Convergence of behavioral and cardiac indicators of distress in toddlerhood: A systematic review and narrative synthesis

Abstract

The objective of the current study was to systematically review the available literature on the relation between behavioral and cardiac indicators used to measure distress in toddlerhood. After ascertaining the eligibility of 2,424 articles through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO (International Prospective Register of Systematic Reviews) guided search process, 22 articles ( N = 2,504) that investigated associations between behavioral and cardiac indicators of distress in toddlerhood were identified. The narrative synthesis described the overall relation (direction [positive, negative], strength [Cohen’s D]) between behavioral and cardiac indicators and was organized by cardiac indicator (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia, pre-ejection period) and type of behavior measured (i.e., coding for expressed emotion behaviors vs. emotion regulation behaviors). Methodological characteristics (i.e., timing of measurement for behavioral and cardiac indicators [concurrent, predictive], length of measurement epochs, inclusion of covariates and moderators) were also described. HR was consistently positively ( D = .05 to .54) related to expressed emotion behaviors. No other cardiac and behavioral indicators were consistently related. Methodological differences related to behavioral and cardiac indicators utilized, timing of measurement, and length of measurement epochs may be responsible for heterogeneity in findings. The findings suggest that researchers might get divergent results depending on whether distress is measured with cardiac or behavioral indicators of distress in toddlerhood. Suggestions for future psychophysiological research with young children are offered.

Caregiver and Young Child Biological Attunement In Distress Contexts: A Systematic Review and Narrative Synthesis

“…Another important consideration is the rapid developmental changes that occur in the PNS, similar to the SNS and HPA axis, which may affect biological attunement. More research is needed to determine whether RSA is a stable indicator of distress within the first few years of life (also see Waxman et al, 2020). The cardiac studies included in the current review had the lowest quality scores on average, as most studies did not estimate or report reliability coefficients for cardiac editing procedures.…”

Investigating convergence of cardiac and behavioral indicators of distress during routine vaccinations over the second year of life

“…A recent systematic review by our group (Waxman, DiLorenzo, & Pillai Riddell, 2020) synthesized the literature on the relation between behavioral and cardiac indicators (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia [RSA], pre‐ejection period) of distress in toddlerhood. Several methodological challenges were outlined that may provide additional explanations for the discordance between behavioral and cardiac indicators of distress regulation, including: (a) the myriad of cardiac indicators of distress regulation; (b) a lack of delineation of phases of distress responding (i.e., initial reactivity vs. regulation from the peak response); and (c) a lack of research in high distress contexts.…”