Executive Functioning Predicts Adaptive Functioning and Self-Care Independence in Pediatric Sickle Cell Disease.

OBJECTIVE: This study examined the impact of executive functioning (EF) on adaptive functioning and self-care independence in pre-transition youth with sickle cell disease (SCD). METHODS: Thirty-four youth with SCD (ages 12-18 years) completed a brief neuropsychological battery and their caregivers completed questionnaires assessing adaptive functioning, EF behaviors, and independence in completing self-care tasks, including disease management. Hierarchical linear regression analyses were utilized to investigate if EF predicted significantly more variability in adaptive functioning and self-care independence than what is accounted for by socioeconomic status (SES), disease knowledge, and estimated intellectual functioning. RESULTS: Mean performance on standardized measures assessing working memory, processing speed, and EF skills fell in the low average range. Performance-based EF and caregiver-reported EF behaviors predicted variance in adaptive functioning and self-care independence above and beyond that accounted for by SES, disease knowledge, and intelligence, with moderate to large effect sizes. CONCLUSIONS: EF skills may support the ability of youth with SCD to adequately achieve independence in self-care, including medical self-care, and other adaptive skills, which may increase the likelihood of successful transition to young adulthood. These findings provide support for the role of neuropsychological screening and individualized intervention in interdisciplinary transition programs.

Trajectories of pain during pregnancy predict symptoms of postpartum depression.

INTRODUCTION: Postpartum depression imparts a significant and long-lasting burden on maternal and child health. Successful prevention or early detection of postpartum depression will rely on the identification of early risk factors. Pain during pregnancy (before childbirth) is a key potential predictor of postpartum depression risk. However, longitudinal studies characterizing pregnancy pain, its normal trajectory over time, and its prospective relations with symptoms of postpartum depression are lacking. METHODS: We used data from a longitudinal study of maternal emotion that included assessments of pain and depressive symptoms at 3 time points-during the second and third trimester of pregnancy and at 4 months postpartum. Structural equation modelling was used to estimate longitudinal patterns of change in maternal pain over time. Latent growth curve parameters were tested as predictors of symptoms of postpartum depression. RESULTS: Ninety-three healthy pregnant women enrolled in this study. Although the sample comprised women with relatively low-risk pregnancies, more than 90% of participants experienced pregnancy pain. Greater linear increases and less negative quadratic change in maternal pain over time were associated with greater levels of postpartum depression, even when controlling for prenatal depressive symptoms. Interpreting both parameters together, pain that increased in late pregnancy, when normative patterns had either levelled off or begun to decline, was associated with greater levels of postpartum depression. CONCLUSION: A developmental trajectory of pain experience that did not subside after childbirth was associated with greater postpartum depressive symptoms, suggesting that atypical trajectories of pain may be a risk factor for postpartum depression.

Perceived social support moderates neural reactivity to emotionally valenced stimuli during pregnancy.

Reactivity to emotional information, measurable at the level of neural activity using event-related potentials, is linked to symptoms of affective disorders. Behavioral evidence suggests that contextual factors, such as social support, can alter emotional reactivity such that affective responding is normalized when social support is high. This possibility remains largely untested at the neural level, specifically through approaches that can offer insight into the mechanistic processes contributing to individual differences in emotional reactivity. Yet, such knowledge could be useful for prevention and intervention efforts, particularly with groups at risk for increased emotional reactivity, such as pregnant mothers for whom emotional distress predicts both maternal and child outcomes. Expectant mothers took part in a longitudinal study that tested whether the late positive potential (LPP), a neural index of reactivity to emotional information, was moderated by maternal perceptions of social support. In the third trimester of pregnancy, lower perceived social support was associated with an absence of a traditional LPP effect, which differentiates valenced from neutral stimuli. Findings suggest that perceptions of social support may normalize emotional processing at the neural level and highlight the potential importance of social support modulation of emotional reactivity during times of known biological change.

Maternal Neural Reactivity During Pregnancy Predicts Infant Temperament.

Maternal biological systems impact infant temperament as early as the prenatal period, though the mechanisms of this association are unknown. Using a prospective, longitudinal design, we found that maternal (N = 89) amplitudes of the late positive potential (LPP) in response to negative stimuli during the second, but not the third, trimester of pregnancy predicted observed and physiological indices of temperamental reactivity in infants at age 4 months. Maternal LPP was positively associated with observed infant fear and negatively associated with frontal EEG asymmetry and cortisol reactivity in infants at age 4 months. Results identify a putative mechanism, early in pregnancy, for the intergenerational transmission of emotional reactivity from mother to infant.

Development and validation of PediaTrac™: A web-based tool to track developing infants.

OBJECTIVE: PediaTrac™, a 363-item web-based tool to track infant development, administered in modules of ∼40-items per sampling period, newborn (NB), 2--, 4--, 6--, 9-- and 12--months was validated. Caregivers answered demographic, medical, and environmental questions, and questions covering the sensorimotor, feeding/eating, sleep, speech/language, cognition, social-emotional, and attachment domains. METHODS: Expert Panel Reviews and Cognitive Interviews (CI) were conducted to validate the item bank. Classical Test Theory (CTT) and Item Response Theory (IRT) methods were employed to examine the dimensionality and psychometric properties of PediaTrac with pooled longitudinal and cross-sectional cohorts (N = 132). RESULTS: Intraclass correlation coefficients (ICC) for the Expert Panel Review revealed moderate agreement at 6 -months and good reliability at other sampling periods. ICC estimates for CI revealed moderate reliability regarding clarity of the items at NB and 4 months, good reliability at 2--, 9-- and 12--months and excellent reliability at 6 -months. CTT revealed good coefficient alpha estimates (α ≥ 0.77 for five of the six ages) for the Social-Emotional/Communication, Attachment (α ≥ 0.89 for all ages), and Sensorimotor (α ≥ 0.75 at 6-months) domains, revealing the need for better targeting of sensorimotor items. IRT modeling revealed good reliability (r = 0.85-0.95) for three distinct domains (Feeding/Eating, Social-Emotional/Communication and Attachment) and four subdomains (Feeding Breast/Formula, Feeding Solid Food, Social-Emotional Information Processing, Communication/Cognition). Convergent and discriminant construct validity were demonstrated between our IRT-modeled domains and constructs derived from existing developmental, behavioral and caregiver measures. Our Attachment domain was significantly correlated with existing measures at the NB and 2-month periods, while the Social-Emotional/Communication domain was highly correlated with similar constructs at the 6-, 9- and 12-month periods. CONCLUSION: PediaTrac has potential for producing novel and effective estimates of infant development via the Sensorimotor, Feeding/Eating, Social-Emotional/Communication and Attachment domains.