Neonatal Risk, Maternal Sensitive-Responsiveness and Infants’ Joint Attention: Moderation by Stressful Contexts Alisa Egotubov 1 & Naama Atzaba-Poria 1 & Gal Meiri 1,2 & Kyla Marks 1,2 & Noa Gueron-Sela 1,3 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Neonatal risk factors have been associated with atypical development in various areas of social communication, including joint attention (JA), but little is known about factors in the early caregiving environment that can modify the negative implications of neonatal risk. The present study examines the links between neonatal risk and infants' JA, while considering the mediating role of maternal sensitive-responsiveness and the moderating roles of stressful contexts. One hundred and eighty-two families with infants (50% female) born in a wide range of gestational ages and birthweights participated in the study. Neonatal risk was assessed shortly after birth using three indicators: birthweight, gestational age, and degree of medical risk. At age 6 months, maternal sensitive-responsiveness to infants’ foci of attention was rated and maternal anxiety and household chaos were mea- sured. Infants’ JA behaviors were assessed at age 12 months. A moderated-mediation model revealed that maternal anxiety symptoms and household chaos moderated the links between neonatal risk, maternal sensitive-responsiveness, and infants’ responding to JA. Specifically, neonatal risk was related to less maternal sensitive-responsiveness only when maternal anxiety symptoms were above average levels, but not when anxiety symptoms were low. Moreover, maternal sensitive-responsiveness was positively related to infants’ responding to JA behaviors when household chaos was low but not when it was high. These findings highlight the complex nature of the links between infants’ early biological risk and caregiving environments in the development of social communication skills. Keywords Neonatal risk . preterm birth . joint attention . parenting . anxiety . household chaos Advances in neonatal intensive care during the past decades have vastly improved the survival rates of infants born at heightened neonatal risk (e.g., premature birth, low birthweight, medical complications; Saigal and Doyle 2008). However, research points to the long-term negative impact of neonatal risk factors on a range of developmental domains, including social communication, and more specifically joint attention (JA) abilities (see Zmyj et al. 2017 for review). JA skills are considered a core developmental milestone that lays the foundation for the development of cognitive, language, and social skills (Mundy et al. 2007), and atypical develop- ment of JA may be indicative of neurodevelopmental disor- ders such as autism spectrum disorder (ASD; Meindl and Cannella-Malone 2011). Thus, there is considerable impetus for achieving a better understanding of the mechanisms by which neonatal risk is associated with JA skills. The biopsychosocial perspective underscores the complex interplay among biological, social, and behavioral factors dur- ing the course of a child’ s development and elucidates multi- ple pathways to adaptive and maladaptive functioning (Calkins 2015). In this study, we employ this perspective to examine whether the links between infants’ biological neona- tal risk and psychosocial functioning (i.e., joint attention skills) are mediated and moderated by social factors such as parenting behaviors, maternal anxiety, and household chaos. We specifically focused on three aspects of biological neona- tal risk (i.e., birthweight, gestational age, and degree of med- ical risk) all of which have been related to atypical social- communication functioning (Garner and Landry 1994; Landry et al. 1990; Landry et al. 1998; Olafsen et al. 2006). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10802-019-00598-3) contains supplementary material, which is available to authorized users. * Noa Gueron-Sela gueron@post.bgu.ac.il 1 Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel 2 Soroka Medical Center, Beer-Sheva, Israel 3 Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel Journal of Abnormal Child Psychology https://doi.org/10.1007/s10802-019-00598-3