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OBJECTIVE: This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic in Italy by specifically looking at the psychosocial response of children/adolescents with neurodevelopmental disabilities (NDD) and their parents, and explored which factors could potentially contribute to increasing or mitigating stress-related behaviors in children/adolescents as well as their parents' stress. METHOD: An online anonymous survey was designed to investigate family demographic characteristics, COVID-19 outbreak and restriction-related variables, children/adolescents' behavioral regulation problems, parental stress, and resilience. Data were collected from 1,472 parents (83.1% mothers) of 1632 NDD children/adolescents (33.7% females). RESULTS: Compared to pre-emergency, parents reported a significant increase in their children's behavioral regulation problems: Anxious/depressed behavior, Attention problems, and Aggressive behavior (p < .001), and they reported feeling more Overwhelmed and Burdened (p < .001) as parents but less Unfulfilled, Numbness, Devastated, and Angry (p < .001). A hierarchical stepwise regression analysis revealed that both behavioral regulation problems in NDD children/adolescents and parental stress are-at least partially-buffered by resilience factors in parents (Perception of self, Planned future, Family cohesion). CONCLUSIONS: Results showed that behavioral regulation problems in children/adolescents with NDD and parental stress increased. However, parental resilience can act as a protective factor, counterbalancing parental difficulties in the care of their NDD children during the emergency. Identifying risk and protective factors impacting the psychosocial response ofchildren/adolescents with NDD and their parents is essential to implement appropriate support interventions both for parents and children/adolescents with NDD during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Previous research supports the CBCL/1½-5's DSM-ASD scale (and its precursor, the DSM-PDP scale) as a Level 1 ASD screener. Confirmatory factor analyses (CFAs) with data from population samples in 24 societies (N = 19,850) indicated good measurement invariance across societies, especially for configural and metric invariance. Items 4. 25, 67, 80, and 98 may be especially good discriminators of ASD because they have tend to have low base rates, strong loadings on the ASD latent construct, and the best measurement invariance across societies. Further research is needed to test the discriminative power of these items in predicting ASD, but our strong measurement findings support the international psychometric robustness of the CBCL/1½-5's DSM-ASD scale.

Early brain damage leading to cerebral palsy is associated to core motor impairments and also affects cognitive and social abilities. In particular, previous studies have documented specific alterations of perceptual body processing and motor cognition that are associated to unilateral motor deficits in hemiplegic patients. However, little is known about spastic diplegia (SpD), which is characterized by motorial deficits involving both sides of the body and is often associated to visuospatial, attentional, and social perception impairments. Here, we compared the performance of a sample of 30 children and adolescents with SpD (aged 7-18 years) and of a group of age-matched controls with typical development (TD) at two different tasks tapping on body representations. In the first task, we tested visual and motor imagery abilities as assessed, respectively, by the object-based mental rotation of letters and by the first-person transformations for whole-body stimuli. In the second task, we administered an inversion effect/composite illusion task to evaluate the use of configural/holistic processing of others’ body. Additionally, we assessed social perception abilities in the SpD sample using the NEPSY-II battery. In line with previously reported visuospatial deficits, a general mental imagery impairment was found in SpD patients when they were engaged in both object-centered and first-person mental transformations. Nevertheless, a specific deficit in operating an own-body transformation emerged. As concerns body perception, while more basic configural processing (i.e., inversion effect) was spared, no evidence for holistic (i.e., composite illusion) body processing was found in the SpD group. NEPSY-II assessment revealed that SpD children were impaired in both the theory of mind and affect recognition subtests. Overall, these findings suggested that early brain lesions and biased embodied experience could affect higher-level motor cognition and perceptual body processing, thus pointing to a strict link between motor deficits, body schema alterations, and person processing difficulties.

The co-regulation of the hypothalamic-pituitary-adrenal (HPA) axis in mother-infant dyads is thought to be key for infant and child development. Nonetheless, previous literature presents some inconsistencies that might at least partially be due to the presence of risk conditions and the use of different statistical approaches to measure HPA axis co-regulation. Very preterm (VPT) birth represents one of these risk conditions as the early foundation of mother-infant interaction is disrupted. Both VPT infants and their mothers present evidence of altered HPA axis regulation. Nonetheless, the comparison of mother-infant HPA axis co-regulation in VPT infants compared to full-term (FT) ones has not been previously investigated. In this study, 3-month-old (corrected age) VPT infants and FT counterparts with their mothers took part in a well-validated stress-inducing laboratory task (i.e., double Face-to-Face Still-Face, FFSF paradigm). Salivary cortisol samples were obtained before (Baseline) and after (Early reactivity, Late reactivity and Recovery) the FFSF procedure. Dyadic HPA axis co-regulation was assessed at each sample time-point (i.e., in-moment coupling) as well as across samples (i.e., in-time synchrony). Significant in-moment coupling emerged at Baseline, Late reactivity and Recovery for FT infants’ dyads only. An overlying pattern of salivary cortisol trajectories emerged between mothers and infants in the VPT group, whereas a more complex pattern of reciprocal and complementary co-regulation was found for FT infants’ dyads. Although both groups gave evidence of HPA axis co-regulation, dyads of VPT infants appear to be less able to adapt reciprocally and dynamically to stressful conditions. These findings suggest that multiple approaches to account for dyadic HPA axis co-regulation should be used in order to depict the complex pattern of biological rhythms coordination in mother-infant dyads.

The present meta-analytic study was conducted to examine differences in temperament between preterm and full-term children, considering behavior style and psychobiological approaches. Moreover, we explored the potential moderators of the associations between prematurity and temperament. A systematic literature search was performed on PubMed, Scopus, Web of Science, and CINAHL. Twenty-two studies were analyzed. Preterm children showed a higher Activity level as well as lower Attentional Focusing and Attention Span/Persistence, in comparison with their full-term counterparts. Extremely preterm children showed a higher Activity level than other preterm levels. These findings support the conclusion that preterm children present with a less regulated temperament relative to those born full term.

BackgroundThe Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is a standardized method for infant neurobehavioral assessment. Normative values are available for newborns, but the NNNS is not always feasible at birth. Unfortunately, 1-month NNNS normative data are lacking.AimsTo provide normative data for the NNNS examination at 1 month and to assess birth-to-one-month changes in NNNS summary scores.Study designThe NNNS was administered at birth and at 1 month within a longitudinal prospective study design.SubjectsA cohort of 99 clinically healthy full-term infants were recruited from a well-child nursery.Outcome measuresBirth-to-1-month NNNS variations were evaluated and the association of neonatal and sociodemographic variables with the rate of change of NNNS summary scores were investigated.Results and conclusionsNNNS scores from the 10th to the 90th percentile represent a range of normative performance at 1 month. A complex pattern of stability and change emerged comparing NNNS summary scores from birth to 1 month. Orienting, Regulation, and Quality of movements significantly increased, whereas Lethargy and Hypotonicity significantly decreased. Birth-to-1-month changes in NNNS performance suggest improvements in neurobehavioral organization. These data are useful for research purposes and for clinical evaluation of neurobehavioral performance in both healthy and at-risk 1-month-old infants.

Electroencephalographic mu rhythm desynchronization is thought to reflect Mirror Neuron System (MNS) activity and represents an important neural correlate of the coupling between action execution and perception. It is still unclear if the MNS in human ontogeny is already available at the beginning of postnatal life and how early experience impacts its development. Premature birth provides a “natural condition” for investigating the effects of early, atypical extra-uterine experience on MNS. The main aim of the present study was to investigate whether the MNS activity is associated with prematurity. We compared the mu rhythm activity in preterm (PT) and full-term (FT) 14-month old infants during an action observation/execution (AO/AE) task. Mu rhythm desynchronization was computed over frontal, central, parietal and occipital regions. Both groups showed mu rhythm suppression in all the scalp regions during action execution. Different desynchronization patterns emerged during action observation. Specifically, FT infants showed mu suppression in the right frontal, bilateral parietal and occipital regions; whereas PT infants exhibited mu suppression only in the right parietal region. Overall, these preliminary findings indicate that an atypical extra uterine experience might have an impact on the MNS activity.

Family-centred care (FCC) is a state-of-the-art practice in neonatal intensive care units (NICU) based on its shown benefits on the well-being of both infants and parents. However, there is no systematic knowledge about how FCC is implemented in different European contexts.To describe parents' presence and the quality of FCC from the perspectives of mothers, fathers and nurses in 11 European NICUs.A prospective survey was conducted in Finland, Sweden, Norway, Estonia, Spain and Italy. The perceived quality of FCC was measured using 8 text-message questions sent to the parents' mobile phones, one question each day, during the infant's hospital stay. Nurses answered corresponding questions through a Web questionnaire during a 3-month period. The responses were rated on a 7-point Likert scale. Parents who were not present in the unit during the day used a "0" response.A total of 262 families of preterm infants born before 35 gestational weeks participated in the study. Mothers gave 5045 responses, fathers gave 3971 responses and nurses gave 11,132 answers. The mothers were present during 92.7% and the fathers during 77.9% of the study days. The mothers rated the quality of FCC slightly higher than the fathers did (5.8 [95% CI 5.7-5.9] vs. 5.7 [95% CI 5.6-5.8], mean difference of 0.12 [95% CI 0.05-0.2], p0.001). There was wide variation in the parents' presence and the quality of FCC between the units. The weakest aspects of FCC were emotional support, parents' participation in decision-making and fathers' participation in infant care. The perceived quality of FCC between the nurses and parents were comparable.This study showed a high perceived quality of FCC in 11 European units, as indicated by both parents and nurses. The innovative data-collection method and instrument successfully quantified each unit's FCC profile for further quality improvement and should be trialled in other NICUs and countries.

Aim: The present study is part of a prospective micro-longitudinal research project and reports on the association between SLC6A4 methylation and socio-emotional stress response in very preterm (VPT) and full-term (FT) infants. Materials & methods: SLC6A4 methylation was assessed at birth and discharge in 32 VPT infants, and at birth in 27 FT infants. Socio-emotional stress response (i.e., negative emotionality) was assessed at 3 months (corrected age). Results: Negative emotionality was higher in VPTs compared with FT counterpart. In VPT infants only, stress response was associated with SLC6A4 methylation status at discharge, which was predictive of greater negative emotionality. Conclusion: The present study extends previous reports, suggesting that altered SLC6A4 methylation associates with greater socio-emotional stress sensitivity in 3-month-old VPT infants.

The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children.Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children' language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM).VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children.Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

Background Very preterm infants are exposed to adverse stressful experiences, which may result in long-term behavioural outcomes. The developmental care practices, including pain management and environmental support, can minimize the effects of stress exposure. However, developmental care quality levels may vary among Neonatal Intensive Care Units (NICUs) and little is known about how differences in developmental care quality affect long-term behavioural outcomes. The aim of this study was to examine the relation between quality levels NICUs developmental care and behaviour problems at 18 months corrected age in preterm children. Methods The behaviour of 134 preterm children from 22 NICUs and 123 full-term controls was examined using the questionnaire Child Behaviour Checklist 1½–5. We compared the behavioural profile of children by splitting NICUs into units with high- and low quality of developmental care according to two main care factors: (1) infant centered care (ICC) index, and (2) infant pain management (IPM) index. Results Preterm children from low-care units in IPM group reported higher scores in Internalizing Problems, compared to children from high-care units. No differences were found between preterm children from high-care in IPM and full-term children. No significant IPM effect was found for externalizing problems. No significant ICC effect emerged both for internalizing and externalizing problems. Conclusions Findings suggest that higher quality of developmental care related to infant pain management can mitigate behavioural problems at 18 months in children born preterm, to such an extent that preterm children exhibit a behavioural profile similar to that displayed by full-term children.

Aim Preterm infants are at high risk of developing motor delay, learning difficulties and behavioural problems and the availability of valid neurodevelopmental assessments is a major clinical issue. This study evaluated the relationship between preterm infants' neurofunctional assessment at term equivalent age and neurodevelopment outcome at three years of chronological age. Methods Neurofunctional assessment was performed in 70 very low birth weight infants at term equivalent age and neurodevelopmental outcome was assessed at three years of chronological age with the Griffiths Mental Development Scale – Extended Revised. Results At term equivalent age, 81% of the children had normal neurofunctional scores and 82.5% of those showed normal neurodevelopmental outcome at three years. Of the 19% who had impaired development at term equivalent age, 38.5% had neurodevelopmental delay at three years. Impaired neurofunctional status was associated with an increased risk of developmental delay in the global quotient (odds ratio 12.1) and locomotor sub-quotient (odds ratio 18.35) compared with normal neurofunctional status. Infants with sepsis or necrotising enterocolitis also faced a higher risk of neurodevelopmental delay. Conclusion Neurofunctional assessment performed at term equivalent age appeared to provide early identification of preterm infants at risk of neurodevelopmental delay at three years of chronological age.

IntroductionNeurodevelopmental disability (ND) represents an adverse condition for infants’ socio-emotional and behavioural development as well as for caregiving (eg, parental sensitivity) and mother-infant interaction. Adverse exposures are associated with altered neuroendocrine hormones concentrations (eg, oxytocin and cortisol) and epigenetic regulation (eg, methylation of stress-related genes), which in turn may contribute to less-than-optimal mother-infant interaction. Parental sensitivity is a protective factor for childrens’ development and early parental interventions (eg, video-feedback intervention) can promote parental caregiving and better developmental outcomes in children. The present multi-centric and longitudinal randomised controlled trial aims to assess if and to which extent early VFI could benefit both infants and mothers in terms of behavioural outcomes as well as neuroendocrine and epigenetic regulation.Methods and analysisDyads will be randomly assigned to the video-feedback Intervention Group or Control Group (‘dummy’ intervention: telephone calls). Infants with ND aged 3 to 18 months will be recruited from three major child neuropsychiatric units in northern Italy. A multi-layer approach to intervention effects will include videotapes of mother-infant interaction, maternal reports as well as saliva samples for hormones concentrations and target-gene methylation analysis (eg, BDNF, NR3C1, OXTR and SCL6A4) that will be obtained at each of the four assessment sessions: T0, baseline; T1, post-intervention; T2, short-term follow-up (3 month); T3, long-term follow-up (6 month). Primary effectiveness measures will be infant socio-emotional behaviour and maternal sensitivity. Neuroendocrine hormones concentrations and DNA methylation status of target genes will be secondary outcomes. Feasibility, moderation and confounding variables will be measured and controlled between the two groups.Ethics and disseminationEthics approval has been obtained in all three participating units. Results of the main trial and each of the secondary endpoints will be submitted for publication in peer-reviewed journals and international conferences.Trial registration numberNCT03853564; Pre-results.

During the first years of life, maternal touch can serve different functions including facilitation of child's gaze orientation to faces which is a key precursor for social attention. Although children with neurodevelopmental disability (ND) may have reduced social skills, the role of maternal touch in contributing to gaze orientation to maternal face has not been explored in previous research. In the present study, we investigate the functions of maternal touch in dyads of mothers and children with ND, compared to dyads of children with typical development (TD). Micro-analytic 2-s coding of maternal touch (i.e., affectionate, playful, facilitating, holding, no touch) and children's gaze orientation (i.e., mother-oriented, object-oriented, non-oriented) occurred during 5-minute interactions between mothers and their 12-to-24-month-old ND and TD children. Dyads were paired for children chronological age and sex. Mothers of children with ND used more touch - especially facilitating and holding types -, compared to mothers of TD peers. Children with ND exhibited more non-orientated gaze compared to TD counterparts. Playful touch associated with increased mother-oriented gaze in children with ND, whereas affectionate and holding touch associated with greater mother-oriented gaze in TD children. Findings suggest that specific types of touch support children's attention to social partners.

Aim: Recent findings show that DNA methylation is susceptible to very preterm (VPT) birth and to the experience of the early stay in the neonatal intensive care unit. The aim of the study was to compare PLAGL1 methylation between VPT and full-term (FT) infants at birth as well as between VPT infants at discharge and FT infants at birth. Methods: DNA was collected from cord blood of 56 VPT and 27 FT infants at birth and from peripheral blood in VPT infants at neonatal intensive care unit discharge. Sociodemographic and neonatal variables were considered. Results: PLAGL1 methylation at birth and at discharge were highly correlated in VPT infants. Lower methylation emerged in VPT infants at birth and discharge compared to FT counterparts. Conclusion: PLAGL1 hypomethylation emerged as a potential epigenetic mark of VPT birth. Future research is warranted to assess the functional consequences of PLAGL1 diminished methylation in VPT infants’ development.

Very preterm (VPT) infants admitted to Neonatal Intensive Care Unit (NICU) are at risk for altered brain growth and less-than-optimal socio-emotional development. Recent research suggests that early NICU-related stress contributes to socio-emotional impairments in VPT infants at 3 months through epigenetic regulation (i.e., DNA methylation) of the serotonin transporter gene (SLC6A4). In the present longitudinal study we assessed: (a) the effects of NICU-related stress and SLC6A4 methylation variations from birth to discharge on brain development at term equivalent age (TEA); (b) the association between brain volume at TEA and socio-emotional development (i.e., Personal-Social scale of Griffith Mental Development Scales, GMDS) at 12 months corrected age (CA). Twenty-four infants had complete data at 12-month-age. SLC6A4 methylation was measured at a specific CpG previously associated with NICU-related stress and socio-emotional stress. Findings confirmed that higher NICU-related stress associated with greater increase of SLC6A4 methylation at NICU discharge. Moreover, higher SLC6A4 discharge methylation was associated with reduced anterior temporal lobe (ATL) volume at TEA, which in turn was significantly associated with less-than-optimal GMDS Personal-Social scale score at 12 months CA. The reduced ATL volume at TEA mediated the pathway linking stress-related increase in SLC6A4 methylation at NICU discharge and socio-emotional development at 12 months CA. These findings suggest that early adversity-related epigenetic changes might contribute to the long-lasting programming of socio-emotional development in VPT infants through epigenetic regulation and structural modifications of the developing brain.

Infants' attention is captured by the redundancy of amodal stimulation in multimodal objects and events. Evidence from this study demonstrates that intersensory redundancy can facilitate discrimination of rhythm changes presented in the visual modality alone in visually impaired infants, suggesting that multisensory rehabilitation strategies could prove helpful in this population.

The Face-to-Face Still-Face (FFSF) paradigm allows to study the mother–infant dyad as a dynamic system coping with social stress perturbations. The State Space Grid (SSG) method is thought to depict both flexibility and stability of the dyad across perturbations, but previous SSG evidence for the FFSF is limited. The main aims were: (1) to investigate mother–infant dyadic flexibility and stability across the FFSF using the SSG; (2) to evaluate the influence of dyadic functioning during Play on infant Still-Face response and of infant stress response in affecting dyadic functioning during Reunion. Forty 4-month-old infants and their mothers were micro-analytically coded during a FFSF and eight SSG dyadic states were obtained. Dyadic flexibility and attractor states were assessed during Play and Reunion. Infants’ stress response was coded as negative engagement during the Still-Face episode. Two dyadic states, “maternal hetero-regulation” and “affective mismatch”, showed significant changes in the number of visits from Play to Reunion. During Play “maternal positive support to infant play” emerged as attractor state, whereas during Reunion a second attractor emerged, namely “affective mismatch”. Dyadic affective mismatch during Play correlated with infants’ negative engagement during Still-Face, whereas infants’ response to Still-Face resulted in minor social matching during Reunion. Findings provide new insights into the flexible, yet stable, functioning of the mother–infant dyad as a dynamic system. Evidence of a reciprocal influence between dyadic functioning and infant social stress response are discussed.

Very preterm (VPT) infants (gestational age < 32 weeks) require long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU), even in absence of severe morbidities. During NICU stay, life-saving interventions occur and include invasive and painful skin-breaking procedures (NICU-related stress), which constitute a major early adverse experience for VPT infants. Telomeres are repeat-sequence at the end of chromosomes, which shorten with age and are highly susceptible to life adversities: the exposure to early adverse experiences is associated with shorter telomere length (TL). Nonetheless, previous research did not assess longitudinally the association between NICU-related stress and TL in VPT infants. In the present study, leukocyte TL was assessed from cord blood at birth in 46 VPT infants and in a group of 31 full-term (FT) infants, as well as at NICU discharge in VPTs only. NICU-related stress was measured as the number of skin-breaking procedures occurring throughout the NICU stay. A significant difference emerged for TL between VPT infants and FT counterparts at birth. TL decreased from birth to discharge in VPT infants, although the change was not significant in the group as a whole. The amount of NICU-related stress emerged as the primary predictor of TL erosion in VPT infants, even controlling for neonatal and clinical confounders. Furthermore, VPT infants exposed to high NICU-related stress exhibited a marked and significant decrease in TL, whereas VPT exposed to low NICU-related stress exhibited a non-significant increase. The present study confirms previous evidence of longer telomeres in VPT infants at birth compared to FT controls. Moreover, NICU-related stress emerged as a key regulator of TL erosion from birth to discharge in VPT infants. Future research is warranted to further explore TL erosion in VPT infants and the factors associated with individual differences in NICU-related stress susceptibility at the epigenetic level.

The main aim of the present study was to examine differences in behavioral problems in toddlers born very preterm in Brazil and Italy. The sample comprised 154 toddlers (18-24 months of age) born very preterm, including 76 toddlers from Brazil and 78 toddlers from Italy. The Child Behavior Checklist was used to assess behavioral problems. Specific sociodemographic factors (i.e., maternal age at childbirth and maternal education) and neonatal factors (i.e., gestational age, sex, and length of hospitalization) were tested as potential mediators of country-related differences in behavioral problems. Brazilian toddlers presented more internalizing, externalizing, and total behavioral problems compared with their Italian counterparts. The effect of country on the toddlers' internalizing and total behavioral problems was mediated by maternal age at childbirth and education. Independent effects of country, maternal age at childbirth, and maternal education emerged for externalizing behavioral problems. No significant effect emerged for neonatal variables. These findings suggest that sociodemographic factors, in addition to country-related differences, should be considered when assessing the risk of behavioral problems in preterm toddlers.

Mothers' and fathers' touch were investigated during their first naturalistic interaction with their newborns, and maternal touch was predicted from newborn to 3-months postpartum during the Still-Face (SF) procedure. Both parents displayed more nurturing types of touch when interacting with their infants for the first time. Maternal touch at newborn predicted maternal touch after, but not before, the SF 3-months later; more touch after birth was associated with more soothing, regulating, types of maternal touch following the SF, suggesting that the nature of these interactive contexts (post-birth, post-SF) may be parallel. To our knowledge, this is the first study to investigate the full range of maternal and paternal touching behaviors during the first hour after birth. It is also one of the only investigations that considers how mothers' very first touch and physical contact relate to their later touch at 3-months. Our results uniquely contribute by revealing the nurturing and predictive quality of parents' touch, and underscore touch as a primary means of early contact and communication.

Aims The study examined the effects of a parental intervention to reduce parents’ stress levels during the hospitalization of their very preterm infants in a NICU, taking into account possible differences between mothers and fathers. Methods Parents of infants born ≤32 weeks gestational age (GA) were randomly assigned to a standard support group (N = 21) or intervention group (N = 21). The intervention was based both on a joint observation method and infant massage provided by both parents. Parents’ stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit, after the first week of admission and at the infant's discharge. Results At discharge, intervention group parents showed significantly lower levels of stress related to infants’ appearance/behaviour and to parental role alteration (PRA) than those of the standard support group (p = 0.000). Overall, mothers reported more stress compared with fathers (p ≤ 0.05). The intervention was effective in reducing the stress-role alteration in mothers (p

We examined whether there are differences in the lateralization of expressive gestures in infants during normal and stressful interactions with their mothers and the relations between their gestures. Thirty full-term 6–12 month-old infants were videotaped during the Face-to-Face Still-Face paradigm. We coded the occurrence and lateralization of infant self-directed and other-directed gestures and maternal proximal and distal gestures. Infant self-directed gestures increased from the Play to Still-Face episode and decreased from the Still-Face to Reunion episode. Other-directed gestures decreased from the Play to Still-Face and increased from the Still-Face to Reunion episode. During the Still-Face, self-directed gestures were predominantly performed with the left side of the body. Maternal gestures were not lateralized, but there was a prevalence of distal gestures in the Play and Reunion episodes of the paradigm. Left-sided infant other-directed gestures and left-sided maternal gestures were associated with each other. The findings highlight a differential utilization and lateralization of self- and other-directed gestures related to context and the stress experienced by the infant as well as to maternal gestures. These results are suggestive of a brain asymmetry, but an asymmetry related to emotional engagement and stress regulation.

Individual differences in infants' temperament are under genetic control. We investigated the association between brain-derived-neurotrophic-factor (BDNF

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse experiences, which may affect health-related quality of life (HRQoL) even in the absence of prematurity-related morbidities. The aim of this multicenter longitudinal study was to examine the relation between quality levels of NICU Developmental Care (DC) and HRQoL at 60 mo in children who were born preterm.HRQoL of 102 very preterm (VPT) children from 20 NICUs and 110 full-term controls was assessed using TNO-AZL Preschool Children's Quality of Life Questionnaire (TAPQOL). In VPT children, we compared HRQoL by splitting NICUs into units with high- and low-quality of DC according to the following two factors: (i) the infant centered care (ICC), and (ii) the infant pain management (IPM).Compared to VPT children from NICUs with high-quality of ICC, VPT children from NICUs with low-quality in ICC scored lower in HRQoL component which resulted from the aggregation of lively, positive emotionality, social and motor functioning. No differences were found between VPT children from high-quality ICC NICUs and full-term children and for the IPM index.Findings suggest that higher quality of DC in NICU related to ICC might mitigate long-term negative quality of life outcomes.

Very preterm (VPT) infants are hospitalized in the Neonatal Intensive Care Unit (NICU) and exposed to varying levels of skin-breaking procedures (pain-related stress), even in absence of severe clinical conditions. Repeated and prolonged pain exposure may alter hypothalamic-pituitary-adrenal (HPA) axis reactivity in VPT infants. During the post-discharge period, altered HPA axis reactivity has been documented in response to non-social stressors, using salivary cortisol as a biomarker. However, little is known about the effects of NICU pain-related stress on subsequent HPA axis reactivity to socio-emotional stress in infants. We examined the relationship between pain-related stress in NICU and HPA axis reactivity (i.e., salivary cortisol reactivity) to an age-appropriate socio-emotional condition in 37 healthy VPT infants compared to 53 full-term (FT) controls. The number of skin-breaking procedures was obtained across NICU stay for VPT infants. At 3 months (corrected age for prematurity), all infants participated in the maternal Face-to-Face Still-Face (FFSF) procedure, in order to assess HPA axis reactivity to socio-emotional stress (i.e., maternal unresponsiveness). VPT infants exhibited a blunted salivary cortisol reactivity, which was associated with the amount of skin-breaking procedures during NICU: greater pain-related stress predicted lower salivary cortisol reactivity, adjusting for neonatal confounders. These findings further advance our knowledge of how early exposure to pain-related stress in NICU contributes to the programming of an altered HPA axis reactivity to socio-emotional stress in 3-month-old VPT infants, even in the absence of major perinatal complications.

Objective To compare maternal and paternal experiences of very preterm (VPT) birth (gestational age Design Qualitative study. Setting Data collection took place at parents’ homes 3 to 6 months after NICU discharge. Participants Ten parental couples participated in the study (20 parents). All VPT infants were healthy, without any neonatal or postnatal complications or injuries. Methods Computer-assisted content analysis was used to highlight thematic clusters from parents' narratives, which were labeled through qualitative interpretation. Results Two main dimensions ( Adjustment Process to Preterm Birth and Parental Role Assumption ) and three main thematic clusters ( Facing the Unexpected , Learning to Parent , and Finally Back Home ) described the parental experience. Mothers focused mostly on the Finally Back Home cluster, which was characterized by moderate levels of adjustment to preterm birth and by awareness of their own maternal roles. Fathers focused mostly on the Learning to Parent cluster, which was characterized by low to moderate levels of adjustment to preterm birth and by a limited assumption of paternal role. Conclusion To our knowledge, this study is unique in that we compared mothers and fathers who experienced the VPT births of their infants and described their experiences of the NICU stay. We found that the VPT birth experience for parents involves a dynamic adjustment. Differences in maternal and paternal experiences may indicate the need for tailored supportive interventions in the NICU.

Individual variability exists in infants' socio-emotional stress regulation, in terms of behavioral response (i.e., negative emotionality) as well as magnitude and direction (i.e., increase or decrease) of hypothalamic-pituitary-adrenal (HPA) axis reactivity (i.e., salivary cortisol post-stress concentration). The catechol-O-methyltransferase polymorphism at codon 158 (COMT

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene (SLC6A4), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study examined a moderation model in which the exposure to NICU-related stress and SLC6A4 methylation moderated infant temperament at 3 months of age. SLC6A4 methylation at 20 CpG sites was quantified in preterm infants (N = 48) and full-term infants (N = 30) from Italian middle-class families. Results suggested that in preterm infants NICU-related stress might be associated with alterations of serotonergic tone as a consequence of SLC6A4 methylation, which in turn, might associate with temperamental difficulties assessed at 3 months of age.

Objective: To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies. Method: Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society. Results: The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA. Conclusions: The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data., Dr. Ivanovo receives research and salary support from the Research Center for Children, Youth, and Families, which publishes the Child Behavior Checklist [CBCL]. Dr. Achenbach is President of the Research Center for Children, Youth, and Families, and receives remuneration. Dr. Rescorla receives remuneration from the Research Center for Children, Youth, and Families. Dr. Harder previously held a University of Vermont Postdoctoral Fellowship funding by the Research Center for Children, Youth, and Families. Drs. Bjarnadottir, Gudmundsson, Leung, Verhulst, and Mr. Gudmundsson, receive research support from the sole of the CBCL. Dr. Bilenberg has received honoraria from Eli Lilly and Co., Novartis, Neuroscience, and Janseen Cilag. He has received research support from the Danish Research Foundation, the Lundbeck Foundation, Hermansens Mindelegat, and Mods Clausen Fond. Dr. Rapes has received research support from the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences. Dr. Jusiene has received research support from the Lithuanian Science and Studies Foundation. Drs. Ang, Capron, Dias, Dobrean, Doepfner, Duyme, Erol, Esmaeili, Ezpeleta, Frigerio, Goncalves, Jung, Kim, Liu, Oh, Plueck, Pomo limo, Shahini, Silva, Simsek, Souronder, Valverde, Van Leeuwen, and Zubrick, Ms. De Paw, Ms. Kristensen, Mr. Lecannelier, Ms. Montirosso, Ms. Jetishi, Ms. Woo, and Ms. Wu report no biomedical financial interests or potential conflicts of interest., info:eu-repo/semantics/publishedVersion

This study examined to which extent the lack of the mother's communicative input is associated to the variability of the infant's behavioral and emotional states at a microtemporal level. Two novel non-linear signal-processing metrics were used as regularity indexes during both normal and stressful mother-infant interactions (Face-to-Face Still-Face paradigm): (1) Sample Entropy estimates the presence of epochs of similar states in a data-series, according to a moment-to-moment analysis; (2) Lempel-Ziv Complexity evaluates the occurrence and recurrence of the patterns of analogous states along the data sequence. Fourteen mothers and their healthy full-term 7-month-old infants were videotaped and the infants' socio-emotional behaviors were micro-analytically coded off-line using a .20s time sampling method. During the maternal still-face episodes, when infants were confronted with the perturbation of their caregiver remaining unresponsive, both regularity indexes were lower than in normal interactions. Evidence is provided that non-linear techniques are suitable to detect variability in the infant's states.

To examine the functioning of patients with alternating hemiplegia of childhood (AHC), a very rare clinical condition manifesting with recurrent episodes of hemiplegia lasting from few minutes to several days, paroxysmal occurrence of tonic/dystonic attacks and other autonomic disturbances. Furthermore, patients exhibit chronic disabilities as well as mental retardation, epilepsy and motor disorders that affect the patients' everyday functioning to a considerable extent.Data about 25 patients with AHC (F = 13) aged 3-34 years were collected with International Classification of Functioning Disability and Health (ICF) questionnaires. Data analysis was carried out on four age groups: 3-6, 7-12, 13-18 and18 years, using only the ICF questionnaires' cross-age items.In the body functions component, paying attention, seeing, muscle tones were common problems for all age groups. In the activity and participation component, all participants showed problems in basic interpersonal interactions. Finally, in the environmental factors component, barriers concern the climate and health services. On the other hand, families reported adequate support from social services.Although these findings must be validated, they appear to be promising and can contribute to understanding the daily functioning features of patients with AHC.

The main aim of this study is to examine the functioning of children with congenital central hypoventilation syndrome (CCHS), a rare disorder of respiratory control associated with physiological and anatomical manifestations of a generalised autonomic nervous system dysfunction, using WHO's International Classification of Functioning, Disability and Health, Children and Youth version (ICF-CY).The data of 26 children, (F = 17) aged 1.5-17.5 years, were collected. Data were analysed in the following four age groups:3, 3-6, 7-12 and 13-18 years, using only the ICF-CY questionnaires' cross-age items.In the body functions, component breathing and paying attention were common problems for four age groups. In the activity and participation component, all children, except adolescents, showed problems with language. Furthermore, problems in social interaction were evident for all age ranges, except the youngest. Finally, in the environmental factors component, parents reported limitations concerning the natural environment and human-made changes to the environment that were common to all ages.The study supports the usefulness of supplementing diagnostic classifications with functional classifications to obtain complete information on health-related conditions in children with CCHS.

Infants' social stress regulation (i.e., reactivity and recovery) might be affected by mother-infant dyadic functioning and infants' vagal tone (i.e., respiratory sinus arrhythmia, RSA). This study investigated the role of a specific dyadic functioning feature (i.e., dyadic reparation) and individual differences in vagal tone regulation (i.e., RSA suppression vs. non-suppression) in relation to social stress regulation in 4-month-old infants. A total of 65 mother-infant dyads participated in the face-to-face still-face paradigm. Social stress reactivity and recovery were measured as negative emotionality during Still-Face and Reunion episodes, respectively. RSA was measured during Play, Still-Face, and Reunion episodes. Suppressors had higher dyadic reparation during Play and higher recovery from social stress compared with non-suppressors. Higher reparation during Play was associated with lower reactivity and higher recovery only for suppressors. Findings suggest a joint role of infants' RSA individual differences and dyadic reparation in affecting infants' social stress regulation at 4 months of age.

The study of infants' interactive style and social stress response to repeated stress exposures is of great interest for developmental and clinical psychologists. Stable maternal and dyadic behavior is critical to sustain infants' development of an adaptive social stress response, but the association between infants' interactive style and social stress response has received scant attention in previous literature. In the present article, overtime stability of infant, maternal, and dyadic behaviors was measured across 2 social stress (i.e., Face-to-Face Still-Face, FFSF) exposures, separated by 15 days. Moreover, infant, maternal, and dyadic behaviors were simultaneously assessed as predictors of infants' social stress to both FFSF exposures. Eighty-one mother-infant dyads underwent the FFSF twice, at 6 months (Exposure 1: the first social stress) and at 6 months and 15 days (Exposure 2: repeated social stress). Infant and mother behavior and dyadic synchrony were microanalytically coded. Overall, individual behavioral stability emerged between FFSF exposures. Infants' response to the first stress was predicted by infant behavior during Exposure 1 Play. Infants' response to the repeated social stress was predicted by infants' response to the first exposure to the Still-Face and by infants' behavior and dyadic synchrony during Exposure 2 Play. Findings reveal stability for individual, but not for dyadic, behavior between 2 social stress exposures at 6 months. Infants' response to repeated social stress was predicted by infants' earlier stress response, infants' own behavior in play, and dyadic synchrony. No predictive effects of maternal behavior were found. Insights for research and clinical work are discussed.

Cluster analysis was used to create patterns of individual differences reflecting infant behaviors during the initial interaction episode of the Face-to-Face Still-Face (FFSF) paradigm. The clusters were used as the basic unit of analysis for studying infant and maternal behavior and dyadic coordination (i.e., matching and reparation) across FFSF. Seventy-five 4-month-old infants participated with their mothers. Cluster analysis identified three patterns: a Socially Engaged cluster (33%) exhibited high levels of social engagement with their mothers; a Disengaged cluster (60%) showed a tendency to be low in social interaction and a Negatively Engaged cluster (7%) showed high negative emotionality. During the Still-Face episode, the Socially Engaged cluster reacted by reducing focus on their mother and shifting their attention elsewhere, while infants in the Disengaged cluster reduced focus on the environment. Although both the Socially Engaged and Disengaged clusters increased in negative emotionality during the Still-Face, the Socially Engaged group largely recovered during the Reunion, whereas the Disengaged group displayed more negative emotion. The Negatively Engaged cluster demonstrated high levels of negative affect throughout the entire procedure. Mothers of Negatively Engaged infants showed less positive engagement and more social monitoring than mothers in other clusters during all episodes. Dyadic interaction differed between groups, with greater levels of matching and reparations in the engaged group, less in the Disengaged group, and very little coordination in the Negatively Engaged cluster. Findings highlight the role of distinctive patterns of infants’ individual differences in determining early dyadic functioning.

Cross-cultural differences between matched samples (N=306) of Italian and U.S. toddlers were evaluated. Italian toddlers received higher scores on cuddliness, impulsivity, low intensity pleasure, perceptual sensitivity and positive anticipation, whereas US toddlers were higher on frustration, high-intensity pleasure, inhibitory control, shyness, and soothability.

OBJECTIVE: To examine the relation between the neurobehavior of very preterm infants and the level of NICU quality of developmental care. METHODS: The neurobehavior of 178 very preterm infants (gestational age ≤29 weeks and/or birth weight ≤1500 g) from 25 NICUs participating in a large multicenter, longitudinal study (Neonatal Adequate Care for Quality of Life, NEO-ACQUA) was examined with a standardized neurobehavioral assessment, the NICU Network Neurobehavioral Scale (NNNS). A questionnaire, the NEO-ACQUA Quality of Care Checklist was used to evaluate the level of developmental care in each of the NICUs. A factor analyses applied to NEO-ACQUA Quality of Care Checklist produced 2 main factors: (1) the infant-centered care (ICC) index, which measures parents’ involvement in the care of their infant and other developmentally oriented care interventions, and (2) the infant pain management (IPM) index, which measures the NICU approach to and the procedures used for reducing infant pain. The relations between NNNS neurobehavioral scores and the 2 indexes were evaluated. RESULTS: Infants from NICUs with high scores on the ICC evidenced higher attention and regulation, less excitability and hypotonicity, and lower stress/abstinence NNNS scores than infants from low-care units. Infants from NICUs with high scores on the IPM evidenced higher attention and arousal, lower lethargy and nonoptimal reflexes NNNS scores than preterm infants from low-scoring NICUs. CONCLUSIONS: Very preterm infant neurobehavior was associated with higher levels of developmental care both in ICC and in IPM, suggesting that these practices support better neurobehavioral stability. * Abbreviations: ANCOVA — : analysis of covariance ANOVA — : analysis of variance ICC — : infant-centered care IPM — : infant pain management NEO-ACQUA study — : Neonatal Adequate Care for Quality of Life study NIDCAP — : Neonatal Individualized Developmental Care and Assessment Program NNNS — : NICU Network Neurobehavioral Scale QCC — : quality-of care checklist SES — : socioeconomic status VON-RA — : Vermont Oxford Network Risk Adjustment

OBJECTIVES: The study examined the early interaction between mothers and their infants with cleft lip, assessing the role of maternal affective state and expressiveness and differences in infant temperament.\ud \ud METHODS: Mother-infant interactions were assessed in 25 2-month-old infants with cleft lip and 25 age-matched healthy infants. Self-report and behavioral observations were used to assess maternal depressive symptoms and expressions. Mothers rated infant temperament.\ud \ud RESULTS: Infants with cleft lip were less engaged and their mothers showed more difficulty in interaction than control group dyads. Mothers of infants with cleft lip displayed more negative affectivity, but did not report more self-rated depressive symptoms than control group mothers. No group differences were found in infant temperament.\ud \ud CONCLUSIONS: In order to support the mother's experience and facilitate her ongoing parental role, findings highlight the importance of identifying maternal negative affectivity during early interactions, even when they seem have little awareness of their depressive symptoms.

Pre-term birth has a significant impact on infants' social and emotional competence, however, little is known about regulatory processes in pre-term mother-infant dyads during normal or stressful interactions. The primary goals of this study were to investigate the differences in infant and caregiver interactive behaviour and dyadic coordination of clinically healthy pre-term compared to full-term infant-mother dyads and to examine pre-term infants' capacity for coping with stress using the face-to-face still-face paradigm (FFSF). Fifty mother-infant dyads, including 25 pre-term infants and 25 full-term infants were videotaped during the FFSF. All infants were 6-9 months of age (corrected for gestational age in the pre-term group). Infant and maternal socio-emotional expressivity and self-regulatory behaviours were coded and measures of dyadic coordination (Matching, Reparation Rate, and Synchrony) were calculated. There were no significant differences in infant and caregiver socio-emotional behaviours between the two groups and both groups demonstrated the still-face (SF) effect and the reunion effect. There was a difference in self-regulatory behaviour. Pre-term infants were more likely than full-term infants to use distancing (e.g., by turning away, twisting, or arching) from their mothers during the FFSF. Additionally, during the Reunion episode of the FFSF pre-term infants showed more social monitoring compared to full-term infants. Regardless of the birth status, the dyads showed less coordination and a slower rate of reparation during the Reunion episode than during the Play episode. The higher proportion of distancing in the pre-term group and the increase in social monitoring suggest that even in normal interactions pre-term infants may experience a higher level of stress and have less capacity for self-regulation compared to the full-terms and that pre-term infants appear to use a compensatory strategy of increased social monitoring to cope with the stress of renegotiating the interaction during Reunion. The findings suggest that pre-term infants have different regulatory and interactive capacities than full-term infants.

The aim of this study was to compare the reports of emotional and behavioral problems of adopted children on the part of mothers, fathers, and teachers, and to examine the agreement in the reports among the three informants. The approach employed was multi-informant, with a three-point sample composed of 75 Italian couples (all parents of international adoptees between 7 and 11 years of age) and one of the child's teachers. Parents reported higher levels of problems in their adopted children than teachers did. Moreover, the agreement between mother and father was higher than that between one parent and the teacher. The percentage of cases in which all three informants agreed on the classification of the child as being part of the clinical group turned out to be considerably lower than when only one informant was concerned.

This study intends to fill the gap in empirical research carried out in Italy regarding international adoptees' behavioral and emotional problems. Assuming a multi-informant approach, it aims to compare parents' reports of behavioral problems of adopted and non-adopted children and to examine parental agreement. The sample was composed of 186 adoptive couples and 195 biological couples with the target child between ages 7 and 11 years. The mother and father filled in the Child Behavior Checklist (CBCL) separately. Analysis of the CBCL revealed that adopted children are perceived by their parents as having more Total and Externalizing Problems than are their non-adopted counterparts. Moreover, they are more likely to demonstrate attention difficulties and aggressive behavior. The agreement between parents turned out to be moderate for adoptive parents and slightly lower for the biological ones. Consistent with most adoption research, the results confirm the higher risk of behavioral problems among adopted children. They also shed light on the significant perceptual discrepancy between mothers and fathers, underlining the importance of considering both parents' reports in the study of adopted children's adjustment.

Before starting antiepilepsy therapy (T1) and after 1 year (T2), 19 children (7 female) affected by focal or generalized idiopathic epilepsy were considered with the aim of studying attention performance. All of the children received a neurological examination and clinical interview, electroencephalography (EEG) in wakefulness or sleep, and a standardized computerized measure of attention (Conners' Continuous Performance Test). At T1, 21% of the patients showed a specific attention disorder, and their percentage rose to 42% after 1 year, despite complete control of seizures. The prognosis was strongly correlated with (1) the presence of active seizures for a period of over 6 months, (2) the persistence of specific interictal abnormalities on an electroencephalogram at T2, and (3) the presence of emotional and behavioral disorders at the diagnosis of epilepsy. Our results confirm that attention disorders are frequent in children with idiopathic epilepsy. The Conners' Continuous Performance Test has proven useful both for diagnosis and follow-up over time. ( J Child Neurol 2004;19:509—515).

Aim of this study was to estimate the cost that is borne by the Italian National Health Service, families, and social security due to very low birth weight infants (VLBWIs) without prematurity-related morbidities up to the age of 18 months. We followed up on 150 VLBWIs and 145 comparable full-term infants (FTIs) who were born in one of 25 different neonatal intensive care units upon discharge from the hospital and at six and 18 months of age. The average length of the primary hospitalisation of the VLBWIs was 59.7 days (SD 21.6 days), with a total cost of €20,502 (SD €8409), compared with three days (SD 0.4 days) with a total cost of €907 (SD €304) for the FTIs. The total societal cost of the VLBWIs for the first 18 months of life was €58,098 (SD €21,625), while the corresponding figure for FTIs was €24,209 (SD €15,557). Among VLBWIs, both low birth weight and gestational age were correlated with the length of hospitalisation after birth (r(2) = 0.61 and r(2) = 0.57, respectively; p values0.0005). Our findings highlight that the existing DRGs and tariffs inadequately reflect the actual costs for Italian National Health Service.