Abstract Background Infants of parents with perinatal anxiety are at elevated likelihood of experiencing disruption in the parent‐infant relationship, as well as difficulties with socio‐emotional functioning in later development. Interventions delivered in the perinatal period have the potential to protect the early dyadic relationship and support infants’ ongoing development and socio‐emotional outcomes. This review primarily aimed to examine the efficacy of perinatal interventions on parent anxiety, infant socio‐emotional development/temperament, and parent‐infant relationship outcomes. Secondarily, the review sought to understand how interventions focused principally on one member of the dyad affected the outcomes of the other, and which intervention components were common to successful interventions. Method Five electronic databases as well as manual search procedures were used to identify randomised controlled trials according to a PICO eligibility criteria framework. Risk of bias assessments were undertaken, and a narrative synthesis was conducted. The review was pre‐registered on PROSPERO (CRD42021254799). Results Twelve studies were analysed in total, including five interventions focused on the adult, and seven interventions focused on the infant, or the infant’s relationship with their parent. Interventions incorporating cognitive behavioural strategies for affective disorders showed reductions in parent anxiety (N = 3), and interventions focusing on altering distorted maternal internal representations showed positive change in parent‐child dyadic interactions, and infant outcomes (N = 2). Evidence that interventions focused on one partner of the dyad led to improved outcomes for the other partner was limited. However, evidence was of mixed methodological quality. Conclusions It is important to integrate both parents and infants into treatment programmes for perinatal anxiety. Implications for clinical practice and future intervention trials are discussed.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jcv2.12116

The effect of perinatal interventions on parent anxiety, infant socio‐emotional development and parent‐infant relationship outcomes: A systematic review

During development we transition from coregulation (where regulatory processes are shared between child and caregiver) to self-regulation. Most early coregulatory interactions aim to manage fluctuations in the infant's arousal and alertness; but over time, coregulatory processes become progressively elaborated to encompass other functions such as sociocommunicative development, attention and executive control. The fundamental aim of coregulation is to help maintain an optimal 'critical state' between hypo- and hyperactivity. Here, we present a dynamic framework for understanding child-caregiver coregulatory interactions in the context of psychopathology. Early coregulatory processes involve both passive entrainment, through which a child's state entrains to the caregiver's, and active contingent responsiveness, through which the caregiver changes their behaviour in response to behaviours from the child. Similar principles, of interactive but asymmetric contingency, drive joint attention and the maintenance of epistemic states as well as arousal/alertness, emotion regulation and sociocommunicative development. We describe three ways in which active child-caregiver regulation can develop atypically, in conditions such as Autism, ADHD, anxiety and depression. The most well-known of these is insufficient contingent responsiveness, leading to reduced synchrony, which has been shown across a range of modalities in different disorders, and which is the target of most current interventions. We also present evidence that excessive contingent responsiveness and excessive synchrony can develop in some circumstances. And we show that positive feedback interactions can develop, which are contingent but mutually amplificatory child-caregiver interactions that drive the child further from their critical state. We discuss implications of these findings for future intervention research, and directions for future work.

Annual Research Review: 'There, the dance is - at the still point of the turning world' - dynamic systems perspectives on coregulation and dysregulation during early development.

In this article we examine how contingency and synchrony during infant-caregiver interaction helps children to learn to pay attention to objects; and how this, in turn, affects their ability to direct caregivers’ attention, and to track communicative intentions in others. First, we present evidence that, early in life, child-caregiver interactions are asymmetric. Caregivers dynamically and contingently adapt to their child more than the other way around, providing higher-order semantic and contextual cues during attention episodes which facilitate the development of specialised and integrated attentional brain networks in the infant brain. Then, we describe how social contingency also facilitates the child’s development of predictive models; and, through that, goal-directed behaviour. Finally, we discuss how contingency and synchrony of brain and behaviour can drive children's ability to direct their caregivers’ attention voluntarily; and how this, in turn, paves the way for intentional communication. 

pdf/contingency-and-synchrony-interactional-pathways-towards-2txjqv6azj.pdf

Contingency and synchrony: interactional pathways towards attentional control and intentional communication

Purpose of review Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health. Recent findings (1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse. Summary During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation.

During development we transition from co-regulation (where regulatory processes are shared between child and caregiver) to self-regulation. Most early co-regulatory interactions aim to manage fluctuations in the infant’s arousal and alertness; but over time, co-regulatory processes become progressively elaborated to encompass other functions such as socio-communicative development, attention and executive control. The fundamental aim of co-regulation is to help maintain an optimal ‘critical state’ between hypo- and hyper-activity. Early co-regulatory processes involve both passive entrainment, through which a child’s state entrains to the caregiver’s, and active contingent responsiveness, through which the caregiver changes their behaviour in response to behaviours from the child. Contingent responsiveness operates via negative feedback, through which the behavioural changes from the caregiver compensate for increases and decreases in the child, to help maintain an intermediate critical state. Similar principles, of interactive but asymmetric contingency, drive joint attention and the maintenance of epistemic states as well as arousal/alertness, emotion regulation, and socio-communicative development. Here, we review work that directly observed child-adult co-regulatory interactions in the context of psychopathology. Early co-regulatory processes are thought to play a role in the development of attachment and can develop atypically in a range of ways, across conditions including premature birth, Autism, Attention Deficit Hyperactivity Disorder, anxiety and depression. The most well-known of these is insufficient contingent responsiveness, leading to reduced synchrony, which has been shown across a range of modalities in different disorders, and which is the target of most current interventions. We also present evidence that excessive contingent responsiveness/synchrony can develop in some circumstances. And we show that positive feedback interactions can develop, which are contingent but mutually amplificatory child-caregiver interactions that drive the child further from their critical state. We discuss implications of these findings for future intervention research, and directions for future work. 

Annual Research Review: Studying interpersonal interactions in developmental psychopathology

Through an application of the Environmental Affordance (EA) Model, this paper explores the impact of environmental degradation on the community at Walpole Island First Nation. We outline how a change in relationships, broadly defined within an Anishinaabek ontology, can impact not only access to the local ecosystem but also how the affordances offered are lost. We base our argument on the local knowledge that nibi (water) is the system upon which all life depends and should therefore be the centre of efforts to maintain community-level mental health. Through the EA model we articulate the need to shift the focus from a human-centered ecosystem services model to an Anishinaabek relational ontology where relationships within ecosystems are bidirectional. As such, when those relationships are damaged through environmental degradation, local mental health and wellness are put at risk.

/pdf/nibi-and-cultural-affordance-at-walpole-island-first-nations-2h2aiab7.pdf

Nibi and Cultural Affordance at Walpole Island First Nations: Environmental Change and Mental Health

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The effect of perinatal interventions on parent anxiety, infant socio‐emotional development and parent‐infant relationship outcomes: A systematic review

Nibi and Cultural Affordance at Walpole Island First Nations: Environmental Change and Mental Health