Department of Psychology

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Open Access
Distinct Trajectories of Caregiver-Toddler Physiological Attunement During Routine Vaccinations
(2023-05) DiLorenzo, Miranda G.; Waxman, Jordana A.; Flora, David B.; Schmidt, Louis A.; Garfield, Hartley; Weinberg, Eitan; Savlov, Deena
Introduction: Toddlers rely on their caregivers for regulatory support when faced with pain-related distress. The caregiver's ability to support their toddler relies on their capacity to regulate their own distress and respond effectively to the child's need for support. The aim of the current study was to describe patterns of caregiver–toddler physiological co-regulatory patterns, also known as attunement, during routine vaccinations across the second year of life. Methods: Caregiver–toddler dyads (N = 189) were part of a longitudinal cohort observed at either 12-, 18-, or 24-month well-baby vaccinations. Parallel-process growth-mixture modeling was used to examine patterns of dyadic physiological co-regulatory responses, indexed by high-frequency heart rate variability (HF-HRV). Results: Three groups of dyads were discerned. The largest group (approximately 80%) demonstrated physiological attunement, with a stable and parallel regulatory pattern of HF-HRV from baseline to postneedle. The second group (7.9%) had parallel regulatory trajectories but with notably lower (ie, less regulated) HF-HRV values, which indicates independent regulatory responses (ie, a lack of attunement among dyad members). The third group (11.1%) showed diverging regulatory trajectories: Caregivers showed a stable regulatory trajectory, but toddlers demonstrated a steep decrease followed by an increase in HF-HRV values that surpassed their baseline levels by the third minute postneedle. Post hoc analyses with the HF-HRV groupings explored heart rate patterns and potential predictors. Conclusions: These findings elucidate potential adaptive and maladaptive co-regulatory parasympathetic patterns in an acute pain context.
Open Access
Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination
(2023-07) Garfied, Hartley; Weinburg, Eitan; Savlov, Deena
Objective: Previous research discerned three groups of caregiver-toddler dyads that differed in their physiological co-regulatory patterns, also known as physiological attunement, during routine vaccinations in the second year of life. One group of dyads (80% of sample) displayed an attuned regulatory pattern and two groups of dyads (20% of sample) showed maladaptive attunement patterns (i.e., a lack of attunement or misattunement). The objective of the current study was to examine how well pain-related distress of children and caregivers during vaccination predicted these patterns. Methods: Caregiver-toddler dyads (N = 189) were part of a longitudinal cohort observed at either 12-, 18-, or 24-month vaccination appointments. Caregiver self-report of worry was assessed before and after the needle and child behavioural pain-related distress was also measured during the vaccination appointment. Logistic regression was used to determine how well these variables predicted caregiver-child physiological attunement patterns, as indexed by high-frequency heart rate variability. Results: Higher behavioural pain-related distress at various timepoints after the needle were associated with membership in the dyad groups that showed misattunement or lack of attunement. Further, caregivers with higher pre-needle worry and lower post-needle worry had a greater likelihood of belonging to groups that showed a maladaptive attunement pattern. Discussion: Findings suggest that caregivers who experience distress associated with their toddlers' vaccination experience more difficulty co-regulating with their child during vaccination, and these children are at risk of experiencing higher levels of pain related distress. This research highlights the need to help caregivers support their children's regulation during vaccination.
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Characterizing heterogeneity among people who use cannabis for medicinal reasons: A latent class analysis of a nationally representative Canadian sample
(Elsevier, 2023-07) Coelho, Sophie G.; Wardell, Jeffrey D.
Background: Many individuals who use cannabis report doing so for medicinal reasons. Few studies have explored heterogeneity within this population, which may be important to inform targeted interventions. This study used latent class analysis to identify subgroups of people who use cannabis for medicinal reasons and their sociodemographic and cannabis-risk-related correlates. Method: Data came from the 2019 Canadian Alcohol and Drugs Survey, which is a representative survey of Canadians ages 15 years and older. Data from 814 individuals reporting past-year use of cannabis for medicinal or mixed medicinal and non-medicinal reasons were included. Latent class analysis was conducted with forms of cannabis used, cannabis use frequency, concurrent non-medicinal cannabis use, and the medical conditions and symptoms cannabis was used to manage as indicators. Results: Four distinct latent classes of medicinal cannabis use were identified: a non-daily cannabis flower for mental health and sleep class (39.56% of the sample), a non-daily cannabis flower for pain class (26.41% of the sample), a non-daily cannabis oil for physical health class (20.15% of the sample), and a daily multi-form cannabis for mental health and non-medical reasons class (13.88% of the sample). Sociodemographic factors and risk level for cannabis-related harms were associated with latent class membership. Conclusions: Results of this study reveal considerable heterogeneity among people reporting medicinal cannabis use and suggest that the distinct patterns of cannabis use behaviors and motives observed may be important for understanding risk for cannabis-related harms in this population. Findings underscore a need for harm reduction interventions tailored toward specific patterns of medicinal cannabis use.
Open Access
Daily associations between cannabis use and alcohol use among people who use cannabis for both medicinal and nonmedicinal reasons: Substitution or complementarity?
(American Psychological Association, 2023-04-20) Coelho, Sophie G.; Hendershot, Christian S.; Rueda, Sergio; Wardell, Jeffrey D.
Objective: People who use cannabis for medicinal (versus nonmedicinal) reasons report greater cannabis use and lower alcohol use, which may reflect a cannabis–alcohol substitution effect in this population. However, it is unclear whether cannabis is used as a substitute or complement to alcohol at the day level among people who use cannabis for both medicinal and nonmedicinal reasons. This study used ecological momentary assessment (EMA) to examine this question. Method: Participants (N = 66; 53.1% men; mean age 33 years) completed daily surveys assessing previous-day reasons for cannabis use (medicinal versus nonmedicinal), cannabis consumption (both number of different types of cannabis used and grams of cannabis flower used), and number of standard drinks consumed. Results: Multilevel models revealed that, in general, greater cannabis consumption on a given day was associated with greater same-day alcohol use. Further, days during which cannabis was used for medicinal (versus exclusively nonmedicinal) reasons were associated with reduced consumption of both cannabis and alcohol. Finally, the day-level association between medicinal reasons for cannabis use and lower alcohol consumption was mediated by using fewer grams of cannabis on medicinal cannabis use days. Conclusions: Day-level cannabis-alcohol associations may be complementary rather than substitutive among people who use cannabis for both medicinal and nonmedicinal reasons, and lower (rather than greater) cannabis consumption on medicinal use days may explain the link between medicinal reasons for cannabis use and reduced alcohol use. Still, these individuals may use greater amounts of both cannabis and alcohol when using cannabis for exclusively nonmedicinal reasons.
Open Access
Out of the Mouth of Babes: A Lot about Pain has Nothing to Do with Pain
(2022-08-12) Pillai Riddell, Rebecca; Jasim, Sara; Hamwi, Lojain
Despite centuries of research focused on elucidating answers regarding pain, research continues to progress without a definitive essential characterization. Using research from the largest longitudinal studies to date studying the development of acute pain responses over the first five years of life, the current paper reviews four key lessons about understanding pain that resonate across the lifespan. First, it is argued that early social relationships may fundamentally influence anticipatory threat appraisals that modulate pain perception. Second, evidence is presented that managing acute pain may be more about what one does not do, than what one does. Third, to optimally manage pain-related distress, it is best to manage distress before the pain. Finally, the last lesson sets out to encourage a healthy distrust of when individuals report on another’s pain. Ironically, deciphering the fundamental mysteries that define pain requires studying factors beyond pain.
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Correlates of self-reported medicinal cannabis use for physical health, mental health, and sleep-related conditions in a population-based survey of Canadian youth
(2022-07-19) Wardell, Jeffrey D.
Objective: Medicinal cannabis use (MCU) among youth is correlated with frequent cannabis use and several substance use and health-related indicators. This study examined whether correlates of self-reported MCU among youth varied as a function of the primary health condition for which cannabis is used. Method: Data came from the 2017 Canadian Tobacco, Alcohol, and Drugs Survey. Youth (ages 15-24) who reported past year cannabis use were included in analyses. Regression analyses (controlling for age and sex) compared youth reporting only non-medicinal cannabis use (NMCU-only, n=2082) to youth reporting MCU primarily for physical health conditions (n=227), mental health conditions (n=271), or insomnia (n=98). Results: Relative to youth reporting NMCU-only, youth reporting MCU for physical or mental health conditions had greater odds of reporting daily cannabis use, cannabis problems, vaporization and oral ingestion of cannabis, and tobacco use. Youth reporting MCU for physical health reasons also had greater odds of both illicit drug use and prescription pain medication use, whereas youth reporting MCU for mental health reasons had greater odds of prescription sedative use. Youth reporting MCU for insomnia only had greater odds of cannabis problems relative to youth in the NMCU-only group. Youth in both the physical health and mental health MCU groups reported poorer health and mental health compared with the NMCU-only group. Some, but not all, differences were accounted for by greater frequency of cannabis use among youth reporting MCU. Conclusions: Findings provide new insight into the correlates of MCU among youth in the general population, suggesting that these correlates vary as a function of the primary reason for MCU.
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Disentangling medicinal and recreational cannabis use among people living with HIV: An ecological momentary assessment study
(Springer, 2022-11-07) Wardell, Jeffrey D.; Rueda, Sergio; Fox, Nicolle; Costiniuk, Cecilia T.; Jenabian, Mohammad-Ali; Margolese, Shari; Madarino, Enrico; Shuper, Paul A.; Hendershot, Christian S.; Cunningham, John A.; Arbess, Gordon; Singer, Joel
This study examined the feasibility of using ecological momentary assessment (EMA) to disentangle medicinal cannabis use (MCU) from recreational cannabis use (RCU) among people living HIV (PLWH). Over a 14-day period, PLWH (N=29) who engage in both MCU and RCU completed a smartphone-based survey before and after every cannabis use event assessing general motivation for cannabis use (MCU-only, RCU-only, or mixed MCU/RCU), cannabis use behavior, and several antecedents and outcomes of cannabis use. A total of 739 pre-cannabis surveys were completed, and 590 (80%) of the prompted post-cannabis surveys were completed. Motives for cannabis use were reported as MCU-only on 24%, RCU-only on 30%, and mixed MCU/RCU on 46% of pre-cannabis surveys. Mixed effects models examined within-person differences across MCU-only, RCU-only, and mixed MCU/RCU events. Results showed that relative to RCU-only events, MCU-only events were more likely to involve symptom management and drug substitution motives, physical and sleep-related symptoms, solitary cannabis use, and use of cannabis oils and sprays; MCU-only events were less likely to involve relaxation, happiness, and wellness motives, cannabis flower use, and positive cannabis consequences. Differences between mixed MCU/RCU and RCU-only events were similar, except that mixed MCU/RCU events were additionally associated with stress reduction motives and current symptoms of anxiety and depression. Findings support the feasibility of partially disentangling MCU and RCU behavior among PLWH who engage in concurrent MCU and RCU. This study highlights the need for more within-person EMA research to inform ongoing changes to cannabis policies.
Open Access
Set of questionnaires used in the Autism Summer Employment Program. Paper title: Autism Summer Employment Program: An Evaluation of a Community-Based Pilot Program
(2022) Porthukaran, Alex
This appendix contains questionnaires that were used as part of the Autism Summer Employment Program. Some of the results from this program have been accepted for publication at the Journal on Developmental Disabilities and a link will be provided when the paper is published. These questionnaires were used to collect background information, and to determine program eligibility, program success, and employer satisfaction with the participants from the program.
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Measuring impaired control over cannabis use: Initial evaluation of the Impaired Control Scale-Cannabis (ICS-C)
(Taylor & Francis, 2022-05-27) Taguba, Korina Kaye; Keough, Matthew T.; Bravo, Adrian J.; Wardell, Jeffrey D.
Background: Impaired control is a central concept in addiction. Impaired control over alcohol has been associated with heavy drinking and alcohol-related problems in young adults, but there is less research on impaired control over cannabis. Currently, there is no validated self-report instrument that comprehensively assesses impaired control over cannabis use. This study examined the factor structure, reliability, and validity of a new measure, the Impaired Control Scale-Cannabis (ICS-C), which was adapted from the Impaired Control Scale (ICS) for alcohol (Heather et. al, 1993). Method: The sample consisted of students at two Canadian universities who reported past-month cannabis use (N=362; 63% women; 66% White, mean age=19.91). Participants completed an online survey including the ICS-C and ICS, along with measures of cannabis use, cannabis problems, alcohol use, impulsivity, and self-regulation. Results: After trimming problematic and redundant items, the final exploratory factor analysis of the ICS-C items yielded two factors: Attempted Control (attempts to control cannabis use) and Failed Control (unsuccessful attempts to limit cannabis use). High correlations between the ICS-C subscales and the Impaired Control subscale of the Marijuana Consequences Questionnaire provided evidence for convergent validity. Support for concurrent and discriminant validity was observed in the associations of the ICS-C subscales with cannabis use, cannabis problems, impulsivity, self-regulation, alcohol use, and the alcohol ICS. Conclusions: The ICS-C is a promising tool for assessing impaired control over cannabis in young adults. Future research should further validate the ICS-C and examine its potential clinical utility for identifying individuals at risk for cannabis use disorder.
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Association of the Fatty Acid Amide Hydrolase C385A Polymorphism with Alcohol Use Severity and Coping Motives in Heavy-drinking Youth
(2021-03-15) Best, Laura M.; Wardell, Jeffrey D.; Tyndale, Rachel F.; McPhee, Matthew D.; Le Foll, Bernard; Kish, Stephen J.; Boileau, Isabelle; Hendershot, Christian S.
Background: Reduced function of fatty acid amide hydrolase, the catabolic enzyme for the endocannabinoid anandamide, can be inherited through a functional genetic polymorphism (FAAH rs324420, C385A, P129T). The minor (A) allele has been associated with reduced FAAH enzyme activity and increased risk for substance use disorders in adults. Whether this inherited difference in endocannabinoid metabolism relates to alcohol use disorder etiology and patterns of alcohol use in youth is unknown. Methods: To examine this question, heavy-drinking youth (n = 302; mean age = 19.74 ± 1.18) were genotyped for FAAH C385A. All subjects completed a comprehensive interview assessing alcohol use patterns including the Timeline Follow-back Method, Alcohol Use Disorders Identification Test (AUDIT) and Drinking Motives Questionnaire. ANCOVAs were conducted to assess differences in drinking patterns and drinking motives between genotype groups, and mediation analyses investigated whether drinking motives accounted for indirect associations of genotype with alcohol use severity. Results: Youth with the FAAH minor allele (AC or AA genotype) reported significantly more frequent drinking days (p=0.045), significantly more frequent heavy episodic drinking (p=0.003) and significantly higher consumption patterns (AUDIT p=0.045, AUDIT-C p=0.02). Mediation analyses suggested that the association of FAAH C385A with drinking outcomes was mediated by coping motives. Conclusions: These findings extend previous studies by suggesting that reduced endocannabinoid metabolism may be related to heavier use of alcohol in youth, prior to the onset of chronic drinking problems. Furthermore, differences in negative reinforcement-related drinking might account in part for this association.
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Shame’s Associations with Depression and Problem Drinking: An Ecological Momentary Study
(Taylor & Francis, 2021-07-12) Bilevicius, Elena; Kempe, Tyler; Pankratz, Lily; Wardell, Jeffrey D.; Johnson, Edward A.; Keough, Matthew T.
Introduction: Depression and problem drinking are comorbid in emerging adulthood, yet the processes that link them are not well understood. Research has argued that shame has a unique influence on the experience of problematic drinking, but this has rarely been assessed at the state level. Using ecological momentary assessments (EMAs), we assessed whether shame, and not guilt, mediated the association between baseline depression and alcohol use and problems. Methods: One hundred and eighty-four emerging adults (Mage = 19.27) completed a 12-day EMA study. Multilevel models were used to test hypotheses. Results: In a model with alcohol use as the outcome, there were no significant associations between shame or guilt and alcohol use at the within- or between-subjects level. In a model with alcohol problems as the outcome, guilt was positively associated with alcohol problems but only at the daily level. At the between-subjects level and after controlling for guilt, there was a significant association between depression, shame, and alcohol problems; average levels of shame mediated the association between depression and alcohol problems. In post-hoc reverse directionality models, average alcohol problems mediated the relationship between depression and shame and guilt at the between-person level. No mediation was present for alcohol use. Conclusion: After controlling for guilt, shame is an emotion that helps explain risk for alcohol problems among depressed emerging adults, which has implications for targeted interventions. Reciprocal associations between shame, guilt, and alcohol problems emerged highlighting the need for more fulsome assessments of shame and guilt in future EMA research.
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Daily associations between cannabis use and alcohol use in young adults: The moderating role of self-report and behavioral measures of impulsivity
(Taylor & Francis, 2021-07-09) Daros, Alexander R.; Pereira, Brian J.; Khan, Dinat; Ruocco, Anthony C.; Quilty, Lena C.; Wardell, Jeffrey D.
Although impulsivity has been implicated in cannabis and alcohol use, its role in alcohol and cannabis co-use behavior use requires further study. We examined the moderating role of self-report and behavioral measures of impulsivity in the daily-level relationships between cannabis use and both (a) likelihood of same-day alcohol use and (b) number of drinks consumed on the same day. Young adults (N=153) completed a 90-day Timeline Follow Back assessing the amount of cannabis smoked (in grams), other forms of cannabis (e.g., oils, edibles), and number of standard drinks consumed each day. Participants also completed a structured interview of Alcohol and Cannabis Use Disorders (AUD/CUD), and both self-report (UPPS impulsivity scales) and behavioral (behavioral disinhibition and delay discounting) measures of impulsivity. Zero-inflated multilevel modelling revealed that negative urgency, delay discounting, and disinhibition were significant, unique moderators of the daily relationship between cannabis and alcohol consumption, after controlling for AUD/CUD symptoms and other covariates. Specifically, individuals high (but not low) on negative urgency and delay discounting showed a positive association between grams of cannabis used on a given day and same-day number of standard drinks consumed. Contrary to expectations, individuals low on negative urgency and low in disinhibition showed a stronger relationship between grams of cannabis consumed and odds of engaging in any drinking on the same day. Results extend research on moderators of within-person, daily-level associations between cannabis and alcohol use, suggesting that several impulsivity-related constructs may contribute to complementary use of cannabis and alcohol among young adults.
Open Access
The longitudinal and concurrent relationship between caregiver sensitivity and preschool attachment: A systematic review and meta-analysis
(PLOS ONE, 2021-01) O'Neill, Monica; Badovinac, Shaylea; Pillai Riddell, Rebecca; Bureau, Jean-Francois; Rumeo, Carla; Costa, Stefano
The present study aimed to systematically review and meta-analyze the concurrent and longitudinal relationship between caregiver sensitivity and preschool attachment measured using the Main and Cassidy (1988) and Cassidy and Marvin (1992) attachment classification systems. This review was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO; Registration Number CRD42017073417) and completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The present review identified 36 studies made up of 21 samples (N = 3, 847) examining the relationship between caregiver sensitivity and preschool attachment. Eight primary meta-analyses were conducted separately according to the proximity of the assessment of sensitivity to attachment (i.e., concurrent versus longitudinal), operationalization of caregiver sensitivity (i.e., unidimensional versus multidimensional) and attachment categorizations (i.e., secure-insecure versus organized-disorganized). Overall, the metaanalyses revealed higher levels of caregiver sensitivity among caregivers with secure and organized preschoolers, relative to insecure and disorganized preschoolers, respectively. Medium effect sizes (g = .46 to .59) were found for both longitudinal and concurrent associations between caregiver sensitivity and preschool attachment when a unidimensional measure of caregiver sensitivity was employed, compared to small to medium effect sizes (g = .34 to .49) when a multidimensional measure of caregiver sensitivity was employed. Child age at attachment measurement was a significant moderator of the longitudinal association between unidimensional caregiver sensitivity and preschool attachment. Future directions for the literature and clinical implications are discussed.
Open Access
Associations between early childhood parent-child attachment and internalizing/externalizing symptoms: A systematic review and narrative synthesis
(Marriage & Family Review, 2021-03-22) Badovinac, Shaylea; Pillai Riddell, Rebecca; Deneault, Audrey-Ann; Martin, Jodi; O'Neill, Monica
Open Access
Caregiver and Young Child Biological Attunement In Distress Contexts: A Systematic Review and Narrative Synthesis
(Neuroscience and Biobehavioral Reviews, 2021) DiLorenzo, Miranda; Bucsea, Oana; Rumeo, Carla; Waxman, Jordana; Flora, David; Schmidt, Louis; Pillai Riddell, Rebecca
Open Access
Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies
(Frontiers in Pediatrics, 2021-10) Shiff, Ilana; Pillai Riddell, Rebecca; Bucsea, Oana
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Getting high to cope with COVID-19: Modelling the associations between cannabis demand, coping motives, and cannabis use and problems
(Elsevier, 2021-08-21) Vedelago, L; Wardell, J.D.; Kempe, T; Patel, H; Amlung, M; MacKillop, J; Keough, M.T.
During the COVID-19 pandemic, people may use substances like cannabis for enhancement or coping purposes. Behavioral economic demand for a substance is a key determinant of its use and misuse and can be measured via hypothetical purchase tasks. Previous research suggests that motivations to use a substance play a mediational role between elevated substance demand and problems, but comparable mechanistic research has yet to be done in the COVID-19 context and on the effects of cannabis demand on cannabis use patterns. Participants (n = 137) were recruited via the online crowdsourcing platform Prolific. Participants completed measures of cannabis use and problems, motivations for cannabis use, and the Marijuana Purchase Task. Two indices of demand, Persistence (i.e., sensitivity to increasing cost of cannabis) and Amplitude (i.e., consumption of cannabis at unrestricted cost), were related to increased cannabis problems via the use motive of coping during the COVID-19 pandemic. This model did not support the mediational role of enhancement motives. Those with increased cannabis demand who tend to use cannabis to cope are at increased risk of experiencing negative cannabis-related consequences during the COVID-19 pandemic.
Open Access
Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol problems
(Wiley, 2020-09) Wardell, Jeffrey; Kempe, Tyler; Rapinda, Karli; Single, Alanna; Bilevicius, Elena; Frohlich, Jona; Hendershot, Christian; Keough, Matthew
Background: The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. Methods: Participants (N = 320; 54.6% male; mean age 32 years old) were Canadian adult drinkers who completed an online survey assessing work- and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within one month of the initiation of the COVID-19 emergency response. Results: The results of a theory-informed path model showed that having at least one child under age 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from living with children, depression, social connectedness, income loss, and living alone were all supported. Conclusions: Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer-term outcomes of drinking to cope during the pandemic.
Open Access
Child distress expression and regulation behaviors: A systematic review and meta-analysis
(2021-07-15) Gennis, Hannah; Bucsea, Oana; Badovinac, Shaylea; Costa, Stefano; McMurtry, C. Meghan; Flora, David; Pillai Riddell, Rebecca
Open Access
Trajectories of distress regulation during preschool vaccinations: child and caregiver predictors
(PAIN, 2021) Shiff, Ilana; Pillai Riddell, Rebecca; Garfield, Hartley; Greenberg, Saul

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