Innovative methods for remote assessment of neurobehavioral development

Higher prenatal dietary glycemic index in the third trimester of pregnancy is associated with infant negative affect at 6 months

The dietary glycemic index (GI) reflects post-prandial plasma glucose generation rate, with higher-GI foods rapidly increasing blood sugar. Prenatal consumption of high-GI foods is associated with offspring risk for obesity and metabolic disorders. The impact of prenatal dietary GI exposure on infant neurodevelopment remains unclear. Maternal dietary intake, percent adiposity, and insulin resistance were prospectively assessed during the second and third trimesters in a sample of women with healthy, singleton pregnancies (N = 302). Infant negative affect was prospectively assessed at six months using observer ratings (Still Face Paradigm) and caregiver-reports (Infant-Behavior Questionnaire-Revised). Structural equation models assessed the independent effects of second and third trimester maternal dietary GI, adiposity, insulin resistance on infant negative affect, adjusted for relevant covariates. Higher third, but not second, trimester dietary GI was associated with increased observer-rated infant negative affect (β = 0.14, p = .04) and with higher caregiver-reported infant sadness (β = 0.17, p = .01), suggesting a programming effect of prenatal dietary GI on infant neurodevelopment. Targeted interventions that decrease dietary GI in later pregnancy may prove more effective for optimizing infant behavioral health compared to longer-term changes needed to alter metabolic state. Identifying modifiable early contributors to infant negative affect supports proactive strategies for mitigating future psychopathology risk.

Employing user-centered design to develop a remote technology kit for studying young children's social communication skills

OBJECTIVE

The COVID-19 pandemic required behavioral researchers to rapidly pivot to the implementation of remote study protocols to facilitate data collection. Remote implementation required robust and flexible research protocols including reliable audio/visual technology that met all the quality, security, and privacy hallmarks of lab-based equipment, while also being portable and usable by nontechnical staff and participants. The project's primary purpose was to develop a technology kit that could be deployed for data collection in homes with young children. The secondary objective was to determine the feasibility of the kit for use longitudinally across four disparate sites.

METHOD

User-centered design principles were employed in the development and implementation of a technology kit deployed across urban, suburban, and rural participant locations in four states. Preliminary feasibility and usability data were gathered to determine the reliability of the kit across three timepoints.

RESULTS

In study 1, a technology kit was constructed addressing all project needs including the provision of the internet to connect remotely with participants. Staff training protocols and participant-facing materials were developed to accompany deployment procedures. In study 2, data gathered in technology logs demonstrated successful capturing of video footage in 96% of opportunities with most technology challenges mitigated. Subsequent behavioral coding indicated 100% of captured assessment footage has been successfully coded to date. Moreover, participants needed less support for technology setup at their later timepoints, and staff rated the kit as highly usable.

CONCLUSION

This study offers a model for future development of technology use in remote community- and home-based pediatric research.

Prenatal Stress and Maternal Role in Neurodevelopment

This review summarizes recent findings on stress-related programming of brain development in utero, with an emphasis on situating findings within the mothers' broader psychosocial experiences. Meta-analyses of observational studies on prenatal stress exposure indicate the direction and size of effects on child neurodevelopment are heterogeneous across studies. Inspired by lifespan and topological frameworks of adversity, we conceptualize individual variation in mothers' lived experience during and prior to pregnancy as a key determinant of these heterogeneous effects across populations. We structure our review to discuss experiential categories that may uniquely shape the psychological and biological influence of stress on pregnant mothers and their developing children, including current socioeconomic resources, exposure to chronic and traumatic stressors, culture and historical trauma, and the contours of prenatal stress itself. We conclude by identifying next steps that hold potential to meaningfully advance the field of fetal programming.

Remote data collection of infant activity and sleep patterns via wearable sensors in the HEALthy Brain and Child Development Study (HBCD)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Wearable and remote sensing technologies have advanced data collection outside of laboratory settings to enable exploring, in more detail, the associations of early experiences with brain development and social and health outcomes. In the HBCD Study, the Novel Technology/Wearable Sensors Working Group (WG-NTW) identified two primary data types to be collected: infant activity (by measuring leg movements) and sleep (by measuring heart rate and leg movements). These wearable technologies allow for remote collection in the natural environment. This paper illustrates the collection of such data via wearable technologies and describes the decision-making framework, which led to the currently deployed study design, data collection protocol, and derivatives, which will be made publicly available. Moreover, considerations regarding actual and potential challenges to adoption and use, data management, privacy, and participant burden were examined. Lastly, the present limitations in the field of wearable sensor data collection and analysis will be discussed in terms of extant validation studies, the difficulties in comparing performance across different devices, and the impact of evolving hardware/software/firmware.

Adipokines measured during pregnancy and at birth are associated with infant negative affect

BACKGROUND

Increased adiposity during pregnancy may be related to offspring risk for mental health disorders, although the biological mechanisms are poorly understood. One promising hypothesis is that factors secreted from adipocytes such as leptin and adiponectin may explain this association. The current study examined whether pregnancy or umbilical cord blood concentrations of leptin and/or adiponectin a) predict elevated infant negative affect at 6 months (an early life marker of risk for psychopathology); and b) help explain the association between pregnancy adiposity and increased infant negative affect.

METHODS

Data came from a prospective cohort (N = 305) of pregnant individuals and their offspring. Second trimester adiposity was assessed using air displacement plethysmography. Concentrations of leptin and adiponectin were measured in second trimester plasma and umbilical cord plasma. Infant negative affect was assessed by standardized observation at 6 months. Second trimester inflammation was assessed using a comprehensive panel of cytokines.

RESULTS

Lower second trimester adiponectin was associated with elevated infant negative affect, and mediated the effect of pregnancy adiposity on infant negative affect. This association was independent of the effect of second trimester inflammation. Umbilical cord leptin also predicted higher infant negative affect and mediated the association between pregnancy adiposity and infant negative affect.

CONCLUSIONS

This is the first study to link pregnancy adiponectin or cord blood leptin to infant markers of risk for psychopathology, and the first to demonstrate that these adipokines mediate the association between pregnancy adiposity and offspring behavioral outcomes, suggesting novel markers of risk and potential mechanisms of effect.

Effects of prenatal psychosocial stress and COVID-19 infection on infant attention and socioemotional development

BACKGROUND

The COVID-19 pandemic dramatically altered the psychosocial environment of pregnant women and new mothers. In addition, prenatal infection is a known risk factor for altered fetal development. Here we examine joint effects of maternal psychosocial stress and COVID-19 infection during pregnancy on infant attention at 6 months postpartum.

METHOD

One-hundred and sixty-seven pregnant mothers and infants (40% non-White; n = 71 females) were recruited in New York City (n = 50 COVID+, n = 117 COVID-). Infants' attentional processing was assessed at 6 months, and socioemotional function and neurodevelopmental risk were evaluated at 12 months.

RESULTS

Maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted infant attention at 6 months. In mothers reporting positive COVID-19 infection, higher prenatal psychosocial stress was associated with lower infant attention at 6 months. Exploratory analyses indicated that infant attention in turn predicted socioemotional function and neurodevelopmental risk at 12 months.

CONCLUSIONS

These data suggest that maternal psychosocial stress and COVID-19 infection during pregnancy may have joint effects on infant attention at 6 months. This work adds to a growing literature on the effects of the COVID-19 pandemic on infant development, and may point to maternal psychosocial stress as an important target for intervention.

IMPACT

This study found that elevated maternal psychosocial stress and COVID-19 infection during pregnancy jointly predicted lower infant attention scores at 6 months, which is a known marker of risk for neurodevelopmental disorder. In turn, infant attention predicted socioemotional function and risk for neurodevelopmental disorder at 12 months. These data suggest that maternal psychosocial stress may modulate the effects of gestational infection on neurodevelopment and highlight malleable targets for intervention.

Phenotypic Environmental Sensitivity and Mental Health During Pregnancy and Post Partum: Protocol for the Experiences of Pregnancy Longitudinal Cohort Study

BACKGROUND

Mental health problems during pregnancy and post partum are common and associated with negative short- and long-term impacts on pregnant individuals, obstetric outcomes, and child socioemotional development. Socio-environmental factors are important predictors of perinatal mental health, but the effects of the environment on mental health are heterogeneous. The differential susceptibility theory and the environmental sensitivity framework suggest that individuals differ in their degree of sensitivity to positive and negative environments, which can be captured by individual phenotypes such as temperament and personality. While there is strong evidence for these models in childhood, few studies examined them in adults, and they were not examined in pregnancy.

OBJECTIVE

The primary objective of the Experiences of Pregnancy study is to explore whether childhood and current environments are associated with mental health and well-being in pregnancy and whether these effects depend on individual sensitivity phenotypes (personality). This study also aims to gather important psychosocial and health data for potential secondary data analyses and integrative data analyses.

METHODS

We will conduct a longitudinal cohort study. The study was not registered elsewhere, other than this protocol. Participants will be recruited through social media advertisements linking to the study website, followed by an eligibility call on Zoom (Zoom Video Communications). Participants must be aged 18 years or older, currently residing in the United States as citizens or permanent residents, and currently planning to continue the pregnancy. A minimum of 512 participants will be recruited based on power analyses for the main objectives. Since the data will also be a resource for secondary analyses, up to 1000 participants will be recruited based on the available budget. Participants will be in their first trimester of pregnancy, and they will be followed at each trimester and once post partum. Data will be obtained through self-reported questionnaires assessing demographic factors; pregnancy-related factors; delivery, labor, and birth outcomes; early infant feeding; individual personality factors; childhood and current environments; mental health and well-being; attachment; and infant temperament. A series of measures were taken to safeguard the study from web robots and fraudulent participants, as well as to reduce legal and social risks for participants following Dobbs v. Jackson.

RESULTS

The study received ethics approval in April 2023 from the University of Oklahoma-Norman Campus Institutional Review Board. Recruitment occurred from May to August 2023, with 3 follow-ups occurring over 10 months.

CONCLUSIONS

The Experiences of Pregnancy study will extend theories of environmental sensitivity, mainly applied in children to the perinatal period. This will help better understand individual sensitivity factors associated with risk, resilience, plasticity, and receptivity to negative and positive environmental influences during pregnancy for pregnant individuals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/49243.

OWLET: An automated, open-source method for infant gaze tracking using smartphone and webcam recordings

Groundbreaking insights into the origins of the human mind have been garnered through the study of eye movements in preverbal subjects who are unable to explain their thought processes. Developmental research has largely relied on in-lab testing with trained experimenters. This constraint provides a narrow window into infant cognition and impedes large-scale data collection in families from diverse socioeconomic, geographic, and cultural backgrounds. Here we introduce a new open-source methodology for automatically analyzing infant eye-tracking data collected on personal devices in the home. Using algorithms from computer vision, machine learning, and ecological psychology, we develop an online webcam-linked eye tracker (OWLET) that provides robust estimation of infants' point of gaze from smartphone and webcam recordings of infant assessments in the home. We validate OWLET in a large sample of 7-month-old infants (N = 127) tested remotely, using an established visual attention task. We show that this new method reliably estimates infants' point-of-gaze across a variety of contexts, including testing on both computers and mobile devices, and exhibits excellent external validity with parental-report measures of attention. Our platform fills a significant gap in current tools available for rapid online data collection and large-scale assessments of cognitive processes in infants. Remote assessment addresses the need for greater diversity and accessibility in human studies and may support the ecological validity of behavioral experiments. This constitutes a critical and timely advance in a core domain of developmental research and in psychological science more broadly.

Exploration of the Feasibility of Remote Assessment of Functioning in Children and Adolescents with Developmental Disabilities: Parents' Perspectives and Related Contextual Factors

The COVID-19 pandemic interrupted face-to-face health services, leveraging telehealth strategies. The aim of this cross-sectional study was to investigate, from a parent's perspective, the feasibility of a remote assessment of functioning in children with developmental disabilities during the pandemic and related contextual factors, based on how parents carry out the assessment. Parents of children with developmental disabilities (mean age = 7.56 ± 3.68) responded to a remote assessment via electronic forms and telephone interview. We analyzed parents' perspectives about the feasibility of the assessment. We also tested the association between feasibility score and sociodemographics/pandemic experience. Regression analysis tested if children's functioning characteristics predicted feasibility. A total of 57 mothers completed the remote assessment, and more than 95% did not report difficulties in accessing/responding to electronic forms. They scored remote assessment as easy and feasible, and reported no difficulties with telephone interview. Greater feasibility rates were related to lower maternal age (rho Spearman = -0.290; p = 0.029). The model shows that children's characteristics predicted 20.4% of feasibility (p < 0.005). Remote assessment showed to be feasible. Younger mothers might consider easier-to-use technologies, beyond considering remote assessment more viable. These results can guide the next steps in research and remote clinical practice.

Maternal Mental Health and Infant Development During the COVID-19 Pandemic

Importance

The COVID-19 pandemic has prompted an unprecedented need to rapidly investigate the potential consequences for maternal mental health, infant and child development, and the mother-infant relationship.

Observations

Globally, the mental health of pregnant and postpartum individuals has worsened during the pandemic regardless of infection status, and these concerning changes have disproportionally affected racial and ethnic minoritized people from underserved populations. Early indicators of infant neurobehavioral outcomes suggest that while in utero exposure to a maternal SARS-CoV-2 infection is likely negligible, limited data are available regarding the neurodevelopmental consequences for the generation of infants born during the pandemic. High maternal depression and grief during the COVID-19 pandemic are associated with lower levels of self-reported maternal-infant bonding. Yet nearly all published reports of child neurodevelopmental outcomes and dyadic functioning in the context of the pandemic rely on self-reported and parent-reported measures, which are subject to bias.

Conclusions and Relevance

In the context of prior research, and considering the paucity of research on infant neurodevelopment following prenatal SARS-CoV-2 exposure and birth during the pandemic, robust scientific investigation is needed to detect indicators of compromised early outcomes that could inform widespread assessment and accessible intervention. We simultaneously caution against reflexive apprehension regarding the generation of children born during the COVID-19 pandemic.

Online testing in developmental science: A guide to design and implementation

At present, most developmental psychology experiments use participants from a mere subsection of the world's population. Moreover, like other fields of psychology, many studies in developmental psychology suffer from low statistical power due to small samples and limited observations. Online testing holds promise as a way to achieve more representative and robust, better powered experiments. As participants do not have to visit in person, it is easier to access populations living further away from a developmental lab, enabling testing of more diverse populations (e.g., urban vs rural areas, various different nationalities or geographies), both within and beyond the researcher's home country. Furthermore, due to the codified nature of browser-based online testing, it is possible for multiple labs to carry out the exact same study, allowing for better replications. Because of these advantages, developmental researchers have started to move experiments online so that caregivers and their children can participate from their home environments. However, the transition from traditional lab testing to remote online testing brings many challenges. Laboratory studies of infant and child development are typically conducted under highly standardized conditions to control factors, such as distractors, distance to the screen, movement, and lighting, and often rely on specialized equipment for measuring behavior. In this chapter, we provide a guide for researchers considering online testing of a developmental population. The different sections comprise an overview of the decision-making processes and the state-of-the-art advances associated with, as well as tangible recommendations for, online data collection.

Zoom, Zoom, Baby! Assessing Mother-Infant Interaction During the Still Face Paradigm and Infant Language Development via a Virtual Visit Procedure

The COVID-19 pandemic has necessitated innovations in data collection protocols, including use of virtual or remote visits. Although developmental scientists used virtual visits prior to COVID-19, validation of virtual assessments of infant socioemotional and language development are lacking. We aimed to fill this gap by validating a virtual visit protocol that assesses mother and infant behavior during the Still Face Paradigm (SFP) and infant receptive and expressive communication using the Bayley-III Screening Test. Validation was accomplished through comparisons of data (i.e., proportions of missing data for a given task; observed infant and maternal behaviors) collected during in-person laboratory visits and virtual visits conducted via Zoom. Of the 119 mother-infant dyads who participated, 73 participated in lab visits only, 13 participated in virtual visits only, and 33 dyads participated in a combination of lab and virtual visits across four time points (3, 6, 9, and 12 months). Maternal perspectives of, and preferences for, virtual visits were also assessed. Proportions of missing data were higher during virtual visits, particularly for assessments of infant receptive communication. Nonetheless, comparisons of virtual and laboratory visits within a given time point (3, 6, or 9 months) indicated that mothers and infants showed similar proportions of facial expressions, vocalizations and directions of gaze during the SFP and infants showed similar and expected patterns of behavioral change across SFP episodes. Infants also demonstrated comparable expressive and receptive communicative abilities across virtual and laboratory assessments. Maternal reports of ease and preference for virtual visits varied by infant age, with mothers of 12-month-old infants reporting, on average, less ease of virtual visits and a preference for in-person visits. Results are discussed in terms of feasibility and validity of virtual visits for assessing infant socioemotional and language development, and broader advantages and disadvantages of virtual visits are also considered.

Effects of maternal psychological stress during pregnancy on offspring brain development: Considering the role of inflammation and potential for preventive intervention

Heightened psychological stress during pregnancy has repeatedly been associated with increased risk for offspring development of behavior problems and psychiatric disorders. This review covers a rapidly growing body of research with the potential to advance a mechanistic understanding of these associations grounded in knowledge about maternal-placental-fetal stress biology and fetal brain development. Specifically, we highlight research employing magnetic resonance imaging to examine the infant brain soon after birth in relation to maternal psychological stress during pregnancy to increase capacity to identify specific alterations in brain structure and function and to differentiate between effects of pre- versus postnatal exposures. We then focus on heightened maternal inflammation during pregnancy as a mechanism through which maternal stress influences the developing fetal brain based on extensive preclinical literature and emerging research in humans. We place these findings in the context of recent work identifying psychotherapeutic interventions found to be effective for reducing psychological stress among pregnant individuals, which also show promise for reducing inflammation. We argue that a focus on inflammation, among other mechanistic pathways, has the potential to lead to a productive and necessary integration of research focused on the effects of maternal psychological stress on offspring brain development and prevention and intervention studies aimed at reducing maternal psychological stress during pregnancy. In addition to increasing capacity for common measurements and understanding potential mechanisms of action relevant to maternal mental health and fetal neurodevelopment, this focus can inform and broaden thinking about prevention and intervention strategies.