Identifying risk earlier: Prenatal exposures, neurodevelopment, and infant sleep as pathways to toddler attention and behavior dysregulation

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PROJECT SUMMARY/ABSTRACT Early attention and behavior dysregulation are developmental precursors to later disruptive behavior disorders, one of the major categories of childhood psychopathology. Recent conceptualizations of child behavior disorders classify these diagnoses as neurodevelopmental conditions, which suggests unexplored prenatal and early life origins. The proposed study will test the premise that child behavior dysregulation emerges, in part, from prenatal exposures to disrupted maternal sleep and emotion dysregulation—a transdiagnostic indicator of psychopathology. Data from our laboratories provide evidence that exposure to maternal emotion dysregulation associates with neurodevelopmental differences in newborn arousal and attention, as measured within hours after birth. Additional pilot analyses reveal that this blunted neurodevelopmental profile associates with behavior problems at 18 months. A goal of this study is to explore whether early sleep difficulties function as a behavioral mechanism connecting infant neurodevelopmental profiles to toddler attention and behavior dysregulation at 12 months. Sleep is a foundational health behavior and one of the earliest dyadic/family-based regulatory processes. We propose an innovative design for measuring maternal, paternal, and infant sleep variability, defined as inconsistency in hours slept per night, using a longitudinal burst design. Sleep will be assessed via actigraphy and research-validated consumer devices during the 2nd and 3rd trimester, week 1 after birth, then months 4, 6, 9, and 12. We aim to test whether (1) prenatal exposure to maternal emotion dysregulation, chronotype, and sleep variability predicts infant neurodevelopment and maternal-infant sleep variability; (2) infant neurodevelopment interacts with environmental sleep structure (e.g., bedtime routines) to affect infant sleep variability over time; and (3) infant sleep trajectories characterized by high variability (i.e., failure to attain normative stability) will mediate associations between neurodevelopmental profiles and toddler attention and behavior dysregulation. An exploratory aim will incorporate direct and indirect influences of partners on maternal and infant sleep. To accomplish these innovative aims, we will use established protocols to enroll women in the 2nd trimester of pregnancy (N=200 women) along a uniform distribution of emotion dysregulation, and their partners. This technique overrepresents women with high dysregulation and increases statistical power. Women, partners, and infants will then be followed for the first 12 months after birth using techniques that minimize burden, due to passive monitoring and brief surveys. This study builds upon rigorous prior research, including work from our own NIH-funded projects, to delve into the crucial challenge of infant sleep. The study unites a stellar team, with expertise in maternal emotion dysregulation, infant neurodevelopment, adult and infant sleep, longitudinal designs, and toddler attention and behavior dysregulation. Our study is significant because we may identify modifiable processes—infant and family sleep—that could contribute to early psychopathology risk, thereby reducing risk for one of the earliest-emerging and most costly classes of pediatric psychiatric distress.