Apathy is a common and impairing sequela of traumatic brain injury (TBI). Yet, little is known about the neural mechanisms determining in which patients apathy does or does not develop post-TBI. We ...aimed to elucidate the impact of TBI on motivational neural circuits and how this shapes apathy over the course of TBI recovery. Resting-state functional magnetic resonance imaging data were collected in patients with subacute mild TBI (
= 44), chronic mild-to-moderate TBI (
= 26), and nonbrain-injured control participants (CTRL;
= 28). We measured ventromedial prefrontal cortex (vmPFC) functional connectivity (FC) as a function of apathy, using an
vmPFC seed adopted from a motivated decision-making study in an independent TBI study cohort. Patients reported apathy using a well-validated tool for assaying apathy in TBI. The vmPFC-to-wholebrain FC was contrasted between groups, and we fit regression models with apathy predicting vmPFC FC. Subacute and chronic TBI caused increased apathy relative to CTRL, replicating previous work suggesting that apathy has an enduring impact in TBI. The vmPFC was functionally connected to the canonical default network, and this architecture did not differ between subacute TBI, chronic TBI, and CTRL groups. Critically, in TBI, increased apathy scores predicted decreased vmPFC-dorsal anterior cingulate cortex (dACC) FC. Last, we subdivided the TBI group based on patients above versus below the threshold for "clinically significant apathy," finding that TBI patients with clinically significant apathy demonstrated comparable vmPFC-dACC FC to CTRLs, whereas TBI patients with subthreshold apathy scores demonstrated vmPFC-dACC hyperconnectivity relative to both CTRLs and patients with clinically significant apathy. Post-TBI vmPFC-dACC hyperconnectivity may represent an adaptive compensatory response, helping to maintain motivation and enabling resilience to the development of apathy after neurotrauma. Given the role of vmPFC-dACC circuits in value-based decision making, rehabilitation strategies designed to improve this ability may help to reduce apathy and improve functional outcomes in TBI.
Background: Emotion regulation develops through bidirectional affective communication. Aim: To investigate the role of maternal interactive behavior in predicting infant affect among preterm versus ...full-term infants. Study Design: The association between maternal interactive behavior (contingent, attention seeking, watching) and infant affect during a modified Still Face (SF) paradigm in a sample of 22 preterm and 28 full term infants (3 ½ - 4 ½ months old) was investigated. Methods: Maternal behavior and infant affect were coded in one second intervals. Results: Maternal contingent interaction was positively correlated with positive infant affect (p < 0.001 for Play; p < 0.001 for Reunion#1; p < 0.01 for Reunion#2, respectively), with a stronger association during the second reunion for preterm infants (p < 0.001). In the preterm sample but not in the full-term sample, attention seeking maternal interaction at Play (baseline), Reunion#1, and Reunion#2 were all positively correlated with negative infant affect at Still Face#2. Maternal watching was negatively associated with positive infant affect for the full sample for both Reunion episodes (p < 0.05). Full term infants' negative affect increased from baseline to the first SF episode and then plateaued, whereas preterm infants demonstrated greater negative affect and less recovery throughout. Mothers of full-term infants showed increased contingent responding after the first SF stressor, while mothers of preterm infants did not (p < 0.05). Conclusions: Preterm infants may be more susceptible to both positive and negative maternal behaviors and mothers of full-term infants may be more responsive to infants' increased distress. Relationship-focused interventions addressing maternal behaviors may enhance positive emotionality and improve self-regulation in medically at-risk infants.
•Preterm infants appear more susceptible to positive aspects of maternal interaction.•Preterm infants appear more susceptible to negative aspects of maternal interaction.•Mothers of full-term infants may respond better to their infants' increased distress.•Maternal behaviors can be targeted to improve self-regulation in at-risk infants.
Stress regulation begins to develop in the first year of life through interactions with caregivers, particularly in the presence of stressors. High quality caregiving, characterized by maternal ...sensitivity and responsiveness to the infant’s emotional cues, is particularly important in the development of infant stress regulation. The purpose of this study was to assess the longitudinal stability of, and associations between, maternal interactive behavior and infant stress regulation (indexed by positive infant affect and cortisol reactivity) in response to the Still Face paradigm (SF) in a cohort of infants born preterm (< 32 weeks gestation, N = 22) at four months and nine months (adjusted age). The percent of time mothers spent using specific interaction styles (contingent maternal interaction (CMI), attention seeking, and watching) during Play/baseline, Reunion#1, and Reunion#2 SF episodes was calculated To assess infant stress regulation, two indices were obtained at both 4 and 9 months during the SF paradigm: the percent of positive affect displayed over each SF episode (0-100%) and a neuroendocrine stress response score based on salivary cortisol reactivity. We found three non-significant but medium-large effect size differences between 4 and 9 month variables, with more positive findings at 9 months. Regarding stability within the 4 month and 9 month episodes, maternal behavior and positive infant affect were non-significantly but moderately stable, with maternal watching behavior being particularly stable. Positive infant affect stability between Reunion#1 and Reunion#2 at 4 months was significantly greater than positive infant affect stability across these two episodes at 9 months. Regarding stability across 4 and 9 month (same) episodes, CMI and positive infant affect showed modest but non-significant stability across (same) 4 and 9 month episodes. Finally, with positive infant affect at Reunion#2 as the “outcome” of the Still Face, CMI at both 4 month Play and Reunion#1 episodes were significantly correlated with this “outcome.” Further, positive infant affect at Reunion#2 was more strongly correlated with CMI at both Play and Reunion#1 for 4 month old compared with 9 month old infants. Thus, sensitive care appears particularly important for younger infants born preterm, and mothers’ behavior early in a repeated stress exposure paradigm may be particularly important in maintaining positive infant affect and in the development of infants’ stress regulation more generally. Identifying the longer-term effects of early stress on infant stress regulation, and its relationship with maternal interaction, has important implications for understanding trajectories of regulatory patterns and deficits. A greater understanding of these relationships is particularly important given that greater emotion and neuroendocrine stress regulation in infancy have been directly associated with numerous positive outcomes throughout childhood.
•Maternal behavior and positive infant affect were moderately stable within 4 and 9 month episodes.•Maternal behavior and positive infant affect were modestly stable across same 4 and 9 month episodes.•Reunion#2 positive infant affect was more strongly correlated with earlier CMI at 4 months compared to 9 months.•Infant cortisol reactivity was unrelated to positive infant affect and maternal behavior.
Addressing systemic injustices and racism in training and clinical service provision are key next steps in clinical science. While the American Psychological Association Multicultural Guidelines and ...accreditation standards have long emphasized this need, most graduate programs offer a single course on diversity, equity, and inclusion topics, which is inadequate to train and sustain culturally humble providers and redress systemic injustices and racism within psychology. Few "real-world" examples exist to guide the development of training models. We provide background on the development and components of a specialty clinic, the University of New Mexico's Cultural Counseling Center, whose mission is providing culturally informed clinical services to diverse clientele, and to infuse multicultural training throughout the graduate program. Informed by the racial-spatial framework for psychology and critical race theory, we describe our approach intended to (a) offer applications for the operationalization and delivery of multicultural and antiracist training, (b) enhance supervisory models, and (c) increase awareness of structural competence. Our clinic, developed collaboratively among students and faculty, serves as a safe forum for dialogue around structural injustices and seeks to improve treatment for diverse clients and those underserved in mental health care. We discuss issues of student and faculty engagement and offer the perspectives of faculty and students of color, case examples illustrating our services, and current efforts to expand and formalize community collaborations. We offer a model that integrates coursework, informal activities, and multicultural supervision for comprehensive student training and that promotes a departmental culture of dialogue and support around equity, diversity, and justice.
Public Significance Statement
We provide background on the development of a specialty clinic, the University of New Mexico Cultural Counseling Center, as a training model and "real-world" example of operationalization and delivery of multicultural and antiracist training and clinical services. Program description and recommendations based on our experience can inform the development and implementation of similar centers in other departments and aid in the training of the next generation of clinicians equipped to provide culturally informed care.
Background: Children born very preterm are more likely to have difficulties with language acquisition and use that persist throughout childhood. Preterm birth occurs at a critical time in brain ...development and interrupts neurodevelopment, which has downstream implications for altered neural structure and function. Prematurity and socioeconomic status greatly impact language performance in children, but the neural substrates are poorly understood. Here the neural constituents of language performance are examined in select cortical and subcortical regions. Methods: Fifty-one children born preterm (24-31 weeks) and 20 born full-term were seen at preschool (mean age = 47 months) and school age (mean age = 74 months). Diverse aspects of language performance were evaluated at preschool and school age and were also aggregated into a single score using principle components analysis. At preschool age, measures of cortical thickness, surface area, subcortical volumes, and fractional anisotropy of white matter tracts were calculated for select frontotemporal regions implicated in language. Caregivers reported on many sociodemographic variables which were reduced using principle components analysis. Repeated measures general linear models were used to examine group differences in language performance and to determine the contributions of group, socioeconomic status, and neuroanatomical substrates to language performance. Results: Children born very preterm performed more poorly than children born full-term on tests of receptive language, verbal fluency and verbal working memory at preschool and school age. Five measures of language performance were reduced to one principle component at both preschool and school age. Socioeconomic status significantly accounted for language performance across groups and time points. Initial neuroanatomical analyses found that subcortical volumes significantly accounted for language performance. Analyses of language performance including neuroanatomy and socioeconomic status revealed that socioeconomic status had a significant main effect, as did some specific measures of cortical thickness, subcortical volumes and white matter tracts. Conclusions: Our findings provide support for poorer language performance in children born very preterm at preschool and school age. The relationship between structural neuroanatomic variations associated with preterm birth and language deficits is supported by our findings that language performance was significantly associated with subcortical volumes. This result highlights the possible importance of corticostriatal learning circuits in poorer language performance in children born very preterm. Importantly, our findings that socioeconomic status substantially accounted for language performance also emphasizes the multifactorial determinants of language problems in preterm birth, which is still poorly understood despite decades of research. Finally, these results have important implications for early intervention on an individual level, as well as policy reform to improve the broader social conditions and medical resources needed by so many Americans.
