Faculty Bibliography

Using an epidemiological sample (N = 1,117) and a prospective longitudinal design, this study tested the direct and indirect effects of preverbal and verbal communication (15 months to 3 years) on executive function (EF) at age 4 years. Results indicated that whereas gestures (15 months), as well as language (2 and 3 years), were correlated with later EF (phis >/= .44), the effect was entirely mediated through later language. In contrast, language had significant direct and indirect effects on later EF. Exploratory analyses indicated that the pattern of results was comparable for low- and not-low-income families. The results were consistent with theoretical accounts of language as a precursor of EF ability, and highlighted gesture as an early indicator of EF.

Intervention studies indicate that children's childcare experiences can be leveraged to support the development of executive functioning (EF). The role of more normative childcare experiences is less clear. Increasingly, theory and empirical work suggest that individual differences in children's physiological stress systems may be associated with meaningful differences in the way they experience these early environments. Using data from a large population-based sample of predominantly low-income rural families, we tested the degree to which children's childcare experiences--quantity, quality, and type--in the first 3 years of life predicted emerging EF. Moreover, we examined whether these effects varied as a function of children's basal cortisol levels in infancy and toddlerhood--an indicator of hypothalamic pituitary adrenal (HPA) axis stress physiology. Our results showed that higher quality care predicted more effective EF at 48 months, irrespective of quantity or type. This relation did not vary as a function of children's early cortisol levels. Attending greater hours of care per week was also related to EF; however--consistent with theory--the positive association between spending more time in childcare and more positive EF extended only to children with low levels of basal cortisol at 7 or 24 months of age. Attending center-based care was unassociated with EF.

Emotionally arousing stimuli have been largely unsuccessful in eliciting cortisol responses in young children. Whether or not emotion challenge will elicit a cortisol response, however, may in part be determined by the extent to which the tasks elicit behavioral reactivity and regulation. We examined relations of behavioral reactivity and regulation to emotional arousal in the context of fear and frustration to the cortisol response at 7, 15, and 24 months of age in a low income, rural population based sample of 1,292 families followed longitudinally from birth. At each age, children participated in fear and frustration inducing tasks, and cortisol samples were taken at three time points (before the tasks began, 20 min following peak emotional arousal or after the series of tasks ended, and 40 min after peak arousal or the tasks ended) in order to capture both increases (reactivity) and subsequent decreases (regulation) in the cortisol response. Using multilevel models, we predicted the cortisol response from measures of behavioral reactivity and regulation. At 7 months of age, cortisol reactivity and recovery were related to behavioral reactivity during a frustration-eliciting task and marginally related to behavioral reactivity during a fear-eliciting task. At 15 and 24 months of age, however, cortisol reactivity and recovery were related only to behavioral reactivity during a fear-eliciting task. Results indicate that while behavioral reactivity is predictive of whether or not infants and young children will exhibit a cortisol response to emotionally arousing tasks, behavioral and cortisol reactivity are not necessarily coupled.

In the current article, we contrast 2 analytical approaches to estimate the relation of parenting to executive function development in a sample of 1,292 children assessed longitudinally between the ages of 36 and 60 months of age. Children were administered a newly developed and validated battery of 6 executive function tasks tapping inhibitory control, working memory, and attention shifting. Residualized change analysis indicated that higher quality parenting as indicated by higher scores on widely used measures of parenting at both earlier and later time points predicted more positive gain in executive function at 60 months. Latent change score models in which parenting and executive function over time were held to standards of longitudinal measurement invariance provided additional evidence of the association between change in parenting quality and change in executive function. In these models, cross-lagged paths indicated that in addition to parenting predicting change in executive function, executive function bidirectionally predicted change in parenting quality. Results were robust with the addition of covariates, including child sex, race, maternal education, and household income-to-need. Strengths and drawbacks of the 2 analytic approaches are discussed, and the findings are considered in light of emerging methodological innovations for testing the extent to which executive function is malleable and open to the influence of experience.

A considerable body of literature suggests that children's child-care experiences may impact adrenocortical functioning in early childhood. Yet emerging findings also suggest that the magnitude and sometimes the direction of child-care effects on development may be markedly different for children from higher risk contexts. Using data from a large population-based sample of families from predominantly low-income backgrounds in rural communities, we tested the degree to which links between children's child-care experiences (at 7-36 months) and their subsequent cortisol levels (at 48 months) were moderated by their level of cumulative environmental risk. Our results provided evidence of a crossover interaction between cumulative risk and child-care quantity. For children from low-risk contexts, greater weekly hours in child care were predictive of higher cortisol levels. In contrast, for children facing several cumulative risk factors, greater hours in child care per week were predictive of lower cortisol levels. These effects were robust after adjusting for several controls, including children's cortisol levels in early infancy. Child-care quality and type were not predictive of children's cortisol levels, and neither mitigated the conditional effect of child-care quantity on cortisol. These findings suggest that links between child care and children's development may differ as a function of children's broader ecologies.

Intervention studies indicate that children's early child-care experiences can be leveraged to foster their development of effective self-regulation skills. It is less clear whether typical child-care experiences play a similar role. In addition, evidence suggests that children with a common variant of the DRD4 gene (48-bp VNTR, 7-repeat) may be more sensitive to their experiences than those without this variant. Using data from the NICHD Study of Early Child Care and Youth Development, we considered the degree to which children's early child-care experiences-quantity, quality, and type-were associated with their attention and self-regulation abilities in prekindergarten, and, in particular, whether these relations were conditional on DRD4 genotype. G x E interactions were evident across multiple neuropsychological and observational measures of children's attention and self-regulation abilities. Across most outcome measures, DRD4 7+ children spending fewer hours in child care showed more effective attention/self-regulation abilities. For those without a copy of the DRD4 7-repeat allele, such associations were typically null. The results for child-care quality and type indicated no interactions with genotype; the main-effect associations were somewhat inconsistent.

OBJECTIVES: We evaluated Beyond the Bridge, a novel mental health program in the New York City jail system designed to provide residentially based cognitive behavioral therapy in jail mental observation units. METHODS: We used propensity score matching and a dose-response analysis. Outcome measures included reduction in violent incidents and fights, reduction in uses of force by corrections officers, reduction in time spent on suicide watch and incidents of self-injurious behavior, and increased length of community survival. RESULTS: There were significant reductions in all outcomes when we compared program participants (n = 218) with an earlier cohort of patients residing on the mental observation unit before programming began (n = 413). However, when we compared program participants with a cohort of other patients residing on the units at the same time but who chose not to participate (n = 267), only time spent on suicide watch unit (rate ratio [RR] = 0.72; 95% confidence interval [CI] = 0.59, 0.89) and recidivism (RR = 0.70; 95% CI = 0.59,0.83) were significantly reduced. CONCLUSIONS: This evaluation and the model we piloted may provide useful information for other settings contemplating similar interventions.

The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.

PURPOSE: Relatively little is known about the prevalence of traumatic brain injury (TBI) among adolescents who come into contact with the criminal justice system. METHODS: We undertook screening for TBI among newly admitted adolescents in the New York City jail system using a validated TBI screening tool. A convenience sample of 300 male and 84 female screenings was examined. RESULTS: Screening revealed that 50% of male and 49% of female adolescents enter jail with a history of TBI. Incidence of TBI was assessed using patient health records, and revealed an incidence of 3,107 TBI per 100,000 person-years. CONCLUSIONS: Elevated prevalence and incidence of TBI among incarcerated adolescents may relate to criminal justice involvement as well as friction in jail. Given the large representation of violence as a cause of TBI among our patients, we have begun focus groups with them to elicit meaningful strategies for living with and avoiding TBI.