Background: In animal models, variations in early maternal care are associated with differences in hypothalamic-pituitary-adrenal (HPA) stress response in the offspring, mediated via changes in the...

The authors hypothesized that a social and emotional learning (SEL) program involving mindfulness and caring for others, designed for elementary school students, would enhance cognitive control, reduce stress, promote well-being and prosociality, and produce positive school outcomes. To test this hypothesis, 4 classes of combined 4th and 5th graders (N = 99) were randomly assigned to receive the SEL with mindfulness program versus a regular social responsibility program. Measures assessed executive functions (EFs), stress physiology via salivary cortisol, well-being (self-reports), prosociality and peer acceptance (peer reports), and math grades. Relative to children in the social responsibility program, children who received the SEL program with mindfulness (a) improved more in their cognitive control and stress physiology; (b) reported greater empathy, perspective-taking, emotional control, optimism, school self-concept, and mindfulness, (c) showed greater decreases in self-reported symptoms of depression and peer-rated aggression, (d) were rated by peers as more prosocial, and (e) increased in peer acceptance (or sociometric popularity). The results of this investigation suggest the promise of this SEL intervention and address a lacuna in the scientific literature-identifying strategies not only to ameliorate children's problems but also to cultivate their well-being and thriving. Directions for future research are discussed.

Depression occurs in an estimated 7% to 15% of all pregnancies¹ and is widely recognized as a perinatal factor that alters birth outcomes and neonatal behaviors.^2,3 However, pharmacologic management of perinatal depression is not without risk to the neonate.⁴ Soon after the introduction of selective serotonin reuptake inhibitor (SSRI) antidepressants in 1988 and their use to manage mood disorders during pregnancy, studies emerged reporting adverse neonatal effects.^4-6 Some early studies suggested that SSRI use was safe,⁷ with little or no risk of adverse outcomes,^8-10 while others reported neurobehavioral disturbances and increased risks of lower birth weight and preterm birth.^5,11,12 While exposure has not been associated with major anomalies,^13,14 recent scientific and public attention has focused on a cluster of symptoms often referred to as “poor neonatal adaptation,” which includes respiratory distress, hypoglycemia, temperature instability, and irritability^5,15-17 that may reflect pharmacologic neurotoxic^12,16 or behavioral teratogenic^18,19 effects. An increased risk of these symptoms, including convulsions, has also been found through the use of large population-based birth registries or World Health Organization data sets.^17,20 Two previous prospective population-based studies matching maternal prescription data with birth data yielded conflicting evidence of adverse outcomes. Using the Swedish Medical Birth Registry, Ericson et al²¹ reported that prenatal exposure was not associated with an increased risk of adverse birth outcomes among 546 neonates of mothers receiving an SSRI during their pregnancy. In contrast, using US health maintenance organization data, Simon et al²² reported that prenatal SSRI exposure was associated with earlier delivery and lower birth weight, and third-trimester SSRI exposure was particularly associated with lower Apgar scores.

Data from animal models indicate that neonatal stress or pain can permanently alter subsequent behavioral and/or physiological reactivity to stressors. However, cumulative effects of pain related to acute procedures in the neonatal intensive care unit (NICU) on later stress and/or pain reactivity has received limited attention. The objective of this study is to examine relationships between prior neonatal pain exposure (number of skin breaking procedures), and subsequent stress and pain reactivity in preterm infants in the NICU. Eighty-seven preterm infants were studied at 32 (+/-1 week) postconceptional age (PCA). Infants who received analgesia or sedation in the 72 h prior to each study, or any postnatal dexamethasone, were excluded. Outcomes were infant responses to two different stressors studied on separate days in a repeated measures randomized crossover design: (1) plasma cortisol to stress of a fixed series of nursing procedures; (2) behavioral (Neonatal Facial Coding System; NFCS) and cardiac reactivity to pain of blood collection. Among infants born <or=28 weeks gestational age (GA), but not 29-32 weeks GA, higher cumulative neonatal procedural pain exposure was related to lower cortisol response to stress and to lower facial (but not autonomic) reactivity to pain, at 32 weeks PCA, independent of early illness severity and morphine exposure since birth. Repeated neonatal procedural pain exposure among neurodevelopmentally immature preterm infants was associated with down-regulation of the hypothalamic-pituitary-adrenal axis, which was not counteracted with morphine. Differential effects of early pain on development of behavioral, physiologic and hormonal systems warrant further investigation.

Assessment of infant pain is a pressing concern, especially within the context of neonatal intensive care where infants may be exposed to prolonged and repeated pain during lengthy hospitalization. In the present study the feasibility of carrying out the complete Neonatal Facial Coding System (NFCS) in real time at bedside, specifically reliability, construct and concurrent validity, was evaluated in a tertiary level Neonatal Intensive Care Unit (NICU). Heel lance was used as a model of procedural pain, and observed with n = 40 infants at 32 weeks gestational age. Infant sleep/wake state, NFCS facial activity and specific hand movements were coded during baseline, unwrap, swab, heel lance, squeezing and recovery events. Heart rate was recorded continuously and digitally sampled using a custom designed computer system. Repeated measures analysis of variance (ANOVA) showed statistically significant differences across events for facial activity (P < 0.0001) and heart rate (P < 0.0001). Planned comparisons showed facial activity unchanged during baseline, swab and unwrap, then increased significantly during heel lance (P < 0.0001), increased further during squeezing (P < 0.003), then decreased during recovery (P < 0.0001). Systematic shifts in sleep/wake state were apparent. Rise in facial activity was consistent with increased heart rate, except that facial activity more closely paralleled initiation of the invasive event. Thus facial display was more specific to tissue damage compared with heart rate. Inter-observer reliability was high. Construct validity of the NFCS at bedside was demonstrated as invasive procedures were distinguished from tactile. While bedside coding of behavior does not permit raters to be blind to events, mechanical recording of heart rate allowed for an independent source of concurrent validation for bedside application of the NFCS scale.