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

Improving the lives of foster children through evidenced-based interventions

In the United States and England, the use of evidence-based interventions for children in foster care has the potential to decrease the widespread disparities in health and mental health outcomes, improve placement stability and increase the likelihood of children achieving permanency. Nevertheless, there have been few discussions about the systematic implementation of evidence-based practice to address different levels of need and risk in foster care. In this paper, we provide a framework for determining the types of programs needed for children with varied needs along a continuum that includes four categories of options: (1) screen and identify those who are functioning adequately in foster care versus those in need of supplemental services; (2) provide 'enhanced foster care' with additional resources for families and children; (3) implement interventions that target specific problems such as disruptive behavior or school functioning; and (4) implement intensive therapeutic foster-care programming. Examples of interventions in each category are provided, and implications for policy and practice are discussed.

Using behavioral and electrophysiological measures to assess the effects of a preventive intervention: a preliminary study with preschool-aged foster children

The current study was designed to explore the use of behavioral (i.e., accuracy and reaction times) and electrophysiological measures (i.e., event-related potentials) to assess the impact of a family-based preventive intervention for preschool-aged, maltreated children in foster care. These measures were recorded during a computerized flanker task designed to assess cognitive control and response monitoring. The sample was recruited from a larger randomized efficacy trial of Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) and included foster children assigned to the intervention condition (n = 10), foster children assigned to a services-as-usual comparison condition (n = 13), and low-income, nonmaltreated community children (n = 11). The children's behavioral and electrophysiological performance on the task was generally consistent with previous research with adults and older children. There were no group differences on the behavioral measures of cognitive control or response monitoring. Notably, however, group differences were observed on the electrophysiological measures of response monitoring. Specifically, the foster children who received services as usual were significantly less responsive to performance feedback about errors than the foster children who received the intervention and the nonmaltreated children. Applications of this methodology and implications of the results for future prevention research are discussed.

Early experience and the development of stress reactivity and regulation in children

Children who spend early portions of their lives in institutions or those maltreated in their families of origin are at risk for developing emotional and behavioral problems reflecting disorders of emotion and attention regulation. Animal models may help explicate the mechanisms producing these effects. Despite the value of the animal models, many questions remain in using the animal data to guide studies of human development. In 1999, the National Institute of Mental Health in the United States funded a research network to address unresolved issues and enhance translation of basic animal early experience research to application in child research. Professor Seymour Levine was both the inspiration for and an active member of this research network until his death in October of 2007. This review pays tribute to his legacy by outlining the conceptual model which is now guiding our research studies.

Neurobiology of empathy and callousness: implications for the development of antisocial behavior

Information on the neurobiology of empathy and callousness provides clinicians with an opportunity to develop sophisticated understanding of mechanisms underpinning antisocial behavior and its counterpart, moral decision-making. This article provides an integrated in-depth review of hormones (e.g. peripheral steroid hormones such as cortisol) and brain structures (e.g. insula, anterior cingulate cortex, and amygdala) implicated in empathy, callousness, and psychopathic-like behavior. The overarching goal of this article is to relate these hormones and brain structures to moral decision-making. This review will begin in the brain, but will then integrate information about biological functioning in the body, specifically stress-reactivity. Our aim is to integrate understanding of neural processes with hormones such as cortisol, both of which have demonstrated relationships to empathy, psychopathy, and antisocial behavior. The review proposes that neurobiological impairments in individuals who display little empathy are not necessarily due to a reduced ability to understand the emotions of others. Instead, evidence suggests that individuals who show little arousal to the distress of others likewise show decreased physiological arousal to their own distress; one manifestation of reduced stress reactivity may be a dysfunction in empathy, which supports psychopathic-like constructs (e.g. callousness). This integration will assist in the development of objective methodologies that can inform and monitor treatment interventions focused on decreasing antisocial behavior.

Prenatal alcohol exposure increases vulnerability to stress and anxiety-like disorders in adulthood

Children and adults with fetal alcohol spectrum disorder (FASD) have elevated rates of depression and anxiety disorders compared to control populations. The effects of prenatal alcohol exposure (PAE) on anxiety, locomotor activity, and hormonal reactivity in male and female rats tested on the elevated plus maze (EPM), a task commonly used to assess anxiety-like behaviors in rodents, were examined. Pregnant dams were assigned to PAE, pair-fed (PF), or ad libitum-fed control (C) groups. At adulthood, half of all male (N= 60) and female (N= 60) PAE, PF, and C offspring were exposed to 10 days of chronic mild stress (CMS); the other half remained undisturbed. Animals were then tested on the EPM, and blood collected 30 min posttest for analysis of corticosterone (CORT), testosterone, estradiol, and progesterone. Overall, CMS exposure produced a significant anxiogenic profile. Moreover, CMS increased anxiety-like behavior in PAE males and females compared to controls and eliminated the locomotor hyperactivity observed in nonstressed PAE females. CMS also increased post-EPM CORT, testosterone, and progesterone levels in all groups, with CORT and progesterone levels significantly higher in PAE than in C females. By contrast, CMS selectively lowered estradiol levels in PAE and PF, but not C, females. CMS exposure reveals sexually dimorphic behavioral and endocrine alterations in PAE compared to C animals. Together, these data suggest the possibility that fetal reprogramming of hypothalamic-pituitary-adrenal (HPA) and -gonadal (HPG) systems by alcohol may underlie, at least partly, an enhanced susceptibility of fetal alcohol-exposed offspring to depression/anxiety-like disorders in adulthood.

Morning cortisol Levels in preschool-aged foster children: differential effects of maltreatment type

Maltreated foster children are subjected to a range of early adverse experiences, including neglect, abuse, and multiple caregiver disruptions. Research suggests that such disturbances alter the development and subsequent functioning of the hypothalamic-pituitary-adrenocortical system. The current study was designed to investigate morning 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 severe physical neglect than the other foster children. In contrast, foster children with high morning cortisol levels experienced more severe emotional maltreatment. These results suggest that specific early adverse experiences have differential effects on the functioning of the hypothalamic-pituitary-adrenocortical system.

Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence

Recent biosocial theories postulate that both biological risk and the social context influence the development of mental health problems [Boyce and Ellis (2005) Development and Psychopathology, 17(2), 271-301]. Guided by this framework, we examined whether basal cortisol and its diurnal rhythm were associated with mental health symptoms in early adolescence. Because cross-sectional and longitudinal investigations sometimes reveal different cortisol-mental health associations, we examined the association both concurrently and longitudinally when children transition to middle school, a time which entails a major change in social context from single to multiple teachers, classrooms, and sets of classmates. Salivary cortisol was measured three times a day (waking, afternoon, and bedtime) across 3 days when adolescents were 5th graders. Mental health was measured when adolescents were in 5th and 7th grades, just before and after the transition to middle school. To deal with the substantial comorbidity of internalizing and externalizing symptoms at this developmental stage, mental health measures distinguished overall symptom severity from the preponderance of internalizing versus externalizing symptoms (i.e., directionality). A three-level Hierarchical Linear Model was used to extract basal cortisol and its diurnal rhythm separate from the day-to-day and within-the-day fluctuations in cortisol in response to daily experiences. Results were specific to symptom severity, suggesting that cortisol is a nonspecific risk factor for mental health symptoms in young adolescents. At 5th grade, low basal cortisol was associated with concurrent symptom severity. However, longitudinally, it was adolescents with high cortisol at 5th grade who were at risk for increasing mental health symptoms by 7th grade. Flat diurnal rhythms in 5th grade were related to levels of symptom severity at both 5th and 7th grades. Considering the change in social context, as defined by the transition to middle school, helped resolve seemingly inconsistent evidence that both hypo- and hyper-arousal were associated with mental health symptoms in early adolescence.

Early care experiences and HPA axis regulation in children: a mechanism for later trauma vulnerability

Post-traumatic stress disorder (PTSD) is associated with functional abnormalities of the hypothalamic-pituitary-adrenocortical (HPA) axis. Emerging evidence suggests that failures in social regulation of the HPA axis in young children manifested as neglectful or abusive care may play a role in shaping cortico-limbic circuits involved in processing experiences threatening experiences encountered later in life. Low cortisol levels, particularly near the peak of the diurnal rhythm, have been reported in abused, neglected and deprived children. Thus early imprinting effects of parenting quality on the HPA system regulation may be one of the mechanisms causing heightened risk of PTSD in responses to later trauma. However there is also evidence that the altered patterns of cortisol production seen in the context of early adverse care are not permanent, and remit once the care children receive improves. What awaits study is whether periods of atypical cortisol levels and altered HPA function early in life, even if transient, impact brain development in ways that heighten vulnerability to PTSD in response to traumas experienced later.

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

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.