Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity

Abstract

Atypical diurnal patterns of hypothalamic-pituitary-adrenal (HPA) axis activity have been observed samples of individuals following early life adversity. A characteristic pattern arising from disrupted caregiving is a low early morning cortisol level that changes little from morning to evening. Less well understood is the plasticity of the HPA axis in response to subsequent supportive caregiving environments. Monthly early morning and evening cortisol levels were assessed over 12 months in a sample of 3-to 6-year-old foster children enrolled in a randomized trial of a family-based therapeutic intervention (N = 117; intervention condition n = 57; regular foster care condition n = 60), and a community comparison group of same-aged, nonmaltreated children from low-income families (n = 60). Latent growth analyses revealed stable and typical diurnal (morning-to-evening) cortisol activity among community comparison children. Foster children in the intervention condition exhibited cortisol activity that became comparable to the comparison group children over the course of the study. In contrast, children in regular foster care condition exhibited increasingly flattened morning-to-evening cortisol activity over the course of the study. In sum, improvements in caregiving following early adversity appear to have the potential to reverse or prevent disruptions in HPA axis functioning.

Interventions to Improve Cortisol Regulation in Children: A Systematic Review

“…Nineteen articles from 17 studies met inclusion criteria; 1 study resulted in 3 articles [44][45][46] ; we describe in detail only the initial article 44 (Table 1). Study characteristics are summarized in Tables 2 and 3.…”

“…The first study that met inclusion criteria was published in 1997. 47 The majority of studies were RCTs (n = 13) 44,45,[47][48][49][50][51][52][53][54][55][56][57][58] ; quasi experiments were less common (n = 4). [59][60][61][62] The sample sizes ranged from 12 53 to 1197, 61 with a median of 126 participants.…”

“…60 Studies in young children were most common; 7 studies restricted enrollment to children younger than 2 years, [47][48][49]54,57,58,62 whereas 3 studies enrolled children aged 7 or older. 53,55,60 Samples were selected on the basis of the following: institutionalization or involvement with foster care (n = 5), 44,47,49,50,59 maltreatment history (n = 2), 56,62 maternal depression (n = 2), 57,58 and other family characteristics associated with developmental risk (eg, parental loss, 55 poverty, 61 maternal drug use 48 ; n = 6); and 2 studies used samples of children from the…”

Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study

“…Further research should disentangle the sources of abuse and warmth within and outside the home. This type of information could inform targeted interventions for abused children similar to a recent family-based therapeutic intervention with children in foster care showing improvements in developmental, physical, and mental health outcomes (51). Similarly, resilience factors may also be important, and future work should consider components of the psychosocial environment (e.g., social support, optimism, trait disposition) that may act as buffers.…”

Editorial: The Violence and Addiction Equation Revisited

“…Emergent evidence suggests that in situations of increased predictability and structures for foster care youth (treatment foster care), stabilization of stress seems to be achievable (i.e., change from atypical to typical cortisol pattern, Fisher et al 2007). This neurobiological resilience system reflects the adaptive capacity to interact with new environments and create new modes of responding and interacting that serve survival and development better (Cicchetti and Curtis 2006).…”