A Developmental Hierarchical-Integrative Perspective on the Emergence of Self-Regulation: A Replication and Extension

Adaptive changes in infant emotion regulation persist three months following birthing parent receipt of cognitive behavioral therapy for postpartum depression

BACKGROUND

Infants exposed to postpartum depression (PPD) exhibit more emotion regulatory (ER) difficulties than infants who are not. While treatments for PPD that include cognitive behavioral therapy (CBT) may adaptively alter infant ER immediately following treatment, it is unclear if these improvements persist.

METHODS

This study examined if adaptive changes in infant ER persisted three months after their birthing parent completed 9-weeks of CBT for PPD. We used data from n = 35 case infants (of birthing parents diagnosed with a postpartum major depressive disorder), and n = 33 healthy control infants (born to non-depressed birthing parents and matched to case infants on age, sex and family SES). A multimethod assessment of infant ER included resting-state frontal EEG asymmetry (FA), high-frequency heart rate variability (HF-HRV), and birthing parent- and partner-reported temperamental positive affect (PA). Infant ER was examined at three study visits (V1 occurred before CBT/at baseline for control infants, V2 took place immediately after CBT (9-weeks later), and V3 was three months after V2).

RESULTS

Three months after birthing parent CBT (V3), infants continued to exhibit greater left FA relative to pre-treatment [∆meanV1 to V3 = 0.19, [SE = 0.082], p = 0.02]-the pre-to-post treatment shift from right to left FA remained statistically significant at V3). HF-HRV at V3 also increased relative to pre-treatment [∆mV1 to V3 = 0.81, [0.19], p < 0.001], as did PA reported by birthing parents [∆mV1 to V3 = 0.64, [0.16], p < 0.001] and their partners [∆mV1 to V3 = 0.54, [0.18], p = 0.004]. No ER measures differed between case and control infants at the three-month visit.

CONCLUSIONS

Treating PPD may set infants on a persistent adaptive ER trajectory.

Early bedtime routines and behavioral outcomes among children from low-income families: Mediating role of emotion regulation

The establishment of early bedtime routine is essential for children's emotion and behavioral outcomes. Less is known, however, about the longitudinal effects and mechanisms predicting behavioral outcomes through early bedtime routine and emotion regulation in school-age children from low-income families. Thus, the present study examined emotion regulation at age three as a potential mediator in the longitudinal links between early bedtime routine and behavioral outcomes among racially diverse school age children from low-income families. Participants include a subsample of families (n = 2977) participating in the Early Head Start Research and Evaluation Project (EHSRE). Structural equation modeling with bootstrapping techniques was used to examine the models. The early bedtime routine index was created from parents' reports at 14, 24, and 36 months. Children's emotion regulation was drawn from interviewer assessments at 36 months and problem behaviors were reported by mothers when the child was approximately at age 10. Results indicated that children with consistent early bedtime routine were better able to regulate their emotions at age three. Also, emotion regulation at age three mediated the associations between early bedtime routine at 14-36 months and internalizing and externalizing behaviors among fifth-grade children. Findings indicated that consistent early bedtime routine helps children to regulate their emerging emotions which in turn has long-term benefits on their emotional and behavioral outcomes. These findings have important implications for pediatricians, nurse practitioners, nurses, and early childhood educators who can provide education and resources to support families in establishing consistent bedtime routine for their young children.

Appetite Self-Regulation in Childhood: A Narrative Review and Conceptual Model of Processes and Mechanisms With Implications for Research and Practice

The purpose of the present narrative review was to propose a unifying generalized conceptual model of mechanisms and processes in appetite self-regulation (ASR) in childhood. Appetite self-regulation, along with other domains of self-regulation, develops across childhood and contributes to energy intake and balance, diet quality, weight, and therefore long-term health outcomes. There have been efforts to conceptualize and measure components of ASR and associated processes/mechanisms, but, at present, there is no unifying conceptualization of ASR in childhood. A search of key databases supplemented by snowballing was undertaken for definitions/conceptions and theoretical models of ASR with a focus on children. An interpretive synthesis approach was used to identify themes from the definitions and models. The themes formed the basis of the proposed unifying generalized model of ASR in childhood, which is the main contribution of the article. At the center of the model is bottom-up reactivity to food, food cues and hunger, satiation and satiety signals, together with top-down regulatory control. An additional contribution is the proposed 5 interacting and overlapping domains (biological, hedonics, cognitive, behavioral, and traits) that function in and influence both bottom-up reactivity and top-down regulation. The domains also contribute to ASR outcomes of enactment and competence. External contextual and intrapersonal factors are conceived as impacting the domains and the bottom-up, top-down processes. The relevance of the model for explanations of ASR phenomena in childhood and children's food choice and diet quality, as well as its implications for research directions and approaches to preventive intervention, including food parenting practices, are discussed. The model provides a framework for researchers and practitioners to support and interpret children's problems and competence in self-directing food choices, energy intake, and nutrition.

A challenge to the expected: Lack of longitudinal associations between the early caregiving environment, executive functions in toddlerhood, and self-regulation at 6 years

Previous research and theory indicate an importance of the quality of the early caregiving environment in the development of self-regulation. However, it is unclear how attachment security and maternal sensitivity, two related but distinct aspects of the early caregiving environment, may differentially predict self-regulation at school start and whether a distinction between hot and cool executive function is informative in characterizing such predictions through mediation. In a 5-year longitudinal study (n = 108), we examined these associations using measures of maternal sensitivity and attachment security at 10-12 months, executive function at 4 years, and self-regulation at 6 years. Surprisingly, and despite methodological rigor, we found few significant bivariate associations between the study variables. We found no credible evidence of a longitudinal association between maternal sensitivity or attachment security in infancy and self-regulation at 6 years, or between executive function at 4 years and self-regulation at 6 years. The lack of bivariate longitudinal associations precluded us from building mediation models as intended. We discuss our null findings in terms of their potential theoretical implications, as well as how measurement type, reliability, and validity, may play a key role in determining longitudinal associations between early caregiving factors and later self-regulation and related abilities. RESEARCH HIGHLIGHTS: The early caregiving environment has been implicated in the development of later self-regulation, which includes more basic skills, such as hot and cool executive functions (EF). In a 5-year longitudinal study, with a sample of 108 children, we rigorously measured aspects of early caregiving, EF, and self-regulation. We found no significant longitudinal associations between early caregiving and self-regulation at 6 years, nor between EF at 4 years and self-regulation at 6 years. These null results highlight the complexity of modeling self-regulation development and raise critical questions about general methodological conventions within self-regulation development research.

Emotions or cognitions first? Longitudinal relations between executive functions and emotion regulation in childhood

Executive functions and emotion regulation develop from early childhood to adolescence and are predictive of important psychosocial outcomes. However, despite the correlation between the two regulatory capacities, whether they are prospectively related in school-aged children remains unknown, and the direction of effects is uncertain. In this study, a sample drawn from two birth cohorts in Norway was biennially examined between the ages of 6 and 14 (n = 852, 50.1% girls, 93% Norwegian). Parents completed the Emotion Regulation Checklist, and teachers completed the Behavior Rating Inventory of Executive Function. A random intercept cross-lagged panel model revealed that improved emotion regulation predicted increased executive functioning to the same extent throughout development, whereas enhanced executive functioning was unrelated to future changes in emotion regulation.

Stress and self-regulation behaviors in preterm neonates hospitalized at open-bay and single-family room Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) could be a risk factor for the development of preterm neonates due to the stressful procedures they undergo. Stress-related behaviors must be managed through environmental strategies that support regulating the neonates' biobehavioural system to minimize the negative impact on their development. The study aimed to compare the NICU environment's stressful procedures and developmental care strategies and the stress and self-regulation behaviors of preterm neonates in groups differentiated by the NICU environmental design. The sample comprised 20 preterm neonates hospitalized in a NICU with an open-bay model (OB NICU) and 20 preterm neonates hospitalized in a single-family room model (SFR NICU). The stressful procedures were assessed by the Neonatal Infant Stressor Scale (NISS). The developmental care strategies and the preterm neonates' stress and self-regulation behaviors were assessed using a structured observational protocol. The between-group comparison was performed by the Mann-Whitney test, and the significance level was set at 5%. Both NICUs had similar stressful procedures and developmental care approaches. However, the preterm neonates hospitalized in the SFR NICU exhibited significantly fewer total stress behaviors, and specifically in the motor system, compared to those in the OB NICU. Additionally, the preterm neonates hospitalized in the SFR NICU exhibited significantly more total self-regulation behaviors, and specifically in the behavioral state system, compared to those in the OB NICU. The findings showed that the single-family room NICU model was consistent with the environmental protection of biobehavioural regulation in preterm neonates hospitalized in the NICU.

A dynamic systems perspective towards executive function development: Susceptibility at both ends for inhibitory control

In light of the dynamic systems perspective, the current study expanded existing literature by examining the moderating effect of maternal sensitivity on the quadratic association between infant negative reactivity and future executive function development. Using a longitudinal, multimethod design, we addressed executive function development among preschoolers. This study utilized data from the Family Life Project (N = 1292). Infant negative reactivity at 6 months, maternal sensitivity across first 3 years, and executive functions during preschool age were observational assessed. A path model with moderation analyses revealed a U-shaped quadratic association between infant negative reactivity and preschoolers' inhibitory control, only when maternal sensitivity was high. The results suggest that maternal sensitivity may assist infants with both low and high, but not moderate, levels of negative reactivity towards better executive function development. Findings support the ongoing nonlinear person-environment interplay during early years of life.

Psychometric Properties of the Italian Version of Sensory Processing and Self-Regulation Checklist (SPSRC)

Sensory processing abilities play important roles in child learning, behavioural and emotional regulation, and motor development. Moreover, it was widely demonstrated that numerous children with neurodevelopmental disabilities show differences in sensory processing abilities and self-regulation compared with those of typical children. For these reasons, a complete evaluation of early symptoms is very important, and specific tools are necessary to better understand and recognize these difficulties during childhood. The main aim of this study was to translate, culturally adapt, and validate in a population of Italian typically developing (TD) children the Sensory Processing and Self-Regulation Checklist (SPSRC), a 130-item caregiver-reported checklist, covering children's sensory processing and self-regulation performance in daily life. Preliminary testing of the SPSRC-IT was carried out in a sample of 312 TD children and 30 children with various developmental disabilities. The findings showed that the SPSRC-IT had high internal consistency, a good discriminant, and structural and criterion validity about the sensory processing and self-regulation abilities of children with and without disabilities. These data provide initial evidence on the reliability and validity of SPSRC-IT, and the information obtained by using the SPSRC-IT may be considered a starting point to widen the current understanding of sensory processing difficulties among children.

Developmental foundations of physiological dynamics among mother-infant dyads: The role of newborn neurobehavior

This study tested whether newborn attention and arousal provide a foundation for the dynamics of respiratory sinus arrhythmia (RSA) in mother-infant dyads. Participants were 106 mothers (M_age  = 29.54) and their 7-month-old infants (55 males and 58 White and non-Hispanic). Newborn attention and arousal were measured shortly after birth using the NICU Network Neurobehavioral Scale. Higher newborn arousal predicted a slower return of infant RSA to baseline. Additionally, greater newborn attention predicted mothers' slower return to baseline RSA following the still-face paradigm, and this effect only held for mothers whose infants had lower newborn arousal. These findings suggest that newborn neurobehavior, measured within days of birth, may contribute to later mother-infant physiological processes while recovering from stress.

A Hierarchical Integrated Model of Self-Regulation

We present a hierarchical integrated model of self-regulation in which executive function is the cognitive component of the model, together with emotional, behavioral, physiological, and genetic components. These five components in the model are reciprocally and recursively related. The model is supported by empirical evidence, primarily from a single longitudinal study with good measurement at each level of the model. We also find that the model is consistent with current thinking on related topics such as cybernetic theory, the theory of allostasis and allostatic load, and the theory of skill development in harsh and unpredictable environments, referred to as “hidden talents.” Next, we present literature that the integrative processes are susceptible to environmental adversity, poverty-related risk in particular, while positive social interactions with caregivers (e.g., maternal sensitivity) would promote self-regulatory processes or mitigate the adverse effect of early risk on the processes. A hierarchical integrative model of self-regulation advances our understanding of self-regulatory processes. Future research may consider broader social contexts of the integrative self-regulation system, such as neighborhood/community contexts and structural racism. This can be an integral step to provide children with equitable opportunities to thrive, even among children living in socioeconomically and psychosocially disadvantaged environments.