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JOURNAL ABSTRACTS
Comparison of Forces Exerted by a
Chiropractor on Children and Adults During
High-Speed, Low-Amplitude Spinal
Manipulations: A Feasibility Study
Walter Herzog PhD; Peter Kevorkian DC; Brent
Russell DC; Joel Alcantara DC
Journal of Manipulative and Physiological
Therapeutics
Volume 45, Issue 6, July–August 2022, Pages
389-399
doi.org/10.1016/j.jmpt.2022.09.003.
Abstract
Objective:
The aim of this study was to demonstrate that
quantification of the forces exerted by a single
chiropractor on children and adults during
high-velocity, low-amplitude spinal
manipulations and the correlation of forces to
age was feasible. Methods: The
force-time profiles of high-velocity,
low-amplitude spinal manipulations were measured
in 48 children (109 manipulations) ranging from
14 weeks to 17 years of age, and 20 adults (49
manipulations) in a clinical setting. The
measurements were taken using a thin, flexible
pressure pad. Outcome variables (peak forces,
preload forces, thrust forces, thrust durations,
rates of force application, and thrust impulses)
were quantified and compared across age groups
using Kruskal-Wallis testing with Dunn post hoc
analysis. Outcome variables were fitted with
best-fitting linear regressions with age as the
dependent variable. The level of significance
for all statistical tests was set a priori at a
= 0.05. Results: Most outcome
variables increased with the age of the patient.
Specifically, peak forces, thrust forces, and
the rate of force application were positively
correlated with age, while thrust durations
remained constant across all ages and preload
forces decreased slightly with patient age for
cervical spine manipulations.
Conclusion: For this single
chiropractor in private practice, the forces he
used increased with the age of the patient, and
he thus used lower forces in children than
adults. This study shows that measuring the
forces used by a chiropractor in clinical
practice on patients with a range of ages was
feasible.
Key Indexing Terms:
Manipulation, Chiropractic, Infant, Child,
Manipulation, Spinal, Mechanical Phenomena.
Association Between Pregnancy-Related
Hormones and Lumbopelvic Pain Characteristics
in Pregnant Women: A Scoping Review
Catherine Daneau; Mariève Houle; Mégane
Pasquier; Stephanie-May Ruchat; Martin
Descarreaux
J Manipulative Physiol Ther. 2021
Sep;44(7):573-583.
doi:10.1016/j.jmpt.2021.10.001. Epub 2021 Dec 9.
Abstract
Objectives:
The objectives of this scoping review were (1)
to document and quantify the potential
associations between lumbopelvic pain
characteristics and pregnancy-related hormones,
and (2) to identify research approaches and
assessment tools used to investigate lumbopelvic
pain characteristics and pregnancy-related
hormones. Methods: The
literature search was conducted in six databases
(MEDLINE, Academic Search Complete, Cumulative
Index to Nursing and Allied Health Literature,
SportDiscus, PsycINFO, and Cochrane) from
inception up to March 2020 and completed using
search terms relevant to pregnant women,
pregnancy-related hormones, and lumbopelvic
pain. The risk of bias was assessed using the
characteristics recommended by Guyatt et al. for
observational studies.
Results: The search yielded
1,015 publications from which nine met the
inclusion criteria. Relaxin was the most studied
pregnancy-related hormone. An association
between relaxin levels and lumbopelvic pain
presence or severity was found in 4 studies,
while five studies did not report an association
between them. One study reported an association
between relaxin and lumbopelvic pain presence or
severity while two studies reported no
association and were considered as having a low
risk of bias. One study reported measures of
estrogen and progesterone levels. It showed that
progesterone levels were found to be
significantly higher in pregnant women with
lumbopelvic pain compared to those without,
while estrogen concentrations were similar in
both groups. Conclusion: The
literature showed conflicting evidence regarding
the association between pregnancy-related
hormones and lumbopelvic pain characteristics in
pregnant women. The assessment tools used to
investigate lumbopelvic pain characteristics and
pregnancy-related hormones are heterogeneous
across studies. Based on limited and conflicting
evidence, and due to the heterogeneity of
assessment tools and overall poor quality of the
literature, the association between
pregnancy-related hormones and lumbopelvic pain
characteristics is unclear.
Keywords: Estrogen; Low Back
Pain; Pelvic Girdle Pain; Pregnancy;
Progesterone; Relaxin.
Adverse infant outcomes among women with
sleep apnea or insomnia during pregnancy: A
retrospective cohort study
Jennifer N Felder; Rebecca J Baer; Larry Rand;
Kelli K Ryckman; Laura Jelliffe-Pawlowski; Aric
A Prather
Sleep Health 2023 Feb;9(1):26-32.
doi:10.1016/j.sleh.2022.09.012. Epub 2022 Nov 10.
Abstract
Objective:
To evaluate whether sleep apnea or insomnia
among pregnant people is associated with
increased risk for adverse infant outcomes.
Design: Retrospective cohort
study SETTING: California
PARTICIPANTS: The sample included singleton live
births. Sleep apnea and insomnia were defined
based on ICD-9 and -10 codes. A referent group
was selected using exact propensity score
matching on maternal characteristics, obstetric
factors, and infant factors among individuals
without a sleep disorder.
Measurements: Adverse infant
outcomes were obtained from birth certificate,
hospital discharge, and death records (eg, Apgar
scores, neonatal intensive care unit (NICU)
stay, infant death, long birth stay, etc.).
Logistic regression was used to calculate odds
of an adverse infant outcome by sleep disorder
type. Results: Propensity-score
matched controls were identified for 69.9% of
the 3,371 sleep apnea cases and 68.8% of the
3,213 insomnia cases. Compared to the
propensity-matched referent group, individuals
with a diagnosis of sleep apnea (n = 2357) had
infants who were more likely to have any adverse
outcome, low 1-min Apgar scores, NICU stay, and
an emergency room visit in the first year of
life. Infants born to mothers with a diagnosis
of insomnia (n = 2212) were at increased risk of
few negative outcomes relative to the propensity
matched referent group, with the exception of an
emergency room visit.
Conclusions:
In unadjusted analyses, infants born to
individuals with a diagnosis of sleep apnea or
insomnia were at increased risk of several
adverse outcomes. These were attenuated when
using propensity score matching, suggesting
these associations were driven by other
comorbidities.
Keywords: Infant outcomes;
Insomnia; Pregnancy; Sleep apnea.
Effect of Vitamin C Supplementation for
Pregnant Smokers on Offspring Airway Function
and Wheeze at Age 5 Years: Follow-up of a
Randomized Clinical Trial.
Cindy T. McEvoy, MD, MCR; Lyndsey E.
Shorey-Kendrick, PhD; Kristin Milner, BA1; et
al.
JAMA Pediatr. 2023;177(1):16-24.
doi:10.1001/jamapediatrics.2022.4401.
Abstract
Importance:
Vitamin C supplementation (500 mg/d) for
pregnant smokers has been reported to increase
offspring airway function as measured by forced
expiratory flow (FEF) through age 12 months;
however, its effects on airway function at age
five years remain to be assessed.
Objective: To assess whether
vitamin C supplementation in pregnant smokers is
associated with increased and/or improved airway
function in their offspring at age five years
and whether vitamin C decreases the occurrence
of wheeze.
Design, Setting, and Participants:
This study followed up the Vitamin C to Decrease
the Effects of Smoking in Pregnancy on Infant
Lung Function (VCSIP) double-blind,
placebo-controlled randomized clinical trial
conducted at three centers in the US (in Oregon,
Washington, and Indiana) between 2012 and 2016.
Investigators and participants remain unaware of
the treatment assignments. Forced expiratory
flow measurements at age five years were
completed from 2018 to 2021.
Interventions: Pregnant smokers
were randomized to vitamin C (500 mg/d) or
placebo treatment.
Main Outcomes and Measures: The
primary outcome was the prespecified measurement
of FEF between 25% and 75% expired volume
(FEF25-75) by spirometry at age five years.
Secondary outcomes included FEF measurements at
50% and 75% of expiration (FEF50and FEF75),
forced expiratory volume in one second (FEV1),
and occurrence of wheeze.
Results: Of the 251 pregnant
smokers included in this study, 125 (49.8%) were
randomized to vitamin C and 126 (50.2%) were
randomized to placebo. Of 213 children from the
VCSIP trial who were reconsented into this
follow-up study, 192 (90.1%) had successful FEF
measurements at age five years; 212 (99.5%) were
included in the analysis of wheeze. Analysis of
covariance demonstrated that offspring of
pregnant smokers allocated to vitamin C compared
with placebo had 17.2% significantly higher mean
(SE) measurements of FEF25-75at age five years
(1.45 [0.04] vs 1.24 [0.04] L/s; adjusted mean
difference, 0.21 [95% CI, 0.13-0.30]; P
<.001). Mean (SE) measurements were also
significantly increased by 14.1% for FEF50(1.59
[0.04] vs 1.39 [0.04] L/s; adjusted mean
difference, 0.20 [95% CI, 0.11-0.30]; P
<.001), 25.9% for FEF75(0.79 [0.02] vs 0.63
[0.02] L/s; 0.16 [95% CI, 0.11-0.22]; P
<.001), and 4.4% for FEV1(1.13 [0.02] vs 1.09
[0.02] L; 0.05 [95% CI, 0.01-0.09]; P =.02). In
addition, offspring of pregnant smokers
randomized to vitamin C had significantly
decreased wheeze (28.3% vs 47.2%; estimated odds
ratio, 0.41 [95% CI, 0.23-0.74]; P =.003).
Conclusions and Relevance: In this follow-up
study of offspring of pregnant smokers
randomized to vitamin C vs placebo, vitamin C
supplementation during pregnancy resulted in
significantly increased airway function of
offspring at age five years and significantly
decreased the occurrence of wheeze. These
findings suggest that vitamin C supplementation
for pregnant smokers may decrease the effects of
smoking in pregnancy on childhood airway
function and respiratory health.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03203603.
Treatment of infant colic with craniosacral
therapy. A randomized controlled trial
Mercedes Castejón-Castejón; M A Murcia-González;
J Todri; O Lena; R Chillón-Martínez
Complement Ther Med. 2022
Dec;71:102885.
doi:10.1016/j.ctim.2022.102885. Epub 2022 Sep 13
Abstract
Objective:
To evaluate the number of craniosacral therapy
sessions that can be helpful to obtain a
resolution of the symptoms of infantile colic
and to observe if there are any differences in
the evolution obtained by the groups that
received a different number of Craniosacral
Therapy sessions at 24 days of treatment,
compared with the control group which did not
received any treatment.
Methods: Fifty-eight infants
with colic were randomized into two groups of
which 29 babies in the control group received no
treatment and those in the experimental group
received 1-3 sessions of craniosacral therapy
(CST) until symptoms were resolved. Evaluations
were performed until day 24 of the study. In
this study crying hours served as primary
outcome. The secondary outcome were the hours of
sleep and the severity, measured by an Infantile
Colic Severity Questionnaire (ICSQ).
Results: Significant
statistical differences were observed in favor
of experimental group compared to the control
group on day 24 in crying hours (mean difference
= 2.94, at 95 %CI = 2.30-3.58; p < 0.001)
primary outcome, and also in hours of sleep
(mean difference = 2.80; at 95 %CI = - 3.85 to -
1.73; p < 0.001) and colic severity (mean
difference = 17.24; at 95 %CI = 14.42-20.05; p
< 0.001) secondary outcomes. Also, the
differences between the groups ≤ 2 CST sessions
(n = 19), 3 CST sessions (n = 10) and control (n
= 25) were statistically significant on day 24
of the treatment for crying, sleep and colic
severity outcomes (p < 0.001).
Conclusion: Babies with
infantile colic may obtain a complete resolution
of symptoms on day 24 by receiving 2 or 3 CST
sessions compared to the control group, which
did not receive any treatment.
Keywords: Craniosacral therapy;
Crying; Infantile colic; Manual therapy;
Osteopathy; Sleep.
Longitudinal Associations Between Use of
Mobile Devices for Calming and Emotional
Reactivity and Executive Functioning in
Children Aged 3 to 5 Years
Jenny S Radesky; Niko Kaciroti; Heidi M Weeks;
Alexandria Schaller; Alison L Miller
JAMA Pediatr. 2023 Jan
1;177(1):62-70.
doi:10.1001/jamapediatrics.2022.4793.
Abstract
Importance:
Mobile devices are often used to keep young
children occupied or calm, but it is not known
whether this practice influences child
development. Objective: To
examine the longitudinal, bidirectional
associations between the parent-reported
frequency of using mobile devices to calm young
children and children’s executive functioning
(EF) and emotional reactivity, testing
moderation by child sex and temperament.
Design, setting, and participants:
This prospective cohort study included a
community-based convenience sample of
English-speaking parents of typically developing
children aged three to five years. The study
duration was from August 2018 to January 2020,
with baseline (T1), 3-month follow-up (T2), and
6-month follow-up (T3) waves.
Exposures: Parent-reported
frequency of use of mobile devices to calm
children when upset (5-point Likert scale).
Main outcomes and measures: At
each wave, the child’s EF was assessed with the
Behavior Rating Inventory of Executive
Function-Preschool Version Global Executive
Composite and emotional reactivity with the
Child Behavior Checklist Emotional Reactivity
subscale. Structural equation models were built
to examine cross-lagged associations of the use
of devices for calming, EF, and emotional
reactivity, testing for moderation by child sex
or temperament (Child Behavior
Questionnaire-Very Short Form surgency score,
median split). Results: Of 422
eligible parents with data at T1, 375 (88.9%)
provided data at T2 and 366 (86.7%) at T3. At
baseline, the mean (SD) age of the 422 children
was 3.8 (0.5) years, the number of boys in the
sample was 224 (53.1%), the number of
individuals of non-Hispanic White race and
ethnicity was 313 (74.2%), and among the
parents, 254 (60.2%) had a college degree or
higher. Among the boys, the use of devices to
calm at T2 was associated with higher emotional
reactivity at T3 (r [standardized regression
coefficient] = 0.20; 95% CI, 0.10-0.30), while
higher emotional reactivity at T2 had a
nonsignificant association with increased device
use for calming at T3 (r = 0.10; 95% CI, -0.01
to 0.21). Among children with high temperamental
surgency, the use of devices to calm at T2 was
associated with increased emotional reactivity
at T3 (r = 0.11; 95% CI, 0.01-0.22), while
higher emotional reactivity at T2 was associated
with increased device use for calming at T3 (r =
0.13; 95% CI, 0.02-0.24).
Conclusions and relevance: The
findings of this study suggest that the frequent
use of mobile devices for calming young children
may displace their opportunities for learning
emotion-regulation strategies over time;
therefore, pediatric health care professionals
may wish to encourage alternate calming
approaches.
Conflict of Interest Disclosures:
Dr Radesky reported receiving personal fees from
Noggin (Viacom/CBS) for serving on their
scientific advisory board in 2021, and
consulting fees from Melissa & Doug Toys
outside the submitted work. Dr Kaciroti reported
receiving grants from the University of Michigan
during the conduct of the study. No other
disclosures were reported.
Sensitivity and Specificity of the Modified
Checklist for Autism in Toddlers (Original and
Revised): A Systematic Review and
Meta-analysis
Andrea Trubanova Wieckowski; Lashae N Williams;
Juliette Rando; Kristen Lyall; Diana L Robins
JAMA Pediatr 2023 Apr
1;177(4):373-383.
doi:10.1001/jamapediatrics.2022.5975.
Abstract
Importance:
The Modified Checklist for Autism in Toddlers
(M-CHAT) and the M-CHAT, Revised With Follow-up
(M-CHAT-R/F)-henceforth referred to as
M-CHAT(-R/F)-are the most commonly used toddler
screeners for autism spectrum disorder (ASD).
Their use often differs from that in the
original validation studies, resulting in a
range of estimates of sensitivity and
specificity. Also, given the variability in
reports of the clinical utility of the
M-CHAT(-R/F), researchers and practitioners lack
guidance to inform autism screening protocols.
Objective: To synthesize
variability in sensitivity and specificity of
M-CHAT(-R/F) across multiple factors, including
procedures for identifying missed cases,
likelihood level, screening age, and single
compared with repeated screenings.
Data sources: A literature
search was conducted with PubMed, Web of
Science, and Scopus to identify studies
published between January 1, 2001, and August
31, 2022.
Study selection: Articles were
included if the studies used the M-CHAT(-R/F)
(ie, original or revised version) to identify
new ASD cases, were published in
English-language peer-reviewed journals,
included at least 10 ASD cases, reported
procedures for false-negative case
identification, screened children by 48 months,
and included information (or had information
provided by authors when contacted) needed to
conduct the meta-analysis.
Data extraction and synthesis:
The systematic review and meta-analysis was
conducted within the Preferred Reporting Items
for Systematic Reviews and Meta-analyses
(PRISMA) reporting guideline. The Quality
Assessment of Diagnostic Accuracy Studies-2 tool
evaluated bias in sample selection. Data
extraction and quality assessment were performed
by two authors independently. The overall
diagnostic accuracy of the M-CHAT(-R/F) was
assessed with the hierarchic summary receiver
operating characteristic (HSROC) model.
Main outcomes and measures: Sensitivity, specificity, diagnostic odds
ratios, and HSROC curves of M-CHAT(-R/F).
Results: The review included 50
studies with 51 samples. The pooled sensitivity
of M-CHAT(-R/F) was 0.83 (95% CI, 0.77-0.88),
and the pooled specificity was 0.94 (95% CI,
0.89-0.97). Heterogeneity analyses revealed
greater diagnostic accuracy for low- vs
high-likelihood samples, a concurrent vs
prospective case confirmation strategy, a large
vs small sample size, use of M-CHAT(-R/F)
Follow-up, and non-English vs English only.
Conclusions and relevance:
Overall, results of this study suggest the
utility of the M-CHAT(-R/F) as an ASD screener.
The wide variability in psychometric properties
of M-CHAT(-R/F) highlights differences in
screener use that should be considered in
research and practice.
Conflict of Interest Disclosures:
Dr Wieckowski reported receiving grants from the
Pennsylvania Medical Society and the Eagles
Autism Foundation. Dr Lyall reported receiving
grants from the Eagles Autism Foundation. Dr
Robins reported receiving personal fees from
M-CHAT LLC co-ownership, in which licensees pay
royalties; receiving grants from the Eagles
Autism Foundation, the National Institutes of
Health, and the Pennsylvania Medical Society;
having a contract to contribute to a Food and
Drug Administration trial from Autism Speaks;
receiving a gift to support pilot research from
the Wawa Foundation; receiving personal fees
from Quadrant Biosciences, Inc, for serving as a
member of an advisory board; having a contract
to collaborate on a toddler screening study in
Monterrey, Mexico, from Autismo ABP outside the
submitted work; and holding a copyright for
M-CHAT, M-CHAT-R/F issued to M-CHAT, LLC (M-CHAT
and M-CHAT-R/F are copyrighted instruments). No
other disclosures were reported.
Outdoor Play as a Mitigating Factor in the
Association Between Screen Time for Young
Children and Neurodevelopmental
Outcomes
Mika Sugiyama; Kenji J Tsuchiya; Yusuke Okubo;
Mohammad Shafiur Rahman; Satoshi Uchiyama; Taeko
Harada; Toshiki Iwabuchi; Akemi Okumura; Chikako
Nakayasu; Yuko Amma; Haruka Suzuki; Nagahide
Takahashi; Barbara Kinsella-Kammerer; Yoko
Nomura; Hiroaki Itoh 8; Tomoko Nishimura
JAMA Pediatr., 2023 Mar
1;177(3):303-310.
doi:10.1001/jamapediatrics.2022.5356.
Abstract
Importance:
Whether the association between higher screen
time in infancy and later suboptimal
neurodevelopment can be mitigated by frequency
of outdoor play is unknown.
Objective: To investigate
whether higher screen time at age two years is
associated with neurodevelopmental outcomes at
age four years and whether this association is
mediated by frequency of outdoor play at age two
years eight months.
Design, setting, and participants:
Participants were a subsample of the Hamamatsu
Birth Cohort Study for Mothers and Children (HBC
Study, N = 1258). Children were born between
December 2007 and March 2012 and followed up
from one year six months to four years. The
analysis was conducted from April 2021 to June
2022. Exposures: Screen time
longer than 1 hour a day at age two years was
coded as higher screen time.
Main outcomes and measures:
Standardized scores for communication, daily
living skills, and socialization domains of the
Vineland Adaptive Behavior Scale, second
edition, at age four years were used (mean [SD],
100 [15]). The mediating factor was frequency of
outdoor play at age two years eight months, with
six or sven days per week coded as frequent
outdoor play. Results: Of 885
participants, 445 children (50%) were female;
mean (SD) screen time per day was 2.6 (2.0)
hours. Causal mediation analyses revealed that
higher screen time at age 2 years was associated
with lower scores in communication at age 4
years (nonstandardized coefficient b = -2.32;
95% CI, -4.03 to -0.60), but the association was
not mediated by frequency of outdoor play.
Higher screen time was also associated with
lower scores in daily living skills (b = -1.76;
95% CI, -3.21 to -0.31); 18% of this association
was mediated by frequency of outdoor play.
Frequency of outdoor play was associated with
socialization (b = 2.73; 95% CI, 1.06 to 4.39),
whereas higher screen time was not (b = -1.34;
95% CI, -3.05 to 0.36).
Conclusions and relevance:
Higher screen time at age two years was directly
associated with poorer communication at age four
years. It was also associated with daily living
skills, but frequency of outdoor play at age two
years eight months alleviated it, suggesting
outdoor play mitigated the association between
higher screen time and suboptimal
neurodevelopment. Future research should specify
the nature of the associations and intervention
measures, enabling targeted interventions that
reduce the potential risk in screen time.
Physical Activity Interventions to Alleviate
Depressive Symptoms in Children and
Adolescents: A Systematic Review and
Meta-analysis
Francesco Recchia; Joshua D K Bernal; Daniel Y
Fong; Stephen H S Wong; Pak-Kwong Chung; Derwin
K C Chan; Catherine M Capio; Clare C W Yu; Sam W
S Wong; Cindy H P Sit; Ya-Jun Chen; Walter R
Thompson; Parco M Siu
JAMA Pediatr. 2023 Feb
1;177(2):132-140.
doi:10.1001/jamapediatrics.2022.5090.
Abstract
Importance:
Depression is the second most prevalent mental
disorder among children and adolescents, yet
only a small proportion seek or receive
disorder-specific treatment. Physical activity
interventions hold promise as an alternative or
adjunctive approach to clinical treatment for
depression. Objective: To
determine the association of physical activity
interventions with depressive symptoms in
children and adolescents.
Data sources: PubMed, CINAHL,
PsycINFO, EMBASE, and SPORTDiscus were searched
from inception to February 2022 for relevant
studies written in English, Chinese, or Italian.
Study selection: Two independent researchers
selected studies that assessed the effects of
physical activity interventions on depressive
symptoms in children and adolescents compared
with a control condition.
Data extraction and synthesis:
A random-effects meta-analysis using Hedges g
was performed. Heterogeneity, risk of bias, and
publication bias were assessed independently by
multiple reviewers. Meta-regressions and
sensitivity analyses were conducted to
substantiate the overall results. The study
followed the PRISMA reporting guideline.
Main outcomes and measures: The
main outcome was depressive symptoms as measured
by validated depression scales at
postintervention and follow-up. Results:
Twenty-one studies involving 2441 participants
(1148 [47.0%] boys; 1293 [53.0%] girls; mean
[SD] age, 14 [3] years) were included.
Meta-analysis of the postintervention
differences revealed that physical activity
interventions were associated with a reduction
in depressive symptoms compared with the control
condition (g = -0.29; 95% CI, -0.47 to -0.10; P
= .004). Analysis of the follow-up outcomes in 4
studies revealed no differences between the
physical activity and control groups (g = -0.39;
95% CI, -1.01 to 0.24; P = .14). Moderate study
heterogeneity was detected (Q = 53.92; df = 20;
P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]).
The primary moderator analysis accounting for
total physical activity volume, study design,
participant health status, and allocation and/or
assessment concealment did not moderate the main
treatment effect. Secondary analyses
demonstrated that intervention (ie, <12 weeks
in duration, 3 times per week, unsupervised) and
participant characteristics (ie, aged ≥13 years,
with a mental illness and/or depression
diagnosis) may influence the overall treatment
effect. Conclusions and relevance: Physical
activity interventions may be used to reduce
depressive symptoms in children and adolescents.
Greater reductions in depressive symptoms were
derived from participants older than 13 years
and with a mental illness and/or depression
diagnosis. The association with physical
activity parameters such as frequency, duration,
and supervision of the sessions remains unclear
and needs further investigation.
Association of Habitual Checking Behaviors on
Social Media With Longitudinal Functional
Brain Development
Maria T Maza; Kara A Fox; Seh-Joo Kwon; Jessica
E Flannery; Kristen A Lindquist; Mitchell J
Prinstein; Eva H Telzer
JAMA Pediatr. 2023;177(2):160-167.
doi:10.1001/jamapediatrics.2022.4924.
Key Points
Question Is adolescents’ frequency of checking
behaviors on three social media platforms
(Facebook, Instagram, Snapchat) associated with
longitudinal changes in functional brain
development across adolescence. Findings: In
this cohort study of 169 sixth- and
seventh-grade students, participants who engaged
in habitual checking behaviors showed a distinct
neurodevelopmental trajectory within regions of
the brain comprising the affective salience,
motivational, and cognitive control networks in
response to anticipating social rewards and
punishments compared with those who engaged in
nonhabitual checking behaviors. Meaning: These
results suggest that habitual checking of social
media in early adolescence may be longitudinally
associated with changes in neural sensitivity to
anticipation of social rewards and punishments,
which could have implications for psychological
adjustment.
Abstract
Importance:
Social media platforms provide adolescents with
unprecedented opportunities for social
interactions during a critical developmental
period when the brain is especially sensitive to
social feedback. Objective: To
explore how adolescents’ frequency of checking
behaviors on social media platforms is
associated with longitudinal changes in
functional brain development across adolescence.
Design, Setting, and Participants:
A 3-year longitudinal cohort study of functional
magnetic resonance imaging (fMRI) among sixth-
and seventh-grade students recruited from three
public middle schools in rural North Carolina.
Exposures: At wave 1,
participants reported the frequency at which
they checked Facebook, Instagram, and Snapchat.
Main Outcome or Measure: Neural
responses to the Social Incentive Delay task
when anticipating receiving social feedback,
measured annually using fMRI for three years.
Participants saw a cue that indicated whether
the social feedback (adolescent faces with
emotional expressions) would be a reward,
punishment, or neutral; after a delay, a target
appeared and students responded by pressing a
button as quickly as possible; a display of
social feedback depended on trial type and
reaction time. Results: Of 178
participants recruited at age 12 years, 169
participants (mean [SD] age, 12.89 [0.58] years;
range, 11.93-14.52 years; 91 [53.8%] female; 38
[22.5%] Black, 60 [35.5%] Latinx, 50 [29.6%]
White, 15 [8.9%] multiracial) met the inclusion
criteria. Participants with habitual social
media checking behaviors showed lower neural
sensitivity to social anticipation at age 12
years compared with those with nonhabitual
checking behaviors in the left amygdala,
posterior insula (PI), and ventral striatum (VS;
ß, −0.22; 95% CI, −0.33 to −0.11), right
amygdala (ß, −0.19; 95% CI, −0.30 to −0.08),
right anterior insula (AI; ß −0.23; 95% CI,
−0.37 to −0.09), and left dorsolateral
prefrontal cortex (DLPFC; ß, −0.29; 95% CI,
−0.44 to −0.14). Among those with habitual
checking behaviors, there were longitudinal
increases in the left amygdala/PI/VS (ß, 0.11;
95% CI, 0.04 to 0.18), right amygdala (ß, 0.09;
95% CI, 0.02 to 0.16), right AI (ß, 0.15; 95%
CI, 0.02 to 0.20), and left DLPFC (ß, 0.19; 95%
CI, 0.05 to 0.25) during social anticipation,
whereas among those with nonhabitual checking
behaviors, longitudinal decreases were seen in
the left amygdala/PI/VS (ß, −0.12; 95% CI, −0.19
to −0.06), right amygdala (ß, −0.10; 95% CI,
−0.17 to −0.03), right AI (ß, −0.13; 95% CI,
−0.22 to −0.04), and left DLPFC (ß, −0.10, 95%
CI, −0.22 to −0.03).
Conclusions and Relevance: The
results of this cohort study suggest that social
media checking behaviors in early adolescence
may be associated with changes in the brain’s
sensitivity to social rewards and punishments.
Further research examining long-term
associations between social media use,
adolescent neural development, and psychological
adjustment is needed to understand the effects
of a ubiquitous influence on development for
today’s adolescents.
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