Supplementary Material for: Adaptive Skills May Moderate the Association Between Prenatal Stress Exposure and Limbic Brain Activation: A Developmental fMRI Study of Superstorm Sandy Exposure

Introduction: The developing brain shows remarkable capacity for adaptation following early adversity, but the behaviors that influence neural compensation mechanisms remain unclear. Prenatal stress exposure provides a natural model for studying these mechanisms, as it alters neurodevelopment while allowing examination of potential protective factors. However, whether early adaptive behaviors—the skills needed to meet everyday demands such as self-care and communication—can buffer against the neural consequences of prenatal stress has not been established. Natural disasters provide a unique opportunity to examine these mechanisms, as they serve as measurable prenatal stressors with well-defined exposure timing. Methods: In this pilot study, using a quasi-experimental design, we examined children with (n=11) and without (n=23) prenatal exposure to Superstorm Sandy (SS) to investigate how early adaptive behaviors (ages 2-6) moderate the association between prenatal stress (i.e., exposure to a natural disaster) and later brain activity during emotional processing (age 8). We first examined main effects of SS on both adaptive behaviors over time (ages 2-6 years) and functional brain activation at age 8 in brain regions responsible for facial emotional processing. Moderation models subsequently explored whether early-life adaptive behaviors influenced the association between SS and later brain activation. The Behavior Assessment System for Children, Second Edition (BASC-2) measured child adaptive behaviors. Functional Magnetic Resonance Imaging (fMRI) measured regional brain activation using an emotional face processing task. Results: Prenatal stress exposure was associated with non-significant trends toward reduced adaptive behaviors over time and reduced brain activation in the right ventral anterior insula. Critically, early adaptive behaviors moderated the association between prenatal stress and later brain activation in the left amygdala and both hemispheres of the hippocampus, ventral anterior insula, and rostral anterior cingulate cortex. Simple slopes analyses revealed that prenatal stress was associated with significantly reduced brain activation at low adaptive skills. However, this association was attenuated among children that exhibited higher adaptive skills such that activation patterns were comparable to their unexposed peers. Conclusion: Our preliminary moderation (i.e., interaction) findings provide initial evidence that adaptive behaviors may serve as a neural buffer against prenatal stress. This protective pattern indicates that early adaptive skills may help maintain neural responsiveness following prenatal stress exposure. If validated in larger, adequately powered samples, interventions targeting adaptive behaviors in early childhood could potentially reduce the neural burden of prenatal stress and support more resilient brain development in at-risk populations. These findings highlight adaptive behaviors as potential targets for early intervention to promote neural resilience following prenatal adversity.