Motor delays in MDMA (ecstasy) exposed infants persist to 2years

Background Recreational use of 3,4 methylenedioxymethamphetamine (ecstasy, MDMA) is increasing worldwide. Its use by pregnant women causes concern due to potentially harmful effects on the developing fetus. MDMA, an indirect monoaminergic agonist and reuptake inhibitor, affects the serotonin and dopamine systems. Preclinical studies of fetal exposure demonstrate effects on learning, motor behavior, and memory. In the first human studies, we found prenatal MDMA exposure related to poorer motor development in the first year of life. In the present study we assessed the effects of prenatal exposure to MDMA on the trajectory of child development through 2 years of age. We hypothesized that exposure would be associated with poorer mental and motor outcomes. Materials and Methods The DAISY (Drugs and Infancy Study, 2003–2008) employed a prospective longitudinal cohort design to assess recreational drug use during pregnancy and child outcomes in the United Kingdom. Examiners masked to drug exposures followed infants from birth to 4, 12, 18, and 24 months of age. MDMA, cocaine, alcohol, tobacco, cannabis, and other drugs were quantified through a standardized clinical interview. The Bayley Scales (III) of Mental (MDI) and Motor (PDI) Development and the Behavior Rating Scales (BRS) were primary outcome measures. Statistical analyses included a repeated measures mixed model approach controlling for multiple confounders. Results Participants were pregnant women volunteers, primarily white, of middle class socioeconomic status, average IQ, with some college education, in stable partner relationships. Of 96 women enrolled, children of 93 had at least one follow-up assessment and 81 (87%) had ≥ two assessments. Heavier MDMA exposure (M = 1.3 ± 1.4 tablets per week) predicted lower PDI (p < .002), and poorer BRS motor quality from 4 to 24 months of age, but did not affect MDI, orientation, or emotional regulation. Children with heavier exposure were twice as likely to demonstrate poorer motor quality as lighter and non-exposed children (O.R. = 2.2, 95%, CI = 1.02–4.70, p < .05). Discussion Infants whose mothers reported heavier MDMA use during pregnancy had motor delays from 4 months to two years of age that were not attributable to other drug or lifestyle factors. Women of child bearing age should be cautioned about the use of MDMA and MDMA-exposed infants should be screened for motor delays and possible intervention.

Flourishing as a dialectical balance: emerging insights from second-wave positive psychology

Positive psychology, an emergent branch of scholarship concerned with wellbeing and flourishing, initially defined itself by a focus on “positive” emotions and qualities. However, critics soon pointed out that this binary logic—classifying phenomena as either positive or negative, and valorising the former while disparaging the latter—could be problematic. For example, apparently positive qualities can be harmful to wellbeing in certain circumstances, while ostensibly dysphoric emotional states may on occasion promote flourishing. Responding to these criticisms, over recent years a more nuanced “second wave” of positive psychology has been developing, in which wellbeing is recognized as involving a dialectical balance of light and dark aspects of life. This article introduces this emergent second wave, arguing that it is characterized by four dialectical principles. First, the principle of appraisal states that it is difficult to categorically identify phenomena as either positive or negative, since such appraisals are fundamentally contextually dependent. Second, the principle of co-valence holds that many states and qualities at the heart of flourishing, such as love, are actually a complex blend of light and dark elements. Third, the principle of complementarity posits that not only are such phenomena co-valenced, but that their dichotomous elements are in fact co-creating, two intertwined sides of the same coin. Finally, the principle of evolution allows us to understand second-wave positive psychology as itself being an example of a dialectical process. This article is published as part of a collection entitled “On balance: lifestyle, mental health and wellbeing”.