Background: In East Tennessee and Middle Appalachia, the epicenter of the opioid epidemic, approximately 15% of women give birth taking buprenorphine or methadone for opioid addiction (medical assisted therapy--MAT) or using other drugs illicitly and 5% of births are diagnosed with neonatal abstinence syndrome (NAS). A better understanding is needed of factors contributing to the severity of NAS. Objective: To identify maternal and infant characteristics associated with length of stay among newborns with neonatal abstinence syndrome. Design/Methods: Participants were 150 newborns systematically sampled from births diagnosed with NAS during the past 5 years at a single medical center. Data were obtained through abstraction of maternal prenatal records, infant delivery and infant medical charts. The abstraction included maternal and child demographic and clinical characteristics. Drug and other substance use/exposure histories were based on maternal history, and urine and cord tissue drug screening. Results: The infants’ average length of stay was 18.6 (s.d. = 11.9), 15% were low birthweight, and had an average gestational age of 38.8 (s.d. = 1.8); 62% were male; 49% were breast-fed. The mothers mean age was 27.5 (s.d. = 5.0); mean parity was 1.6 (s.d. = 1.4); 77% were unmarried; 75% had < HS education; and 89% had exposure at some time during pregnancy to other prescription (in addition to buprenorphine or methadone) or illicit opioids. In the least squares regression, which included important potential covariates such as infant sex, birth weight and gestational age, significant predictors of infant length of stay include: maternal benzodiazepine use (8.3 day longer LOS on average; p = 0.019), and infants whose mothers had a history of mental illness (3.9 day longer LOS on average, p = 0.040 ). While infants born to mothers smoking in the final 30 days of pregnancy had a 2.7 day longer LOS on average after adjustment for other significant predictors, this association was no longer significant in regression analysis (p = 0.293). Conclusion(s): Maternal use of prescription or illicit opioids leading to NAS is rooted in women’s’ life histories characterized by disadvantage, relationship instability, polysubstance use and mental illness. Efforts to reduce the incidence and severity of NAS among those on MAT during pregnancy should focus on preventing poly-substance misuse and providing supports for other maternal health needs including treating mental illness.

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Background: Especially important in the transition process is the role of the providers and parents shifting from that of a manager of health to more of a coach. In group work, as in healthcare management, there is the opportunity for social loafing to occur, which could impede one’s competence in performing the desired task. Social loafing is the reduction in motivation and effort when individuals work collectively compared with when they work individually. Specific to social loafing is the free rider effect —when a person lacks putting forth effort because they believe someone else will pick up the slack which has been demonstrated in parent-child and student-teacher relationships. Objective: In this study we examined the prevalence of social loafing as defined by whether youth report that they know how to perform specific transition readiness skills but report that others do the tasks for them (as opposed to doing it themselves). Design/Methods: We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories assessed 1) whether they know how to do the specific task or not and 2) whether youth perform the task themselves or if someone else does the task for them. Results: We were specifically interested in those who responded “No, someone else does it but I know how”. Of the 21 items on the TRAQ, the rate of endorsement of the “social loafing” response varied between 11% and 53%. For 14 of the 21 items, the rate of endorsement of the “social loafing” response was greater than 30%. Table 1 displays the rate of endorsement of the social loafing response for each TRAQ item. Conclusion(s): Our results demonstrate that although many youth “know” how to perform various transition related tasks, very frequently they allow someone else to perform the task for them. In order for transition to adulthood to be successful, youth should be challenged to accept responsibility for performing task with the support of adults—called scaffolding. This will enhance the youth’s competence and autonomy. Similarly, in healthcare settings, clinicians can implement a scaffolding approach to reduce social loafing and promote more autonomy and gain competence in managing their health.

Research on physical activity has revealed that physical activity may be beneficial for not only physical health, but also mental functioning (Center for Disease Control, 2014; Alexander, Allen, & Bindoff, 2013). For instance, physical activity has been shown to alleviate symptoms of stress responses, has shown promise in alcohol and substance abuse treatments, and has been shown to improve executive functioning in adult and adolescent populations (Taylor, Sallis, & Needle, 1985; Best, 2010). While little research on relations between physical activity and executive functioning in infancy and early childhood exist, the limited results have surprisingly revealed a negative relation between the two (Rothbart, 2001). To investigate these diverging patterns, we aimed to investigate a possible moderator of the physical activity-executive function association, namely, maternal encouragement of physical activity. Fifty-six children (26 boys) visited the lab at M = 18.3 months (SD = 0.43 months). The Early Childhood Behavior Questionnaire (ECBQ; Putnam et al., 2006) superdimension of effortful control was used as a surrogate measure of early executive function. To measure child activity level, we used the mother-reported activity level subdimension from the ECBQ, and also coded mother-child free play periods to quantify children’s predilection to use physical activity in the service of social or cognitive objectives, such as grasping a spoon and extending the arm outwards to feed a baby doll, which we termed sociocognitive activity. To measure sociocognitive activity we used a modified version of Tamis-LeMonda and Bornstein’s (1990) play competence scale wherein each instance of sociocognitive activity was noted and summed for a total score of sociocognitive activity level (See Table 1). Finally, to gauge maternal encouragement, a modified version of the Dyadic Parent Child Interaction Coding System (DPICS; Eyeberg, Nelson, Duke, & Boggs, 2005) was used to identify maternal commands, praise, questions, physical involvement, talking, touching, and scaffolding behaviors during mother-child free play sessions. Zero-order correlations revealed a significant negative relationship between mother-reported activity level and child executive function (r = -.42, p < 0.01), replicating previous findings. However, correlations between sociocognitive activity and executive function, while positive, was not significant. We conducted moderation analyses separately for each maternal encouragement variable, and found that a higher amount of maternal questioning during play corresponded to a positive association between sociocognitive activity and executive functioning (moderator = 1.00, p < 0.05). These findings partially support our hypotheses and suggest that the ways in which caregivers direct and train activity during play through questioning strategies may also direct and train cognitive functioning. However, further research is needed to support these claims. These results also point toward issues with the measurement of activity level, as our two measures of activity produced significantly different correlations with executive functioning (z = -3.4, p < 0.01). Future research in the area of motor development as it pertains to cognitive functioning should investigate and develop a standard measure of motor activity that is capable of capturing not only simple milestone achievement and intensity levels, but also the amount of sociocognitive engagement during physical activity.

Beginning in the late 1960's (e.g., Bell, 1968), a considerable literature has emerged documenting the impact of children's characteristics on their own care and biopsychosocial outcomes. Yet, surprisingly little research has focused on the impact of the child on the experimental setting. It is well known in the infant literature that infant emotional states contribute to their own attrition, and even cognitive performance (e.g., Fagen et al., 1991). Less well known is the extent that infant characteristics contribute to experimenter social engagement. In the present investigation, we explored whether two experimenters responded to infants differently as a function of infant temperament. Sixty- 334 five infants (37 girls) visited the lab at M = 15.38 months (SD = 1.99). Mothers completed the Infant Behavior Questionnaire - Revised (IBQ-R) and a demographic assessment. Temperament measures derived from the IBQ-R were reduced to three overarching superdimensions (negative affectivity, effortful control, and surgency) from 14 subdimensions. Infants participated in a Brooks and Meltzoff (2005) type gaze-following procedure. On Trial 1, either of two experimenters sitting directly across from the infant established eye-contact by calling the child's name, said "Look!", then turned their head to look at a target object on the infant's left for 8 seconds. On Trial 2, experimenters followed the same procedure but looked to the infant's right. Trial 3 was the same as Trial 1. On Trials 4-6, experimenters followed a right-left-right pattern, with the exception that an Elmo videotape played on a monitor behind and above the experimenter as soon as the experimenter looked at the target object. Trials 4-6 were designed to test gazefollowing under conditions of distraction. The two experimenters did not differ statistically from one another in looking to the target object on any trial (see Table 1; t's <= 1.60, p's => .12); although, due to procedural requirements looking time for both experimenters differed as a function of distraction condition [F(1, 57) = 98.53, p = .000; see Table 1]. Nevertheless, during a procedural fidelity check, and despite both experimenters being blind to children's temperamental status, we found that experimenter looking time to the target objects in the control condition was correlated with both effortful control and surgency (see Table 2). These correlations were carried primarily by the subdimensions of duration of orientation and perceptual sensitivity, respectively. Evaluating the correlations separately by experimenter showed that both experimenters appeared to be susceptible to infant temperament. These results raise the possibility that even highly trained experimenters, blind to child temperament status, may be responsive to child characteristics when implementing experimental protocols. Obviously, in the present case, when experimenters remained visually engaged with target objects for longer periods of time for certain children, those children had greater opportunity to demonstrate gazefollowing. In principle, children high in effortful control and surgency could demonstrate longer gaze-following not as a direct effect of their temperament, but as an indirect effect of their temperament mediated through an experimenter. Future experimental researchers may wish to include temperament instruments as standard protocol to test for experimenter fidelity.

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