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Background: The clinical and neurobiological underpinnings of transient nonmotor (TNM) psychiatric symptoms during the optimization of stimulation parameters in the course of subthalamic nucleus deep brain stimulation (STN-DBS) remain under intense investigation., Methods: Forty-nine patients with refractory Parkinson's disease underwent bilateral STN-DBS implants and were enrolled in a 24-week prospective, naturalistic follow-up study. Patients who exhibited TNM psychiatric manifestations during DBS parameter optimization were evaluated for potential associations with clinical outcome measures., Results: Twenty-nine TNM+ episodes were reported by 15 patients. No differences between TNM+ and TNM- groups were found in motor outcome. However, unlike the TNM- group, TNM+ patients did not report improvement in subsyndromal depression or quality of life. TNM+ episodes were more likely to emerge during bilateral monopolar stimulation of the medial STN., Conclusions: The occurrence of TNM psychiatric symptoms during optimization of stimulation parameters was associated with the persistence of subsyndromal depression and with lower quality of life ratings at 6 months. The neurobiological underpinnings of TNM symptoms are investigated yet remain difficult to explain., (© 2016 S. Karger AG, Basel.)

In this study the authors investigate the sound pressure levels produced by crying children and discuss the possible adverse effects that direct exposure may impose on a tending guardian or healthcare professional. Sound intensity levels from various pediatric patients (N = 26) were measured under two segregate conditions, one imitating the exposure of an examining physician and the other resembling that of parental guardians. Interestingly, all of the recorded sound levels fell between 99-120 dB(A) of sound pressure; children presenting the greatest risk for intense cries with potentially harmful sound intensities were between the ages of 9 months and 6 years. The authors found that elevated noise levels produced from crying children can cause acute discomfort and mild pain to those exposed. In addition, there is a theoretical risk that chronic exposure to these intense sound pressures may result in noise-induced hearing loss in a parental guardian or an examining physician. Parents of young children may be more likely to succumb to impulsive reactions in attempting to arrest the crying, which could be a precipitating factor for child abuse, responding to physical stress as much as emotional stress. Social workers and medical personnel should consider suggesting the use of ear plugs by parental guardians of frequently crying children as a modality for the prevention of child abuse.

Background: Anticipatory guidance around the management of sleep and crying problems in early infancy has been shown to improve both infant behaviour and parent symptoms of postnatal depression. Digital technology offers platforms for making such programs widely available in a cost-efficient manner. However, it remains unclear who accesses online parenting advice and in particular, whether the parents who would most benefit are represented amongst users. It is also unknown whether the uptake of online programs can be improved by health professional recommendations, or whether parents require additional prompts and reminders to use the program. In this study we aim to: (1) determine whether weekly email prompts increase engagement with and use of a brief online program about infant sleeping and crying, (2) determine whether encouragement from a maternal and child health nurse promotes greater engagement with and use of the program, (3) examine who uses a brief online program about infant sleeping and crying; and, (4) examine the psychosocial characteristics of participants., Methods/design: This study is a randomised, parallel group, superiority trial, with all participating primary carers of infants aged 2 to 12 weeks, receiving access to the online program. Two modes of recruitment will be compared: recruitment via an online notice published on a non-commercial, highly credible and evidence-based website for parents and carers and via the parent's Maternal and Child Health nurse. After baseline assessment, parents will be randomised to one of two support conditions: online program alone or online program plus weekly email prompts. Follow up data will be collected at 4 months of infant age., Discussion: Results from this trial will indicate whether involvement from a health professional, and/or ongoing email contact is necessary to engage parents in a brief online intervention, and promote parental use of strategies suggested within the program. Results of this trial will inform the development of recruitment and engagement strategies for other online interventions., Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001098729. Registered 01 October 2013.

This study examined the extent to which secure base script knowledge-reflected in the ability to generate narratives in which attachment-relevant events are encountered, a clear need for assistance is communicated, competent help is provided and accepted, and the problem is resolved-is associated with mothers' electrophysiological, subjective, and observed emotional responses to an infant distress vocalization. While listening to an infant crying, mothers (N = 108, M age = 34 years) lower on secure base script knowledge exhibited smaller shifts in relative left (vs. right) frontal EEG activation from rest, reported smaller reductions in feelings of positive emotion from rest, and expressed greater levels of tension. Findings indicate that lower levels of secure base script knowledge are associated with an organization of emotional responding indicative of a less flexible and more emotionally restricted response to infant distress. Discussion focuses on the contribution of mothers' attachment representations to their ability to effectively manage emotional responding to infant distress in a manner expected to support sensitive caregiving.

Many psychotherapists have cried in a therapy session. Those clinicians who do cry see it as likely to have a positive impact on the therapy or to have no impact, and therapist personality characteristics have not shown reliable associations to crying in therapy. However, it is not known how patients experience therapists' crying, or whether the patient's view of the therapist's characteristics is related to that experience. This study used an online survey, recruiting 202 patients with eating disorders, 188 of whom had received therapy for an eating disorder, and 105 of whom had experienced a therapist crying. Retrospective data from those 105 individuals indicated that therapists' crying tended to be seen positively, by patients but that perception was influenced by the patients' perceptions of the demeanor of their therapist and their understanding of the meaning of the crying. Although they need to be extended to other disorders, these findings suggest that therapists' crying needs to be understood in the context of the therapist's perceived characteristics and demeanor, rather than being assumed to be positive or to have no impact on the therapy., ((c) 2015 APA, all rights reserved).)

There are limited data regarding the incidence of pathological laughter and crying (PLC) after traumatic brain injury (TBI). This study aimed to identify the occurrence of PLC in the first year after TBI and to determine whether there is a relationship between PLC and other clinical features or demographics. Subjects who sustained a first-time TBI were recruited from acute trauma units and were assessed at 3, 6, and 12 months after TBI. Rates of PLC at 3, 6, and 12 months after TBI were 21.4%, 17.5%, and 15.5%, respectively. Patients with PLC had higher percentages of psychiatric diagnoses, including personality changes, depressive disorders, and mood disorders secondary to a general medical condition, as well as higher rates of posttraumatic stress disorder. Univariate logistic and linear regression analyses indicated a significant association between PLC and scores on the Clinical Anxiety Scale 3 months after TBI and on the Hamilton Depression Rating Scale 12 months after TBI. Individuals who have PLC during the first year after TBI are more likely to have any psychiatric diagnosis as well as higher rates of mood and anxiety symptoms. In addition, PLC in the early TBI period may serve as a predictor of depression and anxiety symptoms at 12 months after TBI.

Although the configurations of psychoacoustic cues signalling emotions in human vocalizations and instrumental music are very similar, cross-domain links in recognition performance have yet to be studied developmentally. Two hundred and twenty 5- to 10-year-old children were asked to identify musical excerpts and vocalizations as happy, sad, or fearful. The results revealed age-related increases in overall recognition performance with significant correlations across vocal and musical conditions at all developmental stages. Recognition scores were greater for musical than vocal stimuli and were superior in females compared with males. These results confirm that recognition of emotions in vocal and musical stimuli is linked by 5 years and that sensitivity to emotions in auditory stimuli is influenced by age and gender., (© 2015 The British Psychological Society.)

Infants born with medical problems are at risk for less optimal developmental outcomes. This may be, in part, because neonatal medical problems are associated with maternal distress, which may adversely impact infants. However, the reserve capacity model suggests that an individual's bank of psychosocial resources buffers the adverse effects of later-encountered stressors. This prospective longitudinal study examined whether preexisting maternal psychosocial resources, conceptualized as felt security in close relationships, moderate the association between neonatal medical problems and infant fussing and crying 12 months postpartum. Maternal felt security was measured by assessing its indicators in 5,092 pregnant women. At birth, infants were classified as healthy or having a medical problem. At 12 months, experience sampling was used to assess daily maternal reports of fussing and crying in 135 mothers of infants who were healthy or had medical problems at birth. Confirmatory factor analyses revealed that attachment, relationship quality, self-esteem, and social support can be conceptualized as indicators of a single felt security factor. Multiple regression analyses revealed that prenatal maternal felt security interacts with infant health at birth to predict fussing and crying at 12 months. Among infants born with medical problems, higher felt security predicted decreased fussing and crying. Maternal felt security assessed before birth dampens the association between neonatal medical problems and subsequent infant behavior. This supports the hypothesis that psychosocial resources in reserve can be called upon in the face of a stressor to reduce its adverse effects on the self or others., ((c) 2015 APA, all rights reserved).)

Amae is defined as "wishing to be loved (Scheidlinger (1999). The Journal of the American Academy of Psychoanalysis, 27(1), p. 91)". Amae crying is known as crying of infants when seeking intimate emotional communication with caregivers. The objective of this study was to delineate when and how amae crying emerges in early infancy. Crying episodes of four infants were observed bimonthly, in the natural context of their homes, from birth to 6 months of age, for approximately 60min per session. Crying episodes (total=275) as determined by two coders were analyzed with respect to several behavioral measures. Results indicated that amae crying emerged at the age of 2 months, and consistently accounted for 30-40% of the total crying episodes after the ages of 3 months. Amae crying could be accurately identified when infants were not in acute discomfort and had already got the attention of their mothers. At such times, infants did not shed tears, cried with a fussy voice, and frequently looked at their mothers. Mothers responded to amae crying more promptly than they did to other types of crying behaviors. It is concluded that 3 months of age, when infants probably begin to use crying as a social communication tool is a major turning point for crying behavior from the perspective of its biological and social roles. It is suggested that amae crying might play an important role in strengthening and encouraging mother-infant interactions., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Factors underlying developmental delays and psychosocial risks are of interest to international adoption communities. The current study administered a Pre-Adoption Adversity (PAA) Questionnaire to mostly American parents raising (a) adopted Chinese twins or (b) same-age unrelated adopted siblings. A goal was to replicate earlier analyses of pre-adoption adversity/adjustment among adopted preschool-age Chinese girls. A second goal was to conduct genetic analyses of four content areas (Developmental Delays at Adoption, Initial Adaptation to Adoption, Crying/Clinging, and Refusal/Avoidance) derived from the PAA Questionnaire. A key finding was that age at adoption added less than other predictors to adoptees' externalizing and internalizing behaviors. Family factors (e.g., parental education) contributed significantly to behavioral outcomes among the adopted Chinese twins. Genetic effects were indicated for all four content areas, with shared environmental effects evident for Developmental Delays at Adoption and Crying/Clinging. Future investigators should consider incorporating genetically sensitive designs into developmental research programs., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Deviant physiological reactivity to infant stimuli has been suggested to underlie maladaptive parenting behavior. Our study involved 44 maltreating and 42 non-maltreating mothers. During a standardized cry paradigm, mothers listened to nine cry sounds of varying pitches. Saliva was collected at baseline, after each cry sound, and after a recovery episode. Salivary α-amylase (sAA) as a marker of autonomic nervous system (ANS) activity was assayed from saliva samples. Maltreating mothers showed lower overall sAA levels and an attenuated reactivity pattern to infant crying as compared to non-maltreating mothers. No effect of type of maltreatment (neglect only vs. neglect and abuse) was found. Furthermore, positive correlations between sAA and heart rate (HR) for non-maltreating mothers differed significantly from non-significant correlations between sAA and HR for maltreating mothers. This suggests anomalous asynchrony between different aspects of the ANS in maltreating mothers. Results indicate a lack of functional autonomic (re)activity as a contributing risk factor to child maltreatment.

Nelson (2005) associated 3 types of crying (inhibited, protest, despair) with 3 dimensions of attachment (avoidant, anxious, and secure). To test this theory, trained judges rated the intensity of inhibition, protest, and despair in 347 crying episodes for 40 clients and 14 therapists in 1,074 psychotherapy sessions. Crying occurred once out of every 7 sessions, and usually was characterized by protest or inhibition. Pre-therapy attachment dimensions of both therapist and client influenced crying. Therapists with high attachment avoidance had clients who cried frequently but less over time, whereas therapists with high attachment anxiety had clients who cried with more protest over time. Clients with high attachment anxiety initially cried with more protest and inhibition, but decreased over time, whereas clients with low attachment anxiety increased protest over time. Throughout the course of psychotherapy, therapists who were seen by their clients as establishing a secure attachment elicited more overall crying and a higher intensity of protest, whereas therapists who were seen by their clients as establishing insecure attachments had clients who cried less. Clients who established a secure or avoidant relationship with their therapists, relative to other clients of that therapist, cried infrequently and with inhibition, whereas clients who established a preoccupied relationship cried relatively often. Changes are suggested for Nelson's (2005) typology., ((c) 2015 APA, all rights reserved).)

A new non-pharmacological method of distraction was tested with 57 children during their annual flu vaccination. Given children's growing enthusiasm for technological devices, a humanoid robot was programmed to interact with them while a nurse administered the vaccination. Children smiled more often with the robot, as compared to the control condition, but they did not cry less. Parents indicated that their children held stronger memories for the robot than for the needle, wanted the robot in the future, and felt empowered to cope. We conclude that children and their parents respond positively to a humanoid robot at the bedside., (© The Author(s) 2013.)

We investigated the effect of young children's (hereafter children's) facial expressions on adult responsiveness. In Study 1, 131 undergraduate students from a midsized university in the midwestern United States rated children's images and videos with smiling, crying, or neutral expressions on cuteness, likelihood to adopt, and participants' experienced distress. Looking times at images and videos along with perception of cuteness, likelihood to adopt, and experienced distress using 10-point Likert scales were measured. Videos of smiling children were rated as cuter and more likely to be adopted and were viewed for longer times compared with videos of crying children, which evoked more distress. In Study 2, we recorded responses from 101 of the same participants in an online survey measuring gender role identity, empathy, and perspective taking. Higher levels of femininity (as measured by Bem's Sex Role Inventory) predicted higher "likely to adopt" ratings for crying images. These findings indicate that adult perception of children and motivation to nurture are affected by both children's facial expressions and adult characteristics and build on existing literature to demonstrate that children may use expressions to manipulate the motivations of even non-kin adults to direct attention toward and perhaps nurture young children., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant.

Objectives: Previous studies have demonstrated the effectiveness of educational materials on infant crying to change caregivers' knowledge and behaviours related to shaken baby syndrome or abusive head trauma (SBS/AHT) using selected samples in randomized controlled trials. This study investigated the impact of public health practices to prevent SBS/AHT in Japan through the use of educational materials., Study Design: Cross-sectional study., Methods: The intervention was comprised of two parts: (1) the screening of an educational DVD at a prenatal class; and (2) the distribution of a public health pamphlet at a postnatal home visit. Expectant parents watched a DVD (The Period of PURPLE Crying) about the features of infant crying and recommended behaviours (walking away if frustrated in the event of unsoothable crying, sharing information on crying with other caregivers) at a preterm parenting class held at eight months' gestation. A postnatal home-visit service was implemented in which a maternity nurse distributed a pamphlet to explain information about infant crying. Before the four-month health check-up, a self-administered questionnaire was distributed to assess exposure to these public health practices and outcome variables (i.e. infant crying knowledge, walk-away and information-sharing behaviours), and responses were collected at the four-month health check-up (n = 1316). The impacts of these interventions on outcome variables were analysed by comparing those exposed to both interventions, either intervention and neither intervention after adjusting for covariates., Results: Crying and shaking knowledge were significantly higher among women exposed to the public health practices, with a dose-response relationship (both P < 0.001). Further, walk-away behaviour during periods of unsoothable crying was higher among the intervention group. However, sharing information about infant crying with other caregivers was less likely among the intervention group., Conclusions: The impact of educational materials in public health practice on knowledge of crying and shaking, and walk-away behaviour in Japan had a dose-response relationship; however, an increase in sharing information with other caregivers was not observed., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to examine the types of soothing behaviors used by mothers and fathers of infants, differences in use trajectories over time, and associated parenting outcomes., Methods: A longitudinal study of 241 families expecting their second child was performed. Data were collected at 1, 4, and 8 postnatal months and included measures of parental soothing techniques, involvement in soothing, distress in response to infant crying, and parenting self-efficacy., Results: The average number of soothing techniques used was 7.7 for mothers and 5.9 for fathers. Soothing frequency decreased over time, and change patterns of soothing differed over time by gender. In couples who shared responsibility for soothing, fathers felt more efficacious in parenting and mothers were less upset by infant crying., Discussion: Clinicians are encouraged to support fathers' engagement in infant soothing, facilitate the development of fathers' parenting confidence, and promote fathers' involvement in children's health and health care., (Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Infant crying is distressing for parents, evoking a range of difficult feelings. Infants who cry often maybe perceived as difficult by their parents, with negative effects on bonding and attachment. Infant crying as a stimulus for child-abuse is also highlighted, as parents' feelings of frustration may provoke harmful responses towards the child. A non-exhaustive literature review was conducted, exploring the impact of infant crying on parents, using CASP tools to support the analysis of twenty qualitative and quantitative studies, published between 2003 and 2013. This paper reports the findings of the review, with a specific focus on the effects of infant crying on the parent-infant relationship. The findings suggest parents may experience anxiety, depression, helplessness, anger and frustration in response to infant crying. Negative effects on bonding and parental perception of the baby are identified. Parents may also experience thoughts of harming their baby, and subsequent feelings of guilt and shame. Universal interventions to help parents prepare for parenthood, and to respond positively to crying are strongly recommended. Opportunities for parents to discuss their feelings towards their infant should be maximised, reducing the impact of infant crying on bonding and attachment. Parents should be empowered to develop strategies and sources of support to help them cope. Early identification of parents experiencing difficulties in coping with infant crying is essential, and risk in relation to potential abuse must be assessed. Health visitors have a key role in providing such support.

Proton pump inhibitors are increasingly being used to treat infants with crying and/or irritability based on the assumption that these symptoms are attributable to gastroesophageal reflux. However, the data from a systematic review of randomized controlled trials do not support the use of proton pump inhibitors to decrease infant crying and irritability., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The present study focused on relationships between temperament and behavior in early regulation development. Unlike most studies on the topic, we observed infant behavior in a naturalistic playful situation rather than in experimental stressful procedure, and employed temperament measures uniquely reflecting regulatory dispositions rather than a global measure of reactivity. The infant's self-regulatory behaviors were observed at 4 and 6 months during face-to-face interactions and regulatory dimensions were assessed at 4 months. We found that low intensity pleasure and soothability dimensions, related to the infant physical and social experience, respectively, significantly affected regulatory behavior and their influence showed to depend on the infant's age, with the former dimension being influential at the earlier age and the latter being influential when the behavior was observed at the later age. Results are interpreted on the light of a dynamic view of regulation development., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Handgrip force responses to infant signals were examined in a sample of 43 maltreating and 40 non-maltreating mothers. During a standardized handgrip paradigm, mothers were asked to squeeze a handgrip dynamometer at maximal and at half of their maximal handgrip strength while listening to infant crying and laughter sounds. Maltreating mothers used excessive force more often while listening to infant crying and laughter than non-maltreating mothers. Of the maltreating mothers, only neglectful mothers (n=20) tended to use excessive force more often during crying than non-maltreating mothers. Participants did not rate the sounds differently, indicating that maltreating mothers cannot be differentiated from non-maltreating mothers based on their perception of infant signals, but show different behavioral responses to the signals. Results imply that, in response to infant signals (i.e., crying or laughing), maltreating mothers may be insufficiently able to regulate the exertion of physical force., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Aim: To determine whether young childless adults show negative emotions and cognitive disturbances when listening to infant crying, compared to other disturbing noises, and whether negative emotions and cognitive disturbances are associated., Methods: We tested the cognitive performances and emotional reactions of 120 childless participants on a working memory task while being subjected to different disturbing noises including infant crying., Results: Participants had the least correct trials on the working memory task, and showed the most negative emotions, when hearing infant crying as compared to the other noises. Participants also showed less positive emotions when hearing infant crying as compared to working in silence. Overall, negative emotions were associated with less correct trials on the working memory task, except in the infant crying condition. Furthermore, cognitive performance and emotional reactions to infant crying were unrelated to personality characteristics., Conclusion: Negative emotions and cognitive disturbances may be general adult responses to infant crying that are not limited to parents. These results suggest a broadly present human emotional and cognitive response to infant crying, that may underlie a general predisposition to care for infants in distress., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: The majority of psychologists experience therapist crying in therapy (TCIT). This study aimed to determine typical clinical contexts for, and psychologists' experiences of, TCIT., Method: Data was examined from 411 psychologists' and psychology trainees' accounts of their most recent TCIT experience., Results: TCIT occurred with a diverse group of clients and happened throughout treatment. In 55% of accounts, therapists believed that their client was aware of TCIT. In 73%, the client was crying during TCIT. The most common emotion felt by the therapist was sadness. The most common session content for TCIT was grief. Data regarding therapists' experience of their tears and how they handled TCIT are presented., Conclusions: Therapists who discuss their TCIT with clients tended to report improvement in rapport. Suggestions are offered for clinicians regarding how to work with TCIT in therapy sessions.

Predictors of maternal sensitivity to infant distress were examined among 259 primiparous mothers. The Adult Attachment Interview, self-reports of personality and emotional functioning, and measures of physiological, emotional, and cognitive responses to videotapes of crying infants were administered prenatally. Maternal sensitivity was observed during three distress-eliciting tasks when infants were 6 months old. Coherence of mind was directly associated with higher maternal sensitivity to distress. Mothers' heightened emotional risk was indirectly associated with lower sensitivity via mothers' self-focused and negative processing of infant cry cues. Likewise, high physiological arousal accompanied by poor physiological regulation in response to infant crying was indirectly associated with lower maternal sensitivity to distress through mothers' self-focused and negative processing of infant cry cues., (© 2014 The Authors. Child Development © 2014 Society for Research in Child Development, Inc.)

The devastating and for the most part irremediable consequences for an infant, his or her family, and society in cases of abusive head trauma have spurred research into ways of preventing it. In the last four or five decades, increasing interest in infant crying and its clinical manifestation of colic has led to a reconceptualization of crying in early infancy, such that most of the characteristics of colic can be understood as manifestations of the crying typical of normal infants. This includes an early increase and then decrease in the amount of crying, the unexpected and unpredictable appearance of prolonged crying bouts, and the presence of inconsolable crying that occurs in the early months of life. When these concepts are merged with anecdotal clinical experiences, perpetrator confessions and epidemiological evidence of abusive head trauma, it is clear that these crying characteristics--and caregiver responses--are the predominant, and potentially modifiable, risk factors for abusive head trauma. This unfortunate but understandable relationship between early crying, shaking and abuse has opened windows of opportunity for primary, universal prevention efforts that are appropriate for--and support--all parents and may be able to prevent at least some of these tragic cases.

Prolonged inconsolable crying bouts in the first months of life are frustrating to parents and may lead to abuse. There is no empirical description of frustration trajectories during prolonged crying, nor of their emotional predictors or emotional and behavioural sequelae. Frustration responses and their relationships were explored in an analogue cry listening paradigm. Without knowing how long it would last, 111 postpartum mothers were randomized to listen to a 10-min audiotape of infant crying or cooing while continuously recording frustration on a visual analogue 'slider' scale. The listening bout was preceded by questionnaires on negative mood, trait anger and empathy and followed by questionnaires on the reality of the cry sound, positive and negative emotions, soothing strategies, coping strategies and urges to comfort and flee. Individual frustration trajectories were modelled parametrically and characterized by frustration maximum, rate of rise, inflections and harmonicity parameters. As hypothesized, the modal response was of gradually increasing frustration throughout. However, there were marked individual differences in frustration trajectories. Negative mood, trait anger and empathy did not predict modal or modelled individual trajectories. However, frustration responses were significantly related to post-listening emotions and behavioural ratings. In particular, prolonged crying generated highly ambivalent positive and negative emotional responses. In summary, maternal frustration generally increased as the crying bout progressed; however, frustration trajectories were highly individual and emotional responses were highly ambivalent in terms of positive and negative emotions generated. Some emotional and behavioural responses were associated with specific trajectory parameters of frustration responses., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Numerous studies have emphasized the importance of body contact for health, regulation, and development of infants as well as for parent-child interaction. Especially for infants with regulatory disorders (such as excessive crying, sleeping, and feeding problems), high-quality physical contact would be desirable. Observations in the context of parental counseling suggest that precisely these infants have a poor quality of body and eye contact. The present study compares infants with and without regulatory disorders with respect to their body and eye contact., Methods: Quality of body contact and amount of eye contact were examined by means of video ratings of the mother-child interaction. In addition, we measured the daily amount of crying, sleeping, feeding, being fussy, and quiet play in an infant behavior diary., Results: Infants with regulatory disorders scored worse in body contact (p < .01) and gaze contact (p < .001). There were also significant differences in most of the diary variables., Conclusions: Body and eye contact - basic communication skills - may be disturbed in infants with regulatory disorders, which could have an adverse effect on the regulation problems. Therapeutic interventions with affected children and their parents should aim at improving the ability of body and eye contact.

Although evolution has shaped human infant crying and the corresponding response from caregivers, there is marked variation in paternal involvement and caretaking behavior, highlighting the importance of understanding the neurobiology supporting optimal paternal responses to cries. We explored the neural response to infant cries in fathers of children aged 1-2, and its relationship with hormone levels, variation in the androgen receptor (AR) gene, parental attitudes and parental behavior. Although number of AR CAG trinucleotide repeats was positively correlated with neural activity in brain regions important for empathy (anterior insula and inferior frontal gyrus), restrictive attitudes were inversely correlated with neural activity in these regions and with regions involved with emotion regulation (orbitofrontal cortex). Anterior insula activity had a non-linear relationship with paternal caregiving, such that fathers with intermediate activation were most involved. These results suggest that restrictive attitudes may be associated with decreased empathy and emotion regulation in response to a child in distress, and that moderate anterior insula activity reflects an optimal level of arousal that supports engaged fathering., (© The Author (2013). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.)

The Period of PURPLE Crying program is used to educate parents and caregivers about normal infant crying and the dangers of infant shaking. We evaluated nurse-led, hospital-based implementation of the program using a nonexperimental, posttest-only design. New mothers rated the program as useful, and the program was effective in teaching mothers about normal infant crying, the dangers of infant shaking, and soothing and coping techniques. The findings support the feasibility and need for broad dissemination of the program., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Purpose: To prospectively examine relations between maternal DSM-IV-TR anxiety and depressive disorders and excessive infant crying., Methods: Based on the prospective longitudinal Maternal Anxiety in Relation to Infant Development Study, n=306 expectant mothers were enrolled during early pregnancy and repeatedly interviewed until 16 months post partum. Lifetime and prospective information on maternal anxiety and depressive disorders was assessed via standardised diagnostic interviews (Composite International Diagnostic Interview for Women). Excessive crying (crying for ≥3 h per day on ≥3 days per week for ≥3 weeks) was assessed via Baby-DIPS. During the first 16 months after delivery, n=286 mother-infant dyads were available and included in the analyses., Results: Excessive crying was reported by n=29 mothers (10.1%). Infants of mothers with anxiety disorders prior to pregnancy were at higher risk for excessive crying than infants of mothers without any anxiety disorder prior to pregnancy (OR=2.54, 95% CI 1.11 to 5.78, p=0.027). Risk was even increased when considering additionally incident anxiety disorders until delivery (OR=3.02, 95% CI 1.25 to 7.32, p=0.014) and until 16 months post partum (OR=2.87, 95% CI 1.13 to 7.28, p=0.027). Associations remained stable when adjusting for sociodemographic and perinatal covariates. Maternal depressive disorders prior to pregnancy were not significantly associated with excessive crying in this sample., Implications: Maternal lifetime and incident anxiety disorders revealed to be a robust predictor for excessive crying. Thus, early identification and monitoring of women with anxiety disorders is important to identify mother-infant dyads at risk for excessive crying., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: The main objective was to ascertain the typical menopausal symptoms and job-related stress factors in Japanese nurses during the menopausal transition, and the associations of menopausal symptoms with job-related stress. A supplementary objective was to determine whether there were any differences in menopausal symptoms and job-related stress factors among nurses in managerial positions., Methods: One thousand seven hundred female registered nurses aged 45-60 years who were working in hospitals in Japan were asked to complete a self-administered survey that included Greene's Climacteric Scale and the Brief Job Stress Questionnaire., Results: The proportions of nurses who reported feelings of tiredness, irritability and difficulty in concentration were higher than the proportions with other menopausal symptoms. The proportions of nurses reporting feeling unhappy or depressed and having crying spells were higher among nurses in managerial positions than among other nurses. Stresses related to 'quantitative overload' on the Brief Job Stress Questionnaire among nurses in managerial positions were significantly greater than among nurses not in managerial positions, while stresses related to 'physical overload', 'job control', 'skill discretion', 'workplace environment' and 'job satisfaction' among nurses not in managerial positions were significantly greater than they were among nurses in managerial positions. Psychological symptoms were significantly correlated with poor job-related interpersonal relationships., Conclusions: Health care practitioners should be aware that menopausal symptoms are associated with job-related stress during the menopausal transition. Information on the differences in these associations between nurses in managerial positions and other nurses is important as it will allow their health care to be managed on a more individual basis., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study concerns the influence of an improvement of body contact on regulatory disorders in infancy. Two interventions were examined: 1. parent counseling on the subject of body contact; 2. practical training of body contact in connection with exposure. Both methods were supplemented by a video-based parent training., Methods: 20 infants with regulatory disorder were assigned to each treatment. Body and eye contact were examined by means of video ratings before and after treatment. In addition, we measured the daily amount of crying, sleeping, feeding, being fussy, and quiet play by means of an infant behavior diary., Results: Both interventions resulted in an improvement of body contact, though only in the group with practical training was this improvement stable after 3 months. Taking all 40 participating infants together, we found significant improvements for "fussiness," "sleep duration," "awake, quiet or playing," and a marginal significant intervention effect for the duration of crying. Both interventions showed that children who had markedly improved in body contact also improved with regard to the regulation problem. Finally, the practical training of body contact was superior to pure counseling respective to the fussiness of the infants and to their gaze contact., Conclusions: Body contact can be improved through specific therapeutic interventions. Video-based parent training in combination with interventions aiming at an improvement of body contact have a positive effect on the regulation problem.

Objective: to examine the views and practices of first-time and experienced mothers in response to infant crying during the first 12 weeks post birth., Design: longitudinal, qualitative study using an interpretive, phenomenological approach., Setting: postnatal hospital and home settings in Switzerland., Participants: maximum variation sampling of 15 new mothers of diverse parity and educational background who had given birth to a full-term healthy neonate., Methods: participant observations in the postnatal ward and two narrative interviews at participants' homes at 6-8 and 12-14 weeks post partum. Data analysis used interpretive approaches of case analysis, thematic analysis and exemplars., Findings: first-time mothers showed some soothing skills from the beginning, but fine-tuned their practices of handling the crying infant and managing their own reactions. With growing experience mothers acquired a differentiated understanding of the crying's reason and urgency and used more successful soothing techniques. At the same time they learned to assess and mitigate their own stress reactions by self-soothing and adopting realistic expectations of normal infant behaviour. Experienced mothers knew the infant's frequent crying would diminish after a while whereas first-time mothers coped without this positive expectation., Key Conclusions: with increasing child-care experience mothers' skills and attitudes towards crying changed, leading to a calmer and less escalating response to their crying infant., Implications for Practice: inexperienced mothers need information on neonatal crying behaviour and on parents' stress response. They should be taught how to recognise and respond to the new-born's signals, and how to cope with their own stress. Postnatal care should provide novice mothers to learn from experienced role models., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The effect of odor on cognitive and emotional processes has been studied in adults and children, but less so in infants. In this study twenty-seven six-month-olds were presented with a video while in either an odor (pine or baby-powder) or a no odor control condition. The video was a 92-s audiovisual presentation of a woman expressing happiness and sadness, with the order of emotion counterbalanced. Infant attention (looking time) and emotional expression (smiling, crying, mouthing) were coded. Infants looked longer in the presence of odor and expressed less crying and mouthing but more smiling behavior. Presence of odor markedly reduced infant emotional distress and increased attention, suggesting that the olfactory sensory system provides cues to infants that support mood regulation and maintain attention. These results have implications for optimizing infant environments for emotional health and cognitive development., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To determine whether unfamiliar listeners' perceptions of speakers with adductor spasmodic dysphonia (ADSD) differ from control speakers on the parameters of relative age, confidence, tearfulness, and vocal effort and are related to speaker-rated vocal effort or voice-specific quality of life., Method: Twenty speakers with ADSD (including 6 speakers with ADSD plus tremor) and 20 age- and sex-matched controls provided speech recordings, completed a voice-specific quality-of-life instrument (Voice Handicap Index; Jacobson et al., 1997), and rated their own vocal effort. Twenty listeners evaluated speech samples for relative age, confidence, tearfulness, and vocal effort using rating scales., Results: Listeners judged speakers with ADSD as sounding significantly older, less confident, more tearful, and more effortful than control speakers (p < .01). Increased vocal effort was strongly associated with decreased speaker confidence (rs = .88-.89) and sounding more tearful (rs = .83-.85). Self-rated speaker effort was moderately related (rs = .45-.52) to listener impressions. Listeners' perceptions of confidence and tearfulness were also moderately associated with higher Voice Handicap Index scores (rs = .65-.70)., Conclusion: Unfamiliar listeners judge speakers with ADSD more negatively than control speakers, with judgments extending beyond typical clinical measures. The results have implications for counseling and understanding the psychosocial effects of ADSD.

Infant vocalizations and "looming sounds" are classes of environmental stimuli that are critically important to survival but can have dramatically different emotional valences. Here, we simultaneously presented listeners with a stationary infant vocalization and a 3D virtual looming tone for which listeners made auditory time-to-arrival judgments. Negatively valenced infant cries produced more cautious (anticipatory) estimates of auditory arrival time of the tone over a no-vocalization control. Positively valenced laughs had the opposite effect, and across all conditions, men showed smaller anticipatory biases than women. In Experiment 2, vocalization-matched vocoded noise stimuli did not influence concurrent auditory time-to-arrival estimates compared with a control condition. In Experiment 3, listeners estimated the egocentric distance of a looming tone that stopped before arriving. For distant stopping points, women estimated the stopping point as closer when the tone was presented with an infant cry than when it was presented with a laugh. For near stopping points, women showed no differential effect of vocalization type. Men did not show differential effects of vocalization type at either distance. Our results support the idea that both the sex of the listener and the emotional valence of infant vocalizations can influence auditory motion perception and can modulate motor responses to other behaviorally relevant environmental sounds. We also find support for previous work that shows sex differences in emotion processing are diminished under conditions of higher stress.

Objective: To evaluate the role of dextromethorphan/quinidine (DM/Q; Nuedexta™) in the treatment of pseudobulbar affect (PBA)., Data Sources: A literature search of MEDLINE/PubMed (January 1966-June 2013) was conducted using search terms pseudobulbar affect, pathological laughing and/or crying, emotional lability, dextromethorphan, and quinidine., Study Selection and Data Extraction: English language clinical trials and case reports evaluating the safety and efficacy of DM/Q in PBA were included for review. Bibliographies of all relevant articles were reviewed for additional citations., Data Synthesis: PBA, a poorly understood disorder, is characterized by involuntary crying and/or laughing. In the past, antidepressants and antiepileptics have been used off-label with mixed results. Four clinical trials have evaluated the use of DM/Q for the treatment of PBA. Although the therapeutic outcomes with DM/Q have been positive, interpretation of the published evidence is limited by small sample size and short treatment duration., Conclusions: Based on the data available, DM/Q may be a viable, short-term treatment alternative for PBA. Long-term safety and efficacy data are lacking.

An infant's optimal development is determined to a great extent by the adequate and sensitive responses of the caregiver. The adequacy and sensitivity of a reaction to an infant in distress (i.e. crying) will partly depend on the causal attributions of the crying and on the individual's sympathy for the infant. Being female, prior caring experiences, and multiparity have shown to be linked to more sympathetic, tolerant and less hostile emotional responses to crying. However, little is known about other factors explaining inexperienced future caregivers' reactions to infant crying. The present paper's goal is to shed more light on the subject by looking at how personality factors, caregiving interest, sex, promptness of the reaction, and gender identity are related to emotional reactions and causal attributions to crying in a population of young adults without children. One hundred and ninety-one childless university students participated (126 females; ages 18-35 years). The participants completed questionnaires on personality, gender identity and caregiving interest, and listened to an audio sample of an infant crying, reporting their emotions and their causal attributions to the crying. The results showed that experiencing anger was associated with more child-blaming attributions to the crying, while quickness of response and feelings of sympathy predicted more child-oriented attributions. The latter was stronger in males. Explicit care interest decreased child-blaming causal attributions more for men than for the women. Interestingly, solely in the females' personality factors neuroticism and conscientiousness played a role in child blaming attributions together with anger. These findings suggest that the motives that young adults attribute to a crying infant depend in males on the emotions triggered by the crying, responsiveness and care interest. While in females, emotions, responsiveness and personality affect the causal attribution to the crying. Future research is needed in order to determine whether these attributions are also linked to young adults' actual behaviour towards a crying infant., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: To study how the early crying behavior of preterm infants at term, 6 weeks, and 5 months of corrected age is related to later behavioral problems at age 3 and 4 years and parenting stress at 2 and 4 years., Methods: The study group included 202 live-born, low birth weight infants (birth weight ≤1500 g) born from January 2001 through December 2006 at the Turku University Hospital, Finland. A Baby Day Diary was used to assess the preterm infants' crying behavior at term, 6 weeks, and 5 months of corrected age. The children's behavior was assessed using the Child Behavior Check List at 3 and 4 years old, and parenting stress was assessed by using the Parenting Stress Index when the child was 2 and 4 years old., Results: The duration and frequency of crying bouts in infancy was associated with Child Behavior Check List scores at 4 years old and to both mothers' and fathers' stress when the child was 2 and 4 years old., Conclusions: Early excessive crying, especially if lasting up to 5 months of corrected age, is a clinically relevant signal in preterm infants because it may reflect infants' regulatory problems and/or parenting stress. The crying behavior of preterm infants should be systematically inquired about at well-baby clinics.

Background: Infants' continuous crying is a challenge both for the child and the principal caregiver. However, the links between infants' sleep, crying and cortisol secretion and mothers' well-being and sleep have been scarcely investigated. The aim of the present study was therefore to examine the link between cortisol secretion, crying and sleep of infants characterized by infantile colic (IC) and mothers' psychological well-being and own sleep., Methods: Mothers of 24 infants characterized by IC (mean age = 8 weeks, SD = 1.5 weeks) completed a series of questionnaires regarding the infant's crying and sleeping patterns. Infants' sleep was objectively assessed with actigraphs. Cortisol secretion was measured by means of saliva samples in the mornings after waking. After 4 weeks, infants were assessed once again. Mothers completed questionnaires assessing their psychological well-being (depressive symptoms, family strain) and sleep., Results: Mothers' psychological well-being and sleep was greatly predicted by infants' morning saliva cortisol levels, sleep disruptions and crying intensity, whereas infants' crying duration and volume had low predictive value., Conclusions: Mothers with infants characterized by IC are at increased risk for reporting impaired sleep, developing depressive symptoms and reporting higher family strain. Most importantly, this risk seems to be greater if their infants' sleep is fragmented.

Two empathy-related processes were recently distinguished neuroscientifically: automatic embodied-simulation (ES) based on visceromotor representation of another's affective state via cingulo-insulary circuit, and emotional sharing relying on cognitive 'theory of mind' (ToM) via prefrontal-temporo-parietal circuit. Evidence that these regions are not only activated but also function as networks during empathic experience has yet to been shown. Employing a novel approach by analyzing fMRI fluctuations of network cohesion while viewing films portraying personal loss, this study demonstrates increased connectivity during empathic engagement (probed by behavioral and parasympathetic indices) both within these circuits, and between them and a set of limbic regions. Notably, this effect was context-dependent: when witnessing as a determined-loss presented as a future event, the ToM and ToM-limbic cohesion positively correlated with state- and empathy indices. During the dramatic peak of this condition, the ToM cohesion was positively correlated with the trait-empathy index of personal distress. However, when the loss was presented as a probabilistic real-time occurrence, ToM cohesion negatively correlated with state-empathy index, which positively correlated with ES-limbic cohesion. In this case, it was the ES-limbic cohesion during the emotional peak which was correlated with personal distress scores. The findings indicate a dichotomy between regulated empathy toward determined-loss and vicarious empathy toward a real-time occurrence.

Crying is a unique form of human emotional expression that is associated with both positive and negative evocative antecedents. This article investigates the psychometric properties of a newly developed Crying Proneness Scale by examining the factor structure, test-retest reliability, and theoretically hypothesized relationships with empathy, attachment, age, and gender. Based on an analysis of data provided by a Dutch panel (Time 1: N = 4,916, Time 2: N = 4,874), exploratory and confirmatory factor analyses suggest that crying proneness is a multidimensional construct best characterized by four factors called attachment tears, societal tears, sentimental/moral tears, and compassionate tears. Test-retest reliability of the scale was adequate and associations with age, gender, empathy, and attachment demonstrated expected relations. Results suggest that this scale can be used to measure crying proneness, and that it will be useful in future studies that aim to gain a better understanding of normal and pathological socioemotional development.

This study examined the affect of infants just before the onset of crying and just after crying stopped. Two infants (between 7 and 14 months old) were observed longitudinally. In total, 102 crying episodes were analyzed. The infants displayed negative affect almost always just before starting to cry and soon after crying terminated. However, there were exceptions. Positive affect was observed. These were crying behaviors that the mother identified as "fake crying" or "emergence of fake crying". These data indicate that, although normally infant affect just before and right after crying is negative, infants also can exhibit positive affect when they show fake crying. Infants who are capable of fake crying might communicate successfully with their caregivers., (Copyright © 2013 Elsevier Inc. All rights reserved.)