This manuscript provides a critical review of the literature on parent-child physiological synchrony-the matching of biological states between parents and children. All eligible studies found some evidence of physiological synchrony, though the magnitude and direction of synchrony varied according to methodological factors, including the physiological system examined (i.e., parasympathetic or sympathetic nervous system activity, adrenocortical functioning) and the statistical approach used (e.g., multilevel modeling, correlation). The review underscores the need to consider the context in which physiological synchrony occurs (e.g., family risk) to best understand its significance. Furthermore, the review delineates vital avenues for future research, including the need to assess synchrony across multiple physiological systems and the importance of documenting continuity/change in physiological synchrony across developmental periods. Such research is crucial for understanding how the parent-child relationship unfolds at a physiological level and, in turn, how this relationship can facilitate or hinder parent, child, and family adjustment.

Physiological synchrony, or concordance, among caregiver–child dyads involves the matching of biological states. Understanding this process is critical for enhancing our knowledge of the ways that the caregiver–child relationship supports child development. However, the meaning of physiological synchrony for child adjustment is poorly understood. This study examined physiological synchrony in respiratory sinus arrhythmia (RSA), an indicator of parasympathetic activity, between 87 mothers (M age = 35.30 years, SD = 6.71 years) and their preadolescent children (M age = 10.36 years, SD = 1. 19 years, 52.9% girls). Dyads, all of which were from economically impoverished backgrounds, participated in 3 tasks that varied in the level of interaction that was required between the partners. Mothers self-reported their own depressive symptoms and rated their children’s externalizing and internalizing symptoms. Physiological synchrony was generally strongest in tasks requiring the greatest levels of interaction among partners. Further, RSA synchrony was positive in the context of low levels of maternal depressive and child internalizing symptoms, and negative in the context of high levels of such symptoms, though results varied by task. Child externalizing symptoms did not moderate the RSA concordance process. The results identify both proximal and distal contexts in which physiological synchrony occurs, which ultimately broadens our understanding of the meaning and significance of parent–child physiological synchrony.

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Respiratory sinus arrhythmia (RSA) is a biomarker of physiological functioning that has been implicated in self‐regulatory processes and shown to relate to children's socioemotional health. RSA is a dynamic process reflecting an individual's response to their environment; thus, temporally sensitive methods are critical to better understanding this self‐regulatory process in different contexts. Prior work has studied young children's RSA change in the context of emotion clips and interactions with a stranger. The present study meaningfully expanded upon this work by examining: (a) preschoolers’ dynamic RSA change during a challenging task with their mothers, and (b) factors that may explain variability in children's dynamic RSA change. Preschoolers (N = 108; Mage = 3.56 years) and their mothers from diverse backgrounds completed a challenging activity together while children's physiological activity was monitored. Mothers reported on children's positive affect, parent emotional support, and family cohesion and indicators of socioemotional health. Children's positive affect and family cohesion explained variability in children's dynamic RSA change, which concurrently related to better socioemotional health. This study advances research and theory on biological correlates implicated in the development of children's self‐regulation and furthers our understanding of factors that may support children's developing self‐regulation at the physiological level.

Background: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre-and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. Methods: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. Results: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. Conclusion: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities. K E Y W O R D S social determinants of health, disparity, pediatric organ transplantation 2 of 33 | REA et al. 1 | INTRODUC TI ON Equitable access to organ transplantation and subsequent transplantrelated medical care is a critical goal across healthcare centers. Over the years, studies have identified risk factors impacting listing status and transplant-related outcomes, with greater scrutiny recently on clinical tools impacting organ allocation, selection, and donation processes. 1 These steps are critical in identifying areas of structural racism which continue to impact Black, Indigenous, and people of color as well as the intersectionality of socioeconomic factors within the patient population as a whole. To summarize findings to date, a systematic review of the available literature was conducted. Studies included assessments of SDoH in the evaluation, listing, and post-transplant periods. The US Department of Health and Human Services identifies five domains of SDoH that include economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. 2 Special consideration was given to dynamic interplay between these factors to better understand social processes underlying health outcomes and identify potential intervention areas. | ME THODS | Search strategyThis systematic review is in accordance with PRISMA guidelines.Comprehensive search strategies were created for Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature, including controlled vocabulary terms from each database combined logically with keywords using Boolean Logic. Terms were extracted per the following concepts: pediatrics, organ transplantation, disparities, and identity (see example searc...

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Background:The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI.Methods: A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership.Results: Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. Conclusions:The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.

This cross-sectional study examined behavioral and physiological indicators of the parent-child relationship as moderators of the link between maternal depressive and child psychopathology symptoms. Ninety-seven mothers (M age ϭ 35.38 years) and their 9-to 12-year-old children (M age ϭ 10.32 years, 53.7% girls, 78.1% African American) from economically impoverished backgrounds participated. Mothers reported on their own depressive symptoms using the Beck Depression Inventory-2 (BDI-2) and their child's emotional and behavioral problems using the Child Behavior Checklist (CBCL). Physiological activity (i.e., respiratory sinus arrhythmia) of both mother and child was collected during a dyadic conflict discussion task, and interactions were coded independently for mother and child positivity, negativity, and engagement. Physiological synchrony was computed using multilevel modeling, and dyad-level behavioral indicators (i.e., dyadic positivity, negativity, and engagement) were created by averaging individual mother and child behavioral codes. Moderation analyses indicated that the link between mother and child symptoms was exacerbated for dyads who displayed low levels of positivity and low levels of engagement, as well as in the context of positive physiological synchrony. In contrast, high levels of positivity and engagement and negative physiological synchrony buffered the link between symptoms. Findings have implications for conceptual models of intergenerational risk for psychopathology and for clinical prevention and intervention efforts that target the parent-child relationship.