Negative Emotional Reactivity Research Articles

Associations between emotional reactivity to stress and adolescent substance use: Differences by sex and valence.

Although stress is often related to substance use, it remains unclear whether substance use is related to individual differences in how adolescents respond to stress. Therefore the present study examined associations between substance use and daily emotional reactivity to stress within a year across adolescence. Adolescents (N=330; Mage=16.40, SD=0.74 at study entry; n=186 female; n=138 Latine; n=101 European American; n=72 Asian American; n=19 identifying as another ethnicity including African American and Middle Eastern) completed a longitudinal study, including three assessments between the 10th grade and 3-years post-high school. At each assessment, participants reported frequency of alcohol and cannabis use and the number of substances they had ever used. They also completed 15 daily checklists, in which they reported the number of daily arguments and their daily emotion. Multilevel models suggested that more frequent alcohol and cannabis use were related to attenuated positive emotional reactivity to daily stress (i.e., smaller declines in positive emotion on days when they experienced more arguments) for both male and female adolescents. Associations for negative emotional reactivity to stress varied by sex; more frequent alcohol use and use of more substances in one's lifetime were related to greater anxious emotional reactivity to stress among female adolescents, whereas more frequent alcohol and cannabis use and higher lifetime substance use were related to attenuated depressive emotional reactivity to stress among male adolescents. Taken together, substance use was related to emotional reactivity to daily stress within the same year during adolescence, although associations differed by valence and adolescent sex.

Affective cognition in response to infant stimuli in pregnant compared with non-pregnant women

ABSTRACT Physiological, neurocognitive, and psychological changes facilitates adaptation to motherhood. This cross-sectional study aimed to examine differences between pregnant and non-pregnant women in affective cognitive and psychophysiological responses to infant stimuli. We hypothesized that pregnant women would display (I) reduced negative emotional reactivity and perception of distressed infant stimuli, (II) increased attention toward infants compared to adults, and (III) greater psychophysiological response to infant distress. The sample comprised 22 pregnant women (22–38 weeks gestation) and 18 non-pregnant nulliparous women. Four computerized tasks were administered to measure affective cognitive processing of infant stimuli, while recording facial expressions, electrodermal activity, and eye gazes. Results indicated that pregnant women exhibited fewer negative facial expressions, reported less frustration when exposed to distressed infant cries, and showed greater attention to emotional infant faces compared to non-pregnant women, but the differences did not remain statistically significant after correction for multiple comparisons. No differences were observed in psychophysiological responses. The findings indicate a possible pregnancy-mediated effect regarding the cognitive processing of infant stimuli, potentially as preparation for motherhood. Future research with larger samples and longitudinal design is needed to understand the predictors, timing, and plasticity of cognitive changes during pregnancy.

Mechanisms underlying food devaluation after response inhibition to food

Multiple studies reveal that a requirement to stop a response to appetitive food stimuli causes devaluation of these stimuli. However, the mechanism underlying food devaluation after stopping is still under debate. The immediate-affect theory suggests that an increase in negative affect after stopping a response is the driving force for food devaluation. A competing value-updating theory presumes that food devaluation after stopping occurs through the need to align behavior with goals. The current study assessed how food devaluation after response inhibition is influenced by negative emotional reactivity and behavior-goal alignment on a trial-by-trial basis. The study included 60 healthy participants who completed a Food-Stop-Signal-Emotion task. Participants categorized high vs. low-calorie food stimuli and stopped their response upon encountering a stop signal. Subsequently, participants made subjective negativity ratings of negative- or neutral-valenced emotional images, and rated their desire to eat the previously depicted food. In contrast to predictions made by the immediate-affect account, food devaluation after stopping was not mediated nor moderated via changes in negative emotional reactivity after stopping. In support of the value-updating account, food devaluation was modulated by behavior-goal alignment, indicated by larger food devaluation after successful vs. failed stopping. In agreement with this theory, the findings indicate that devaluation occurs more strongly when performance aligns with the task requirement. This study sheds light on the mechanism that likely underlies food devaluation after stopping. Implications regarding applied use of food-inhibition trainings are discussed.

Negative emotional reactivity and maladaptive emotional regulation strategies mediate the prospective relationship between depressive symptoms and insomnia symptoms in individuals with insomnia

BackgroundEmotional reactivity and regulation have been frequently proposed to explain the relationship between insomnia symptoms and depressive symptoms. However, no longitudinal study has examined insomnia symptoms, depressive symptoms, and emotional reactivity and regulation simultaneously and evaluated the mediating role of emotional reactivity and regulation. The current study investigated emotional reactivity and regulation as potential mediators of the relationship between insomnia symptoms and depressive symptoms in a three-wave longitudinal study over three months. MethodsNine hundred and twenty-four participants with clinically significant insomnia were recruited (ages ranging from 16 to 69 years, 72.9 % female). They filled out questionnaires that measured insomnia symptoms, depressive symptoms, emotional reactivity, and the use of emotion regulation strategies once per month for three months. ResultsThe results showed that depressive symptoms predicted insomnia symptoms (but not vice versa) via negative emotional reactivity, rumination, and catastrophizing. LimitationsThis study is limited by its attrition rate (52.9 %) and self-report measures. Participants were individuals with insomnia and mainly young, educated adults, so the generalizability of the findings to other populations might also be limited. ConclusionsThese novel findings highlighted the importance of targeting emotional processes in assessing and treating individuals with insomnia and depression.

Evaluating the indirect roles of anxiety and depressive symptoms in the relations between negative emotional reactivity to racial/ethnic stress and cigarette smoking among Hispanic adults who smoke.

There has been increased recognition that Hispanic/Latinx (hereinafter Hispanic) persons are a tobacco disparities group in the United States. Although some past work has found greater exposure to racial/ethnic discrimination is associated with indices of smoking among Hispanic persons, research has not explored the degree of negative emotional reactivity to racial/ethnic stress in terms of smoking processes. The present cross-sectional study served to evaluate the indirect effects of depressive and anxiety symptoms in terms of relations between racial/ethnic stress reactivity and cigarette dependence, severity of problems when trying to quit, and perceived barriers for quitting among Hispanic persons who smoke in the United States. Participants included 329 Hispanic adults who smoked cigarettes daily (Mage = 35.5 years; SD = 8.67; 37.4% female). Results indicated that depressive symptoms exerted a statistically significant indirect effect in the association between negative emotional reactivity to racial/ethnic stress and cigarette dependence and severity of problems when trying to quit, whereas anxiety symptoms maintained an indirect effect for perceived barriers for smoking cessation. The current findings help characterize the intricacies by which negative emotional reactivity to racial/ethnic stress is related to smoking behavior and beliefs among Hispanic persons who smoke. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

DHEA: a neglected biological signal that may affect fetal and child development.

The stress-sensitive maternal hypothalamic-pituitary-adrenal (HPA) axis through the end-product cortisol, represents a primary pathway through which maternal experience shapes fetal development with long-term consequences for child neurodevelopment. However, there is another HPA axis end-product that has been widely ignored in the study of human pregnancy. The synthesis and release of dehydroepiandosterone (DHEA) is similar to cortisol, so it is a plausible, but neglected, biological signal that may influence fetal neurodevelopment. DHEA also may interact with cortisol to determine developmental outcomes. Surprisingly, there is virtually nothing known about human fetal exposure to prenatal maternal DHEA and offspring neurodevelopment. The current study examined, for the first time, the joint impact of fetal exposure to prenatal maternal DHEA and cortisol on infant emotional reactivity. Participants were 124 mother-infant dyads. DHEA and cortisol were measured from maternal hair at 15 weeks (early gestation) and 35 weeks (late gestation). Observational assessments of positive and negative emotional reactivity were obtained in the laboratory when the infants were 6 months old. Pearson correlations were used to examine the associations between prenatal maternal cortisol, prenatal maternal DHEA, and infant positive and negative emotional reactivity. Moderation analyses were conducted to investigate whether DHEA might modify the association between cortisol and emotional reactivity. Higher levels of both early and late gestation maternal DHEA were linked to greater infant positive emotional reactivity. Elevated late gestation maternal cortisol was associated with greater negative emotional reactivity. Finally, the association between fetal cortisol exposure and infant emotional reactivity was only observed when DHEA was low. These new observations indicate that DHEA is a potential maternal biological signal involved in prenatal programming. It appears to act both independently and jointly with cortisol to determine a child's emotional reactivity. Its role as a primary end-product of the HPA axis, coupled with the newly documented associations with prenatal development shown here, strongly calls for the inclusion of DHEA in future investigations of fetal programming.

Age-related emotional advantages in encountering novel situation in daily life.

People encounter novel situations throughout their lives that contribute to the acquisition of knowledge and experience. However, novelty can be misaligned with goals and motivation in later adulthood according to socioemotional selectivity theory. This study investigated age differences in emotional reactions associated with novel experiences. Multilevel structural equation models were used to analyze experience-sampling data obtained from an adult sample of 375 participants aged 18-94 years who reported their current situation and momentary emotional experience five times per day for 7 days. On occasions where situations were rated as more novel, people reported reduced positive and increased negative emotion. Those who had more overall exposure to novel situations tended to have more negative emotional experiences in general. Contrary to our hypothesis, there were age differences in individuals' negative emotional reactivity to situations that are perceived as more novel, such that novel situations were reported as less negative among older adults. By applying theoretical understanding of age differences in motivation and well-being in adulthood, our findings illuminate aspects of situations that elicit negative emotions. Findings highlight age-related benefits in emotional well-being, consistent with socioemotional selectivity theory postulates, and further implies that older adults may not be novelty averse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Negative Emotional Reactivity and Somatic Symptoms during Adolescence Predict Adult Health and Wellbeing in Early and Middle Adulthood

Longitudinal research is lacking with respect to how negative emotional reactivity and somatic symptoms during adolescence set the stage for later health. The aim of this longitudinal study was to examine within-person associations between negative emotional reactivity and somatic symptoms during adolescence and their effects on health and wellbeing in adulthood. Participants (N = 1527; 48.3% female) were assessed annually at the age of 12 to 16 years and at the age of 35 and 45 years. Adolescents with frequent somatic symptoms reported higher reactivity. Individual differences in levels and changes of somatic symptoms and reactivity were independently associated with adult health and wellbeing decades later. The findings underscore the importance of considering how individual differences change during adolescent development.

Is irritability multidimensional: Psychometrics of The Irritability and Dysregulation of Emotion Scale (TIDES-13).

Irritability is a common, impairing, and potentially multifaceted manifestation of psychopathology. We designed The Irritability and Dysregulation of Emotion Scale (TIDES-13) to determine whether various expressions of irritability in children and youth form multiple subdimensions with distinct correlates. We administered parent-report (n=3875, mean age=8.9) and youth self-report (n=579, mean age=15.1) versions of TIDES-13 in a population and community-based sample. We conducted exploratory/confirmatory factor analyses and regression analyses to examine the dimensionality of TIDES-13 and the associations of the scale with age, gender, anxiety, depression, ODD, ADHD traits, and the Affective Reactivity Index (ARI). A higher-order model with a global irritability dimension and four subdimensions, including proneness to anger (PA), internalized negative emotional reactivity (iNER), externalized negative emotional reactivity (eNER), and reactive aggression (RA), showed good to excellent fit in both parent-report and self-report. The global irritability dimension showed excellent internal reliability (⍵Total; parent-report=0.97, ⍵Total; self-report=0.95), explained a majority of the item variance (⍵Hierarchical; parent-report=0.94, ⍵Hierarchical; self-report=0.90), and was moderately correlated with the ARI (rparent=0.68, rself=0.77). Subdimensions PA, eNER, and RA were negatively associated with age in males, whereas iNER was positively associated with age in females. Traits of ODD and ADHD were associated primarily with the global irritability dimension, whereas iNER was strongly associated with anxiety and depression traits over and above the global irritability dimension. Our results support a unidimensional interpretation of irritability in a population sample. However, limited evidence of specific behavioral, age, and sex correlates with particular irritability subdimensions may warrant further investigation.

Parents’ emotion socialization beliefs over the first four months of children’s cancer treatment: a pilot longitudinal study

ABSTRACT In this pilot study, we longitudinally investigated parents’ coaching and dismissing emotion socialization (ES) belief changes over the first four months of children’s cancer treatment. Children were 1–18 years old, M(SD) = 7.66(5.26), at enrollment. We also investigated whether parents’ negative emotion intensity or reactivity moderated changes. We collected data at chemotherapy commencement, one month later, and four months later. We used hierarchical linear models to investigate study aims. Parents reported decreased emotion coaching beliefs over time but did not change their emotion dismissing beliefs. Parents’ perceptions of their own emotional intensity and reactivity were unrelated to ES beliefs or ES belief changes. These findings could inform future intervention efforts to decrease children’s adjustment difficulties and/or promote resilience during pediatric cancer treatment. Our findings also shed light on mechanisms of ES belief change because the intensity and reactivity of parents’ own negative emotions did not explain significant variance in their beliefs about their child’s ability to manage emotions during early cancer treatment.

Vocabulary size predicts behavioral problems in emotionally reactive children

Internalizing and externalizing behavioral problems place children at an increased risk for low academic achievement and socioemotional maladjustment. Children's language skills and level of emotional reactivity have been shown to predict behavioral problems later in development. Yet, there is an absence of research investigating vocabulary by negative emotionality interactions with respect to the development of behavioral problems during early childhood. Our study sought to fill this gap by examining whether the relation between preschool (age 3) vocabulary size and internalizing/externalizing problems during the early school years (age 6) is moderated by preschool negative emotional reactivity, even after controlling for preschool behavioral problems as well as children's socioeconomic background. Longitudinal data was collected from 256 typically developing children (129 girls, 75% White) and their mothers (64% held a college degree). Linear regression analyses revealed moderate rank-order stability in children's internalizing and externalizing problems across this period of development. Evidence of an interaction effect emerged in both the internalizing and externalizing problems regression models. That is, age 3 vocabulary was negatively related to age 6 behavioral problems, but only among children exhibiting higher levels of negative emotional reactivity. Our results indicate that early vocabulary acquisition may serve as a buffer against adverse behavioral outcomes in children with a natural propensity toward expressing negative emotions. These findings point to a more nuanced picture of the relations between language, emotional reactivity, and behavioral problems in childhood, which are discussed in greater detail to inform future intervention and educational research.

Emotions under control? Better cognitive control is associated with reduced negative emotionality but increased negative emotional reactivity within individuals.

Associations between impaired cognitive control and maladaptive emotion regulation have been extensively studied between individuals. However, it remains unclear if this relationship holds within individuals. In this study, we tested the assumption that momentary within-person fluctuation in cognitive control (working memory updating and response inhibition) is associated with emotional reactivity in everyday life. We conducted an experience sampling study (eight two-hourly prompts daily) where participants repeatedly performed short 2-back and Go/no-go tasks in daily life. We assessed negative and positive affective states, and unpleasantness of a recent event to capture emotional reactivity. We analyzed two overlapping samples: a Go/no-go and a 2-back dataset (N = 161/158). Our results showed that better momentary working memory updating was associated with decreased negative affect if the recent event was on average unpleasant for the given individual. However, better-than-average working memory updating in interaction with higher event-unpleasantness predicted higher negative affect levels (i.e., higher negative emotional reactivity). These findings may challenge the account of better cognitive control being universally related to adaptive emotion regulation. Although it is unlikely that emotional reactivity boosts working memory, future studies should establish the direction of causality.

Young Children's Temperament and Their Emerging Prejudice Against Stuttering

Purpose: The purpose of the present study was to determine whether typically developing children's temperament is associated with their awareness and emerging prejudice against stuttering. Method: The emotional reactivity and emotion regulation of 42 typically developing 3- to 7-year-old children were assessed using parent report of temperament (i.e., Children's Behavioral Questionnaire). Children viewed a video of two puppets, one with fluent speech and the other with nonfluent speech. Children were prompted to answer questions to assess their awareness of stuttering as well as their preference for fluent speech and negative evaluation of stuttering, with the latter two being combined to index children's emerging prejudice against stuttering. Results: Findings indicated that typically developing children's positive emotional reactivity was significantly associated with their verbally expressed awareness of stuttering. In addition, children's higher negative emotional reactivity was significantly associated with greater emerging prejudice against stuttering. Conclusion: Findings were taken to suggest that young typically developing children's emotional reactivity may play an important role in developing awareness of stuttering and prejudice against stuttering in their early years.

The Relationship Between Interpersonal Sensitivity and Emotion Regulation in Youths

Abstract: Background: In clinical psychology, interpersonal sensitivity is defined as a vulnerability to perceived signs of rejection in interpersonal situations; it plays an important role in the development of psychopathology, especially mood disorders. We investigated the relationship between interpersonal sensitivity, emotion-regulation strategies, and emotional reactivity in a group of youths without mental health issues. Method: Participants ( N = 231, 46 men, 185 women, 18–25 years old) were recruited from online groups focusing on education, social activism, and psychological self-help. Measures: Interpersonal Sensitivity Measure, Perth Emotional Reactivity Scale, and Emotion Regulation Questionnaire. Results: Negative emotional reactivity predicted all dimensions of interpersonal sensitivity. Positive emotional reactivity negatively predicted fear of rejection and dependence on the opinion of others. Only expressive suppression predicted the fear of rejection. Activation and intensity of negative emotions moderated the link between expressive suppression and fear of rejection. The Interpersonal Sensitivity subscales predicted negative emotional reactivity and expressive suppression. Discussion: The present study corroborates and broadens the results of previous studies that utilized rejection sensitivity – a narrower construct than interpersonal sensitivity. Expressive suppression and emotional reactivity emerge as differential predictors of individual dimensions of interpersonal sensitivity.

Social problem solving moderates emotion reactivity in predicting suicide ideation among college students

Objective: To evaluate the hypothesis that social problem solving (SPS) moderates strong emotion reactivity (ER) to stressful events in predicting suicide ideation (SI). Participants: 200 college students: mean age = 20.33; 75% women; 58% white. Methods: Participants completed the following self-report inventories: Beck Scale for Suicide Ideation, Emotion Reactivity Scale, and Social Problem-Solving Inventory-Revised. Results: Regression and slope analyses found SPS to moderate the association between ER and SI. Specifically, (a) as ER increased, SI increased significantly less for average problem solvers as compared to ineffective problem solvers, and (b) SI increased only slightly for effective problem solvers as ER increased. A secondary exploratory analysis found 20 college students who previously attempted suicide reported more negative ER, less effective SPS, and higher SI, as compared to a group of 20 sex-and age-matched peers. Conclusions: Effective social problem solving serves to decrease the likelihood that college students will experience higher levels of suicide ideation even when their negative emotion reactivity is high. Clinical implications for treatment and prevention are discussed.

Application of attentional bias modification to reduce attentional bias and emotional reactivity to stress in mildly depressed individuals.

This study aims to verify the effectiveness of attentional bias modification (ABM) in reducing attentional bias related to depression, particularly in the later stages of attention as a pattern of difficulty in disengagement from depression-relevant stimuli, and to assess its effects on emotional reactivity to stress. A total of 78 participants were separated into four groups based on their levels of depression (minimal and mild) and the types of ABM. The positive ABM (pABM) trained participants to disengage their attention from depression-relevant stimuli and directed their attention toward more positive stimuli, whereas the neutral ABM (nABM) was designed to have no effect. The participants underwent a free-viewing task by eye tracker both before and after ABM to observe changes in attentional bias. Subsequently, they reported their emotional response after a stress-inducing task. The group of mildly depressed participants receiving pABM showed significantly less attention to depression-relevant negative affective stimuli and reported significantly decreased negative emotional reactivity to stress compared to the other groups. pABM had an effect on decreasing difficulty in disengaging from depression-relevant negative affective words (DW). However, it did not increase the dwell time on positive affective words (PW) in the current study. This might be due to the short duration of the application of ABM. The current study conducted ABM twice in 1 day, and this might not be enough to increase the dwell time on PA. This study verified that the ABM effectively decreased the attentional bias of depression and its relevant symptom, emotional reactivity to stress.

The Application of the Metacognitive Model of Desire Thinking and Craving in Problematic Social Networking Sites Use

Cognitive models of addictive behaviours have highlighted the central role of Desire Thinking (DT) – a conscious and voluntary cognitive process orienting to prefigure images and information about a positive target-related experience – in increasing craving and maintaining addictive behaviors. The metacognitive model of DT and craving posits that metacognition plays a central role in understanding dysregulation in DT. The current study aims to test the role of metacognitions about DT, DT, and craving in the relationship between Fear of Missing Out (FoMo), boredom proneness, negative emotional reactivity and Problematic Social Network Sites Use (PSNSU). A sample of 529 participants (Mage= 32.45 ± 13.33; F = 62.9%) completed an online survey. The hypothesised model produced an adequate fit to the data and accounted for 86% of PSNSU variance. FoMO predicted positive metacognitions about DT (PMDT), which predicted DT that, in association with craving, predicted PSNSU. Boredom proneness positively predicted PSNSU directly and indirectly through the serial mediation of PMDT, DT, and craving. A direct path between negative emotional reactivity and PSNSU was found. The current findings provide preliminary evidence for applying the metacognitive model of DT and craving in PSNSU. PMDT and DT may be central cognitive processes in craving and PSNSU for individuals who experience boredom proneness and FoMo.

Corticolimbic structural connectivity encapsulates real-world emotional reactivity andhappiness.

Emotional reactivity to everyday events predicts happiness, but the neural circuits underlying this relationship remain incompletely understood. Here, we combined experience sampling methods and diffusion magnetic resonance imaging to examine the association among corticolimbic structural connectivity, real-world emotional reactivity and daily experiences of happiness from 79 young adults (35 females). Participants recorded momentary assessments of emotional and happiness experiences five times a day for a week, approximately 2weeks after brain scanning. Model-based emotional reactivity scores, which index the degree to which moment-to-moment affective state varies with the occurrence of positive or negative events, were computed. Results showed that stronger microstructural integrity of the uncinate fasciculus and the external capsule was associated with both greater positive and negative emotional reactivity scores. The relationship between these fiber tracts and experienced happiness was explained by emotional reactivity. Importantly, this indirect effect was observed for emotional reactivity to positive but not negative real-world events. Our findings suggest that the corticolimbic circuits supporting socioemotional functions are associated with emotional reactivity and happiness in the real world.

An Integrative Model of Youth Anxiety: Cognitive-Affective Processes and Parenting in Developmental Context.

Multiple theoretical frameworks have been proposed to provide a more comprehensive picture of the risk factors that influence anxiety-related developmental trajectories. Nonetheless, there remains a need for an integrative model that outlines: (1) which risk factors may be most pertinent at different points in development, and (2) how parenting may maintain, exacerbate, or attenuate an affective style that is characterized by high negative emotional reactivity to unfamiliar, uncertain, and threatening situations. A developmentally informed, integrative model has the potential to guide treatment development and delivery, which is critical to reducing the public health burden associated with these disorders. This paper outlines a model integrating research on many well-established risk mechanisms for anxiety disorders, focusing on (1) the developmental progression from emotional reactivity constructs early in life to those involving higher-level cognitive processes later in youth, and (2) potential pathways by which parenting may impact the stability of youth's cognitive-affective responses to threat-relevant information across development.

B - 71 Neurocognitive and Self-Reported Psychosocial and Behavioural Functioning in Siblings of Individuals with Neurodevelopmental Conditions: a Study Using Remote Self-Administered Testing.

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs), and associations between objective test performance and self-reported psychosocial functioning. Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88years, range 11-27years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15months. NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20). Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualised prevention and intervention for NDC siblings.