Intervention effects on foster parent stress: Associations with child cortisol levels

Abstract

Foster children exhibit high rates of atypical neuroendocrine functioning compared to children in the general population. In particular, alterations in the daytime diurnal activity of the hypothalamic-pituitary-adrenal (HPA) axis have been observed in foster children, often characterized by blunted salivary cortisol levels (i.e., low morning levels that remain low throughout the day). There is emerging evidence that therapeutic interventions for foster children can affect this pattern of HPA axis activity, but the specific intervention components responsible for change have not been fully explicated. Within a randomized trial to evaluate a therapeutic intervention for foster preschoolers (n = 57 intervention condition; n = 60 comparison condition; n = 60 community comparison condition), the present study examined whether diurnal cortisol activity was associated with caregiver self-reported stress in response to child problem behavior. Results showed immediate reductions in caregiver stress that were sustained through 12 months postbaseline in the intervention condition. In contrast, caregivers in the regular foster care condition showed higher rates of stress across time and increased stress sensitivity to child problem behaviors. In addition, among caregivers in regular foster care, higher self-reported stress was associated with lower morning cortisol levels and more blunted diurnal cortisol activity. These results provide evidence that interventions can simultaneously impact caregiver stress and buffer children from the negative impacts of caregiver stress on HPA axis regulation Keywords foster care; cortisol; problem behavior; caregiver stress; preschool Prevention science has great potential to improve outcomes of children in the foster care system. This is an issue of considerable public health significance given that there are more than 500,000 children in foster care in the United States, one third of whom are age 5 years or younger (U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 2005). Moreover, foster care is increasingly being employed as an alternative to institutional care in developing countries (George, van Oudenhoven, & Wazir, 2001). Studies of foster children have consistently found high rates of psychosocial maladjustment and emotional/behavioral disorders (Landsverk, Garland, & Leslie, 2002). Among infants and young children in foster care, developmental delays are also very prevalent (Klee, Kronstat, & Zlotnick 1997 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThat such disparities exist in foster care is not surprising. In addition to maltreatment (e.g., neglect, physical abuse, and sexual abuse), foster children undergo at least one and often numerous caregiver transitions. Many of these transitions occur without warning to the child and result in the immediate loss of contact with prior caregivers, sometimes permanently (Fisher & Kim, 2007). Compounding this situation, some of these children have lacked a ...

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