Six and a half years after adoption, 6- to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO, n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, ≤ 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic–hypothalamic–pituitary– adrenal axis directly or were mediated by differences in parent–child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.

Attachment security was assessed in children who had spent at least 8 months in a Romanian orphanage (RO) and two comparison groups of children: a Canadian-born, nonadopted comparison group (CB) and a comparison group adopted from Romania before the age of 4 months (RC). We also assessed differences in displays of indiscriminately friendly behavior between the two adopted groups of children. Attachment security was assessed using parent report on a questionnaire comprised of the 23 items with the highest and lowest loadings on the Waters and Deane (1985) attachment Q-sort. Indiscriminately friendly behavior was assessed using parents' responses to five questions about their children's behavior with new adults. Children's attachment security scores were also compared to parents' scores on the parent attachment subscale of the Parenting Stress Index (Abidin, 1990). RO children scored significantly lower on security of attachment than did either the RC or CB children. RC and CB children did not differ on attachment security. Based on their parents' reports, RO children displayed significantly more indiscriminately friendly behaviors than did RC children, but such behaviors were not correlated with security of attachment. Children's attachment security scores were related to their parents attachment scores only in the RO group. It is suggested that RO children's experience of extreme neglect contributed to their low attachment-security scores, and that indiscriminate friendliness may be an important behavior to consider in the study of attachment in institutionalized children.

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Objective-The purpose of this study was to assess relations and concordance between behavioral and physiologic reactivity to pain in preterm neonates at 32 weeks postconceptional age as a function of gestational age at birth. Setting-Level III neonatal intensive care unit.Design/Patients-The study group comprised 136 preterm neonates (mean [range] birthweight, 1,020 g [445-1,500 g]; gestational age at birth, 28 weeks [23-32 weeks]) separated into three groups according to gestational age at birth as follows: 23 to 26 weeks (n = 48), 27 to 29 weeks (n = 52), and 30 to 32 weeks (n = 36).Outcome Measures-Reactivity to routine blood collection at 32 weeks postconceptional age was assessed using bedside-recorded behavioral and autonomic measures. Coders who were blinded to the study design scored behavioral responses (facial activity using the Neonatal Facial Coding System, sleep/waking state, and finger splay). Autonomic reactivity was assessed by change in heart rate and spectral analysis of heart rate variability (change in low-frequency and high-frequency power, and the ratio of low-frequency to high-frequency power during blood collection).Results-Facial activity and state correlated moderately with change in heart rate across gestational age groups (r = 0.41-0.62). Facial activity and state did not correlate significantly with change in low-frequency and high-frequency power, or the ratio of low-frequency to high-frequency power (r = 0.00-0.31). Finger splay did not correlate with any autonomic recording (r = 0.03-0.41). Concordance between established biobehavioral measures of pain revealed individual differences. Although some neonates showed high behavioral but low physiologic reactivity, other neonates displayed the opposite reaction; however, the majority displayed concordant reactions. Conclusions-The study findings confirm the value of measuring domains independently, especially in neonates born at a very young gestational age. Multidimensional assessment of pain using both biological and behavioral measures is essential because different parameters can potentially yield different information. 3-5 This assessment can be approached in two ways. Composite scales additively combine elements of physiologic and behavioral responses, providing a summary score. Alternatively, multiple sources of response are recorded, but are not combined into a single score. The purpose of this study was to examine the relations between behavioral and physiologic reactivity to further understand the development of pain-response systems. For the purpose of research, several univariate measures were studied. KeywordsFew studies have reported relations between behavioral and physiologic responses during painful procedures. Relations between responses may differ across GA and vary with background experience. 5 In some studies with neonates of young postconceptional age (PCA) and with neonates born close to term, facial activity and measures of heart rate were moderately related. Among neonates with a mean PCA of 28-29 week...

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant-mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother-infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal-infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics.RESUMEN: Este estudio examinó los perfiles de afectividad del infante, la madre y la díada madre-infante, a los tres meses después del parto en díadas que estuvieron expuestas a medicamentos sicotrópicos en el Disclaimer: this research was not industry funded. We would like to thank all the families who participated in this study. We also appreciate all the work that Colleen Fitzgerald, Annie Kuan, and Demetra Kostaros put into the project. We would like to acknowledge the following departments: reproductive psychiatry, developmental neonatology, pharmacology, and obstetrics at Children's and útero, y se les comparó con díadas de control que no habían estado expuestas a tales medicamentos. Las díadas de control, formadas por madres no depresivas y sus infantes, mostraron muchas similaridades en la expresión del afecto con díadas que estuvieron expuestas a selectivos inhibidores para la absorción de serotoninas (SSRIs), administrados solos para el tratamiento de la depresión maternal. En contraste, las madres que recibieron SSRIs y Rivotril (un derivado de Benzodiapazina) para el tratamiento de la depresión y la ansiedad, expresaron un afecto tanto positivo como negativo hacia sus infantes. Se discuten las implicaciones clínicas con respecto al uso de medicamentos sicotrópicos tales como SSRIs solos o en combinación con otras drogas médicas para tratar la ansiedad maternal y la depresión durante el embarazo. El personal clínico debe estar consciente de la posible diferente reacción en la interacción materno-infantil en un grupo con diagnosis mezcladas (v.g., depresión y ansiedad) con respecto al temperamento del infante, lo cual posiblemente sugiera una latente teratogenicidad de conducta con los sicotrópicos.RÉ SUMÉ : Cette étude a examiné des profils affectifs infantils, maternels et dyadiques à trois mois postpartum chez des dyades bébé-mère qui étaient exposées à des médicaments psychotropes in utero, comparées à ...