Elsevier

Biological Psychology

Volume 94, Issue 1, September 2013, Pages 22-37
Biological Psychology

Review article
Cardiac vagal control and children's adaptive functioning: A meta-analysis

https://doi.org/10.1016/j.biopsycho.2013.04.011Get rights and content

Highlights

  • We examined RSA withdrawal and children's adaptive functioning outcomes.

  • RSA withdrawal was associated with fewer externalizing and internalizing problems.

  • RSA withdrawal was associated with fewer cognitive/academic problems.

  • RSA withdrawal was associated with fewer social problems for healthy samples.

  • Lower levels of RSA withdrawal were found among clinical/at-risk samples.

Abstract

Polyvagal theory has influenced research on the role of cardiac vagal control, indexed by respiratory sinus arrhythmia withdrawal (RSA-W) during challenging states, in children's self-regulation. However, it remains unclear how well RSA-W predicts adaptive functioning (AF) outcomes and whether certain caveats of measuring RSA (e.g., respiration) significantly impact these associations. A meta-analysis of 44 studies (n = 4996 children) revealed small effect sizes such that greater levels of RSA-W were related to fewer externalizing, internalizing, and cognitive/academic problems. In contrast, RSA-W was differentially related to children's social problems according to sample type (community vs. clinical/at-risk). The relations between RSA-W and children's AF outcomes were stronger among studies that co-varied baseline RSA and in Caucasian children (no effect was found for respiration). Children from clinical/at-risk samples displayed lower levels of baseline RSA and RSA-W compared to children from community samples. Theoretical/practical implications for the study of cardiac vagal control are discussed.

Section snippets

Vagal withdrawal and social functioning

Perhaps the most widely cited area of adaptive functioning in which the role of vagal withdrawal has been implicated is within the social domain. As noted by Porges (2003a), social interactions arguably require considerable neural and physiological involvement due to the range of tasks required for a successful interaction (e.g., ability to maintain eye contact/gaze with another person, attend to his/her vocalizations/language, interpret his/her vocalizations/language, observe his/her facial

Vagal withdrawal and externalizing behavior problems

Vagal withdrawal is also thought to facilitate metabolic and regulatory processes important for attention and behavioral control strategies. Children with externalizing behavior problems such as aggression, hyperactivity, and inattention are more likely to have emotion regulation and behavioral control difficulties such as impulsivity (Gilliom and Shaw, 2004, Keenan and Shaw, 2003). A pattern of physiological dysregulation in the form of both lower sympathetic activity and lower levels of vagal

Vagal withdrawal and cognitive/academic problems

Negative emotionality is known to interfere with higher order cognitive processes such as executive functioning (Blair, 2002, Posner and Rothbart, 2007). The physiological mechanism responsible for such interference remains relatively understudied in children, although there is a well-documented overlap in the brain structures (e.g., anterior cingulated cortex and orbitofrontal cortex) responsible for regulating both emotions and higher order cognitive processes (Bush et al., 2000, Levesque et

Vagal withdrawal and internalizing problems

The role of vagal withdrawal in contributing to internalizing problems is perhaps the least understood and examined adaptive functioning domain. Some researchers have suggested that an extreme vagal withdrawal response contributes to a sense of over vigilance and one in which the individual is paying too much attention to potential threats in the environment. Such an over reactivity contributes to physical and cognitive internalizing symptoms such as stress/anxiety and worry (Thayer & Lane, 2000

Measurement issues associated with RSA

There is a significant debate over the methodology that is required to accurately measure children's RSA as an estimate of vagal tone (see Allen et al., 2007, Denver et al., 2007, Grossman and Taylor, 2007 for thorough reviews). Studies vary on how RSA is quantified with some using spectral analysis (Miskovic et al., 2009, Scheinin et al., 1999, Wolff et al., 2012) while others use time-domain peak valley analysis (El-Sheikh and Whitson, 2006, Hinnant and El-Sheikh, 2009, Willemen et al., 2009)

Goals of the current meta-analysis

In summary, while vagal withdrawal has emerged as a biological marker for children's emotion regulation abilities, it remains unclear the extent to which it equally predicts various adaptive functioning domains. From a developmental psychopathology perspective, it is important to understand whether vagal withdrawal deficits act as a broad risk factor for various maladaptive outcomes or only certain ones. It is also important to note that several caveats for measuring RSA has been recently

Literature review

We conducted a comprehensive search for empirical research regarding the relation between RSA withdrawal and children's adaptive functioning outcomes over the last 25 years (since the early publications leading to Polyvagal theory), using PsychINFO (1986–2012), Science Citation Index Expanded (1986–2012), Social Sciences Citation Index (1986–2012), Arts & Humanities Citation Index (1986–2012), Google Scholar (1986–2012), and MEDLINE (1986–2012). The terms used in the search included RSA

Primary analyses

Study identification information, coded categories, and ESs representing the relation between RSA withdrawal scores and children's adaptive functioning outcomes can be found in Table 1. The relation between RSA withdrawal and measures of children's externalizing problems had a weighted ES of r = −.16 (95% CI = −.19 to −.12, p = .001), indicating a small negative effect. Similarly, the relation between RSA withdrawal and measures of children's internalizing problems had a weighted ES of r = −.16 (95% CI =

Discussion

Given emerging research over the last 20 years regarding the importance of the parasympathetic branch of the autonomic nervous system (ANS), as indexed by cardiac vagal control or RSA withdrawal, in children's emotion regulation development, we sought to determine the extent to which such a biological marker is associated with more complex adaptive functioning outcomes across domains. We also sought to examine measurement issues that have recently been highlighted (Allen et al., 2007, Denver et

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