Social Cognitive and Affective Neuroscience, 2020, 437–446

doi: 10.1093/scan/nsaa051
Advance Access Publication Date: 20 April 2020
Original manuscript

How do expectant fathers respond to infant cry?

Examining brain and behavioral responses and the
moderating role of testosterone
Hannah Khoddam,1 Diane Goldenberg,1 Sarah A. Stoycos,1
Katelyn Taline Horton,1 Narcis Marshall,1 Sofia I. Cárdenas,1 Jonas Kaplan,1,2
and Darby Saxbe1
1 Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA, and 2 Department
of Psychology, Brain and Creativity Institute, University of Southern California, Los Angeles, CA 90089, USA
Correspondence should be addressed to Hannah Khoddam, Department of Psychology, University of Southern California, SGM 501, 3620 McClintock Ave,
Los Angeles, CA 90089, USA. E-mail: lyden@usc.edu

Abstract
Expectant parents’ responses to infant cry may indicate future risk and resiliency in the parent-child relationship. Most
studies of parental reactivity to infant cry have focused on mothers, and few studies have focused on expectant fathers,
although fathers make important contributions to parenting. Additionally, although different responses to infant cry
(behavioral, psychological and neural) are hypothesized to track together, few studies have analyzed them concurrently. The
current investigation aimed to address these gaps by characterizing multimodal responses to infant cry within expectant
fathers and testing whether prenatal testosterone moderates these responses. Expectant fathers responded to infant cry vs
frequency-matched white noise with increased activation in bilateral areas of the temporal lobe involved in processing
speech sounds and social and emotional stimuli. Handgrip force, which has been used to measure parents’ reactivity to cry
sounds in previous studies, did not differentiate cry from white noise within this sample. Expectant fathers with higher
prenatal testosterone showed greater activation in the supramarginal gyrus, left occipital lobe and precuneus cortex to cry
sounds. Expectant fathers appear to interpret and process infant cry as a meaningful speech sound and social cue, and
testosterone may play a role in expectant fathers’ response to infant cry.

Key words: infant cry; response; fathers; physiological; behavioral; cognitive; affective

Introduction infant’s distress (Brosch et al., 2007). Researchers have studied

An infant’s survival depends on the caregiving relationship. endocrine, behavioral and, more recently, neural responses to
Caregivers who respond sensitively to their infant’s needs can infant cry, finding that hormone levels, handgrip strength and
facilitate their child’s healthy development (Ainsworth, 1979; patterns of brain activation may vary while listening to infant
Malmberg et al., 2016). An infant’s primary form of communica- cries (Fleming et al., 2002; Crouch et al., 2008; Kim et al., 2010).
tion, crying, may arouse the parent to respond and attend to an Previous studies have suggested that calm parental responses to

Received: 12 September 2019; Revised: 27 March 2020; Accepted: 6 April 2020

© The Author(s) 2020. Published by Oxford University Press.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/li
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 438 Social Cognitive and Affective Neuroscience, 2020, Vol. 15, No. 4

cry may be linked with approach-oriented, sensitive responses gyrus and supramarginal gyrus) bilateral posterior cingulate and
to infants (e.g. Joosen et al., 2013), whereas irritated or hyper- bilateral midbrain structures (Li et al., 2018). No differences were
reactive responses may be linked with risk for aggression or found between own infant cry and unfamiliar infant cry in these
neglect (Reijman et al., 2014; Zeifman and St James-Roberts, first-time fathers. Similarly, a study of the effects of vasopressin
2017). on processing infant cry sounds in expectant fathers found that
Despite these intriguing findings, the literature on reactiv- infant crying (vs control sounds) was associated with increased
ity to infant cry has several notable gaps. Surprisingly, given activation in the bilateral auditory cortex and posterior medial
that fathers often participate in infant caregiving, few studies cortex (Thijssen et al., 2018). First-time fathers, similarly to first-
have investigated responses to infant cry sounds in fathers time mothers, appear to engage five neural systems while lis-
and even fewer have included expectant fathers (Thijssen et al., tening to unknown infant cries: (i) auditory cortex (auditory
2018; Alyousefi-Van Dijk et al., 2019). Interventions have tar- perception), (ii) dMPFC (perspective-taking, theory of mind), (iii)
geted parents’ possible responses to infant cry as a marker of fronto-insular cortex (emotional empathy), (iv) thalamocingu-
aggressive responses to a crying infant (Barr et al., 2009; Coster, late circuits (parental caregiving) and (v) midbrain dopaminergic
2017). However, it is imperative to thoroughly study expectant regions (approach motivation) (Feldman, 2015). A recent meta-
fathers’ responses to infant cry in order to best tailor these analysis similarly confirmed involvement of the cingulate, the
interventions specifically before the baby even arrives. Men’s auditory system, the pre-supplementary motor area, the dorsal
hormones prior to the birth of their child (e.g. their testosterone anterior insula, the dMPFC and the IFG in infant cry perception
levels during their partner’s pregnancy) may also reflect their as well as larger activations in the right IFG, temporal pole and
preparation for parenting (Saxbe et al., 2017a) and also warrant left angular gyrus in men in response to infant cry compared to
examination in conjunction with expectant fathers’ responses women (Witteman et al., 2019).
to infant cry. Lastly, although responses across different mea-
surement domains, such as brain and behavioral responses,
Handgrip modulation response to infant cry
are assumed to relate to one another (Messina et al., 2016),
few studies have measured multiple responses to cry sounds Modulation of handgrip force is interpreted as a behavioral indi-
within the same population and analyzed them concurrently cator of motivation to respond to the distressed infant (Crouch
(e.g. Riem et al., 2012). Understanding how behavior works in et al., 2008; Riem et al., 2012; Zeifman and St James-Roberts,
tandem with the brain will help to clarify an overarching the- 2017). The ability to modulate handgrip force is measured by
ory of the biological response to infant cry and identify where a dynamometer, which tracks grip strength while an individ-
this system may go awry in aggressive or abusive parenting ual listens to an infant crying. Studies have suggested that
responses. excessive handgrip force, referred to as ‘poor modulation’, may
The current investigation aims to address these gaps by indicate risk for abuse or aggressive responding toward an infant
characterizing behavioral, psychological and neural responses to (Bakermans-Kranenburg et al., 2012). Poorly modulated handgrip
infant cry compared to frequency-matched white noise within response to infant cry has been linked with neglectful and
expectant fathers and by testing whether paternal prenatal physically abusive mothers (Compier-de Block et al., 2015) and
testosterone, a hormone that may reflect paternal investment, with parents at risk for child physical abuse (Crouch et al., 2008).
affects reactivity to infant cry. Other studies suggest that poor modulation of handgrip may
be an indicator of motivation to act or help while an infant is
crying (Parsons et al., 2013). One study of expectant fathers failed
Neural responses to infant cry
to find a difference in handgrip modulation between infant cry
Studies of parental brain responses to infant cry have focused and frequency-matched white noise control sounds (Alyousefi–
primarily on mothers, with few studies on fathers and even Van Dijk et al., 2019). However, this study involved vasopressin
fewer investigating expectant fathers (for review see Lynch, 2003; administration and viewing pictures of infant faces while lis-
Rilling and Young, 2014; Feldman, 2015; Abraham and Feldman, tening to infant cry. Earlier studies of infant cry and handgrip
2018; Thijssen et al., 2018; Witteman et al., 2019). These studies force also rarely utilized control sound stimuli, making it difficult
have investigated how parents respond to own infant cry vs to assess whether poor modulation is tied specifically to infant
unfamiliar infant cry or an unfamiliar infant cry compared to cry or more broadly to any distressing sound. The current study
a control sound. Infant cry sounds, in comparison to video builds on previous studies in examining the response to infant
or picture stimuli of infants, have been linked with amygdala cry in expectant fathers while also using a control condition of
activation in mothers, but not fathers or non-parents (Feldman, frequency-matched white noise.
2015). Recruitment of the amygdala may underscore parental
vigilance to infant distress cues (Abraham et al., 2014). Studies
Psychological response to infant cry
have found that mothers listening to an unknown infant com-
pared to a frequency-matched white noise show activation in In addition to neural and behavioral responses to infant cry,
components of the midbrain dopamine system (i.e. substantia researchers have investigated individual differences in parents’
nigra and ventral tegmental area), anterior and posterior cingu- self-reported interpretations of infant cry. Interpretations of a
late cortex, right fronto-insular cortex, dorsomedial pre-frontal crying infant as intentionally hostile or reporting increased frus-
cortex (dMPFC) (regions involved with emotional and cognitive tration and negative emotion while listening to infant cry have
empathy) and right lateralized auditory cortices extending to the been associated with risk for aggressive or harsh parenting
temporal pole (Lorberbaum et al., 1998). A study of neural reac- behaviors (Crouch et al., 2008; Rodriguez et al., 2015). However,
tivity in first-time fathers listening to unknown infant cry com- the question of whether these interpretations are associated
pared to a white noise control found bilateral activations in the with neural or behavioral responses to cry sounds is underex-
medial pre-frontal cortex, bilateral anterior insula and inferior plored. Parents who rate infant cry sounds as more hostile may
frontal gyrus (IFG), bilateral striatum, bilateral thalamus, bilat- show more excessive handgrip force while listening to infant
eral auditory cortex (including the planum temporale, Heschl’s cry (Crouch et al., 2008). Similarly, one study found that fathers
 H. Khoddam et al. 439

who rated infant cry as more aversive exhibited greater neural Current study
activation in auditory cortices (Li et al., 2018). Li and authors
Although neural, behavioral and psychological responses to
interpreted this greater neural activation as reflecting a form of
infant cry have been examined separately in previous studies,
negative emotional overarousal in response to infant cry sounds.
multi-modal approaches are needed to characterize how
However, another study found no relationship between mothers’
and whether these responses are correlated across domains.
irritation with infant cry sounds and their neural responses to
Moreover, understanding how expectant fathers respond to
the same sounds (Riem et al., 2012). In sum, this literature is
infant cry, and the role of testosterone in shaping these
small and inconclusive and has generally not included expectant
responses, might elucidate how fathers transition to parenthood
fathers.
and prepare to care for their infants.
Within a sample of fathers expecting their first child, we
The role of testosterone tested four hypotheses:

Many recent studies have investigated the neuroendocrine (i) In response to infant cry sounds (vs white noise), we
underpinnings of parenting (Bos et al., 2010; Bos, 2017). Testos- expected that expectant fathers would show greater neural
terone appears to decline across the transition to parenthood activation in regions that have been associated with infant
in men and may be associated with paternal sensitivity and cry specifically (e.g. socio-cognitive areas such as the STG,
involvement in childcare (Gettler et al., 2011; Storey and Ziegler, insula, mPFC, dlPFC, auditory cortices and IFG). We planned
2016; Saxbe et al., 2017b). Infant cry can elicit sensitive caregiving to use whole-brain analyses to test this hypothesis and to
(Murray, 1985) or frustration and annoyance (Frodi, 1985; Barr supplement these analyses with an a priori ROI focused on
et al., 2006; Del Vecchio et al., 2009). Some parents may be the amygdala.
physiologically overly responsive to noxious child stimuli, (ii) We also expected fathers to show behavioral responses to
such as infant cry (Knutson, 1978). This hyperreactivity can infant cry sounds, specifically poor handgrip modulation
lead to an increase in ‘irritable aggression,’ which may reflect when listening to infant cry sounds compared with white
heightened parenting stress and compromised parent-child noise sounds.
bonding. (iii) We expected that fathers’ responses to infant cry would
Higher levels of T around the transition to parenthood may be consistent across neural, behavioral and self-report
indicate the potential for harsh or insensitive parenting, partic- modalities. Specifically, given evidence that fathers who
ularly when coupled with this hyperreactivity to infant cry. The rated infant cry more negatively also showed heightened
role of testosterone in modulating paternal responses to infant neural activation to cry (Li et al., 2018), we expected that
cry, however, has received little attention, with most studies fathers who showed greater neural activation to infant
focusing on T reactivity to infant stimuli rather than baseline cry in hypothesized brain areas would also show poorer
levels of T across the transition to parenthood. One of the only handgrip modulation, greater interpretation of the infant
studies to investigate baseline levels of T in first-time fathers as more negative during infant cry and greater self-reported
(post-partum) failed to find a relationship between baseline T negative emotions after infant cry compared to white noise.
levels and neural activation differences in response to infant (iv) Given that prenatal testosterone may reflect paternal
cry vs frequency-matched white noise (Li et al., 2018). In studies investment in sensitive parenting, which requires the ability
investigating T reactivity to infant cry, it has been found that to modulate negative responses to aversive stimuli such
men with higher T reactivity (non-fathers and new fathers) in as infant cry, we hypothesized that fathers with higher
response to unfamiliar infant cries show less sympathy for these prenatal testosterone levels would show more reactivity to
infant cries (Fleming et al., 2002). Another study of reactivity infant cry, including more negative ratings of the infant,
to infant cry video stimuli found greater activation in the left more negative emotions after listening to infant cry, poorer
caudate in fathers whose testosterone increased more after handgrip modulation and more activation in hypothesized
interacting with their child (Kuo et al., 2012). These authors brain areas in response to infant cry.
suggest that increased testosterone and greater neural activa-
tion may indicate the body readying itself to protect the baby
as signaled by the urgent cries (Kuo et al., 2012). Additionally, Methods
another study found that infant cries from a baby doll decreased
T levels when the father was allowed to care for the infant but
Participants
increased T levels when the father was blocked from nurturing Participants were drawn from the larger longitudinal Hormones
the infant (Van Anders et al., 2012), while another found lower and Attachment Across the Transition To Childrearing (HATCH)
T after interacting with an infant in fathers with low cortisol study. The study follows couples from mid-to-late pregnancy
levels (Bos et al., 2018). Therefore, context may be important across the first year post-partum. Recruitment occurred via
for understanding the relationship between T and infant cry flyers, social media advertising and word of mouth. The current
reactivity in fathers, and increased T levels (both baseline and study uses data from a prenatal laboratory visit, conducted in
reactivity) may indicate a physiological hyperreactivity to infant mid-to-late pregnancy, and a separate MRI visit that occurred
cry and be associated with other potential hyperactive responses within 2 weeks of the in-lab visit. Inclusion criteria included that
to infant cry such as neural activity and handgrip modulation. couples were cohabiting, pregnant for the first- time with a sin-
Notably, testosterone level appears to be positively associated gleton fetus and free of use of psychotropic medication. Exclu-
with handgrip strength in men (Gallup et al., 2010), but the rela- sion criteria included any contraindications for MR scanning, the
tionship between testosterone and handgrip modulation has not use of psychotropic medication and left-handedness.
been thoroughly tested in the context of infant cry. Few studies Data for the current study were available for 41 expectant
have investigated testosterone levels in expectant fathers before fathers who provided handgrip and self-report data. Of these,
the birth of their child (prenatal T) and its potential role in 34 fathers also provided neuroimaging data, and 32 of these
reactivity to infant cry. fathers provided testosterone data. Mean age was 31.7 years
 440 Social Cognitive and Affective Neuroscience, 2020, Vol. 15, No. 4

old (s.d. = 4.25 years). The sample was highly educated with 80% Neuroimaging protocol. Imaging was performed on a Siemens 3
of participants achieving a college degree or higher, and the Tesla MAGNETOM Prisma scanner using a 20-channel matrix
population was ethnically diverse (36% White, 7% Black, 26% head coil. Functional images were collected using a T2∗ -
Hispanic or Latin, 24% Asian or Pacific Islander and 5% others). weighted echo planar (EPI) sequence (32 transversal slices;
TR = 2000 ms; TE = 25 ms; flip angle = 90◦ ) with a voxel resolution
of 3 mm × 3 mm × 2.5 mm. Anatomical images were acquired
Procedure
using a magnetization-prepared rapid acquisition gradient echo
Expectant fathers participated in one in-lab visit scheduled (MPRAGE) sequence (TR = 2530 ms; TE = 3.13 ms; flip angle 10o ;
mid-to-late pregnancy (average weeks pregnant = 29 weeks, isotropic voxel resolution 1 mm3 ). Task sounds were transmitted
s.d. = 4.7 weeks, range = 18–38 weeks) and an MRI visit an average using Siemens V14 sound headphone system.
of 1.05 (s.d. = 1.04, range 0–4 weeks) weeks later. The majority of
fathers (31 out of 34 fathers) completed the scan visit within
2 weeks of the in-lab visit. During the prenatal in-lab visit, Measures
each father provided three saliva samples for testosterone Emotional reactions questionnaire. Following the in-lab cry task,
sampling over 90 minutes and completed the handgrip task participants completed the ERQ (Milner et al., 1995) to indicate
after saliva collection, as described below. Additionally, after how well each adjective describes their present mood (1, not
completing the handgrip task, fathers were asked to listen to at all, to 7, extremely well). The negative emotion (bothered,
the infant cry noise and complete the Emotional Reactions irritated, annoyed and hostile) subscales were averaged to deter-
Questionnaire (ERQ) and trait rating task. During the MRI visit, mine negative emotions after listening to infant cry (alpha = 0.95,
fathers completed the same infant cry task as part of a larger Milner et al., 1995).
MRI data collection protocol. All procedures were approved by
University IRB, and all participants signed informed consent Trait rating task. Also following the in-lab infant cry task, each
forms prior to participation. father was asked to rate the infant on nine traits (i.e. hostile,
negative, difficult, friendly, cooperative, sweet, content, lively,
Infant cry task. Using the same infant cry and control sounds as attached). Following the procedures of previously conducted
a previous study (Riem et al., 2014), the cry task included six 30- studies (Crouch et al., 2008; Bakermans-Kranenburg et al., 2012),
second auditory clips of infant crying interspersed with six 30- the trait ratings were made on a 10-point scale (ranging from
second clips of frequency-matched white noise counterbalanced 1, not at all, to 10, extremely likely). Positive traits were also
across participants leading to 12 trials. The stimuli were pre- included to increase validity and decrease bias toward negative
sented electronically using the E-Prime 3.0 software (Psychology traits. Trait ratings were averaged across the three negative traits
Software Tools, Pittsburgh, PA) in a block design. The task was (hostile, negative and difficult) to obtain a composite negative
6-minute long and administered in one run. trait rating.

Handgrip modulation. Established procedures for handgrip

dynamometer data collection (Crouch et al., 2008; Bakerman- Analyses
s-Kranenburg et al., 2012; Riem et al., 2012) were followed. Prior Hypothesis 1. Neural responses to infant cry were analyzed
to playing the infant cry task, a research assistant demonstrated using FEAT (FMRI Expert Analysis Tool) of FSL (FMRIB’s Software
correct hand placement on the dynamometer and modeled the Library, www.FMRIb.ox.ac.uk/fsl; Smith et al., 2004). First, motion
handgrip task (with their dominant hand). Participants watched correction using MCFLIRT, non-brain removal, spatial smoothing
a line graph indicating grip-strength on the computer screen. (5 mm FWHM Gaussian kernel) and registration to T1-weighted
The participant was asked to perform a full-strength squeeze images using FSL FLIRT were done for pre-processing. Then,
and a half-strength squeeze while watching the line graph. functional activation was examined with general linear model
The RA gave verbal feedback on each trial to demonstrate analyses. To identify regions involved in the perception of infant
an accurate full-strength and half-strength grip. Once the crying, contrasts of cry > white noise and white noise > cry
participant performed this task accurately for three consecutive were assessed. Contrasts of parameter estimates (COPEs) for
trials, the participant performed the infant cry task. During cry > white noise and white noise > cry sound tested primary
data collection, participants were prompted to do a full-strength hypotheses regarding response to infant cry vs a frequency-
squeeze, followed 2 seconds later by a half-strength squeeze one matched white noise. First-level COPEs served as inputs to
time per infant cry and white noise trial. Participants averaged higher-level group analyses conducted using FLAME to model
30 trials (of one full-strength grip and one half-strength grip) random-effect components of mixed-effect variance. Images
during training, with a range of 7–50 trials to master the task. were thresholded with clusters determined by Z > 2.3 and a
cluster-corrected significance threshold of P < 0.05 (Worsley
Testosterone. Saliva samples were collected in CryoSafe collec- et al., 2002) to identify regions that were activated during cry
tion tubes using passive drool and then stored at −80◦ C before vs white noise across the six blocks for each sound. Father’s
shipment on dry ice to the Technical University of Dresden age and weeks pregnant were mean-centered and included
(Kirschbaum, PI) to be assayed. Fathers were instructed not to as confound regressors in all models. Models were run with
eat, drink anything besides water and chew gum within an and without covariates and yielded similar results. To visualize
hour of before collection. Timing of collection was held constant results, spherical ROIs (r = 5 mm) centered on activation peaks
across participants to minimize variability, and testosterone were used to extract signal change for each condition.
samples were taken during the first 90 minutes of the prenatal Additionally, given our a priori hypotheses focusing on the
laboratory visit and were not concurrent with the handgrip task amygdala, ROI analyses of the bilateral amygdala were con-
described above which occurred after all saliva samples were ducted. Parameter estimate values were converted to percentage
collected. Testosterone levels were averaged across the three signal change values via scaling of the PE or COPE values by (100∗ )
samples. the peak-peak height of the regressor (or effective regressor in
 H. Khoddam et al. 441

Table 1. Means and standard deviations for study variables

N Mean (s.d.)

Average handgrip cry 39 0.584 (0.124)

Average handgrip control 40 0.597 (0.126)
ERQ 39 11.28 (5.77)
Trait rating task 39 4.93 (2.17)
Aggregate testosterone 33 56.61 (20.65)
Age of expectant father 41 31.70 (4.25)
Days pregnant at prenatal visit 41 205.80 (33.01)

the case of COPEs) and then by dividing by the mean over time of was dropped due to neural activation in the contrast of interest
the filtered functional data. A report was generated using feat- (cry > white noise) being three standard deviations above the
query with statistics derived from each image’s values within mean. Means and standard deviations of all study variables are
the mask. Percent signal change was extracted from bilateral presented in Table 1, and bivariate correlations of main study
amygdala using anatomically defined masks created using the variables are shown in Table 2.
Harvard-Oxford subcortical atlas.

Hypothesis 1
Hypothesis 2. Consistent with previous studies (Crouch et al.,
2008; Bakermans-Kranenburg et al., 2012; Riem et al., 2012), hand- As depicted in Table 3 and Figure 1, greater activation to infant
grip modulation was calculated by dividing the half-squeeze cry than frequency-matched white noise emerged primarily in
intensity by the maximum squeeze intensity per block, and areas of the bilateral temporal lobes consisting of the auditory
an average ratio of half strength/full strength squeezes was cortices. These areas included bilateral planum temporale, left
calculated for infant cry and white noise per person. insular cortex, R Heschl’s gyrus, R STG (posterior and anterior),
R planum polare and left supramarginal gyrus, as well as the
right IFG. No differences were found in amygdala activation in
Hypothesis 3. Demeaned self-report ratings of infant cry and
response to infant cry vs white noise. No activation differences
negative emotions were added (separately) as regressors into
were found in response to white noise > infant cry.
the general linear model described above. The first-level con-
trast images of cry > white noise and white noise > cry were
submitted to second-level whole-brain analysis to determine Hypothesis 2
differences in activation depending on interpretations of the
A paired samples t-test was used to test for differences in hand-
infant as more negative and self-reported negative emotions
grip modulation during infant cry and white noise across fathers.
after infant cry. Both positive and negative contrast weights were
This hypothesis was not supported. No significant differences
tested for each continuous predictor to determine whether it is
were found in the ratio of half-strength/full-strength during
related to increased or decreased neural response. Lastly, mul-
infant cry vs white noise across fathers (t(40) = −1.21, P = 2.32).
tivariate regression analyses were used to test the relationship
Given the lack of a main effect finding of handgrip modulation
between interpretations of the infant as more negative, and
during infant cry compared to white noise, no further analyses
negative emotions during infant cry and signal change in the
were done testing the relationship between handgrip strength
amygdala ROI.
during infant cry and testosterone or psychological and neural
responses to infant cry.
Hypothesis 4. First, testosterone was added as a regressor to
the FSL models testing the relationship between prenatal T
and neural activation to infant cry as described above. Next, Hypothesis 3
multivariate regressions were run to determine the relationship This hypothesis was partially supported. Neural activation in
between (i) testosterone and negative infant interpretations and whole-brain analyses was not associated with fathers’ self-
(ii) testosterone and self-reported negative emotions while lis- reported negative emotions or their negative trait ratings
tening to infant cry. All analyses included gestational age of the of infant cry when using whole-brain analyses. Negative
infant and father’s age as covariates. interpretations of infant cry (trait rating task) predicted right
We adjusted for multiple comparisons using the Holm– amygdala percent signal change to infant cry (B = 0.36, P = 0.04;
Bonferroni method (Holm, 1979), in which the alpha value is Table 4), but this effect was not significant following correction
adjusted such that the lowest P-value (I = 1) is expected to fall for multiple comparisons. Handgrip force was not tested given
below a/k, where k is the number of analyses) and the higher the null findings in hypothesis two.
values to progressively less restrictive thresholds (a/(k − I + 1).
Therefore, for six planned analyses, we would require at
least one model be significant at P = 0.008 (0.05/)6, one model
Hypothesis 4
significant at 0.01 (0.05/5), one at 0.013 (0.05/4), one at 0.017 As hypothesized, expectant fathers with higher prenatal testos-
(0.05/3) and one at 0.025 (0.05/2). terone showed greater activation to infant cry sounds relative
to white noise sounds in the right supramarginal gyrus, the left
occipital cortex and the precuneus cortex (Table 5, Figure 2). No
Results
activation was found to be negatively associated with prena-
First, all data were explored for outliers and normality of distri- tal testosterone level. Prenatal testosterone level did not pre-
bution. All variables met the criteria for normality. One subject dict fathers’ negative emotion ratings in response to infant cry
 442 Social Cognitive and Affective Neuroscience, 2020, Vol. 15, No. 4

Table 2. Bivariate correlations of main study variables

Variables 1 2 3 4 5 6 7

1 Avg handgrip cry -

2 Avg handgrip control 0.88∗∗ -
3 ERQ −0.07 −0.08 -
4 Trait rating task −0.09 −0.13 0.48∗∗ -
5 Aggregate 0.17 0.09 0.12 0.15 -
testosterone
6 Age −0.03 0.04 0.10 0.00 −0.27 -
7 Days pregnant 0.04 0.05 0.08 0.24 −0.32∗ 0.26 -

∗∗ P < 0.01, ∗ P < 0.05, Avg = Average

Table 3. Neural activation during infant cry (N = 34)

Trial type Region x y z Z-max Voxels

Main effect
Cry > control
L supramarginal gyrus −46 −10 2 5.48 4673
L planum temporale −50 −36 14 5.12
L insula −46 4 −6 4.86
L temporal pole −46 14 −8 4.68
R planum temporale 62 −10 4 5.93 4430
R superior Temporal gyrus, posterior 66 −14 −4 5.20
R Heschl’s gyrus 50 −18 4 4.93
R planum porale 48 2 −8 4.81
R superior temporal gyrus, anterior 66 0 −6 4.70
R inferior frontal gyrus 53 29 12 2.58

Note: x, y, and z refer to MNI coordinates; Z-max refers to the peak level of activation intensity; voxels refers to the number of voxels in each significant cluster; L and
R refer to left and right hemispheres.

(B = 0.12, P = 0.52) nor negative ratings of the infant during infant

cry (B = 0.22, P = 0.16).

Discussion
This study sought to characterize neural, behavioral and
psychological responses to infant cry sounds among expectant
fathers and to examine whether their testosterone levels were
associated with these responses to cry sounds. Our hypotheses
were partially supported. As expected, infant cry (vs white noise
Fig. 1. Main effects for the contrast of interest infant cry > frequency-matched
sounds) elicited activation in regions including the superior
white noise. Revealed activation in the L supramarginal gyrus, L and R planum
temporal gyrus, IFG and insula, although we did not find porale, L Insula, L temporal pole, R superior temporal gyrus, anterior and poste-
expected differences in amygdala activation. Additionally, parts rior, R Heschl’s gyrus, R planum porale, and R IFG. Analyses cluster corrected at
of the auditory cortices such as the planum temporale, Heschl’s z = 2.3. (N = 34).
gyrus and supramarginal gyrus were additionally found to be
more active during infant cry than a frequency-matched white
noise, similarly to previous studies of first-time fathers and
expectant fathers (Li et al., 2018; Thijssen et al., 2018). The that, in contrast to biological mothers, who form a physical bond
planum temporale is situated posterior to the primary auditory with the infant prior to birth, the paternal brain primarily comes
cortex and has been found to be active during the processing ‘online’ after the birth of a child and in interacting with their
of speech-related cues (Baars and Gage, 2010), locating sound newborn (Abraham et al., 2014). However, the current research
in space (Hickok, 2009) and stimulus selection and auditory suggests that infant cry is nevertheless a salient stimulus for
attention (Hirnstein et al., 2013). The supramarginal gyrus has expectant fathers, even though they have not yet participated in
been implicated in phonological processing (e.g. Saur et al., 2008; caregiving for their own infants. Fine-tuning of these processes
Church et al., 2011) and in social cognition (Silani et al., 2013; may occur with socialization with the infant as has been previ-
Singer and Klimecki, 2014). Our sample of expectant fathers ously hypothesized (Atzil et al., 2012; Abraham et al., 2014; Feld-
appeared to recognize infant cry sounds as a meaningful speech man, 2015). However, the current study suggests that expectant
signal over and above a frequency-matched white noise. fathers show processing of infant cry that is similar to mothers
Additionally, areas of the brain associated with social cogni- and to fathers whose child is already born. Future studies would
tion (i.e. insula, supramarginal gyrus) appear to be more active benefit from including expectant fathers at different stages of
during cry than white noise. Previous research has suggested pregnancy or age-matched non-fathers to understand whether
 H. Khoddam et al. 443

Table 4. Summary of multiple regression analysis for variables predicting left and right amygdala activation to infant cry compared to white
noise
Left amygdala Right amygdala

t P β F df P t P β F df P

Model 1 1.17 3,29 0.34 1.96 3,29 0.15

Trait rating task 1.7 0.33 0.11 2.5 0.02 ∗ 0.46
Age −0.15 −0.03 0.88 0.18 0.85 0.03
Days pregnant −1.27 0.21 −0.26 −0.15 0.26 −0.23
R2 0.11 0.17
Model 2 1.14 3, 29 0.35 0.70 3, 29 0.56
Emotion reaction 1.65 0.11 0.29 1.4 0.16 0.26
Age −0.45 0.65 −0.08 −0.23 0.82 −0.04
Days pregnant −0.76 0.45 −0.14 −0.22 0.83 −0.04
R2 0.11 −0.03
Model 3 0.13 3,30 0.51 1.12 3, 30 0.36
Prenatal T 1.26 0.22 0.25 1.81 0.08 0.35
Age 0.04 0.97 0.01 0.45 0.65 0.09
Days pregnant −0.38 0.70 −0.07 0.20 0.84 0.04
R2 0.07 0.31

∗ P < 0.05. Bold = significant values.

Table 5. Associations between neural activation on task and prenatal testosterone (N = 32)

Trial type Region x y z Z-max Voxels

Positive associations with testosterone

Cry > control
R supramarginal gyrus 37 −44 60 4.24 184
L occipital cortex −34 −68 52 4.18 262
Precuneus cortex −10 −68 62 3.85

Note: x, y and z refer to MNI coordinates; Z-max refers to the peak level of activation intensity; voxels refers to the number of voxels in each significant cluster; L and
R refer to left and right hemispheres.

similar brain responses emerge in non-parents and if not, when may not be a specific response to infant cry per se but may reflect
and how these brain responses come ‘online’ during pregnancy. hyperarousal to aversive stimuli in general. Our null results
Although we did not find a main effect for amygdala acti- may also be due to limitations of the handgrip task itself or an
vation in response to infant cry vs white noise, we did find underpowered sample size. It was challenging for participants
that fathers’ negative views of infant cry predicted greater right to master the half-strength grip procedure, and many subjects
amygdala activation during infant cry compared to white noise. became frustrated during the training. It may be that this task
This finding contradicts a previous study that found no rela- is not reliable enough across participants to indicate a sensitive
tionship between amygdala activation and mothers’ reported response to infant cry.
irritation during infant cry (Riem et al., 2012), suggesting that this The relationship between psychological and neural response
finding may be specific to expectant fathers. However, this result to infant cry was additionally only partially supported in the
should be interpreted with caution given that it did not reach the current investigation, unlike previous studies which found a
level of significance after controlling for multiple comparisons. relationship between neural activation in auditory cortices and
Amygdala activation has been found to be greater during infant greater irritation to infant cry in new fathers (Li et al., 2018).
cry compared to other forms of infant stimuli (such as laughter), However, these results are in line with a previous investigation
and activation in these areas has been purported to underlie of mothers which failed to find a relationship between reported
parental vigilance to infant distress cues (Abraham et al., 2014). aversiveness of infant cry and neural activation to the same
Amygdala activation may also represent the hub of the emotion- sound (Riem et al., 2012). These null results may be due to a
processing sub-network of the parenting brain (Feldman, 2015; small sample size and an underpowered whole-brain analysis.
Abraham and Feldman, 2018). However, the current sample size is in line with the previous
Counter to hypotheses, no difference in handgrip modulation investigations (Riem et al., 2012; Li et al., 2018). Additionally, this
was found during infant cry compared to frequency-matched relationship may be stronger in fathers who could be at risk for
white noise. Several reasons may explain these null results. aggressive parenting or abuse. The current investigation sought
Firstly, although handgrip has been used to reflect potential to characterize the neural and psychological response to infant
aggression in response to infant cry in previous studies (Crouch cry in a community sample of expectant fathers and thus may
et al., 2008), these studies did not include a control sound com- not capture the responses indicative of abusive parenting risk.
parison. Similar null results were found in another population of Higher prenatal testosterone predicted greater activation in
expectant fathers (Alyousefi-Van Dijk et al., 2019) when compar- right supramarginal gyrus, left occipital cortex and the pre-
ing handgrip during infant cry and a frequency-matched white cuneus cortex. As stated above, previous studies have found
noise. These results together suggest that handgrip modulation the supramarginal gyrus to be implicated in social cognition
 444 Social Cognitive and Affective Neuroscience, 2020, Vol. 15, No. 4

Fig. 2. Whole-brain associations with neural activation during infant cry > white noise and prenatal testosterone level as regressor, peak cluster results. Greater
activation in the right supramarginal gyrus, precuneus and L occipital cortex was found during infant cry compared to frequency-matched white noise in expectant
fathers with higher prenatal testosterone level. Corresponding scatterplots show signal change in these areas associated with testosterone level. All analyses cluster-
corrected at z = 2. 3, P < .05. R = right; L = left (N = 32).

(Silani et al., 2013; Singer and Klimecki, 2014) and the precuneus (handgrip), hormonal (testosterone) and self-report data as well
cortex to be associated with arousal and reward learning (Swain, as MRI data. Another limitation is that because our sample
2011). Previous studies of first-time fathers and baseline T found consisted of expectant fathers, we were not able to present own
no neural activation differences in infant cry vs white noise in infant sounds and instead played unfamiliar cry sounds. How-
conjunction with T level (Li et al., 2018). However, T reactivity ever, this limitation is balanced by the advantage that the stimuli
to infant stimuli has been found to be associated with greater was standardized across participants and has been used in pre-
neural activation in the left caudate to infant cry while listening vious studies even with participants who were already parents.
to infant cry and watching infant video stimuli (Kuo et al., 2012). Additionally, testosterone levels and neuroimaging responses
Given that this is the first investigation to look at neural acti- were collected on different days and therefore may not fully
vation to infant cry in expectant fathers and baseline prenatal map onto each other. Finally, these data are cross-sectional,
T levels, this finding may be specific to the prenatal period. focusing only on expectant fathers. Future studies can extend
Additionally, greater activation to infant cry in association with this work by focusing on prenatal responses to cry as a predictor
higher T level may indicate a hyperreactivity to infant cry in line of later parenting behavior. Given the exploratory nature of this
with previous investigations that have found a positive relation- study and the novel population included, future research should
ship between neural activation and greater reports of irritation endeavor for an increased sample size to replicate and clarify
to infant cry in new fathers (Li et al., 2018). However, the current these results.
investigation did not measure parenting behaviors post-partum Despite its important limitations, this study is one of the
in these fathers with higher T. Future studies can investigate first to investigate responses to infant cry in expectant fathers
whether fathers’ prenatal responses to cry sounds predict their across multiple modalities. Our sample was ethnically diverse
actual parenting behaviors following the birth of their child and and contributed hormonal, behavioral, neural and self-report
how this relates to testosterone level across pregnancy. data. Our findings suggest that expectant fathers process
The current study had a number of limitations. Our sam- infant cry as a salient and meaningful speech sound that may
ple size was small (34 fathers), albeit larger than the samples require empathic responding, even before the child is born.
used in most published studies of the parenting brain. More- Additionally, it appears that testosterone may moderate this
over, we used a multimodal approach, incorporating behavioral effect, with expectant fathers who were higher in testosterone
 H. Khoddam et al. 445

also showing stronger neural responses to infant cry. Given Bos, P.A., Hermans, E.J., Montoya, E.R., Ramsey, N.F., van
the importance of fathers to healthy child development, this Honk, J. (2010). Testosterone administration modulates neural
work contributes to our understanding of the fathering brain responses to crying infants in young females. Psychoneuroen-
and can ultimately improve the detection of fathers at risk and docrinology, 35(1), 114–21. doi: 10.1016/j.psyneuen.2009.09.013.
inform the development of interventions that target expectant Bos, P.A., Hechler, C., Beijers, R., Shinohara, K., Esposito, G., de
fathers. Weerth, C. (2018). Prenatal and postnatal cortisol and testos-
terone are related to parental caregiving quality in fathers,
but not in mothers. Psychoneuroendocrinology, 97, 94–103. doi:
10.1016/j.psyneuen.2018.07.013.
Funding Brosch, T., Sander, D., Scherer, K.R. (2007). That baby caught my
This work was supported by the National Science Foundation eye... attention capture by infant faces. Emotion, 7(3), 685–9. doi:
(NSF) Career Award # 1552452 (Saxbe) and the Eunice Kennedy 10.1037/1528-3542.7.3.685.
Shriver National Institute of Child Health and Human Develop- Church, J.A., Balota, D.A., Petersen, S.E., Schlaggar, B.L. (2011).
ment, Grant Number 1F31HD093107-01A1 (Khoddam). Manipulation of length and lexicality localizes the func-
tional neuroanatomy of phonological processing in adult read-
ers. Journal of Cognitive Neuroscience.. 23(6), 1475–1493. doi:
Conf lict of interest 10.1162/jocn.2010.21515.
Compier-de Block, L.H.C.G., Alink, L.R.A., Reijman, S., et al.
The authors declare no competing interests.
(2015). Handgrip force of maltreating mothers in reaction
to infant signals. Child Abuse and Neglect, 40, 124–31. doi:
10.1016/j.chiabu.2014.03.006.
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