Measures of infant self-regulation during the first year of life: a systematic review

REVIEW ARTICLE Measures of infant self-regulation during the first year of life: A systematic review Tiago Miguel Pinto 1,2 | Bárbara Figueiredo 1 1 School of Psychology, University of Minho, Braga, Portugal 2 Lus ofona University/HEI-Lab: Digital Human-Environment Interaction Lab, Porto, Portugal Correspondence Tiago Miguel Pinto, Universidade do Minho, Escola de Psicologia, Campus de Gualtar, Braga 4700-057, Portugal Email: [email protected].pt Funding information Portuguese Foundation for Science and Technology; Portuguese Ministry of Education and Science; European Regional Development Fund, Grant/Award Number: POCI01-0145-FEDER-007653; Fundaç˜ao para a Ciência e a Tecnologia, Grant/Award Numbers: SFRH/BD/115048/2016, PTDC/ SAU/SAP/116738/2010; Foundation for Science and Technology, Grant/Award Number: UIDB/05380/2020 Abstract This study aimed to systematically review the measures used to assess infant self-regulation during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement protocol. From 235 selected papers, 79 provided information on behavioural and physiological measures to assess infant selfregulation during the first 12 months of life. Thirty-six behavioural (30 observational and 6 parent-report) and five physiological different measures were identified. Studies with a longitudinal design, comprising larger samples, and aiming to assess infant self-regulation later in infancy, mostly used behavioural measures than physiological measures. Studies comprising lower samples and aiming to assess infant self-regulation earlier in infancy, mostly used observational than parent-reported measures. Studies targeting younger infants used physiological measures and studies targeting older infants used behavioural measures, with observational measures used with younger infants and parental-reported measures used with older infants during the first year of life. When measuring self-regulation is important to consider infant's age, to fit the measurement procedures with the selfregulation development level. Received: 4 August 2022 Revised: 12 February 2023 Accepted: 15 February 2023 DOI: 10.1002/icd.2414 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Infant and Child Development published by John Wiley & Sons Ltd. Inf Child Dev. 2023;e2414. wileyonlinelibrary.com/journal/icd 1of19 https://doi.org/10.1002/icd.2414 KEYWORDS behavioural measures, infant, observational measures, parentreported measures, physiological measures, self-regulation 1|INTRODUCTION Self-regulation results from the activity of “processes that serve to modulate reactivity”(Rothbart et al., 2011, p. 442) and grants adequate behaviours and appropriate responses to situational demands (van den Bergh & Mennes, 2006). Self-regulating processes vary according to the infant's age and reactivity pattern and include orienting, fearful inhibition, angry attack, surgent or extraverted approach, and behaviour control the effort based on the executive attention system (Rothbart et al., 2011). Infants can engage in sensorimotor activities and voluntarily contact others, and this ability plays a major role in the development of self-control throughout the life cycle (Crockenberg & Leerkes, 2004; Morales et al., 2005; Rothbart et al., 2011). Empirical evidence indicated that several self-regulation processes manifested early in infancy occur at a nonconscious and automatic level (e.g., Aarts, 2007;Bargh&Morsella,2008). Behaviours manifested during the first 12 months of age, namely self-soothing and orienting, serve self-regulatory functions (Rothbart et al., 1992,2011). Orienting is an effective way of lowering the expression of negative affect, serving as a major self-regulatory mechanism (e.g., Sheese et al., 2009). Infants who can quickly disengage from distressing objects are less susceptible to negative affect and easier to soothe (Crockenberg & Leerkes, 2004;Morales et al., 2005). Self-regulation is a major developmental task in infancy. Physiological and behavioural states are progressively regulated during the first year of life (Bell & Deater-Deckard, 2007; Calkins, 2009). Infants start first to regulate their physiological states which promotes their emotional, cognitive and behavioural regulation (Calkins, 2009; Porges, 2007). Vagal inhibition in response to stress and activation during recovery from stress are both associated with effective self-regulatory behaviours, such as higher soothability (e.g., Bazhenova et al., 2001; Ham & Tronick, 2006; Stifter & Corey, 2001), while difficulties in regulating vagal tone during stressing tasks are associated with self-regulatory difficulties in later ages (e.g., El-Sheikh et al., 2009; Graziano & Derefinko, 2013). Infant selfregulation is a resource to promote further development, while self-regulation difficulties predict several adjustment problems, including internalizing and externalizing problems, lower social skills, and disrupted physiological regulation to stress (e.g., Eisenberg et al., 2004; Perry et al., 2016; Williams et al., 2016). Infant self-regulation has been distinctly conceptualized, operationalized, and measured in the literature, leading to several struggles, namely, to compare results from different studies (Bell & Deater-Deckard, 2007; Bridges et al., 2004; Cole et al., 2004; Nigg, 2017). Namely, infant self-regulation has been conceptualized and operationalized using different indicators—physiological (e.g., vagal reactivity), behavioural (e.g., orienting regulation, self-soothing, inhibition), and cognitive and emotional (e.g., effortful control). Likewise, different measures have been used to assess this construct, namely observational or parent-reported measures (Bell & Deater-Deckard, 2007; Cole et al., 2004). Assessing self-regulation early in infancy is a major issue to understand self-regulatory processes in typically developing infants and identify infants with self-regulation difficulties. A systematic review of the measures used to assess infant self-regulation can add to the literature in this field by providing evidence on the measures more adequate to assess physiological, emotional, cognitive, or behavioural regulation. This may contribute to assisting researchers and clinical practitioners to make empirically based decisions and select the most adequate measures to assess infant self-regulation at different ages and in diverse contexts and circumstances. This study aimed to systematically review the measures used to assess infant self-regulation during the first 12 months of life. 2of19 PINTO and FIGUEIREDO 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 2|METHOD This systematic review was conducted according with the standard protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement (Moher et al., 2009). 2.1 |Literature search The literature search for relevant papers was conducted on September 27, 2022 in three databases: MEDLINE, ISI Web of Knowledge, and PsycINFO. This search was conducted to identify manuscripts that referred to infant selfregulation during the first 12 months of life. The search was limited to English, Portuguese, Spanish, and French written articles, and articles conducted with human samples. The following search term was used: infant (title/abstract) AND self-regulation (title/abstract). The electronic search was first performed by one author (TMP) and then independently replicated by another author (BF). In the first stage, the titles, and the abstracts were independently analysed by two authors (TMP and BF) to identify potentially relevant manuscripts. In the second stage, the full texts of the potentially relevant articles were independently evaluated by the two authors for inclusion and exclusion criteria examination. In case of disagreement, the consensus was reached through discussion. 2.2 |Inclusion and exclusion criteria Studies were included according to the following criteria: (a) original studies; (b) studies including infants aged between 0 and 12 months; (c) and studies assessing physiological, emotional, cognitive, or behavioural regulation. Exclusion criteria included: (a) non-original research (e.g., literature reviews, systematic reviews, or meta-analysis); (b) research projects; (c) studies with a qualitative design; and (d) studies assessing self-regulation in infants above 12 months of age. 2.3 |Quality assessment The quality of all studies was assessed according to a Quality Index (QI) checklist based on the system of Downs and Black (1998). This QI is a 27-item checklist that was designed to assess the methodological quality of randomized and non-randomized studies and is comprised of five subscales. As some items did not apply to most of the revised studies, 14 from the total 27 items were selected to score the studies. Some examples of the items used are as follows: (1) “Are the main outcomes to be measured clearly described in the Introduction or Methods section?”, (2) “Were the statistical tests used to assess the main outcomes appropriate?”, and (3) “Were the main outcome measures used accurate (valid and reliable)?”All items are scored between zero and one, with exception of one item that was scored between 0 and 2. Total scores range between 0 and 15, with higher scores indicating better methodological quality. Papers scoring more than 10 were qualified as good, those scoring between seven and 10 were qualified as moderate, and those scoring less than seven were qualified as poor. 2.4 |Data extraction Data from studies that met the inclusion criteria were extracted for three data sheets (see Tables 1–3). This information was extracted by one author (TMP) and then reviewed by another author (BF). The studies were organized according to the objective of this systematic review. PINTO and FIGUEIREDO 3of19 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 3|RESULTS 3.1 |Databases search The literature search identified 235 relevant papers (after the elimination of duplicates). After the examination of titles and abstracts, 60 non-relevant papers were excluded. The full texts of the remaining 175 papers were examined for inclusion/exclusion criteria. After the full-text reading, 96 papers were excluded as they met one or more exclusion criteria, and 79 papers were included in the review (see Figure 1). 3.2 |Articles reviewed Most studies (77.2%) were conducted in the United States (n=38), or European countries (n=23), and one study was conducted both in the United States and Austria (Coyle et al., 2012). More than half of the studies presented a longitudinal design (69.6%; n=55) and assessed infant self-regulation one time across the 12 months of life (93.7%; n=7). Studies' sample size ranged between 15 and 7450 infants (Grenier et al., 2003; Radesky et al., 2014). Infant's ages ranged between 0 and 12 months (Anzman-Frasca et al., 2013; Bates et al., 2021; Cevasco-Trotter et al., 2019; Freedman et al., 2019; Sun et al., 2022; Twohig et al., 2021). A high percentage of studies were qualified as good (78.5%; n=62) and the remaining studies were qualified as moderate (see Tables 1–3). Regarding the measures to assess infant self-regulation during the first 12 months of life, most studies used only behavioural measures (81%; n=6), 12 studies (15.2%) used only physiological measures, while seven studies used both behavioural and physiological measures (8.9%). From the studies assessing infant self-regulation with behavioural measures, 46 studies (58.2%) used observational measures, 20 (25.3%) studies used parent-reported measures, and one study used both observational and parent-reported measures (Anzman-Frasca et al., 2013). A total of 41 behavioural or physiological measures were identified to assess infant self-regulation during the first 12 months of life. Overall, these measures presented good psychometric characteristics. 3.3 |Behavioural measures to assess infant self-regulation during the first year of life 3.3.1 | Observational measures Table 1summarizes the observational behavioural measures to assess infant self-regulation during the first 12 months of life. More than half of studies using observational measures had a longitudinal design (61.7%; n=29). Studies' sample size ranged between 15 and 1053 infants, M sample =183.02 infants (Grenier et al., 2003; Salisbury et al., 2007). Infant's age ranged between 0.1 and 12 months, M age =3.72 months. A total of 30 different observational measures were identified in the 47 studies, assessing self-regulation at emotional, cognitive, and behavioural levels (see Table 1). Most studies used one observational measure(89.4%; n=42). Some of the studies that used more than one observational measure assessed self-regulation more than one times in different ages across the first 12 months of life, assessing behavioural regulation in neonates and emotional and cognitive regulation later in infancy (Feldman et al., 2002; Lundqvist-Persson, 2001; Wolf et al., 2002). On the other hand, other studies used different observational measures to assess infant self-regulation at different levels—emotional, attentional, and behavioural (BrandesAitken et al., 2019; Hendry et al., 2022; Wiebe et al., 2014). The Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNS; Lester & Tronick, 2004)andthe Face-to-Face Still-Face paradigm (FFSF; Tronick et al., 1978) were the observational measures used by more studies(51.1%; n=24). The NNS was the observational measure used by more studies to assess behavioural 4of19 PINTO and FIGUEIREDO 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License TABLE 1 Observational measures to assess infant self-regulation during the first 12 months of life. Self-regulation measure First author (year of publication) Country Design N Age (months) QI Face-to-Face Still-Face paradigm Lan et al. (2022) China Cross-sectional 204 6.6 11 Face-to-Face Still-Face paradigm Abney et al. (2021) USA Cross-sectional 114 5 10 Face-to-Face Still-Face paradigm Erickson et al. (2021) Mexico Cross-sectional 50 4.6 10 Face-to-Face Still-Face paradigm Barbosa et al. (2021) Portugal Longitudinal 108 3, 9 11 Face-to-Face Still-Face paradigm Beauchamp et al. (2020) Mexico Longitudinal 100 6.9 11 Face-to-Face Still-Face paradigm Busuito et al. (2019) USA Cross-sectional 140 6 12 Face-to-Face Still-Face paradigm Conradt et al. (2015) USA Longitudinal 128 5 14 Face-to-Face Still-Face paradigm Noe et al. (2015) Germany Cross-sectional 68 3.9 11 Face-to-Face Still-Face paradigm MacLean et al. (2014) USA Cross-sectional 84 4.1 10 Face-to-Face Still-Face paradigm Chow et al. (2010) USA Longitudinal 36 6.1 8 Face-to-Face Still-Face paradigm Montirosso et al. (2010) Italy Cross-sectional 50 9.2 9 Face-to-Face Still-Face paradigm Crandell et al. (2003) UK Cross-sectional 20 2.1 8 Face-to-Face Still-Face paradigm Rosenblum et al. (2002) USA Longitudinal 100 7 10 Face-to-Face Still-Face paradigm Weinberg et al. (1999) USA Cross-sectional 81 6 9 Neonatal Intensive Care Unit Network Neurobehavioral Scale McGowan et al. (2020) USA Cross-sectional 661 0.1 11 Neonatal Intensive Care Unit Network Neurobehavioral Scale Velez et al. (2018) USA Longitudinal 41 1 10 Neonatal Intensive Care Unit Network Neurobehavioral Scale Salisbury et al. (2015) USA Longitudinal 184 1 12 Neonatal Intensive Care Unit Network Neurobehavioral Scale Stroud et al. (2016) USA Longitudinal 45 1 10 Neonatal Intensive Care Unit Network Neurobehavioral Scale Conradt et al. (2013) USA Longitudinal 482 0.3 13 Neonatal Intensive Care Unit Network Neurobehavioral Scale Pineda et al. (2013) USA Longitudinal 75 1 10 Neonatal Intensive Care Unit Network Neurobehavioral Scale Coyle et al. (2012) USA Austria Longitudinal 39 1 12 Neonatal Intensive Care Unit Network Neurobehavioral Scale Yolton et al. (2011) USA Longitudinal 318 1 13 Neonatal Intensive Care Unit Network Neurobehavioral Scale Stroud et al. (2009) USA Longitudinal 318 0.5 9 Neonatal Intensive Care Unit Network Neurobehavioral Scale Salisbury et al. (2007) USA Longitudinal 1053 1 12 (Continues) PINTO and FIGUEIREDO 5of19 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License TABLE 1 (Continued) Self-regulation measure First author (year of publication) Country Design N Age (months) QI Neonatal Behavioral Assessment Scale Shoaff et al. (2021) USA Longitudinal 370 0.5 12 Neonatal Behavioral Assessment Scale Lundqvist-Persson et al. (2012) Sweden Longitudinal 51 1 9 Neonatal Behavioral Assessment Scale HernándezMartínez et al. (2008) Spain Longitudinal 163 0.1 12 Neonatal Behavioral Assessment Scale Wolf et al. (2002) Netherlands Longitudinal 30 0.3 9 Neonatal Behavioral Assessment Scale Lundqvist-Persson (2001) Sweden Longitudinal 38 0.1 8 Neonatal Behavioral Assessment Scale Lester et al. (1996) USA Cross-sectional 44 0.1 8 Bayley Scales of Infant Development—III McManus et al. (2020) USA Longitudinal 39 3, 6 10 Bayley Scales of Infant Development—II Lundqvist-Persson et al. (2012) Sweden Longitudinal 51 3, 6 9 Bayley Scales of Infant Development—II Wolf et al. (2002) Netherlands Longitudinal 30 6 9 Free play Egmose et al. (2021) Sweden Cross-sectional 69 4 11 Free play Zhang et al. (2014) China Cross-sectional 281 6 11 Touchscreen approach Hendry et al. (2022) UK Longitudinal 115 10 11 Toy prohibition Hendry et al. (2022) UK Longitudinal 115 10 11 Touchscreen prohibition Hendry et al. (2022) UK Longitudinal 115 10 11 A-not-B task Hendry et al. (2022) UK Longitudinal 115 10 11 Early childhood inhibitory touchscreen task Hendry et al. (2022) UK Longitudinal 115 10 11 Mother-Infant Face-to-Face Interaction Coding System Kahya et al. (2022) Turkey Cross-sectional 56 4 10 Typical daily activity task Planalp et al. (2021) USA Longitudinal 682 4, 8 12 Early attention to reading situations Brandes-Aitken et al. (2019) USA Longitudinal 1204 7 14 Infant behaviour record Brandes-Aitken et al. (2019) USA Longitudinal 1204 7 14 Infant Behavior Rating Scales— Revised de l'Etoile et al. (2015) USA Cross-sectional 30 5.3 9 Tronick's Monadic phases Lin et al. (2014) USA Longitudinal 295 3 13 Newborn distress pain related behaviour coding Warnock et al. (2014) Canada Longitudinal 21 0.1 8 6of19 PINTO and FIGUEIREDO 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License regulation in neonates, M age =0.79 months, while the FFSF was the observational measure used by more studies to assess emotional and behavioural regulation in older infants, M age =5.64 months. All the studies using the FFSF measured infant self-regulation during the interaction between the infant and the mother. Besides these measures, the Neonatal Behavior Assessment Scale (NBAS; Brazelton & Nugent, 1995)andthe Bayley Scales of Infant Development—II (BSID-II; Bayley, 1993) were also used by more than one study. The NBAS was used in six studies to assess behavioural regulation in neonates, M age =0.35 months, and the BSID-II was used in three studies to assess emotional and behavioural regulation in older infants, M age =4.8 months. 3.3.2 | Parent-reported measures Table 2summarizes the parent-reported behavioural measures to assess infant self-regulation during the first 12 months of life. All the studies using parent-reported measures presented a longitudinal design. The studies' sample size ranged between 29 and 7450 infants, M sample =907.43 infants (Milgrom et al., 2015; Radesky et al., 2014). Infants' ages ranged between two and 12 months, M age =6.69 months. A total of six different parent-reported measures were identified in the 21 studies assessing emotional, cognitive, and behavioural regulation (see Table 2). All TABLE 1 (Continued) Self-regulation measure First author (year of publication) Country Design N Age (months) QI Arm Restraint task Wiebe et al. (2014) USA Longitudinal 218 6 13 Visual delayed response task Wiebe et al. (2014) USA Longitudinal 218 6 13 Novel object habituation task Wiebe et al. (2014) USA Longitudinal 218 6 13 Fagan Test of Infant Intelligence Wiebe et al. (2014) USA Longitudinal 218 6 13 Toy removal task Anzman-Frasca et al. (2013) USA Longitudinal 110 12 13 Manual for the Naturalistic Observation of Newborn Behavior Ferreira and Bergamasco (2010) Brazil Cross-sectional 32 0.5 10 Bathing task Liaw et al. (2010) Taiwan Cross-sectional 24 0.5 8 Mask presentation task Sheese et al. (2008) USA Cross-sectional 50 6.5 11 Caregiving task Grenier et al., 2003 USA Cross-sectional 15 1 9 State observation procedure Feldman et al. (2002) Israel Longitudinal 146 0.1 13 Behavior response paradigm Feldman et al. (2002) Israel Longitudinal 146 3 13 Toy exploration task Feldman et al. (2002) Israel Longitudinal 146 6 13 Infant behavioural assessment Wolf et al. (2002) Netherlands Longitudinal 30 3 9 Abbreviation: QI, quality index. PINTO and FIGUEIREDO 7of19 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License TABLE 2 Parent-reported measures to assess infant self-regulation during the first 12 months of life. Self-regulation measure First author (year of publication) Country Design N Age (months) QI Infant Behavior Questionnaire revised—very short form Ju et al. (2022) USA Longitudinal 84 3 12 Infant Behavior Questionnaire revised—short form Kajanoja et al. (2022) Finland Longitudinal 1173 6 11 Infant Behavior Questionnaire revised Mattera et al. (2022) USA Longitudinal 64 2 10 Infant Behavior Questionnaire revised—very short form Bates et al. (2021) USA Longitudinal 168 10.5 10 Infant Behavior Questionnaire revised Koenraads et al. (2021) Netherlands Longitudinal 3421 6 12 Infant Behavior Questionnaire revised Pingeton et al. (2021) USA Longitudinal 90 4 10 Infant Behavior Questionnaire revised—short form Morales-Muñoz et al. (2020) Finland Longitudinal 1415 6 12 Infant Behavior Questionnaire revised Sun et al. (2022) USA Longitudinal 166 3, 6, 12 13 Infant Behavior Questionnaire revised—short form Freedman et al. (2019) USA Longitudinal 136 12 10 Infant Behavior Questionnaire revised—Short Form Jones et al. (2018) USA Longitudinal 111 4 12 Infant Behavior Questionnaire revised Bush et al. (2017) USA Longitudinal 151 4 14 Infant Behavior Questionnaire revised van deWeijer-Bergsma et al. (2016) Netherlands Longitudinal 76 7 12 Infant Behavior Questionnaire revised Anzman-Frasca et al. (2013) USA Longitudinal 110 12 13 Infant Behavior Questionnaire revised Martinos et al. (2012) UK Longitudinal 60 7.5 10 Ages and Stages Questionnaire: Social emotional Twohig et al. (2021) Ireland Longitudinal 61 6, 12 9 Ages and Stages Questionnaire: Social emotional Milgrom et al. (2015) Australia Longitudinal 29 9 11 Ages and Stages Questionnaire: Social emotional van den Heuvel et al. (2015) Netherlands Longitudinal 90 9.7 11 Infant sleep activity record Öztürk Dönmez and Bayik Temel (2019) Turkey Longitudinal 42 1, 2, 3, 6 9 Australian Temperament Scales Williams et al. (2017) Australia Longitudinal 4109 8.8 12 Infant toddler symptom checklist Radesky et al. (2014) USA Longitudinal 7450 9 13 Regulatory disorders checklist Dale et al. (2011) USA Longitudinal 50 9 10 Abbreviation: QI =Quality index. 8of19 PINTO and FIGUEIREDO 15227219, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/icd.2414 by Cochrane Portugal, Wiley Online Library on [27/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License TABLE 3 Physiological measures to assess infant self-regulation during the first 12 months of life. Self-regulation measure First author (year of publication) Country Design N Age (months) QI Vagal regulation through respiratory sinus arrhythmia Lan et al. (2022) China Cross-sectional 204 6.6 11 Vagal regulation through respiratory sinus arrhythmia Abney et al. (2021) USA Cross-sectional 114 5 10 Vagal regulation through respiratory sinus arrhythmia Rudd et al. (2021) USA Longitudinal 60 6 10 Vagal regulation through respiratory sinus arrhythmia Lin et al. (2021) USA Longitudinal 78 2, 6 11 Vagal regulation through respiratory sinus arrhythmia Busuito et al. (2019) USA Cross-sectional 140 6 12 Vagal regulation through respiratory sinus arrhythmia Van Puyvelde et al. (2019) Belgium Cross-sectional 41 2.3 9 Vagal regulation through respiratory sinus arrhythmia Jones et al. (2018) USA Longitudinal 111 4 12 Vagal regulation through respiratory sinus arrhythmia Busuito et al. (2017) USA Cross-sectional 53 6.8 11 Vagal regulation through respiratory sinus arrhythmia Gray et al. (2017) USA Longitudinal 167 4 12 Vagal regulation through respiratory sinus arrhythmia Dale et al. (2011) USA Longitudinal 50 9 10 Vagal regulation through respiratory sinus arrhythmia Moore et al. (2009) USA Cross-sectional 152 6 13 Vagal regulation through respiratory sinus arrhythmia Lester et al. (1996) USA Cross-sectional 44 0.1 8 Heart rate variability through electrocardiogram Della Longa et al. (2021) Italy Cross-sectional 30 0.1 10 Heart rate variability through electrocardiogram Raghunath et al. (2020) Singapore Cross-sectional 24 1.9 10 Heart rate variability through electrocardiogram Busuito et al. 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