Journal of Experimental Child Psychology 184 (2019) 192–209

Contents lists available at ScienceDirect

Journal of Experimental Child

Psychology
journal homepage: www.elsevier.com/locate/jecp

Sustained attention in infancy: A foundation

for the development of multiple aspects of
self-regulation for children in poverty
Annie Brandes-Aitken ⇑, Stephen Braren, Margaret Swingler,
Kristin Voegtline, Clancy Blair
Department of Applied Psychology, New York University, New York, NY 10012, USA

a r t i c l e i n f o a b s t r a c t

Article history: There are many avenues by which early life poverty relates to the
Received 11 October 2018 development of school readiness. Few studies, however, have
Revised 9 April 2019 examined the extent to which sustained attention, a central com-
Available online 3 May 2019
ponent of self-regulation in infancy, mediates relations between
poverty-related risk and cognitive and emotional self-regulation
Keywords:
at school entry. To investigate longitudinal relations among
Attention
Self-regulation
poverty-related risk, sustained attention in infancy, and self-
Infancy regulation prior to school entry, we analyzed data from the
Poverty Family Life Project, a large prospective longitudinal sample
Executive function (N = 1292) of children and their primary caregivers in predomi-
Emotion Regulation nantly low-income and nonurban communities. We used struc-
tural equation modeling to assess the extent to which a latent
variable of infant sustained attention, measured in a naturalistic
setting, mediated the associations between cumulative poverty-
related risk and three domains of self-regulation. We constructed
a latent variable of infant sustained attention composed of a mea-
sure of global sustained attention and a task-based sustained
attention measure at 7 and 15 months of age. Results indicated
that infant sustained attention was negatively associated with
poverty-related risk and positively associated with a direct assess-
ment of executive function abilities and teacher-reported effortful
control and emotion regulation in pre-kindergarten. Mediation
analysis indicated that the association between poverty-related
risk and each self-regulation outcome was partially mediated by
infant attention. These results provide support for a developmental

⇑ Corresponding author.
E-mail address: aba396@nyu.edu (A. Brandes-Aitken).

https://doi.org/10.1016/j.jecp.2019.04.006
0022-0965/Ó 2019 Elsevier Inc. All rights reserved.
 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209 193

model of self-regulation whereby attentional abilities in infancy

act as a mechanism linking the effects of early-life socioeconomic
adversity with multiple aspects of self-regulation in early
childhood.
Ó 2019 Elsevier Inc. All rights reserved.

Introduction

Increasingly, research demonstrates that self-regulation is a critical component of healthy child

development (Blair & Raver, 2016; Ursache, Blair, & Raver, 2012). Self-regulation describes the grow-
ing ability of a child to adapt behavior to the context in which the behavior is occurring—to be stu-
dious and attentive in the classroom during a lesson in mathematics, but to then run and play on
the playground during recess. More specifically, self-regulation is an integrative construct that
describes the multiple ways in which social, emotional, behavioral, cognitive, and physiological
aspects of the person are organized and influence a response to a given stimulus (Posner &
Rothbart, 2007; Rothbart, 2004). Although research on self-regulation has increased since the turn
of the 21st century, more studies are needed on the early antecedents of self-regulation that con-
tribute to variation in its emotional and cognitive aspects. Work in this area is particularly warranted
to understand why children living in poverty demonstrate disparities in early school readiness.
Research and theory suggest that lower-order cognitive abilities, such as attention, act as early precur-
sors for more advanced, higher-order self-regulation processes (Posner & Rothbart, 2000; Ursache,
Blair, Stifter, & Voegtline, 2013). Therefore, the goal of the current work was to investigate whether
attention processes emerging in early infancy may set the foundation for the development of multiple
aspects of self-regulation, particularly for children who live with socioeconomic risk.

Theoretical models of self-regulation

Self-regulation is composed of cognitive, behavioral, and emotional components and is best charac-
terized by the reciprocal interaction of conscious, effortful, and reflective aspects of the person with
nonconscious, automatic, and reactive aspects of emotional and physiological responses to stimulation
(Blair & Raver, 2016; Blair and Ursache, 2011). The origin of this model of self-regulation is found in the
theoretical model of temperament proposed by Rothbart, Posner, and collaborators (Derryberry &
Rothbart, 1997; Posner & Rothbart, 2000; Rothbart et al., 2004). Broadly, this model conceptualizes
self-regulation as the balance and interplay between bottom-up reactivity and top-down regulation,
which are predominantly enduring, biologically based behaviors present at birth. Research supports
a neurobiological model of this relation suggesting that self-regulation relies on a bidirectional relation-
ship between the limbic system and the prefrontal cortex (PFC) in which the top-down activity of the
PFC regulates the bottom-up reactivity in the limbic system (Arnsten, 2009). Notably, both the PFC
and limbic system are susceptible to environmental influence, especially early in development
(Hensch, 2005; Mackey, Raizada, & Bunge, 2014). Variability within the child’s environmental context
can bias the PFC–limbic network to be more or less reactive or reflective, thereby supporting or under-
mining self-regulation capacities (Blair, 2010). In this regard, the PFC is of particular importance given
its ability to downregulate reactivity within the limbic system and its prolonged susceptibility to envi-
ronmental influences throughout childhood. Moreover, the protracted nature of PFC development high-
lights the importance of early life experience in promoting the development of adaptive top-down
control over bottom-up reactivity. Therefore, whereas temperament models typically highlight reactiv-
ity and regulation to be trait-like and relatively fixed, more recent developmental and neuroscience
research suggests that processes related to self-regulation and reactivity are sensitive to environmental
influences (Diamond, 2009). Evidence for the plasticity of self-regulation indicates that its development,
especially early in life, is influenced by the context of the home and family environment and the quality
194 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

of early parenting (Blair, 2010; Raver, 2004; Zeytinoglu, Calkins, Swingler, & Leerkes, 2017). Although
the relations between environmental experience and self-regulation have been extensively studied,
the developmental origins of these associations remain largely unknown. Given the malleability of
the PFC in early life, self-regulation disparities may emerge around the same time that some of the ear-
liest PFC-dependent cognitive control processes, such as attention, begin to develop in infancy.

The development and measurement of infant sustained attention

Attention, like self-regulation, is a multidimensional construct. Sustained attention, in particular,

emerges within the first year of life and continues to develop across childhood (Amso & Scerif,
2015; Reynolds & Romano, 2016; Rose, Feldman, & Jankowski, 2001; Ruff & Lawson, 1990). An infant’s
ability to sustain attention is a core component of self-regulation and, thus, is critical to development
(Casey & Richards, 1988; Ruff, 1986; Swingler, Perry, & Calkins, 2015). For instance, infants focus on
and sustain their attention to stimuli in their environment to support their volitional control of behav-
ior (Rothbart & Rueda, 2005; Ruff & Capozzoli, 2003). Specifically, by practicing sustained attention,
infants are better able to resolve internal or external conflicts and guide adaptive responses and deci-
sions (Rothbart, Sheese, Rueda, & Posner, 2011), thereby setting the stage for self-regulation.
Measurement of sustained attention in infancy is difficult, with most studies using indirect meth-
ods of assessment to elicit and infer attentional processes. For instance, sustained attention in infancy
has been indexed behaviorally during looking paradigms in the laboratory. Research in this domain
has found that sustained attention manifests behaviorally in the form of prolonged gaze, decreased
distractibility, and object manipulation (Ruff & Capozzoli, 2003; Ruff & Rothbart, 1996). Ruff (1986)
postulated that the amount of time an infant spends attending to an object promotes stimuli process-
ing and object learning. Furthermore, research has demonstrated that infants visually focused to
objects for sustained periods were less prone to distractions (Oakes & Tellinghuisen, 1994).
Consequently, sustained attention has often been indexed by look duration and frequency during
structured computer-based tasks or semi-naturalistic interactions in the laboratory (Casey & Richards,
1988; Pérez-Edgar et al., 2010). These lab-based tasks frequently rely on attention that is intentionally
elicited. However, sustained attention has also been measured as it occurs spontaneously during natu-
ralistic paradigms in the home by observing global patterns of sustained attention during unstructured
tasks such as free play and parent–child interactions (Johansson, Marciszko, Brocki, & Bohlin, 2016;
Rothbart et al., 2011; Towe-Goodman, Stifter, Coccia, Cox, & Family Life Project Key Investigators, 2011).
The methodological distinction between lab-based elicited attention and home-based spontaneous
attention is important because, as it functions in the real world, infant attention is largely guided by
social contexts and social interactions, especially in the home (e.g., Colombo & Salley, 2015; Kopp,
1982; Miller, Ables, King, & West, 2009; Parrinello & Ruff, 1988; Spruijt, Dekker, Ziermans, &
Swaab, 2019; Vygotsky, 1978). However, relatively little research has studied sustained attention as
it naturally occurs, outside of the laboratory, in an infant’s day-to-day environment. During everyday
interactions in the home, caregivers offer affordances and set constraints to guide children’s sustained
attention and avoid distractions (Suarez-Rivera, Smith, & Yu, 2019; Wass et al., 2018; Yu & Smith,
2016). As such, to better understand the process and development of sustained attention, it is impor-
tant to assess sustained attention in contexts where it naturally occurs and develops.

Attention in infancy and self-regulation at school entry

In the current analysis, we focused on three manifestations of self-regulation—executive function,

emotion regulation, and effortful control—and their relation to infant sustained attention. Executive
functions refer to cognitive abilities associated with inhibitory control, working memory, and atten-
tion shifting that are recruited to execute problem solving and goal-directed planning (Miyake
et al., 2000). Emotion regulation is an interrelated yet distinct component of self-regulation that
involves the behavioral and cognitive modulation of affective experiences and expressions (Calkins
& Hill, 2007). At the intersection of emotion regulation and executive functions lies effortful control,
which can be conceptualized as the ability to inhibit a dominant or impulsive response, especially in
emotionally valenced contexts (Blair & Ursache, 2011). Although these three domains of self-
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regulation are interrelated, effortful control is generally considered to be more behavioral (Rothbart &
Rueda, 2005), whereas executive function is more cognitive (Blair, 2016; Posner & Rothbart, 2000) and
emotion regulation is primarily affective (Derryberry & Rothbart, 1997; Ursache et al., 2013). Further
previous studies have demonstrated only moderate correlations among these constructs, suggesting
that they constitute distinct but interdependent components of self-regulation (Blair, Ursache,
Greenberg, & Vernon-Feagans, 2015; Liew, 2012; Zhou, Chen, & Main, 2012).
The developmental link between early attention and self-regulation requires further investigation.
However, theory and research suggest that the association between attention in infancy and self-
regulation in childhood may be supported by a common mechanism underlying both processes such
as the ability to inhibit behavior, ignore distractions, and focus on relevant stimuli in the environment
(Colombo & Cheatham, 2006; Fox & Calkins, 2003; Posner, 2012). Multiple studies have found associ-
ations with increased visual processing efficiency (a component of infant attention) and domains of
self-regulation (Cuevas & Bell, 2014; Rose, Feldman, & Jankowski, 2012; Sigman, Cohen, & Beckwith,
1997). However, researchers have indicated the need to differentiate speed of information processing
from the more complex aspects of focused or sustained attention and its relation to cognitive and
behavioral outcomes (Courage, Reynolds, & Richards, 2006). To this end, some research suggests that
sustained attention observed during free play in infancy is positively related to working memory per-
formance (Johansson et al., 2016) and global executive function performance in toddlerhood (Frick
et al., 2018; Johansson, Marciszko, Gredebäck, Nyström, & Bohlin, 2015). This longitudinal work offers
preliminary support for infant sustained attention as an important component of executive function
development (Posner & Rothbart, 2000; Ruff and Rothbart, 2001).
Furthermore, by measuring look duration during a semi-structured play task, research found infant
sustained attention to predict parent-reported effortful control in toddlerhood (Kochanska, Murray, &
Harlan, 2000). Additional evidence from eye-tracking research corroborated these findings by demon-
strating a positive association between duration of visual fixation to a computerized multimodal
object in infancy and parent-reported effortful control at 4 years of age (Papageorgiou et al., 2014).
Finally, researchers measuring global patterns of sustained attention during a free play task found a
positive relation with effortful control in toddlerhood (Johansson et al., 2015). These findings collec-
tively support the theory that infant sustained attention, indexed through both task-specific para-
digms and global observations, is longitudinally associated with effortful control.
Finally, attentional control is closely related to children’s ability to regulate their emotions. For
instance, previous work has demonstrated that infants with lower levels of sustained attention were
more likely to demonstrate social anxiety during a structured social interaction scenario in adoles-
cence (Pérez-Edgar et al., 2010). Additional support from neurobiological studies shows that higher
frontal electroencephalography (EEG) power (a neural marker of top-down attention control) during
an attention task at 10 months of age negatively predicted frustration response to an emotional chal-
lenge at 3 years of age. Importantly, this association between EEG power and frustration was mediated
by observed infant sustained attention at 10 months (Perry, Swingler, Calkins, & Bell, 2016). These
findings demonstrate additional biologically based evidence for the role of infant attention in modu-
lating development of emotion regulation. Together, these findings suggest that attention serves as a
gatekeeper for regulating processes underlying emotion regulation.

Attention and self-regulation in the context of poverty

Children living in poverty are more likely to live in conditions that are less supportive of self-
regulation development (Blair & Raver, 2015; Blair & Razza, 2007; Ursache et al., 2012). Given that
self-regulation is fundamental to children’s school readiness (McClelland et al., 2007), it has been pro-
posed as a mechanism for explaining gaps in school readiness associated with poverty (Blair & Raver,
2015). Indeed, substantial evidence has found that by the time children enter the school system, they
show considerable disparities in the cognitive, behavioral, and emotional domains of self-regulation
(Blair, Raver, Granger, Mills-Koonce, & Hibel, 2011; Blair, Granger, et al., 2011; Raver, Blair, &
Willoughby, 2013). Critically, the biological underpinnings of early self-regulation components, such
as attention, develop rapidly in the first year of life and as such are especially susceptible to environ-
ments of early life adversity and stress (Cerqueira, Mailliet, Almeida, Jay, & Sousa, 2007; Grossmann,
196 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

2013; Hodel, 2018). As a result, poverty-related risk factors may compromise the development of self-
regulation, and a potential mechanism through which these effects may occur is early attention. Only
recently, however, have the effects of psychosocial adversity on attention in infancy been demon-
strated. Clearfield and Jedd (2013) found that across the first year of life, infants from lower socioeco-
nomic status (SES) backgrounds spent less time demonstrating focused attention toward people and
toys in a free play task. Moreover, Lipina, Martelli, Vuelta, and Colombo (2005) demonstrated similar
disparities in early life executive function skills, measured with the A-not-B task, based on income
background. These behavioral findings are substantiated by neuroimaging research in infancy and tod-
dlerhood suggesting that socioeconomic factors are associated with reduced gray matter growth in
frontal and parietal lobes (Hanson et al., 2013) and decreased EEG activity in frequency bands associ-
ated with sustained attention (Tomalski et al., 2013) and executive attention (Conejero, Guerra,
Abundis-Gutiérrez, & Rueda, 2018). Collectively, the existing literature provides preliminary support
for the susceptibility of frontal cortical-dependent processes to early psychosocial adversity. However,
to date prior research has not explicitly examined sustained attention in infancy as a mediating path-
way linking early-life poverty-related adversity and self-regulation in early childhood.

The current study

Most prior research has measured attention using a single attention variable derived from standard
laboratory tasks. However, the measurement of attention in infancy is subject to error, and the gener-
alizability from the lab to the home environment is uncertain (Hughes, 2011; Schmuckler, 2001). Here
we aimed to extend current knowledge of attention in infancy by examining how a multimethod,
multi-time-point measure of naturalistic sustained attention in infancy is associated with a cumulative
measure of poverty-related risk and whether sustained attention mediates the influence of poverty-
related risk on multiple aspects of self-regulation at school entry. In doing so, we examined sustained
attention as an early precursor of self-regulation abilities that may be malleable and, therefore, serve as
a focus for efforts to promote healthy child development in the infant and toddler periods. Therefore,
the purpose of the current work was to longitudinally examine how early poverty-related adversity is
related to infant sustained attention, with potential implications for the development of self-regulation
in early childhood. We broadly conceptualized infant sustained attention in the current analysis by
using more global measurements as a means to improve external validity and expand on previous
laboratory-based attention research. Specifically, to investigate naturalistic infant sustained attention,
we used two ecologically valid, home-based measures of sustained attention. First, we assessed task-
specific sustained attention in a caregiver–infant book reading task in participants’ homes (see exam-
ples of similar task-specific methods: Frick et al., 2018; Marcovitch, Clearfield, Swingler, Calkins, & Bell,
2016; Suarez-Rivera et al., 2019; Wass et al., 2018; Yu, Suanda, & Smith, 2019). Second, we assessed
global infant sustained attention behavior to gauge how infants typically practice attention behaviors
in their natural environment toward objects, activities, and people throughout the home visits (see
examples of similar global observation methods: Johansson et al., 2016; Towe-Goodman et al., 2011).
To investigate our main questions of interest, we evaluated associations between early-life poverty-
related risk and three separate measures of self-regulation in pre-kindergarten (preK): executive func-
tion, effortful control, and emotion regulation. Consistent with the prior literature and the theoretical
model of self-regulation described above, we hypothesized that: (a) poverty-related risk would be neg-
atively associated with sustained attention in infancy, (b) sustained attention in infancy would be pos-
itively associated with all three measures of self-regulation, and (c) sustained attention in infancy would
mediate the relationship between poverty-related risk and measures of self-regulation at school entry.

Method

Participants

The Family Life Project (FLP) is a prospective longitudinal study of families residing in six low-
income counties in eastern North Carolina and central Pennsylvania (three counties per state) that
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were selected to be indicative of the Black South and Appalachia, respectively, in the eastern United
States. The FLP adopted a developmental epidemiological design whereby complex sampling proce-
dures were used to recruit a representative sample of 1292 children whose families resided in one
of the six counties at the time of their children’s birth. Detailed descriptions of the participating fam-
ilies and communities are available in Vernon-Feagans, Cox, and the FLP Key Investigators (2013).

Procedures

As part of the larger protocol, home visits were conducted when children were 7, 15, and
60 months old; at 60 months, children were also seen in preK. During each home visit, primary care-
givers provided information on demographics and numerous aspects of family life and relationships.
In addition, at 7 and 15 months, children and their primary caregivers participated in a book reading
task from which observational indicators of infant attention were derived. Immediately following the
home visits, research assistants (RAs) completed ratings of the children’s attention during the 2–3 h of
the data collection period. At 60 months, children were administered a battery of executive function
tasks in the home and preK teachers completed ratings of children’s effortful control and emotion
regulation.

Measures

Cumulative risk
Cumulative poverty-related risk was measured by creating an aggregate variable composed of mul-
tiple measures of poverty-related risk to encompass the many contributing environmental factors that
are associated with living in poverty. Given the high likelihood of co-occurrence between risk factors
associated with poverty and the difficulty in parsing them from each other, a cumulative risk model
can better encompass the multidimensional nature of poverty-related risk. Thus, as with prior FLP
data (see Vernon-Feagans, Cox, & FLP Key Investigators, 2013), we created a cumulative risk index
of seven measures collected at 7 months: family income-to-needs ratio, maternal education, consis-
tent partner, hours of employment, occupational prestige, household density, and neighborhood noise
and safety (see Table 1 for descriptive statistics). These variables were chosen as indicators of social
and economic resources that previous research has demonstrated are significantly related to the con-
text of poverty, especially in rural communities (Burchinal, Roberts, Hooper, & Zeisel, 2000; Dill, 1999;
Evans, 2004; Vernon-Feagans et al., 2013). Principal components analysis confirmed that these seven
indicators each loaded significantly onto a single factor (Vernon-Feagans et al., 2013). The cumulative
risk index was calculated by z-scoring each variable, reverse-scoring positively framed variables, and
averaging the seven factors. For the current analysis, we used the cumulative risk scores to obtain a
variable of early-life exposure to poverty-related cumulative risk.

Infant sustained attention

Task-specific infant sustained attention was assessed at 7 and 15 months using a wordless picture
book task, the Early Attention to Reading Situations (EARS; Feagans, Kipp, & Blood, 1994). At each time
point, the caregivers were given a wordless picture book to review before the session began. The care-

Table 1
Descriptive statistics for cumulative risk variables.

N Mean % SD Min Max

Income-to-needs ratio 1102 1.92 1.70 0 16.49
Maternal education 1204 14.44 2.82 6 22
Consistent partner 1292 57.10
Employment hours 1204 31.64 21.78 0 104
Occupational prestige 1096 39.94 12.04 16.78 86.05
Household density 1092 0.88 0.36 1 4
Neighborhood safety 1195 2.99 0.58 0.36 3.33
198 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

givers were asked to go through the book and talk to their children about the book as they might nor-
mally do. Caregivers and their children shared the books Baby Faces (DK Publishing, 2002) at 6 months
and No David! (Shannon, 1998) or David Gets in Trouble (Shannon, 2002) at 15 months. After approx-
imately 10 min, the RA asked the caregiver to stop if the picture book task had not ended. The RA live-
coded for sustained attention using Observer software (Noldus, Wageningen, Netherlands) on a laptop
computer that was programmed to receive observational ratings every 5 s. The RA rated the child’s
focus of attention at 5-s intervals using one of the following mutually exclusive categories: (a) a look
at the book when the infant’s eyes were focused on the cover or pages of the book, (b) a look at the
caregiver when the infant’s eyes were focused on the face of the caregiver who was going through
the book, (c) a gaze aversion when the child’s eyes were distracted from the task, (d) a look at the
coder when the infant was looking at the coder or camera, or (e) a leave if the infant left the task
momentarily or dropped the book. RAs practiced the rating system with pilot children until acceptable
reliability was reached with the master rater (Cohen’s kappas .70). Five selected video recordings of
the book sharing activity were then rated by the master rater every 6 months to confirm and maintain
a Cohen’s kappa of at least .70 for each rater. Because the length of the book sharing activity varied
between participants, raw frequency scores were converted to proportion scores to be used in analy-
ses. We created a mean proportion score at each time point that represented the proportion of 5-s
intervals in which a look at the book was observed.
Global sustained attention was assessed at 7 and 15 months of age with the Infant Behavior Record
(IBR; Bayley, 1969) as adapted for use by Stifter and Corey (2001) and completed independently by
both RAs. The IBR was applied to infant behavior observed globally across the entire (2- to 3-h) home
visit. The IBR consists of 11 items rated on a 9-point scale, with higher scores indicating greater sus-
tained attention skills. As was conducted in prior analyses with these data (Towe-Goodman et al.,
2011), three items were used in the current analysis to index the child’s global sustained attention:
attention to objects, which assessed the degree to which the child demonstrated sustained interest
in toys, test materials, or other objects (a score of 1 indicated the child did not look at or in any
way indicate interest in objects, whereas a score of 9 indicated sustained interest in objects to the
point where they were reluctantly relinquished); attention to activities, which assessed the child’s per-
sistence in attending to 13 activities with toys, objects, or persons (a score of 1 indicated the child
showed a fleeting attention span, whereas a score of 9 indicated long-continued absorption); and over-
all attention, which assessed the child’s attention across the demands of the home visit (a score of 1
indicated the child tired easily and quickly regressed to lower levels of functioning, whereas a score
of 9 indicated the child continued to respond well and with interest even during prolonged tasks at
difficult levels). These items were chosen as the most relevant to probing behaviors related to sus-
tained attention, in contrast to other IBR items that pertain more to behaviors related to arousal,
mood, and reactivity. The mean of both home visitors’ ratings were used for each item; intraclass cor-
relations ranged from .66 to .80. The final global attention score was calculated by summing the means
across RAs for the three attention-related items.

Executive functions
At 60 months of age, children were administered an executive function battery consisting of two
working memory tasks, three inhibitory control tasks, and one attention shifting task. Preceding the
test trials in each task, RAs administered training trials and children completed up to three practice
trials. RAs discontinued the task for those children who did not demonstrate an understanding of
the task. Each task was presented by an RA in an open spiral-bound flipbook with pages that measured
8  14 inches. Details on the tasks and administration procedures, as well as psychometric character-
istics, are available in Willoughby, Wirth, and Blair (2011) and Willoughby, Blair, Wirth, and
Greenberg (2012). We provide a brief description of the tasks below.

Working memory span (working memory). In the span task, children are shown the outline of a house
with an animal and a colored dot inside it and are prompted to name the animal and the color of the
dot. Then they are shown a blank house and are asked to report either the animal or the color they had
seen in the previous house. To perform correctly, children must hold two pieces of information in
mind (i.e., the animal and the color) but recall only the prompted feature (e.g., animal).
 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209 199

Pick the picture game (working memory). In this self-ordered pointing task, children are presented with
sets of items. For each set, the same items appear on two sequential pages in a different arrangement.
On the first page, children are asked to ‘‘pick one” item. On each subsequent page, children are
instructed to pick an item that was not previously picked so that each picture ‘‘gets a turn.” Difficulty
increases as more items (up to six) are added to sets.

Silly sounds stroop (inhibitory control). Children are presented with pictures of cats and dogs and asked
to make the sound opposite of that which is typically associated with that animal (e.g., when shown a
dog, a correct response would be to make a cat sound).

Spatial conflict arrows (inhibitory control). In this Simon-like task children are presented with response
cards with two black circles (‘‘buttons”) on either side of the page and an arrow on either the left or
right side of the page. Children are instructed to touch the button corresponding to the side to which
the arrow is pointing. The task proceeds in difficulty from displaying left-pointing arrows on the left
side and right-pointing arrows on the right side of the page (congruent trials) to most arrows pointing
to the side opposite from which they are positioned (incongruent trials).

Animal go/no-go (inhibitory control). In this standard go/no-go task, children are instructed to click a
button (which made an audible sound) every time they see an animal (go trials) unless the animal
is a pig (no-go trials). Varying numbers of go trials appear prior to each no-go trial, including, in stan-
dard order, 1-go, 3-go, 3-go, 5-go, 1-go, 1-go, and 3-go trials.

Something’s the same game (attention shifting). In this task, children are presented with a pair of pic-
tures for matching on a single dimension (e.g., the same color). Subsequently, a third picture is pre-
sented and children are asked to identify which of the first two pictures is similar to the new
picture. This task requires children to shift attention from the initial dimension to a new dimension
of similarity (e.g., from color to size).

Executive function task scoring and composite formation. Children needed to complete at least 75% of
trials for each task for their performance to be analyzed. Tasks were scored using item response theory
because this is a more precise way to estimate children’s executive function abilities than percentage
correct scores. Expected a posteriori (EAP) scores were derived for each task and averaged to obtain a
composite score (Willoughby et al., 2011). Then z-scores were calculated to reflect accuracy on each of
the six executive function assessments. The total score reflected the mean of all completed z-scored
individual scores. We used a formative composite because it has been found to more appropriately
represent the overarching construct of executive function than a latent factor, which is limited to mea-
surement of the shared variance between tasks that are only weakly to moderately correlated
(Willoughby, Holochwost, Blanton, & Blair, 2014). Prior studies using this battery with the same pop-
ulation have demonstrated acceptable psychometric properties with the composite executive function
score (Willoughby et al., 2012). As is typical of executive function measures (Willoughby, Holochwost,
Blanton, & Blair, 2014), the reliability coefficient for the composite was relatively low (a = .50).

Effortful control
The child’s preK teacher reported on child effortful control using the Children’s Behavior Question-
naire (CBQ) at 60 months of age (Rothbart, Ahadi, Hershey, & Fisher, 2001). The two CBQ dimensions
that most directly relate to effortful control—Attentional Focusing and Inhibitory Control—were
assessed. Attentional Focusing consisted of seven items, for example, ‘‘When picking up toys or other
jobs, usually keeps at the task until it’s done.” Inhibitory Control was composed of five items, for
example, ‘‘Can lower his or her voice when asked to do so.” Teachers rated each item using a 7-
point Likert scale ranging from extremely untrue of the child to extremely true of the child. Reliability
estimates in this sample were a = .77 for Attentional Focusing and a = .78 for Inhibitory Control. These
are very similar to those reported by Rothbart et al. (2001). The scales were highly correlated within
reporter (r = .77, p < .001) for teachers and were averaged into a single indicator of effortful control.
200 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

Emotion regulation
Children’s ability to regulate emotions was indexed through teacher reports of emotion regulation
skills on a subscale of the Social Competence Scale (SCS; Conduct Problems Prevention Research
Group, 1995) when children were in preK. The SCS is a 14-item measure composed of three subscales:
emotion regulation skills, prosocial skills, and aggressive oppositional behaviors. Each item was scored
on a scale of 1 (almost never) to 6 (almost always). Only the emotion regulation subscale was used in
the current analysis. Five items representing the emotional regulation subscale (e.g., ‘‘Copes well with
disappointment or frustration”) were taken from the SCS developed for the Fast Track Project (CPPRG,
1995) and had an internal reliability estimate of a = .84.

Demographic covariates
State of residence (Pennsylvania = 0, North Carolina = 1), sex (0 = male, 1 = female), and race
(0 = White, 1 = African American) of children were included as covariates to control for site and demo-
graphic differences in study variables. Covariates were included in all subsequent models.

Data analysis

The total sample size recruited at study entry was 1292, with 1204 children seen at 7 months, 1169
seen at 15 months, and 1099 seen at 60 months. To avoid bias in estimates associated with missing
data, we used full information maximum likelihood (FIML) for all analyses. We were specifically inter-
ested in estimating (a) the direct paths from cumulative risk to infant sustained attention, executive
functions, effortful control, and emotion regulation; (b) the direct paths from infant attention to exec-
utive functions, effortful control, and emotion regulation; and (c) the indirect paths from cumulative
risk to executive functions, effortful control, and emotion regulation via infant sustained attention. To
address our primary research question, we used structural equation modeling. The construct of infant
sustained attention was assessed using confirmatory factor analysis. We first assessed model fit for the
infant attention measurement model. We then defined our hypothesized structural model and used
bootstrapping with 5000 samples to generate bias-corrected confidence intervals for indirect effects
(Shrout & Bolger, 2002). The predictor variable was cumulative risk, and the outcome variables were
the EAP executive functions factor score, CBQ mean effortful control score, and SCS emotion regulation
score. We controlled for the effects of sex, state, and race on all paths in our model. All analyses were
conducted in the R environment (R Core Team, 2013). We tested overall model fit using root mean
square error of approximation (RMSEA), standardized root mean square residual (SRMR), and compar-
ative fit index (CFI) (Hu & Bentler, 1999). All parameter estimates are standardized estimates and,
thus, indicate how much the dependent variables would be expected to change for a single standard
deviation change in the predictor variable.

Results

Preliminary analyses

Tables 2 and 3 present descriptive statistics and correlations for our analysis variables, respectively.
Table 3 indicates a significant positive correlation between each attention variable, suggesting reason-
able reliability within each measure over time and validity between measures. Moreover, task-specific
sustained attention at 15 months was positively correlated with effortful control in preK. Global sus-
tained attention at 7 months was positively correlated with executive function in preK. Global sus-
tained attention at 15 months had a positive correlation with executive function, effortful control,
and emotion regulation in preK. Furthermore, cumulative risk was negatively correlated with global
sustained attention at 7 and 15 months and moderately negatively correlated with executive func-
tions, effortful control, and emotion regulation in preK. Notably, there was a significant positive cor-
relation between each outcome measure of self-regulation in preK. These preliminary findings
provided support for our hypothesized structural model.
 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209 201

Table 2
Descriptive statistics for variables in the analysis.

N Mean % SD Min Med Max

Task-based sustained attention, 7 months (EARS) 1172 0.77 0.19 0.00 0.82 1.00
Task-based sustained attention, 15 months (EARS) 1134 0.70 0.22 0.00 0.75 1.00
Global sustained attention, 7 months (IBR) 1196 17.68 2.47 4.50 18.00 24.00
Global sustained attention, 15 months (IBR) 1155 17.71 2.70 4.00 18.00 23.50
Executive functions, preK 1038 0.29 0.48 1.98 0.35 1.40
Effortful control mean, preK (CBQ) 793 4.92 1.17 1.00 5.08 7.00
Emotion regulation, preK (SCS) 816 3.91 1.03 1.20 4.00 6.00
Cumulative risk, 7 months 1204 0.01 0.66 2.93 0.01 1.98
Child’s race (% African American) 1292 42
Child’s sex (% Female) 1292 51
State of residence (% North Carolina) 1292 60

Note. EARS, Early Attention to Reading Situations; IBR, Infant Behavior Record; preK, pre-kindergarten; CBQ, Children’s Behavior
Questionnaire; SCS, Social Competence Scale.

Table 3
Correlations among variables.

1 2 3 4 5 6 7 8
1. Task-based sustained attention, 7 months (EARS) 1
2. Task-based sustained attention, 15 months (EARS) .10** 1
3. Global sustained attention, 7 months (IBR) .11** .08* 1
4. Global sustained attention, 15 months (IBR) .04* .22** .21** 1
5. Executive function, preK .01 .03 .09* .10* 1
6. Effortful control mean, preK (CBQ) .01 .07* .01 .12* .45** 1
7. Emotion regulation, preK (SCS) .06 .04 .01 .06** .25** .59** 1
8. Cumulative risk .03 .03 .11** .07* .32** .28** .20** 1

Note. EARS, Early Attention to Reading Situations; IBR, Infant Behavior Record; preK, pre-kindergarten; CBQ, Children’s Behavior
Questionnaire; SCS, Social Competence Scale.
*
p  .05.
**
p  .01.

Cumulative risk and self-regulation in preK

To assess the direct effects of poverty-related risk on the three domains of self-regulation (without
infant sustained attention in the model), we constructed a regression of executive functions, effortful
control, and emotion regulation at preK on cumulative risk at 7 months, controlling for all demo-
graphic covariates. Results from our model indicate that poverty-related risk was significantly nega-
tively associated with executive functions (b = .27, p < .001), effortful control (b = .23, p < .001),
and emotion regulation (b = .15, p < .001).

Measurement model of attention in infancy

We evaluated a latent variable of infant sustained attention at 7 and 15 months using confirmatory
factor analysis. The model fit was adequate, v2 (2) = 16.24, p = .008, CFI = .91, RMSEA = .076,
SRMR = .028. Inspection of parameter estimates indicated that all the factor loadings were statistically
significant and in the expected direction (task-specific sustained attention at 7 months: b = .16,
p = .001; task-specific sustained attention at 15 months: b = .35, p < .001; global sustained attention
at 7 months: b = .34, p < .001; global sustained attention behavior at 15 months: b = .68, p < .001).

Structural mediation model

In the hypothesized structural model, we examined the direct effects of cumulative risk on each
self-regulation outcome as well as the indirect effects of risk on executive functions, effortful control,
202 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

and emotion regulation through infant sustained attention while controlling for demographic covari-
ates. The estimated structural model is shown in Fig. 1. This model fit the data adequately, v2 (25)
= 101.84, p < .0001, CFI = .92, RMSEA = .049, SRMR = .034. First, significant negative direct effects were
observed for cumulative risk on executive functions (b = .23, p < .001), effortful control (b = .10,
p < .001), and emotion regulation (b = .11, p < .001). Compared with the preliminary model without
infant sustained attention in the model, the three coefficients for self-regulation were somewhat
reduced after infant sustained attention was included in the model, suggesting potential partial
mediation.
Second, the model demonstrated a direct effect of cumulative risk on the infant sustained attention
latent variable such that cumulative risk was negatively related to infant sustained attention (b = .22,
p < .001). Third, there was a direct effect between infant sustained attention and self-regulation skills
such that sustained attention was positively associated with preK executive functions (b = .16,
p = .001), effortful control (b = .22, p < .001), and emotion regulation (b = .13, p = .009). Results from
tests of indirect effects of cumulative risk on self-regulation through infant sustained attention
(Table 4) indicated that sustained attention partially mediated the relationship between cumulative
risk and executive functions (b = .033, p = .019, 95% confidence interval (CI) [ .049, .008]), effortful
control (b = .047, p = .010, 95% CI [ .156, .031]), and emotion regulation (b = .028, p = .029, 95% CI
[ .090, .012]).

Fig. 1. The observed mediation model relating cumulative risk to attention and self-regulation outcomes. All coefficients are
standardized (b). *p < .05; **p < .01. preK, pre-kindergarten; mo, months. Covariates are not shown.

Table 4
Standardized indirect effects.

b SE 95% Confidence interval

Cumulative risk ? infant attention ? executive function .033 .011 [ .049, .008]
Cumulative risk ? infant attention ? effortful control .047 .033 [ .156, .031]
Cumulative risk ? infant attention ? emotion regulation .028 .020 [ .090, .012]
 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209 203

Discussion

In the current study, we assessed relations among early-life poverty-related risk, sustained atten-
tion in infancy, and multiple domains of self-regulation in preK. Specifically, we investigated the
extent to which infant sustained attention mediated the association between cumulative risk and
executive functions, effortful control, and emotion regulation. Based on previous theoretical and
empirical evidence, we hypothesized that early poverty-related risk would be negatively associated
with reduced sustained attention, which in turn would positively predict higher-order self-
regulation difficulties in preK. This research was motivated by an understanding of infant attention
as a foundational aspect of self-regulation that is affected by the context in which children are devel-
oping. Although previous research has reported poverty to be negatively associated with early atten-
tion (Clearfield and Jedd (2013); Conejero et al., 2018; Lipina et al., 2005), and early attention to be
positively associated with childhood cognitive development (Cuevas & Bell, 2014; Johansson et al.,
2015; Rose et al., 2012) and emotion regulation development (Johansson et al., 2015; Pérez-Edgar
et al., 2010; Perry et al., 2016), this is the first study, to the best of our knowledge, that has tested a
model of infant sustained attention as a mediator of the effects of socioeconomic adversity on multiple
domains of self-regulation at school entry. Importantly, one of the strengths of our analysis is that we
used two observational measures of attention that were collected during naturalistic, semi-structured
paradigms in the home over a period of 2–3 h. This method of measurement assesses more global sus-
tained attention behavior, which is in contrast to other relevant studies that measured specific atten-
tion behaviors during unfamiliar structured tasks in the laboratory. Nonetheless, our results are in line
with other longitudinal research done in more controlled settings (Cuevas & Bell, 2014; Papageorgiou
et al., 2014; Pérez-Edgar et al., 2010; Rose et al., 2012; Sigman et al., 1997).

Poverty and attention in infancy

Our findings contribute to the extant literature in several ways. First, we found that poverty-related
adversity is negatively associated with sustained attention processes in the first year and a half of life.
This finding adds to a growing literature demonstrating that the effects of adversity on attention are
evident in infancy (Clearfield and Jedd (2013); Conejero et al., 2018; Hanson et al., 2013; Lipina et al.,
2005; Tomalski et al., 2013). Here, we extended previous lab-based studies by measuring infant sus-
tained attention in the home environment and by including both a task-specific measure and a global
measure to create an ecologically valid inclusive construct of infant sustained attention. Furthermore,
much of the prior literature has taken a comparative and cross-sectional approach, testing distinct
groups of children from low-income versus middle-income backgrounds at single time points. In con-
trast, we analyzed a continuous measure of early adversity and demonstrated an association between
variation in adversity and variation in sustained attention over children’s first year and a half of life.
More broadly, our results are also consistent with a growing body of evidence indicating that early
poverty-related risk affects the developing brain in areas known to be associated with top-down emo-
tion regulation and cognitive control (Hair, Hanson, Wolfe, & Pollak, 2015; Luby, Barch, Whalen,
Tillman, & Belden, 2017; Noble et al., 2015). In particular, our findings are in line with structural imag-
ing work demonstrating the effect of poverty on brain development from a very early age in life
(Hanson et al., 2013). Specifically, Hanson et al. (2013) found large SES-related reductions in gray mat-
ter in the frontal and parietal regions associated with cognitive control abilities. Similarly, a study
using EEG with 6- to 9-month-old infants found reduced high-frequency (gamma) oscillations in
the PFC among children in poverty relative to children from higher-income homes (Tomalski et al.,
2013). Corroborating neural evidence in a second study indicates that toddlers in low-SES homes
demonstrated decreased theta power (Conejero et al., 2018). Importantly, both frontal gamma and
theta power are spectral frequencies considered to support attentional control processes (Engel,
Fries, & Singer, 2001; Tsujimoto, Shimazu, & Isomura, 2006).
These neuroimaging findings also highlight the protracted development and malleability of PFC in
infancy and childhood (Casey, Giedd, & Thomas, 2000; Holmes & Wellman, 2009; Sheridan, Sarsour,
Jutte, D’Esposito, & Boyce, 2012). The first years of brain development are characterized by rapid
204 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

growth and increased plasticity in the PFC (Grossmann, 2013; Hodel, 2018), which are characterized
by heightened susceptibility to environmental influences (Hensch, 2005). It follows that PFC-
dependent processes such as attention may be differentially affected by environments of adversity
within the first years of life. Although studies explicitly assessing the importance of developmental
timing are lacking, our findings indicate that behavioral differences associated with poverty are
observable within the first year and a half of life. These findings have implications for the need for con-
tinued efforts to identify windows of plasticity and malleability around which to gauge the relative
impacts of efforts to foster the well-being of children and families in poverty.

Attention in infancy and self-regulation at school entry

Our findings also contribute to the growing literature demonstrating that attention in infancy is
associated with multiple aspects of self-regulation in early childhood. Specifically, similar to other lon-
gitudinal studies, we found a positive relation between infant sustained attention and executive func-
tion at school entry (Cuevas & Bell, 2014; Frick et al., 2018; Johansson et al., 2015, 2016; Rose et al.,
2012). These findings are consistent with a theoretical model in which early attention skills are essen-
tial in supporting executive functions (Bell & Deater-Deckard, 2007; Colombo & Cheatham, 2006;
Rueda, Posner, & Rothbart, 2005). Moreover, our finding that sustained attention in infancy was pos-
itively associated with effortful control in preK is largely consistent with prior theoretical and empir-
ical work using Rothbart and Posner’s conceptualization of effortful control (Derryberry & Reed, 1994;
Posner & Rothbart, 2000; Rothbart & Rueda, 2005). In particular, attention is necessary for children’s
volitional control over prepotent behaviors, such as inhibiting an inappropriate response, particularly
in school settings. For instance, when responding to a question posed by a teacher, a child recruits
effortful attentional control to raise his or her hand instead of shouting out an answer. Such an inter-
pretation aligns with prior studies demonstrating associations between observational ratings of atten-
tion in infancy and effortful control at 2 years of age (Johansson et al., 2015; Kochanska et al., 2000;
Papageorgiou et al., 2014). The reported associations between infant sustained attention and executive
function and effortful control suggest that basic cognitive abilities developed in infancy precede the
emergence of more advanced cognitive and behavioral abilities.
Our finding that infant sustained attention predicts emotion regulation ability is also consistent
with the theoretical and biological models of attention and self-regulation as well as with prior lon-
gitudinal research demonstrating relations between attention in infancy and emotion regulation in
childhood (Pérez-Edgar et al., 2010; Posner & Rothbart, 2000). In a prior study, Pérez-Edgar et al.
(2010) theorized that sustained attention in the first year of life forms the core of a regulation mech-
anism to temper emotional responses to environmental stimuli. This theory is supported by research
suggesting that frontal cortical activation during an attention task in infancy is indirectly associated
with emotion regulation at 3 years of age (Perry et al., 2016). Alternatively, control of attention may
allow children to learn how to selectively attend to salient aspects of their environment, enhancing
one’s ability to discriminate between threatening and nonthreatening environmental stimuli
(Sroufe, 1996). Thus, we theorize that the development of attention control in infancy is likely con-
tributing to the development of emotion regulation.

Attention mediates effects of early risk on self-regulation

Our mediational findings support our central hypothesis that the ability to sustain attention in
infancy is a foundational early mechanism linking early life experience with later self-regulation.
Although small in size, the indirect effects demonstrate that infant attention is one pathway through
which environments of risk exert effects on the development of self-regulation skills in early child-
hood. This finding is well situated within a rich body of literature linking early life adversity with dis-
parities in the development of brain and behavior as well as research connecting early cognitive
control with later self-regulation outcomes (Cuevas & Bell, 2014; Papageorgiou et al., 2014; Raver
et al., 2013). We postulate that because infant PFC neurodevelopment is especially susceptible to early
life experiences, exposure to poverty-related risk in infancy disrupts attention from an early age.
These early alterations in attention may have enduring effects on the development of self-
 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209 205

regulation abilities when considering the empirical research supporting a cascade model of infant PFC
development (Amso & Scerif, 2015; Colombo & Cheatham, 2006; Rose et al., 2012). Broadly, we
speculate that infant sustained attention is an important antecedent to more complex
self-regulation processes that may be affected by early life adversity through attention.
Although the reported pathway is correlational, our model is longitudinal, thereby establishing
temporal precedence that supports a potentially causal relation. Indeed, evidence from intervention
efforts suggests a causal role for infant sustained attention in later self-regulation. For instance, recent
training efforts have found that, relative to an active control group, infants in an attention training
protocol demonstrated enhanced development of distal cognitive control processes in toddlerhood
(Wass, Porayska-Pomsta, & Johnson, 2011; Wass, Scerif, & Johnson, 2012). Although this finding is lim-
ited to toddlerhood and basic cognitive control abilities, these preliminary studies offer promising evi-
dence for infant attention as a viable target mechanism for promoting higher-order cognitive abilities,
particularly when infants are in high-risk environments. Collectively, this research has implications
for prevention research aimed at cultivating a supportive home environment to promote the develop-
ment of early cognitive control.

Limitations and future directions

There are several limitations that preclude our ability to come to strong inferential conclusions
based on our results. First, there are caveats associated with the use of observational ratings to mea-
sure infant sustained attention. Observer ratings of sustained attention are subjective and could
reflect aspects of child behavior that are associated with attentiveness such as interest, motivation,
sociability, and reactivity. Similarly, aspects of the home environment, such as number of distrac-
tors, could be confounding our association between cumulative risk and sustained attention. This
potential problem is minimized somewhat by the fact that we combined the ratings of two highly
trained RAs who independently rated infant behavior over a 2- to 3-h home visit across two child
ages. This consideration is an important one, however, given that our infant sustained attention
latent variable was primarily driven by global sustained attention behavior at 15 months. Sustained
attention at 15 months becomes more sophisticated and intentional as the executive attention net-
work functionally matures around this time (Colombo & Cheatham, 2006; Rueda et al., 2005). As
such, attention manifests more prominently and is likely easier to observe as a naturally occurring
behavior. Whereas this article focuses on the cognitive antecedents of self-regulation, future analy-
ses would benefit from considering the role of related behaviors such as reactivity and motivation in
infancy as well. Similarly, controlling for chaos in the home and parent behaviors during the task
would strengthen future studies aimed at assessing infant sustained attention in naturalistic envi-
ronments. Furthermore, measurement of sustained attention during the book reading task would
be improved by the inclusion of a looking duration code (in addition to frequency) and a physiolog-
ical measure of heart rate to validate infants’ attention state. In addition, measures of effortful con-
trol and emotion regulation relied solely on teacher reports, which may limit the generalizability of
these findings beyond classroom contexts. The analysis would benefit from the inclusion of direct
assessments to measure these constructs. Importantly, the longitudinal model presented here is cor-
relational. Although the consideration and inclusion of covariates in our model improves our ability
to draw inferences, causal conclusions about the relations among variables are not possible. There-
fore, future intervention and cross-species research is needed to develop causal conclusions about
relations among attention, context, and the development of higher-order cognitive and emotion
abilities.
The current study highlights infant sustained attention as a foundation for the development of
more complex self-regulatory processes in contexts of poverty. This work provides a mechanistic
model by which early environments of cumulative risk may be negatively affecting the development
of basic attention processes in infancy, initiating later disparities in higher-order self-regulation abil-
ities. Given the plastic nature of attention networks early in life, amelioration efforts could produc-
tively focus on cultivating supportive and nurturing home environments for parents and their
infants to support the development of foundational cognitive processes.
206 A. Brandes-Aitken et al. / Journal of Experimental Child Psychology 184 (2019) 192–209

Acknowledgments

This work was supported by the National Institute of Child Health and Human Development under
Grants R01 HD51502 and P01 HD 39667, with cofunding from the National Institute on Drug Abuse.
The role of the first author was also supported by the National Science Foundation Graduate Research
Fellowship Program under Grant DGE1342536. Any opinions, findings, and conclusions or recommen-
dations expressed in this article are those of the authors and do not necessarily reflect the views of the
National Science Foundation.

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