivity profiles of reciprocal sympathetic activation and parasympathetic withdrawal increased. Correlations showed moderate stability for resting and challenging conditions but not reactivity. CONCLUSIONS: : These findings suggest that low-income Latino children, from 6 to 60 months of age, showed ANS developmental changes and moderate individual stability for resting and challenge responses but not for reactivity. There was a significant shift in the frequency of children with the classic reactivity profile from 6 by 60 months of age. This is the first cohort study to show the developmental changes in ANS and young children's increase in their biologic sensitivity to the environment during the first 5 years of life.

Mapping cardiac physiology and parenting processes in maltreating mother-child dyads.

Child maltreatment (CM) lies on an extreme end of the continuum of parenting-at-risk, and while CM has been linked with a variety of behavioral indicators of dysregulation in children, less is known about how physiological markers of regulatory capacity contribute to this association. The present study examined patterns of mother and child physiological regulation and their relations with observed differences in parenting processes during a structured interaction. Abusing, neglecting, and non-CM mothers and their 3- to 5-year-old children completed a resting baseline and moderately challenging joint task. The structural analysis of social behavior was used to code mother-child interactions while simultaneous measures of respiratory sinus arrhythmia were obtained. Results indicated that physically abusive mothers were more likely to react to children's positive bids for autonomy with strict and hostile control, than either neglecting or non-CM mothers. CM exposure and quality of maternal responding to children's autonomous bids were uniquely associated with lower parasympathetic tone in children. Results provide evidence of neurodevelopmental associations between early CM exposure, the immediate interactive context of parenting, and children's autonomic physiology.

Effects of tonic and phasic respiratory sinus arrhythmia on affective stress responses.

Adaptive affective responses in the face of environmental challenges require flexible physiological responding. The present study examined the extent to which tonic respiratory sinus arrhythmia (RSA)-a putative marker of regulatory capacity-moderated the association between stress-related changes in RSA (i.e., phasic RSA) and concurrent changes in affect. Ninety-eight healthy, young adults completed ratings of affect during a resting baseline and following the recall of a recent stressor. Tonic RSA moderated the association of phasic RSA with stress-related change in positive affect (PA), such that change in RSA had a positive association with PA for individuals with higher tonic RSA and a negative association for those with lower tonic RSA. Examination of specific aspects of PA indicated that phasic RSA was positively associated with changes in ratings of attentive engagement among individuals with higher tonic RSA. These findings inform our understanding of phasic RSA and support the notion that flexible parasympathetic nervous system functioning is an important component of adaptive stress regulation.

Matters of the variable heart: respiratory sinus arrhythmia response to marital interaction and associations with marital quality.

Maintenance of relationship quality requires self-regulation of emotion and social behavior, and women often display greater effort in this regard than do men. Furthermore, such efforts can deplete the limited capacity for self-regulation. In recent models of self-regulation, resting level of respiratory sinus arrhythmia, quantified as high-frequency heart rate variability (HF-HRV), is an indicator of self-regulatory capacity, whereas transient increases in HF-HRV reflect self-regulatory effort. To test these hypotheses in marriage, 114 young couples completed measures of marital quality and a positive, neutral, or negative initial marital task, preceded and followed by resting baseline assessments of HF-HRV. Couples then discussed a current marital disagreement. Resting HF-HRV was correlated with marital quality, suggesting that capacity for self-regulation is associated with adaptive functioning in close relationships. For women but not men, the negative initial task produced a decrease in resting HF-HRV. This effect was mediated by the husbands' negative affect response to the task and their ratings of wives as controlling and directive. When the subsequent disagreement discussion followed the negative initial task, women displayed increased HF-HRV during the discussion but a decrease when it followed the neutral or positive task. The valence of the initial task had no effect on men's HF-HRV during disagreement. Negative marital interactions can reduce women's resting HF-HRV, with potentially adverse health consequences. Women's reduced health benefit from marriage might reflect the depleting effects on self-regulatory capacity of their greater efforts to manage relationship quality.