Cortisol Levels in Babies Who Are in Foster Care

Dev Psychobiol. Writer manuscript; available in PMC 2010 Jan 1.

Published in final edited form as:

PMCID: PMC2644049

NIHMSID: NIHMS76051

Forenoon Cortisol Levels in Preschool-Aged Foster Children: Differential Effects of Maltreatment Type

Jacqueline Bruce

Oregon Social Learning Center, Eugene, OR and Middle for Research to Exercise, Eugene OR

Philip A. Fisher

Oregon Social Learning Middle, Eugene, OR and Center for Research to Practice, Eugene OR

Katherine C. Pears

Oregon Social Learning Center, Eugene, OR and Center for Research to Practice, Eugene OR

Seymour Levine

Center for Neuroscience, University of California, Davis, CA

Abstruse

Maltreated foster children are subjected to a range of early adverse experiences, including neglect, abuse, and multiple caregiver disruptions. Enquiry suggests that such disturbances change the development and subsequent functioning of the hypothalamic-pituitary-adrenocortical system. The current study was designed to investigate forenoon cortisol levels in 117 foster children and 60 low-income, nonmaltreated children. Maltreatment and foster care placement experiences were coded from official records. Analyses revealed that the foster children were significantly more likely than the nonmaltreated children to have low morning cortisol levels. Additionally, specific maltreatment experiences were significantly associated with the foster children's morning cortisol levels. Foster children with low morning cortisol levels experienced more than astringent physical neglect than the other foster children. In contrast, foster children with high morn cortisol levels experienced more than severe emotional maltreatment. These results advise that specific early agin experiences accept differential effects on the performance of the hypothalamic-pituitary-adrenocortical arrangement.

Keywords: cortisol, preschool-aged children, foster care, physical neglect, emotional maltreatment

In the The states, at that place are 513,000 children in foster care and 311,000 children enter foster care each yr (U.S. Section of Health and Human Services, 2006). Foster children are exposed to a host of early agin experiences, including neglectful and/or abusive care and repeated caregiver disruptions. Information technology is not surprising, therefore, that numerous studies accept institute foster children to be an exceptionally loftier-risk grouping. Foster children exhibit concrete, cognitive, and socioemotional disparities compared to their peers (Leslie, Gordon, Ganger, & Gist, 2002; Pears & Fisher, 2005; Zima et al., 2000). These children are also at risk for feet disorders, melancholia disorders, and confusing behavior disorders (Casey Family unit Programs, 2005; Clausen, Landsverk, Ganger, Chadwick, & Litrownik, 1998; Garland et al., 2001). Although there is considerable evidence of negative outcomes amid foster children, little is known nigh the biological mechanisms underlying the clan between early adverse experiences and afterward maladaptation in this population. Moreover, in that location is express research examining the differential impact of specific dimensions of early adverse experiences on these mechanisms. The current study was aimed at examining the touch of maltreatment and foster intendance placement experiences on one possible biological mechanism, the hypothalamic-pituitary-adrenocortical (HPA) system.

The HPA system serves two distinct functions: maintaining the diurnal rhythmicity of hormone product and mounting responses to stressors. Cortisol, the hormonal stop product of the HPA arrangement, displays a diurnal rhythm characterized by relatively high levels at waking that steadily decrease to very depression levels at bedtime (Schmidt-Reinwald et al., 1999). Elevated morning cortisol levels play a role in the metabolism of stored energy, the stimulation of appetite, and the promotion of processes involved in learning (de Kloet, 1991; de Kloet, reugdenhil, Oitzl, & Joels, 1998). The HPA system is also sensitive to a wide range of physically aversive and psychologically stressful situations. Cortisol facilitates the mobilization of the fundamental and peripheral resource necessary to manage such challenges (Hennessy & Levine, 1979; Sapolsky, Romero, & Munck, 2000). Although the HPA organization is critical to adaptive performance, prolonged dysregulation of this system has deleterious effects on physical development, immune functioning, and cognitive functioning (Johnson, Kamilaris, Chrousos, & Gold, 1992; Lupien, Maheu, Tu, Fiocco, & Schramek, 2007; Sapolsky et al., 2000). Additionally, dysregulation of the HPA system has been implicated in the etiology of feet disorders, melancholia disorders, and disruptive behavior disorders (De Bellis et al., 1999; Heim & Nemeroff, 2001; Kaufman & Charney, 2001; Repetti, Taylor, & Seeman, 2002).

There is substantial testify suggesting that early adverse experiences profoundly alter the development and subsequent functioning of the HPA system (Bremner & Vermetten, 2001; Gunnar & Vazquez, 2001; Sáchez, Ladd, & Plotsky, 2001). Acute stressors activate the HPA system and elevate cortisol levels. As such, atypically high morning cortisol levels have been observed among children who experienced multiple types of maltreatment, maltreated children with posttraumatic stress disorder, and adolescents exposed to maternal postnatal depression (Cicchetti & Rogosch, 2001; De Bellis et al., 1999; Halligan, Herbert, Goodyer, & Murray, 2004). In contrast, chronic stress and activation of the HPA organization are believed to lead to downwardly-regulation of the arrangement and blunted cortisol levels at the expected peak of the diurnal rhythm and/or during stressors (Fries, Hesse, Hellhammer, & Hellhammer, 2005; Gunnar & Vazquez, 2001; Heim, Ehlert, & Hellhammer, 2000). For example, low morning time cortisol levels have been observed in rhesus monkeys exposed to repeated maternal separations, children raised in institutions, and women with histories of childhood abuse (Carlson & Earls, 1997; Heim, Newport, Bonsall, Miller, & Nemeroff, 2001; Sáchez et al., 2005). Near germane to the current written report, children placed in foster care as infants had lower morning cortisol levels than nonmaltreated children (Dozier et al., 2006). In sum, although at that place is testify that early on adverse experiences alter the development of the HPA organisation, high and low morning cortisol levels accept been observed amidst different populations exposed to these experiences.

Given these findings, it might be fruitful to elucidate the specific dimensions of early on adverse experiences that impact the HPA system. For example, prolonged maternal separations during the first weeks of life have been shown to alter stress reactivity in rodents (Rosenfeld, Wetmore, & Levine, 1992; van Oers, de Kloet, & Levine, 1997). However, these effects on stress reactivity were related to disruptions in specific maternal behaviors such every bit licking, grooming, and nursing behaviors during the separations (Suchecki, Rosenfeld, & Levine, 1993; van Oers, de Kloet, & Levine, 1999). Similarly, specifying the relevant dimensions of early adverse experiences in humans might shed lite on the observation of loftier and low forenoon cortisol levels among unlike populations. In this regard, foster children might be an ideal population to study. Foster children'southward early adverse experiences can be abstracted from detailed official records and can exist quantified using standardized coding systems (e.g., Barnett, Manly, & Cicchetti, 1993). Additionally, foster children tend to be quite heterogeneous in terms of their maltreatment and foster intendance placement experiences (e.g., type and severity of maltreatment). Thus, the impact of specific dimensions of early adverse experiences can be examined.

Although there has been express research on the HPA arrangement with foster children, prior research has suggested that specific maltreatment and foster care experiences are associated with differential effects on the HPA system. For example, astringent sexual abuse was related to loftier morning cortisol levels in schoolhouse-anile maltreated children (Cicchetti & Rogosch, 2001). In contrast, it has been argued that the absenteeism of a responsive caregiver, as is seen in cases of astringent neglect, leaves immature children vulnerable to stressors and chronic activation of the HPA arrangement, ultimately leading to blunted morning time cortisol levels (Gunnar, Fisher, & the Early Experience, Stress, and Prevention Network, 2006). Indeed, low morning cortisol levels have been observed among children placed in foster care primarily due to neglect and children raised in neglectful institutions (Carlson & Earls, 1997; Dozier et al., 2006). Finally, because repeated maternal separations resulted in low diurnal cortisol levels in nonhuman primates (Dettling, Feldon, & Pryce, 2002; Sáchez et al., 2005), the number of caregiver disruptions might be associated with low morning time cortisol levels among foster children. Nevertheless, although the number of caregiver disruptions has not been examined in foster children, two other foster care placement variables, age at entry into foster care and length of time since inbound foster care, were found to be unrelated to morning cortisol levels (Dozier et al., 2006).

The current report was designed to examine patterns of morning cortisol product in foster children and their nonmaltreated peers and to explore associations between foster children's morning cortisol levels and their maltreatment and foster care experiences. The study was focused on morning cortisol levels because diurnal cortisol levels can be assessed noninvasively in young children and because prior research has suggested that early adverse experiences impact morn cortisol levels (Carlson & Earls, 1997; Cicchetti & Rogosch, 2001; Dozier et al., 2006). In addition to using morning time cortisol levels as a continuous variable, a trichotomous variable was created to let the test of low, average, and high morning time cortisol levels separately. Furthermore, prior research has shown that adverse experiences broaden the distribution of cortisol levels by increasing the frequency of extreme values (Kaspers & Scholz, 2004), which distorts the sample mean and violates the distributional assumptions of most statistical tests. It was hypothesized that foster children, as a group, would be more likely to display low morning time cortisol levels than nonmaltreated children. However, information technology was predicted that specific early agin experiences would exist differentially associated with morning cortisol levels. In particular, foster children who had experienced more than severe sexual abuse were expected to exhibit high morning time cortisol levels and foster children who had experienced more severe concrete neglect were expected to exhibit low morning cortisol levels. It was hard to make specific hypotheses regarding the relations between morning cortisol levels and foster care placement experiences; thus, these analyses were exploratory.

Methods

Participants

The sample included a foster care (FC) group of 117 maltreated three- to 6-year-olds residing in foster intendance and a community comparison (CC) grouping of lx low-income, nonmaltreated 3- to 6-twelvemonth-olds living with their biological parents. For the FC grouping, children who were within the selected age range and were entering a new foster intendance placement were referred to the written report by the county branch of the state child welfare arrangement office. Referrals included children being placed in foster care for the kickoff time, reentering foster intendance post-obit failed reunifications with biological parents, or transitioning to a new foster care placement. The CC children were recruited via flyers posted throughout the community and advertisements in local newspapers. Inclusion criteria for the CC group were every bit follows: child consistently lived with at least one biological parent, household income was less than $30,000, parental education was less than a 4-year higher degree, and family unit did non have any previous interest with child welfare services as verified by child welfare services records.

All of the children were role of a randomized efficacy trial of a preventive intervention programme for preschool-aged foster children and their caregivers (Multidimensional Handling Foster Care for Preschoolers; Fisher, Ellis, & Chamberlain, 1999), in which the FC children were randomly assigned to the intervention status or services-every bit-usual comparison condition. Even so, considering the measures in the current paper were collected prior to the intervention, foster care treatment condition was non considered in the analyses. (The bear on of the intervention on the children's diurnal cortisol levels over a 12-calendar month period is presented elsewhere [Fisher & Stoolmiller, in press; Fisher, Stoolmiller, Gunnar, & Burraston, 2007].)

Measures

Salivary cortisol

The caregivers were trained past staff members to collect saliva samples from their children. The samples were obtained on 2 consecutive, typical weekday mornings (xxx min afterwards waking simply before eating breakfast). To stimulate salivation, the children chewed Trident Original sugarless gum, which prior research has shown to not affect cortisol levels (Schwartz, Granger, Susman, Gunnar, & Laird, 1998). Salivettes (Sarstedt, Inc., Newton, NC) were so placed in the children'due south mouths. In one case saturated, the Salivettes were placed in prelabeled plastic vials. The caregivers were instructed to freeze the samples until transported to the laboratory by staff members. The samples were then stored at −five°F (−20°C) until assayed. The samples were assayed for cortisol determination using the Loftier Sensitivity Salivary Cortisol Enzyme Immunoassay Kit (Salimetrics, LLC, State Higher, PA). Samples from each kid were included in the aforementioned assay batch to minimize within-subject field variability. The samples were assayed in indistinguishable and were averaged. Duplicates varying by more than than fifteen% were reassayed. The intraassay and interassay coefficients of variance were 2.lxx% and 10.98%, respectively.

Certain medications, full general wellness, food intake, and sleep patterns accept been shown to touch on cortisol levels. Thus, children who used steroid-based medications (e.g., steroidal asthma inhalers) on a regular basis were excluded from the written report. Caregivers were reminded during daily phone conversations to avoid sampling when their children were using steroid-based medications or were ill. Caregivers completed a brief questionnaire regarding sampling times and their children's eating and sleeping behaviors on the sampling days. The questionnaires were inspected to ensure compliance with sampling guidelines; 2 samples (i.e., both samples from one CC kid) were excluded from analyses due to incorrect sampling times.

Cortisol level and cortisol classification

Because cortisol values (the term used to refer to the untransformed cortisol data) from the two sampling days were significantly correlated, r(169) = .37, p < .001, they were averaged to create a more reliable measure. For the continuous variable referred to as cortisol level, the cortisol values were subjected to a foursquare root transformation and two outliers (i.due east., more than 2.five standard deviations in a higher place the hateful) were replaced with less farthermost cortisol values (i.due east., next highest cortisol value in the sample) to normalize the distribution. The cortisol values were also transformed into a trichotomous variable referred to as cortisol classification. Cortisol values respective with the lower and upper quartile for the sample were used to classify the cortisol values equally low (< .30 µg/dl), boilerplate (.30–.threescore µg/dl), or high (> .60 µg/dl). The whole sample was used to establish these cutoffs to avoid biasing the analyses examining the group difference in cortisol classification. (Information technology is difficult to compare cortisol values across studies due to different sampling and assaying techniques. However, equally an breezy comparison, Dozier and colleagues (2006) classified morning cortisol values less than .21 µg/dl every bit low and greater than .84 µg/dl as high.) Although the children'due south cortisol values are displayed in Figure 1, the transformed cortisol level and cortisol classification variables were used in all analyses.

Distributions of the untransformed, uncensored cortisol values for the foster care (FC) and customs comparison (CC) children. (The circle indicates a cortisol value more than 3 times the interquartile range away from the upper quartile.)

Maltreatment experiences

The FC children's maltreatment experiences were coded from child welfare services records using the Maltreatment Classification System (MCS; Barnett et al., 1993), which allows for the nomenclature of each incident according to type and severity. The types of maltreatment defined in the MCS comprise physical abuse, sexual corruption, concrete neglect (i.e., parental failure to provide adequate nutrient, clothing, shelter, or medical intendance), supervisory neglect (i.e., parental failure to provide historic period-appropriate supervision), and emotional maltreatment (i.e., parental rejection, abandonment, or failure to protect child from witnessing traumatic events). Maltreatment severity in the MCS is coded on a v-point calibration ranging from less serious incidents to potentially life-threatening incidents.

Training in the use of this coding system was provided by one of the MCS authors (J. T. Manly). Twenty pct of the records were coded past two coders to compute interrater agreement. Coders outset examined the child welfare services records to place incidents of maltreatment. To exist considered an incident, the situation had to match the provided definitions of maltreatment and had to be reported past a mandated reporter or founded past a kid welfare services caseworker. Understanding on the identification of incidents of maltreatment was high (80%). Similarly, interrater agreement for the severity of each type of maltreatment was high (boilerplate κ = .72, range for individual categories = .82–.65). Number of maltreatment incidents, number of types of maltreatment, and hateful severity for each type of maltreatment were calculated for each FC child.

Foster care placement experiences

The FC children's foster care placement experiences were also coded from child welfare services records. These highly detailed records include the date of commencement entry into the foster intendance system and the date of entry and get out from every foster care placement thereafter. From these records, age at offset entry into foster care, number of caregiver disruptions (i.e., due to placements in foster intendance, transitions within the foster care system, and eunifications with biological parents), and length of time since entering the current foster care placement were calculated for each FC kid.

Statistical Analysis

Preliminary analyses were conducted to investigate the associations between cortisol level and cortisol classification and a number of potentially confounding demographic variables. Group differences in cortisol level and cortisol classification were then examined using an independent-samples t exam and chi-square analyses, respectively. Pearson product-moment correlations were subsequently conducted to investigate the relations between the FC children'south cortisol levels and their early agin experiences, and one-way analyses of variance (ANOVAs) and post hoc paired comparisons using Fisher'due south to the lowest degree significant difference were conducted to examine the associations betwixt the FC children's cortisol classifications and their early agin experiences. Because the CC children did not have any involvement with child welfare services, they were non included in the analyses exploring early adverse experiences. An alpha level of .05 was used for all statistical tests.

Results

Preliminary Analyses

The FC and CC children did not significantly differ in terms of age, F(1, 175) = 0.56, ns, sex, Pearson χ²(1, Due north = 177) = 0.01, ns, or ethnicity, Pearson χ²(ane, N = 177) = 3.twenty, ns. The mean age was iv.41 years (SD = 0.84) for the FC children and 4.31 years (SD = 0.79) for the CC children. Males fabricated up 54% (n = 63) of the FC group and 53% (northward = 32) of the CC grouping. The ethnicity of the FC children was 87% (northward = 102) European American, 7% (north = 8) Latino, v% (n = half dozen) Native American, and 1% (due north = i) African American. The ethnicity of the CC children was 77% (n = 46) European American, 8% (n = 5) Latino, 7% (north = iv) Native American, vii% (n = 4) African American, and 2% (north = i) Pacific Islander. Preliminary analyses revealed that cortisol level was not significantly related to sex, r(174) = .02, ns, historic period, F(1, 174) = 0.01, ns, or ethnicity F(1, 174) = 0.47, ns. Similarly, cortisol classification was not predicted by age, F(2, 173) = 0.25, ns, sex, Pearson χ²(2, N = 176) = one.46, ns, or ethnicity, Pearson χ^two(two, N = 176) = 1.45, ns.

Most of the FC children remained in foster care over the course of the study, which made information technology difficult to obtain information near the FC children's biological families and to compare the family unit characteristics of the FC and CC children. Yet, this information was obtained for a subsample of FC children who returned to their biological parents' care (due north = 39). The income level for these FC families and the CC families was significantly unlike, F(1, 97) = x.62, p < .005, with median income levels of $10,000–14,999 for the FC families and $xv,000–19,999 for the CC families. The groups too differed on the highest level of education attained by the FC and CC parents, F(1, 97) = 16.98, p < .001 (FC Mdn = completed high school; CC Mdn = completed some college or vocational school courses). Preliminary analyses with the children for whom this information was available indicated that cortisol level was not associated with income, r(96) = .12, ns, or parental education, r(96) = .14, ns. Additionally, cortisol classification was non related to income, F(ii, 95) = 0.96, ns, or parental education, F(two, 95) = 1.43, ns.

There were 24 sibling dyads (14 FC and 10 CC), iii sibling triads (3 FC), and i sibling tetrad (i FC) in the written report. Preliminary analyses, which included only 1 randomly selected child from each sibling group, were conducted to make up one's mind the effect of these sibling groups on the results. The pattern of these results was the aforementioned as the results obtained from the analyses that included all of the children. Thus, to preserve ability, all of the children were retained for subsequent analyses.

Group Differences in Cortisol Level and Cortisol Classification

An contained-samples t test was conducted to explore the divergence betwixt the FC and CC children'southward cortisol levels. Levene's Test for Equality of Variances indicated that the variances of the groups differed, F(1, 174) = ten.42, p < .001. Thus, the statistics for the t test that does not assume equality of variances are reported. The cortisol levels of the FC and CC children were significantly different, t(149.73) = −i.99, p < .05, with lower cortisol levels observed in the FC children (Thousand = 0.64, SD = 0.xx) than in the CC children (M = 0.69, SD = 0.15). The distributions of cortisol values for each grouping are presented in Figure 1.

Consistent with the results for cortisol level, the results from a chi-square analysis with the FC and CC children revealed that at that place was a pregnant group difference in cortisol nomenclature, Pearson χ^two(2, Northward = 176) = eight.00, p < .05. As is shown in Figure 2, follow-up pairwise comparisons indicated that the FC children were more probable to be in the low cortisol classification grouping than the CC children, Pearson χ^two(ane, Due north = 176) = six.73, p < .01, and that the CC children were more likely to be in the average cortisol nomenclature group than the FC children, Pearson χ²(ane, Northward = 176) = 5.75, p < .05. The percentage of children in the high cortisol classification group did non differ beyond groups, Pearson χ²(1, N = 176) = 0.02, ns.

Percentage of foster care (FC) and community comparing (CC) children in the depression (FC n = 37; CC n = 8), boilerplate (FC n = 49; CC north = 36), and high (FC n = 31; CC due north = 15) cortisol nomenclature groups.

Given the rapid decrease in cortisol levels beyond the forenoon, it was important to verify that the observed grouping differences in cortisol level and cortisol classification did not reverberate differential sampling procedures. Although cortisol level was non significantly related to the length of time between waking up and collecting the sample, r(174) = −.13, ns, it was correlated with the time of sample collection, r(174) = −.17, p < .05. Similarly, cortisol classification was significantly associated with the fourth dimension of sample collection, F(two, 173) = 3.92, p < .05, but not the length of fourth dimension between waking up and collecting the sample, F(2, 173) = 1.92, ns. However, one-way ANOVAs revealed that the groups did non significantly differ in terms of the length of time betwixt waking upwards and collecting the sample, F(ane, 174) = 0.84, ns, or the fourth dimension of sample collection, F(1, 174) = 0.45, ns. Thus, the differences between the FC and CC children in morning cortisol levels were not merely manifestations of differential sampling procedures.^ane

Associations Betwixt Cortisol Level and Cortisol Classification and Early on Adverse Experiences

Descriptive information about the FC children'due south maltreatment and foster care placement experiences suggested that these children encountered a range of early adverse experiences: 95% (north = 111) of the FC children experienced multiple types of maltreatment. In terms of the specific types of maltreatment, 32% (n = 38) experienced physical abuse, 26% (north = thirty) experienced sexual abuse, 82% (n = 96) experienced physical neglect, 89% (n = 104) experienced supervisory fail, and ninety% (northward = 105) experienced emotional maltreatment. Additionally, the FC children experienced an average of 3.74 caregiver disruptions (SD = two.25), with 85% (n = 100) of the FC children having experienced multiple caregiver disruptions.

Relations between the FC children's cortisol levels and maltreatment and foster care experiences were examined using Pearson product-moment correlations. As was expected, cortisol level was negatively correlated with severity of physical fail, r(115) = −.22, p < .05. In addition, cortisol level was positively related to severity of emotional maltreatment, r(115) = .25, p < .01. Cortisol level was non associated with the number of maltreatment incidents, r(115) = −.06, ns, number of types of maltreatment, r(115) = −.06, ns, severity of physical abuse, r(115) = −.05, severity of sexual abuse, r(115) = −.07, ns, or severity of supervisory neglect, r(115) = − .03, ns. Cortisol level was likewise non significantly correlated with age at entry into foster care, r(115) = .17, ns, number of caregiver disruptions, r(115) = −.14, ns, or length of time since entering the current foster care placement, r(115) = −.06, ns.

Paralleling the results for cortisol level, the results from a ane-way ANOVA indicated that the severity of physical neglect was significantly related to cortisol nomenclature, F(2, 114) = 4.01, p < .05. Equally is shown in Table 1, the children in the low cortisol classification grouping experienced more astringent physical neglect than the children in the average and high cortisol classification groups, t(84) = two.xv, p < .05, and t(66) = 2.68, p < .01, respectively. In contrast, the children in the boilerplate and high cortisol classification groups did not differ on severity of physical neglect, t(78) = −.80, ns. Additionally, cortisol nomenclature was significantly associated with the severity of emotional maltreatment, F(two, 114) = 3.98, p < .05. Post hoc paired comparisons showed that children in the high cortisol classification group had experienced more severe emotional maltreatment than children in the low and boilerplate cortisol classification groups, t(66) = 2.23, p < .05, and t(78) = 2.70, p < .01, respectively. Children in the low cortisol nomenclature group did non significantly differ from children in the average cortisol classification group on severity of emotional maltreatment, t(84) = 0.35, ns. Cortisol classification was not related to the number of maltreatment incidents, F(2, 114) = 0.03, ns, number of types of maltreatment, F(2, 114) = 0.03, ns, severity of concrete corruption, F(2, 114) = 0.29, ns, severity of sexual corruption, F(2, 114) = 0.10, ns, or severity of supervisory neglect, F(2, 114) = 0.04, ns. Cortisol classification was also not significantly related to age at entry into foster care, F(ii, 114) = ane.60, ns, number of caregiver disruptions, F(2, 114) = 0.95, ns, or length of time since entering the current foster care placement, F(2, 114) = 0.49, ns.^two

Table 1

Descriptive Statistics for Early on Agin Experiences for Foster Care Children in Each Cortisol Classification Group

	Low		Average		High		Total
Early adverse experiences	M	SD	Thou	SD	M	SD	Grand	SD
Number of maltreatment incidents	six.95	3.17	6.88	4.61	7.10	iv.xl	six.96	4.eleven
Number of types of maltreatment	three.35	0.98	3.31	1.18	3.29	ane.24	iii.32	1.13
Mean severity of concrete corruption	0.73	1.29	0.86	ane.27	0.65	i.12	0.76	1.23
Hateful severity of sexual abuse	0.73	1.xl	0.71	i.29	0.threescore	one.14	0.69	one.28
Mean severity of physical fail*,a	ii.21	1.05	1.70	1.00	i.51	1.23	1.81	ane.11
Mean severity of supervisory fail	2.88	ane.42	2.86	1.16	2.79	i.xiv	2.85	1.23
Hateful severity of emotional maltreatment*,b	2.61	1.44	2.52	one.35	3.32	i.02	ii.76	i.34
Historic period at first entry into foster care (years)	3.11	1.66	iii.46	ane.41	3.72	1.06	three.42	i.42
Number of caregiver disruptions	3.89	two.13	3.92	2.41	3.26	2.xi	3.74	2.25
Time since entering electric current foster intendance placement (days)	32.32	10.45	33.86	7.58	32.29	half-dozen.68	32.96	eight.36

Word

The current study was designed to examine patterns of morning cortisol production among maltreated foster children compared to their nonmaltreated peers. Overall, at that place were 2 noteworthy findings. Starting time, the results of this report provide corroborating evidence that early on adverse experiences have a significant affect on the HPA system. As was hypothesized, the foster children displayed significantly lower morning cortisol levels than the nonmaltreated children. Furthermore, when the children's morning cortisol levels were classified as low, average, or high, nearly one third of the foster children (more than twice the percentage of nonmaltreated children) were in the low cortisol classification grouping. These results are consistent with inquiry involving nonhuman primates exposed to repeated maternal separations, children raised in institutions, and children placed in foster care equally infants (Carlson & Earls, 1997; Dozier et al., 2006; Sáchez et al., 2005). Taken in combination, these studies back up the conceptualization that blunted morning cortisol levels are a likely consequence of chronic stress and chronic activation of the HPA system (Chips et al., 2005; Gunnar & Vazquez, 2001; Heim, Ehlert, et al., 2000). Although the exact mechanism is not known, it has been proposed that chronic elevations in corticotrophin-releasing factor (CRF), a hypothalamic secretogogue that begins the hormonal cascade of the HPA system, issue in an adaptive downwardly-regulation of CRF receptors in the pituitary and ultimately blunted cortisol levels (Heim, Ehlert, et al., 2000; Heim et al., 2001). However, at that place is a demand for research examining the counterregulatory mechanisms underlying the depression morning cortisol levels observed amid these populations.

Second, the results from the current study suggest that specific early on adverse experiences differentially affect the HPA organization. That is, although the foster children were more likely to showroom low morning cortisol levels, there was a not bad deal of heterogeneity within the foster sample. Notably, private differences in morn cortisol levels were associated with different maltreatment experiences. Consistent with prior research with neglected children (Carlson & Earls, 1997; Dozier et al., 2006), foster children with histories of severe physical neglect were more than likely to have low morning cortisol levels. In contrast, foster children who had experienced severe emotional maltreatment were more probable to accept loftier morn cortisol levels. This result is consequent with prior research findings that depressed, school-anile children who were experiencing ongoing, severe emotional maltreatment demonstrated increased activation of the HPA system in response to pharmacological manipulation (Kaufman et al., 1997). In the current written report, morning time cortisol levels were non significantly associated with severity of physical corruption, sexual abuse, or supervisory neglect or with number of caregiver disruptions.

A possible explanation for the differential effects of physical fail and emotional maltreatment is that these experiences stand for dissimilar types of stressors. That is, it has been suggested that chronic stress results in decreased cortisol product, whereas acute stress results in increased cortisol production (Fries et al., 2005). In the current study, severe concrete neglect involved parental failure to run across the children'southward physical needs and to provide responsive caregiving. Such unresponsive caregiving might also fail to buffer young children from stressors and chronic activation of the HPA organization (Gunnar & Donzella, 2002; Gunnar et al., 2006). As such, physical fail might exist considered a pervasive, chronic stressor. In contrast, emotional maltreatment included parental rejection and failure to protect children from witnessing traumatic events. Emotional maltreatment of this nature might exist characterized equally a periodic, acute stressor. Although this explanation is consequent with the conceptualization formulated by Fries and colleagues (2005), boosted inquiry is needed to understand the nature of these maltreatment experiences. Such research might prove beneficial in moving toward more than defined conceptual models with specific early on adverse experiences contributing to specific outcomes.

There are a number of potential implications of the different patterns of morning cortisol product observed among foster children. Because elevated forenoon cortisol levels mobilize energy resource, children with low morning cortisol levels might lack the needed resource to undertake the processes involved in learning and socialization (Gunnar & Vazquez, 2001). In addition, because cortisol has an immunosuppressive action, low cortisol levels might result in increased vulnerability to autoimmune disorders (Heim, Ehlert, et al., 2000). Finally, low diurnal cortisol levels have been observed in adolescent males with externalizing behaviors and adults with posttraumatic stress disorder (Shirtcliff, Granger, Booth, & Johnson, 2005; Yehuda, Halligan, & Bierer, 2002). In dissimilarity, elevated cortisol levels have been shown to impair cerebral processes, particularly vigilance and retentiveness (Lupien et al., 2007). Elevated cortisol levels also suppress immune and inflammatory reactions, leaving individuals vulnerable to illnesses and infections (Sapolsky et al., 2000). Finally, a number of studies have reported elevated diurnal cortisol levels amid individuals with melancholia disorders (Gold, Goodwin, & Chrousos, 1988; Plotsky, Owens, & Nemeroff, 1998). Thus, both depression and loftier morning cortisol levels might exist dysfunctional and might place foster children at risk for a host of difficulties.

Conversely, elevated diurnal cortisol levels amongst foster children might be an adaptive response to neglectful and/or abusive environments (Tarullo & Gunnar, 2006). That is, the capacity to mobilize the HPA arrangement might reflect an active effort to cope with stressful living conditions. Indeed, Cicchetti and Rogosch (2007) found high morning cortisol levels among physically driveling children to be associated with higher resilient functioning. Similarly, high morning time cortisol levels might be an adaptive response to the unpredictable, astute stressors experienced within emotionally maltreating environments. Withal, it is likely that this initially adaptive pattern of cortisol product would exist less adaptive in new environments and would be detrimental to the children over time.

It is notable that severity of sexual abuse was not significantly related to the foster children's forenoon cortisol levels in the electric current report. This result diverges from a prior study that found a positive clan between severity of sexual abuse and forenoon cortisol levels (Cicchetti & Rogosch, 2001). At that place were, however, several differences between the two studies. Specifically, the sample for the current study included preschool-anile maltreated foster children rather than schoolhouse-aged maltreated children and the cortisol samples for the electric current written report were collected at the children'due south homes rather than at a mean solar day military camp. Thus, future research should explore whether the discrepant results were due to developmental or contextual differences. For case, the morn cortisol levels in the prior written report might reflect the children's responses to a novel environment and peer group rather than their typical diurnal pattern.

In the current study, the foster children's morning cortisol levels were also non related to their foster care placement experiences. Similarly, Dozier and colleagues (2006) reported a lack of clan betwixt morning cortisol levels and foster intendance placement experiences. Taken together, these results suggest that specific maltreatment experiences affect the evolution of the HPA system more strongly than foster care placement experiences.

The results of the current study heighten many questions for futurity inquiry. Considering of ethical and methodological issues, virtually research with young foster children has focused on measures of diurnal cortisol. Although chronic stress appears to event in low morning cortisol levels, it is not appropriate to assume a similar effect on the organization'southward response to psychological or pharmacological challenges. For example, although women with histories of babyhood abuse accept been shown to showroom low diurnal and pharmacologically stimulated cortisol levels, they take also been shown to demonstrate more typical cortisol responses to a psychological stressor (Heim et al., 2001; Heim, Newport, et al., 2000). Additionally, it volition exist important to examine the malleability of the HPA system following a change in the environment. Interestingly, research with rodents has shown that environmental enrichment later in life ameliorates the upshot of maternal separations on stress reactivity (Francis, Diorio, Plotsky, & Meaney, 2002). Furthermore, as is noted higher up, the children in the current study participated in a randomized efficacy trial of a family unit-based preventive intervention program. Results of this efficacy trial take demonstrated that the intervention might exist effective in preventing the increasingly dysregulated morning cortisol levels observed amongst the foster children who did not receive the intervention (Fisher & Stoolmiller, in press; Fisher et al., 2007).

In summary, maltreated foster children showed significant alterations in their morning cortisol product compared to nonmaltreated children. Although low morning cortisol levels were the characteristic pattern observed in the foster children, morning time cortisol levels varied depending upon their maltreatment experiences. Specifically, the foster children with low morning cortisol levels had experienced more severe physical neglect, whereas the foster children with high morning cortisol levels had experienced more than severe emotional maltreatment. Physical abuse, sexual abuse, and supervisory neglect did not appear to touch morning cortisol levels. Overall, these results suggest that the HPA system responds differentially to specific types of early adverse experiences.

Acknowledgements

Back up for this research was provided by the post-obit grants: MH059780 and MH065046, NIMH, U.Due south. PHS; HD045894, NICHD, U.South. PHS; and DA021424, NIDA, U.S. PHS. The authors give thanks the staff and families of the Multidimensional Treatment Foster Intendance for Preschoolers plan, Kristen Greenley for project management, and Matthew Rabel for editorial assist.

Footnotes

ⁱAlthough the current study focused on morning time cortisol levels, evening cortisol levels were also assessed. The bulk of the FC and CC children displayed very low evening cortisol values. Indeed, the cortisol values corresponding with the lower and upper quartile for the sample were .02 µg/dl and .05 µg/dl, respectively. Thus, the evening cortisol values were but examined as a continuous variable. These cortisol values were subjected to a mutual logarithmic transformation, and four outliers were replaced with less extreme cortisol values to normalize the distribution. The evening cortisol level variance was larger for the FC children than the CC children, F(1, 174) = five.81, p < .05. Withal, at that place was not a meaning group departure in evening cortisol level, t(145.50) = ane.53, ns. Of the FC children's maltreatment and foster care experiences, evening cortisol level was only significantly correlated with severity of sexual corruption, r(115) = −.xix, p < .05.

^twoA prior publication (Fisher et al., 2007) noted that the current study found that the foster children who entered foster care before the age of two years or who had experienced more 4 caregiver disruptions were more probable to brandish depression morning cortisol levels than the other foster children and the nonmaltreated children. Subsequent analyses suggested that these associations were not as robust every bit the associations between morning cortisol levels and maltreatment experiences. Thus, these split up analyses are non presented in the electric current report.

Contributor Information

Jacqueline Bruce, Oregon Social Learning Center, Eugene, OR and Eye for Research to Exercise, Eugene OR.

Philip A. Fisher, Oregon Social Learning Centre, Eugene, OR and Center for Research to Practice, Eugene OR.

Katherine C. Pears, Oregon Social Learning Center, Eugene, OR and Center for Research to Exercise, Eugene OR.

Seymour Levine, Center for Neuroscience, University of California, Davis, CA.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644049/

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