Development Of Emotion Regulation Research Articles

Social and Communication Development in Infants with Isolated Agenesis of the Corpus Callosum

ObjectiveTo evaluate the development of social behavior, communication, emotion regulation, and repetitive behaviors in infants with congenital malformation of the corpus callosum, specifically those with isolated Agenesis of the Corpus Callosum (ACC) in comparison to typically developing infants. Study DesignThis case-control longitudinal observation study examined parent report of social behavior, social-communication, emotion regulation, and repetitive behavior development in community ascertained infants (n = 156) and infants with isolated ACC (n = 57) between 12 and 24 months of age. ResultsInfants with isolated ACC produced fewer words at 12- (p = 0.003) 18- (p < 0.001), and 24-months of age (p = 0.003), and fewer gestures at 12- (p < 0.001), 18- (p < 0.001), and 24-months of age (p < 0.001). In addition, the ACC group demonstrated delays in reciprocal social behavior at 18-months (p = 0.01) and social competence at 12- (p < 0.001) and 18-months (p = 0.01). No concerns were noted in emotion regulation or restricted and repetitive behavior and social behavior appears to normalize at 24 months. ConclusionsExisting data suggests heterogeneity in developmental outcomes among individuals with isolated ACC. The current findings fill a gap in knowledge about development in the second year of life. Surveillance of social and communication ability in infants with ACC may be warranted. The role of the corpus callosum in facilitating rapid interhemispheric information processing impacts skills beyond the motor system. More work is needed to identify intervention targets for infants and toddlers with ACC.

Adverse childhood experiences and insecure attachment: The indirect effects of dissociation and emotion regulation difficulties.

Difficulties with dissociation and emotion regulation are well-documented reactions to early adverse childhood experiences (ACEs). Although findings identify dissociation and emotion dysregulation as explaining the relationship between various forms of ACEs and adult psychopathology, less is known about their combined effect in the relationship between ACEs and insecure attachment in adulthood. This study examined the indirect effects of dissociation and emotion regulation difficulties in the relationship between early adverse experiences and insecure attachment traits. Participants (N = 260) completed an online questionnaire measuring ACEs, dissociation, emotion regulation difficulties, and anxious and avoidant attachment. Results indicated that, after controlling for mental health treatment, dissociation and emotion regulation difficulties explained the relationship between ACEs and insecure (anxious and avoidant) attachment. Emotion regulation difficulties were not a significant predictor of avoidant attachment. Findings provide support for greater research on mediating factors in the maintenance of insecure attachment across development and potential implications of dissociation and emotion regulation in clinical and nonclinical populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The association of maternal-infant interactive behavior, dyadic frontal alpha asymmetry, and maternal anxiety in a smartphone-adapted still face paradigm

Mother-infant interactions form a strong basis for emotion regulation development in infants. These interactions can be affected by various factors, including maternal postnatal anxiety. Electroencephalography (EEG) hyperscanning allows for simultaneous assessment of mother-infant brain-to-behavior association during stressful events, such as the still-face paradigm (SFP). This study aimed at investigating dyadic interactive behavior and brain-to-behavior association across SFP and identifying neural correlates of mother-infant interactions in the context of maternal postnatal anxiety. We measured frontal alpha asymmetry (FAA), a physiological correlate of emotion regulation and a potential marker of risk for psychopathology. To emulate real-life interactions, EEG and behavioral data were collected from 38 mother-infant dyads during a smartphone-adapted dual-SFP. Although the behavioral data showed a clear still-face effect for the smartphone-adapted SFP, this was not reflected in the infant or maternal FAA. Brain-to-behavior data showed higher infant negative affect being associated with more infant leftward FAA during the still-face episodes. Finally, mothers with higher postnatal anxiety showed more right FAA during the first still-face episode, suggesting negative affectivity and a need to withdraw from the situation. Our results form a baseline for further research assessing the effects of maternal postnatal anxiety on infants’ FAA and dyadic interactive behavior.

Gender Differences in the Function of Music for Emotion Regulation Development in Everyday Life: An Experience Sampling Method Study

The present study employed experience sampling methodology (ESM) to examine the role of music in regulating emotions and the potential differences in music usage for emotion regulation between men and women in everyday life. The study spanned over seven days, including both weekdays and weekends, during which 28 participants (14 men and 14 women) were asked to complete a brief questionnaire 21 times a day. The questionnaire aimed to document instances of music listening in the past three hours, resulting in a total of 588 questionnaires being sent and 264 instances of music listening being analysed. Results indicate that listening to music in daily life may have a positive impact on emotion regulation and suggest possible differences in music usage between men and women for this purpose. The study's primary findings include: (1) Relaxation was the most commonly used strategy for regulating emotions with music; (2) Four primary mechanisms of music usage for emotion regulation, including emotion type, familiarity, and content of music, were found to be essential; (3) Listening to music was an effective emotion regulation strategy, particularly for regulating happiness and peacefulness; (4) Men were more likely to use music for active coping and to consider the type and content of music when selecting music; and (5) Music appeared to regulate the intensity of emotions similarly for both men and women, although men tended to report higher emotional intensity.

Interactive synchrony and infants' vagal tone as an index of emotion regulation: associations within each mother- and father-infant dyad and across dyads.

Studies have shown that infants' emotion regulation capacities are closely linked to the quality of parent-infant interactions. However, these links have been mostly studied in mother-infant dyads and less is known about how the quality of father-infant interactions contributes to the development of emotion regulation during infancy. In this study, we aimed to investigate the links between interactive synchrony (i.e., an index of the quality of parent-infant coordination of interactive behaviors) and infants' vagal tone (i.e., a physiological index of emotion regulation). To understand the respective contributions of both parents, as well as the interrelations between the functioning of both dyads within a family, we observed mothers and fathers from 84 families interacting with their infants. Synchrony was assessed by using the CARE-Index; infants' vagal tone was derived from the analysis of infants' electrocardiograms recorded during the interactions. Moreover, to take the play's order into account, we counterbalanced the procedure, so that approximately half of the mothers played first. We specified a first structural equation modeling (SEM) model to investigate the associations between interactive synchrony and the infants' root mean square of successive differences (RMSSD), an index of vagal regulation, in the two successive parts of the play. We conducted a multigroup analysis in a second SEM model to investigate the associations of the first SEM model in two groups based on the order of interaction. The results of the SEM models showed that greater synchrony was related to greater infant RMSSD within mother-infant dyads and across one dyad to the other dyad in the full sample and in the group of fathers who interacted first with the infants. The associations between synchrony and infant vagal tone within father-infant dyads never appeared to be significant, nor did any associations within each dyad and across dyads when mothers interacted first. This study highlights that the links between interactions and infants' vagal tone are sensitive to family members' interdependencies and some conditions (the order of interaction).

Theory of Mind, Roles, and the Development of Emotion Regulation in Early Childhood

The ability to regulate children's emotions is the basis for psychosocial development which is the key to future success, and they can quickly adapt to other people or situations that may not always be comfortable for them. Theory of mind (ToM) is a construct used to describe the ability to interpret other people's mental states, which then develops into the ability to empathize. This study examines how the theory of mind contributes to the development of emotion regulation in children aged 4, 5, and 6 years. This research used a quasi-experimental design to find the effect of ToM stimulation on children's emotional regulation. 109 respondents were selected using a purposive sampling technique. The scales used in this research are the PreBers scale to examine children's emotional regulation and the ToM scale. The research results showed that the influence of ToM development on children's emotional regulation was 52.4%. The results of this research highlight that the better the child acquires a Theory of Mind, the better the development of the child's emotional regulation. Furthermore, these findings are significant for early childhood education providers to develop programs to optimize ToM acquisition from childhood.&#x0D; Keywords: theory of mind, empathy, emotion regulation, children aged 4, 5, and 6 years&#x0D;

Perezhivanie: An investigation into drama and emotions as children enter a conceptual Playworld

A growing number of studies have investigated play in early childhood education, with some bringing forward the development of emotions in imaginary play situations. Of significance, is the creative pedagogy of play developed by Lindqvist (1995) who drew on a cultural-historical concept of play to bring forward emotions in Playworld. This paper investigates how children experience different perezhivanie within the Playworld settings in Indonesia. The cultural-historical concept of play, perezhivanie, and the social situation of development are used to understand how a 4-year-old boy experienced contradictions during collective imaginary play. Eight hours of digital-visual observation data selected from 98 h of group-play activities were used to show how nine teachers interacted with 38 children during the play (3.5 to 5 years old, mean age 4.4 years). The findings show how the cultural device used in the Playworld provides rich opportunities and conditions for children to experience different emotions in play, and where a dynamic perezhivanie emerges through the contributions of the play partners to the play that results in development of emotional regulation. By drawing attention to children's perezhivanie, Playworld can be seen as a promising play pedagogy that offers rich social interactions in play that support children's development.

Research Review: Child emotion regulation mediatesthe association between family factors andinternalizing symptoms in children and adolescents - a meta-analysis.

Parental influence on children's internalizing symptoms has been well established; however, little is known about the underlying mechanisms. One possible mechanism is child emotion regulation given evidence (a) of its associations with internalizing symptoms and (b) that the development of emotion regulation during childhood and adolescence is influenced by aspects of the family environment. This meta-analysis aimed to systematically investigate the mediating role of child emotion regulation in the relationship between various family factors and internalizing symptoms in children and adolescents. We searched Medline, Embase, PsychInfo, and Web of Science for English articles up until November 2022. We included studies that examined child emotion regulation as a mediator between a family factor and child/adolescent internalizing symptoms. Random-effects models were used to calculate pooled indirect effects and total effects for nine family factors. Heterogeneity and mediation ratio were also calculated. Of 49 studies with 24,524 participants in this meta-analysis, family factors for which emotion regulation mediated the association with child/adolescent internalizing symptoms included: unsupportive emotion socialization, psychological control, secure attachment, aversiveness, family conflict, parent emotion regulation and parent psychopathology, but not supportive emotion socialization and behavioral control. Various family factors impact children's emotion regulation development, and in turn, contribute to the risk of internalizing symptoms in young people. Findings from this study highlight the need for interventions targeting modifiable parenting behaviors to promote healthy emotion regulation and better mental health in children and adolescents.

Persistent Primitive Reflex and Developmental Delay in the School-Aged Child

Primitive reflexes are an integral part of a newborn’s survival mechanism and will naturally integrate during the first years of life as more mature postural reflexes emerge. A persistent primitive reflex can interfere with the development of motor skills, cognitive processing, and emotional regulation. Research suggests an association between persistent primitive reflexes and neurodevelopmental delays such as learning disabilities, autism spectrum disorders, and processing disorders. Developmental surveillance and screening support early recognition and guide intervention. More research is needed regarding the usefulness of reflex integration techniques for improving motor, cognitive, and emotional functioning and better overall quality of life.

The role of digital art in treating students with functional cognitive disorders

BackgroundFunctional Cognitive disorders are a common neurodevelopmental disorder that negatively affects students’ learning and social skills. Digital art as an innovative therapeutic approach has aroused wide interest in the field of psychology, but its therapeutic effect in identifying functional cognitive disorders is still unclear.Subjects and MethodsThe subjects of this study were 60 middle school students diagnosed with functional cognitive disorders. They were randomly divided into two groups. One group received digital art communication therapy, and the other group received regular rehabilitation training as a control group. The treatment period was 12 weeks, three times a week. SPSS23.0 was used for data analysis, including descriptive statistics and correlation analysis before and after treatment.ResultsResults showed that students in the Digital Arts Communication group showed significant improvement in identifying functional cognitive disorders. After treatment, the average recognition accuracy of the digital art group increased from 60% before treatment to 80% after treatment. Correlation analysis results showed that there was a significant positive correlation between digital art communication and cognitive ability (r = 0.70, P&lt; 0.05).ConclusionsThrough statistical analysis with SPSS23.0, this study identified the effectiveness of digital art communication as a therapeutic tool for improving students’ identification of functional cognitive disorders. Digital art communication therapy can enhance students’ cognitive ability and have a positive impact on the development of emotional regulation and social skills. Therefore, digital art communication has potential in the treatment of identifying functional cognitive disorders.

Altered Gut Microbiota Composition Is Associated with Difficulty in Explicit Emotion Regulation in Young Children.

Executive function (EF) consists of explicit emotion regulation (EER) and cognitive control (CC). Childhood EER in particular predicts mental and physical health in adulthood. Identifying factors affecting EER development has implications for lifelong physical and mental health. Gut microbiota (GM) has attracted attention as a potential biomarker for risk of physical and mental problems in adulthood. Furthermore, GM is related to brain function/structure, which plays a crucial role in emotional processing. However, little is known about how GM compositions are associated with the development of emotion regulation in early childhood. Therefore, in this study, we examined 257 children aged 3-4 to investigate links between GM and risk to EF. EF was measured using the Mother-Reported Behavior Rating Inventory of Executive Function-Preschool version. GM composition (alpha/beta diversity and genus abundance) was evaluated using 16S rRNA gene sequencing and compared between EF-risk and non-risk groups. Our results show that children with EER-risk (an index of inhibitory self-control) had a higher abundance of the genera Actinomyces and Sutterella. Although we have not established a direct link between GM and CC risk, our findings indicate that GM of preschoolers is closely associated with emotional processing and that EERrisk children have more inflammation-related bacteria.

Reducing alexithymia and increasing interoceptive awareness: A randomized controlled trial comparing mindfulness with dyadic socio-emotional app-based practice

BackgroundEmotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, the differential efficacy of brief scalable digital mental trainings remains understudied. MethodsThis randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. ResultsBoth interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. LimitationsGiven the subclinical study sample, findings are limited in their generalizability to clinical samples. ConclusionsFindings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.

Maternal recognition of positive emotion predicts sensitive parenting in infancy.

Research on parent-child relationships demonstrates the importance of maternal sensitivity for the development of children's emotion regulation, social competence, and health; thus, it is important to understand the emotional-cognitive capacities underlying maternal sensitivity. We followed 120 mothers and their full-term infants from the newborn period to 5 months postpartum. Mothers' emotion recognition during the newborn period was measured using a validated facial emotion recognition task assessing discrimination (d') of six facial expressions of emotion: happiness, fear, anger, sadness, disgust, and neutrality. Maternal behavior at 5 months postpartum was coded from a mother-infant free-play session using Ainsworth's Sensitivity Scales. Preregistered analyses revealed that mothers' ability to detect happiness specifically (but not other emotions such as fear or sadness) in the neonatal period predicted greater observed sensitivity 4 months later, β = .30, p = .002, ΔR² = .08. Results suggest that maternal recognition of positive emotion may be uniquely predictive of sensitive behavior in low-stress parent-infant interaction contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional Experience and Consequences of Growing Up in a Family with Alcoholism in Adult Children of Alcoholics

Adult children of alcoholics are adults who spent a part of, or their whole childhood in a dysfunctional family, where the biggest problem was alcohol addiction in one or both parents. In families with parental alcoholism, there is usually a lot of dysfunction in interpersonal relationships and in the upbringing of the children, which does not provide a healthy and optimal developmental environment for the child. There is often physical and psychological violence, and other forms of abuse and neglect that children perceive as traumatic. All this leaves the child with severe consequences, which they also struggle with in adulthood. Unresolved and traumatic childhood content often remains repressed and unprocessed and helps shape one’s functioning in adulthood, which is frequently emotionally and socially immature. Adult children of alcoholics often have problems in experiencing and regulating their emotions, as they had to carry many emotional burdens in a dysfunctional family, while they had no real opportunity for the healthy development of emotional regulation. The article will present research on the emotional experience of children with their alcoholic parents and how they recognize related consequences in their adult lives. Using the content analysis method, we analyzed 71 anonymous forum posts on the counselling forum on the topic “Adult children of alcoholics.” The directed approach to content analysis was used to validate forum posts by people who described their childhood experiences with an alcoholic parent. We identified parts of the content that fell into two predetermined categories: emotional experience in childhood with an alcoholic parent and the experience of its consequences in adulthood. The results showed that the adult children of alcoholics mostly experienced severe feelings of fear, shame, sadness and disgust with their alcoholic parents in their childhood, and that these feelings have remained unprocessed. In adulthood, they struggle with negative consequences in the personal sphere (e.g. poor self-esteem, inferiority, anxiety, depression), in interpersonal relationships (e.g. problems in partnerships, mistrust, social phobia, parental stress, complicated relationships with parents) and in everyday functioning (e.g. coping with one’s own addiction, dysfunctional behavioural patterns), but they also recognize that because of this experience they have managed to lay the foundations of their lives differently and better. The results confirm that children are hidden victims of parental alcoholism and justify the need for psychosocial and therapeutic support even in their adulthood.

Emotional Regulation Play Therapy for Maltreated Children: A Single Case Study

Aggressive children's behavior can arise from the child's inability to regulate the emotions that are felt as a result of the violence they have experienced as one form of maltreatment. This study aims to see how Emotional Regulation Play Therapy affects the behavior of maltreated children. This study was a quasi-experiment with a single case pre-test and post-test design. The participant of this study was a 10 years old boy with physical abuse and neglect history. Emotional Regulation Play Therapy consists of 5 therapy sessions based on emotional regulation development steps by Knell (2009). Measurement of emotional regulation ability was carried out using the Emotional Regulation Questionnaire for Child and Adolescence (ERQ-CA) developed by Gullone and Taffe (2011). The measurement results show an increase in the ERQ-CA score by 19 points accompanied by an increase in the ability to regulate emotion which is described qualitatively.

A Randomized Controlled Trial of a Parenting Intervention During Infancy Alters Amygdala-Prefrontal Circuitry in Middle Childhood

Early adverse parenting predicts various negative outcomes, including psychopathology and altered development. Animal work suggests that adverse parenting might change amygdala-prefrontal cortex (PFC) circuitry, but work in humans remains correlational. The present study leveraged data from a randomized controlled trial examining the efficacy of an early parenting intervention targeting parental nurturance and sensitivity (Attachment and Biobehavioral Catch-up [ABC]) to test whether early parenting quality causally affects amygdala-PFC connectivity later in life. Participants (N= 60, mean age= 10.0 years) included 41 high-risk children whose parents were referred by Child Protective Services and randomly assigned to receive either ABC (n= 21) or a control intervention (n= 20) during the children's infancy and a comparison sample of low-risk children (n= 19). Amygdala-PFC connectivity was assessed via functional magnetic resonance imaging while children viewed fearful and neutral faces. Across facial expressions, ABC produced different changes than the control intervention in amygdala-PFC connectivity in response to faces. The ABC group also exhibited greater responses than the control intervention group to faces in areas classically associated with emotion regulation, including the orbitofrontal cortex and right insula. Mediation analysis suggested that the effect of ABC on PFC activation was mediated by the intervention's effect on amygdala-PFC connectivity. Results provide preliminary causal evidence for the effect of early parenting intervention on amygdala-PFC connectivity and on PFC responses to face viewing. Findings also highlight amygdala-PFC connectivity as a potential mediator of the effects of early parenting intervention on children's emotion regulation development. Intervening Early With Neglected Children; https://clinicaltrials.gov/; NCT02093052. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Development and validation of the Interpersonal Emotion Regulation for Couples Scale (SIERC) in the Spanish population

Antecedents Interpersonal emotional regulation (IER) is the deliberate attempt to influence others’ emotions. There is not enough research on IER in the context of romantic couples. Aim The aim of the present study was to develop and validate an instrument to assess couples’ IER and understanding its functioning at both an individual and dyadic level. Method Participants were 764 adults and 91 dyads. Three studies were carried out: first, to study the psychometric properties of the scale and its validity; second, to understand the functioning of the scale at a dyadic level; third, to analyse the predictive capacity of the instrument. Results Our 11-item scale has four factors: observe, ask, validate, and soothe feelings. These factors are doubly evaluated: as an agent (SIERC-A) and as a target (SIERC-B). The scale showed good psychometric properties and adequate internal consistency. It presents convergent validity with emotional competences, and divergent validity with emotional dysregulation and insecure attachment. At a dyadic level, there is an actor-partner effect of IER on couple adjustment. Finally, IER seems to predict relationship satisfaction, sexual satisfaction, and life satisfaction. Discussion This new instrument can be a useful tool for assessment and intervention in couple therapy and research.

The development of emotion regulation in adolescence: What do we know and where to go next?

AbstractEmotion regulation is critical for adolescent functioning. Theories on the subject have evolved rapidly in recent years and have led to a more contextualized and dynamic conceptualization of emotion regulation processes. In this paper, based on the distinction between emotion regulation strategies and abilities, we propose future directions for research on emotion regulation development in adolescence. We first present evidence that emotional, cognitive, and social changes that occur in adolescence are central in emotion regulation development. We then review empirical findings on emotion regulation development by tying them to their conceptual foundations. We discuss their limitations and argue that building better conceptual clarity is essential to study emotion regulation. Because current knowledge on recent concepts that emerged in adult‐based models remains limited and contested in adolescence, we end this article by discussing new research perspectives to provide a better understanding of the topic. We stress the need for researchers in the field to adopt a more contextualized and person‐oriented approach, to combine different time scales and methods, and examine the predictors of emotion regulation as well as its outcomes.

Maternal socialization of emotion and the development of emotion regulation in early adolescent girls.

Regulation of negative emotions is a core competency of child development. Parental emotion socialization profoundly influences later capacity to regulate negative affect in childhood and adolescence. The present study examined the effects of maternal emotion socialization on the development of emotion regulation in the context of a longitudinal study of 210 mother-daughter dyads. Dyads completed a conflict resolution task when the child was age 11 years during which maternal warmth and hostility were coded. At ages 11 to 13 years, mothers completed self-report measures of supportive and nonsupportive responses to child negative emotion, and children completed self-reports of inhibition and adaptive regulation of sadness and anger. We used latent growth curve modeling to estimate changes in inhibition and adaptive regulation of sadness and anger over time; observed maternal warmth and hostility were included as time-invariant covariates and maternal self-report of supportive and nonsupportive responses were included as time-varying covariates. Observed maternal warmth was positively associated with girls' adaptive regulation of anger and sadness at age 11 years. Maternal self-reported supportive responses to girls' negative affect were positively associated with girls' adaptive regulation of anger, and nonsupportive responses were negatively associated with adaptive regulation of anger and sadness. These findings support the role of maternal emotion socialization and indicate specific effects of maternal warmth and supportive responses in the development of girls' capacity to modulate negative emotions during early adolescence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using machine learning to identify early predictors of adolescent emotion regulation development.

As 20% of adolescents develop emotion regulation difficulties, it is important to identify important early predictors thereof. Using the machine learning algorithm SEM-forests, we ranked the importance of (87) candidate variables assessed at age 13 in predicting quadratic latent trajectory models of emotion regulation development from age 14 to 18. Participants were 497 Dutch families. Results indicated that the most important predictors were individual differences (e.g., in personality), aspects of relationship quality and conflict behaviors with parents and peers, and internalizing and externalizing problems. Relatively less important were demographics, bullying, delinquency, substance use, and specific parenting practices-although negative parenting practices ranked higher than positive ones. We discuss implications for theory and interventions, and present an open source risk assessment tool, ERRATA.