Familiar and novel contexts yield different associations between cortisol and behavior among 2-year-old children

Parenting and Adjustment Problems among Preschoolers during COVID-19

A critical area of developmental science explores factors that confer risk or protection as young children and their families experience stressful circumstances related to sociohistorical events. This study contributes to this important area by assessing relations between family context and child adjustment as children transitioned from preschool to home learning during COVID-19, and whether children higher in stress levels, indexed by morning basal cortisol, were more strongly affected. Parents of 74 children (M _age  = 53.56 months, SD _age = 3.68 months) completed reports spanning the home learning transition; children's pre-COVID-19 transition salivary cortisol levels were assessed. Path analyses were used to test the preregistered study aims. Significant interactions were decomposed using simple slopes and Preacher's Regions of Significance (ROS) method. Across the COVID-19 transition to home-based school, children with higher morning basal cortisol experienced the sharpest increase in anger when exposed to harsh/inconsistent parenting contexts. Importantly, these effects held when controlling for household chaos, socioeconomic resources, and supportive parenting. Parallel models with supportive parenting were also tested and are discussed. This study is one of the first to test and provide support for biological sensitivity to context theory within the context of a natural experiment like COVID-19.

Stress, cortisol, and social hierarchy

We review the literature on the relationships between cortisol, stress, and various forms of social status, concluding that cortisol (and stress) is typically elevated when one chronically lacks, or may soon lose, status. Moreover, cortisol is lower when status is higher, as long as that status is stable, enhances one's sense of control, and does not also substantially increase one's responsibilities. Because cortisol is both an output (stress indicator) and input (cause of behavioral inhibition), this low cortisol may be both a cause and consequence of stable status. Altogether, the cortisol-status relationship depends not just on one's status but on what that status means for the individual (e.g. How frequent and severe are stressors? Does one feel a sense of control? Does one need to be vigilant and deferential?).

Developmental consequences of behavioral inhibition: a model in rhesus monkeys (Macaca mulatta)

In children, behavioral inhibition is characterized by a disposition to withdraw in the presence of strangers and novel situations. Later in life, behavioral inhibition can result in an increased risk for anxiety and depression and a decrease in social behavior. We selected rhesus monkeys that, during infancy, showed evidence of behavioral inhibition in response to separation, and contrasted them with non-inhibited peers. To understand the development of behavioral inhibition at juvenile age, we collected behavioral data in response to relocation; in response to a human intruder challenge; and in naturalistic outdoor field corrals. At 4 years of age (young adulthood), we again collected behavioral data in the outdoor field corrals to understand the adult social consequences of behavioral inhibition. We also included sex, dominance rank, and number of available kin in our analyses. Finally, to understand the consistency in behavior in behaviorally inhibited animals, we conducted exploratory analyses contrasting behaviorally inhibited animals that showed high vs. low durations of non-social behaviors as adults. At juvenile age, behaviorally inhibited animals continued to show behavioral differences in the novel testing room and during the human intruder challenge, generally showing evidence of greater anxiety and emotionality compared to non-inhibited controls. In their outdoor corrals, behaviorally inhibited juveniles spent more time alone and less time in proximity and grooming with mother and other adult females. In young adulthood, we found that behavioral inhibition was not related to time spent alone. We did find that duration of time alone in adulthood was related to time alone exhibited as juveniles; sex, dominance rank, or the number of kin were not influential in adult non-social duration, either as main effects or as moderators. Finally, exploratory analyses revealed that behaviorally inhibited females that were more sociable (less time spent alone) as adults had spent more time grooming as juveniles, suggesting that high-quality social interaction at a young age might mitigate the social consequences of behavioral inhibition. Overall, we believe that the many similarities with the human data that we found suggest that this monkey model of naturally occurring behavioral inhibition can be valuable for understanding social development.

The Role of Salivary Neuropeptides in Pediatrics: Potential Biomarkers for Integrated Therapies

INTRODUCTION

Objective measures of symptom response to integrated complementary approaches in pediatrics are evolving. The purpose of this study was to document the concentration range of salivary neuropeptides in healthy controls and in children with cancer, to explore correlations between serum and salivary measurements for Calcitonin Gene-Related Peptide (CGRP) and Vasoactive Intestinal Polypeptide (VIP), and to determine whether there is a change in these salivary neuropeptide levels in response to integrated mind-body therapies.

METHODS

A non-randomized pragmatic study with three phases: Phase 1- Healthy Control Saliva-10 healthy controls provided saliva samples; Phase 2- Cancer Diagnosis Serum-Saliva- 16 mixed-type cancer patients provided blood and saliva samples; Phase 3- Acute Lymphocytic Leukemia (ALL) Saliva Intervention- 12 patients with ALL provided pre- and post-complementary intervention saliva samples.

INTERVENTIONS

20-minutes of structured touch or scripted relaxation breathing were administered to patients in Phase 3; Phase 1 and 2 patients did not receive this intervention.

OUTCOME MEASURES

cortisol, CGRP, VIP, State/Trait Anxiety Scale, visual analogue scale, vital signs.

RESULTS

Salivary CGRP and VIP were similar for children in Phases 1 and 2. There was a correlation between serum and salivary VIP in the mixed cancer group, though not between serum and salivary CGRP. In Phase 3 children, following a complementary intervention, salivary CGRP, heart rate, and systolic blood pressure decreased.

DISCUSSION/CONCLUSIONS

These data provide evidence of a decrease in sympathetic output after integrative/complementary therapy intervention in children with cancer. The study underscores the potential role of salivary neuropeptides as non-invasive biomarkers for integrated therapies in pediatrics.

The longitudinal association of the diurnal cortisol rhythm with internalizing and externalizing problems in pre-schoolers. The Generation R Study

BACKGROUND

Studies investigating the association between diurnal cortisol rhythm and behavioural problems in young children have yielded inconsistent results. We tested the hypothesis that variations in diurnal cortisol rhythm in pre-schoolers are already related to problem behaviour early in life with a cross-sectional and longitudinal design.

METHODS

This study was embedded in Generation R, a population-based cohort from foetal life onwards. Parents collected saliva samples from their infant at 5 moments during 1 day. In 322 infants aged 12-20 months, we determined the diurnal cortisol rhythm by calculating the area under the curve (AUC), the cortisol awakening response (CAR), and the diurnal slope. Problem behaviour was assessed at ages 1.5 and 3 years with the Child Behavior Checklist/1.5-5 years.

RESULTS

No cross-sectional associations between the cortisol composite measures and problem behaviour were found at 1.5 years. However, cortisol predicted change in internalizing problems as assessed from 1.5 to 3 years, but not change in externalizing problems. Children with higher AUC levels, flatter slopes and a more positive CAR at baseline were more likely to score higher on the Internalizing Problems scale (β per nmol/L AUC: 0.08, 95% CI: 0.00; 0.17, p=0.04; β per nmol/L/h slope: 0.57, 95% CI: 0.17; 0.98, p=0.006; β per nmol/L CAR: 0.04, 95% CI: 0.01; 0.08, p=0.02) at follow-up.

CONCLUSIONS

Variations in diurnal cortisol rhythm are associated with change in internalizing problems in pre-schoolers. The results suggest that variations in diurnal cortisol patterns early in life precede internalizing problems.

Temperament moderates the influence of periadolescent social experience on behavior and adrenocortical activity in adult male rats

Adolescence is a period of significant behavioral and physiological maturation, particularly related to stress responses. Animal studies that have tested the influence of adolescent social experiences on stress-related behavioral and physiological development have led to complex results. We used a rodent model of neophobia to test the hypothesis that the influence of adolescent social experience on adult behavior and adrenocortical function is modulated by pre-adolescent temperament. Exploratory activity was assessed in 53 male Sprague-Dawley rats to classify temperament and then they were housed in one of the three conditions during postnatal days (PND) 28-46: (1) with familiar kin, (2) with novel social partners, or (3) individually with no social partners. Effects on adult adrenocortical function were evaluated from fecal samples collected while rats were individually-housed and exposed to a 1-hour novel social challenge during PND 110-114. Adolescent-housing with novel or no social partners led to reduced adult glucocorticoid production compared to adolescent-housing with familiar littermates. Additionally, highly-exploratory pre-weanling rats that were housed with novel social partners during adolescence exhibited increased exploratory behavior and a more rapid return to basal glucocorticoid production in adulthood compared to those housed with familiar or no social partners during adolescence and compared to low-exploratory rats exposed to novel social partners. In sum, relatively short-term adolescent social experiences can cause transient changes in temperament and potentially longer-term changes in recovery of glucocorticoid production in response to adult social challenges. Furthermore, early temperament may modulate the influence of adolescent experiences on adult behavioral and adrenocortical function.

Interparental aggression and children's adrenocortical reactivity: testing an evolutionary model of allostatic load

Guided by an evolutionary model of allostatic load, this study examined the hypothesis that the association between interparental aggression and subsequent changes in children's cortisol reactivity to interparental conflict is moderated by their temperamental dispositions. Participants of the multimethod, longitudinal study included 201 2-year-old toddlers and their mothers. These children experienced elevated levels of aggression between parents. Consistent with the theory, the results indicated that interparental aggression predicted greater cortisol reactivity over a 1-year period for children who exhibited high levels of temperamental inhibition and vigilance. Conversely, for children with bold, aggressive temperamental characteristics, interparental aggression was marginally associated with diminished cortisol reactivity. Further underscoring its implications for allostatic load, increasing cortisol reactivity over the one year span was related to concomitant increases in internalizing symptoms but decreases in attention and hyperactivity difficulties. In supporting the evolutionary conceptualization, these results further supported the relative developmental advantages and costs associated with escalating and dampened cortisol reactivity to interparental conflict.

IV. Growth Failure in Institutionalized Children

Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.

IV. Growth Failure in Institutionalized Children

Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e.g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any care-giving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.

Inhibition and exuberance in preschool classrooms: associations with peer social experiences and changes in cortisol across the preschool year

Associations between behavioral inhibition and activity of the hypothalamic-pituitary-adrenocortical (HPA) system, a stress-sensitive neuroendocrine system indexed by salivary cortisol, have varied widely across studies. In the current study, we examined the role of peer social experiences in moderating patterns of association between inhibition/risk-aversion and cortisol reactivity. As expected based on previous research, preschool children (N = 165, 78 boys, 87 girls, 3.0-5.0 years) had significantly different social experiences in their preschool classrooms depending on temperament. Highly inhibited/risk-averse children were less socially integrated, less dominant, and less involved in aggressive encounters than both average and highly exuberant/risk-seeking children, but they were no more likely to be peer rejected. Highly exuberant children were more dominant, exhibited anger more often, and had friendships characterized by higher conflict. Cortisol levels fell from fall to spring for average and highly exuberant children but not for highly inhibited children. Unexpectedly, for highly inhibited children, having friends and being more dominant and popular than other highly inhibited children was associated with increasing cortisol levels over the school year. In contrast, highly exuberant children who were less socially integrated than other highly exuberant children maintained higher cortisol levels. Results indicate that the types of social experiences that affect stress-responsive biological systems may differ markedly for highly inhibited and highly exuberant children.

Effects of an Early Family Intervention on Children's Memory: The Mediating Effects of Cortisol Levels

Developmental psychologists have long been concerned with the ways that early adversity influences children's long-term outcomes. In the current study, activity of the HPA axis of medically at-risk (e.g., preterm) infants was measured as a result of maternal participation in a novel cognitively-based home visitation program (versus a Healthy Start home visitation program). Maternal participation in the cognitive intervention predicted lower basal cortisol levels among infants - with reduced levels of maternal avoidance/withdrawal serving as a mediator of this relation. Lower cortisol levels in infancy, in turn, predicted higher verbal short-term memory at age 3. Short-term memory represents a cognitive ability that has importance for children's later educational outcomes. Findings provide experimental evidence concerning the pathway by which an early intervention may produce hormonal changes that can, in turn, influence children's learning outcomes.

Stress and the Development of Self-Regulation in Context

This article considers the effects of psychosocial stress on child development and describes mechanisms through which early stress in the context of poverty affects the functioning of neural networks that underlie executive functions and self-regulation. It examines the effects of early experience on glucocorticoid and catecholamine levels that influence neural activity in areas of the brain associated with executive functions, primarily as studied in animal models. Finally, it considers the strengths and limitations of this research, its relevance to understanding stress reactivity from the perspective of biological sensitivity to context, and the implications for the study of risk and resilience processes and early intervention to prevent developmental delays.

Cortisol levels in relation to maternal interaction and child internalizing behavior in preterm and full-term children at 18 months corrected age

Cortisol levels were compared in children born preterm at extremely low gestational age (ELGA; 24-28 weeks), very low gestational age (VGLA; 29-32 weeks), and full-term in response to cognitive assessment at 18 months corrected age (CA). Further, we investigated the relationship between maternal interactive behaviors and child internalizing behaviors (rated by the mother) in relation to child cortisol levels. EGLA children had higher "pretest" cortisol levels and a different pattern of cortisol response to cognitive assessment compared to VGLA and full-terms. Higher cortisol levels in ELGA, but not full-term, children were associated with less optimal mother interactive behavior. Moreover, the pattern of cortisol change was related to internalizing behaviors among ELGA, and to a lesser degree VLGA children. In conclusion, our findings suggest altered programming of the hypothalamic-pituitary-adrenal (HPA) axis in preterm children, as well as their greater sensitivity to environmental context such as maternal interactive behavior.

Behavioral adjustment in a community sample of boys: links with basal and stress-induced salivary cortisol concentrations

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been observed in association with internalizing symptoms and is thought to be involved in the pathogenesis of depression and some anxiety disorders. This study examined basal and stress-induced cortisol concentrations in relation to internalizing and externalizing symptoms in a racially mixed community sample of 102 8-11-year-old boys. Afternoon basal cortisol concentrations were positively correlated with measures of internalizing behavior problems, social problems, and emotionality. Greater change in cortisol across a home-visit challenge task was also significantly associated with internalizing behaviors and social problems, as well as attention and thought problems. The implications of these findings and how they may relate to the pathogenesis of emotional and behavioral problems are discussed.

Diurnal cortisol secretion at home and in child care: a prospective study of 2-year-old toddlers

BACKGROUND

Previous studies indicate that children may experience disrupted cortisol secretion in child care. The extent to which this is a transient or long-term disruption is not known, as most studies have relied on cross-sectional designs, and age-heterogeneous small sample sizes. This study aims to (a) compare cortisol secretion measured at home and in child care at 2 and 3 years of age, (b) investigate cortisol changes from 2 to 3 years of age, (c) examine whether age at initiation of child care is associated with cortisol secretion, and (d) investigate whether cortisol secretion in child care is linked to behavioural problems.

METHODS

Saliva samples were collected in a cohort of children recruited at 2 years of age from a larger population sample composed of women seen for the first time during pregnancy. Saliva was sampled twice a day (morning and afternoon) over two consecutive days at home and in child care at 2 (n = 155) and 3 years of age (n = 116). Interviews regarding the familial socioeconomic background and child care history were conducted with the mothers.

RESULTS

At 2 years of age, children showed a flat diurnal cortisol pattern in child care and a decreasing pattern at home. At age 3 years, children showed decreasing patterns both at home and in child care. Also at 3 years, children with less child care experience (i.e., entry after 16 months) had higher cortisol levels in child care and lower levels at home. In contrast, those with more experience (i.e., entry prior to 8 months) had lower cortisol in child care and higher cortisol at home.

CONCLUSION

The different patterns of diurnal secretion observed in child care as compared to home is transient for most children, diminishing as they get older, whereas home and child care overall levels later on may be influenced by the cumulated experience with child care.

Individual differences in preschoolers' salivary cortisol and alpha-amylase reactivity: relations to temperament and maladjustment

We examined the relations of 84 preschoolers' (43 boys; mean age=54 months) situational stress reactivity to their observed emotions and mothers' reports of temperament and adjustment. Salivary cortisol and salivary alpha-amylase (sAA) were collected prior to, and following, a frustrating task. Children's anger, sadness, and positive affect were measured, and mothers reported on preschoolers' dispositional emotionality, regulation, impulsivity, and problem behaviors. Forty-seven percent of children had an increase in sAA and 52% had an increase in cortisol following the challenging task. On average, sAA levels showed the predicted pattern of rise following the frustrating task, followed by return to baseline. For cortisol, there was a mean increase from pre-task to 40 min post-test. sAA reactivity was associated with relatively low levels of dispositional anger and impulsivity and relatively high regulation, particularly for girls. sAA reactivity also was related to low externalizing problems for girls, but not boys. Although cortisol reactivity was unrelated to children's emotions and maladjustment, it was positively related to mothers' reports of regulation. The findings suggest that sAA reactivity in response to a frustrating social task may reflect girls' constrained behavior.

Cortisol response to inoculation in 4-year-old children

This study examined whether there was a cortisol response to inoculation or if pre-inoculation levels were already elevated due to an anticipatory response to going to the doctors' office. For 4-year-old children, a base saliva sample was obtained in the home on a non-stress day, and a pre-inoculation saliva sample was obtained in the doctors' office prior to the stress. Doctors' office pre-inoculation cortisol was higher than home-based cortisol, suggesting the occurrence of an anticipatory cortisol response to the impending stress. Post-inoculation cortisol levels (+20 min) were comparable to home-based cortisol, indicating that there was no cortisol response to the inoculation itself. While there was no mean increase in cortisol, individual differences in cortisol response existed. Cortisol increases were related to important aspects of child behavioral functioning, including internalizing and externalizing behavior ratings.

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.

Salivary alpha-amylase and cortisol in toddlers: differential relations to affective behavior

This study applies a minimally invasive and multi-system measurement approach (using salivary analytes) to examine associations between the psychobiology of the stress response and affective behavior in toddlers. Eighty-seven 2-year-olds (48 females) participated in laboratory tasks designed to elicit emotions and behavior ranging from pleasure/approach to fear/withdrawal. Saliva samples were collected pretask and immediately posttask, and assayed for markers of sympathetic nervous system (alpha-amylase or sAA) and hypothalamic-pituitary-adrenal axis (cortisol) activity. Individual differences in sAA were positively associated with approach behavior and positive affect; whereas, cortisol was positively associated with negative affect and withdrawal behavior. The findings suggest that individual differences in sAA may covary specifically with positive affect and approach behaviors or the predominant emotional state across a series of tasks. The results are discussed with respect to advancing biosocial models of the concomitants and correlates of young children's affective behaviors.

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.

Salivary cortisol levels in children of low-income women with high depressive symptomatology

Children (N = 324 boys, 315 girls) between the ages of 2.5 and 6 (mean age = 3.63) were identified in a house to house survey in low-income areas (income <20th percentile nationally) of urban Mexico. The Center for Epidemiologic Studies-Depression Scale was administered to mothers of all children. Salivary cortisol samples were taken in children as a measure of hypothalamic-pituitary-adrenocortical (HPA) system activity at time of arrival (baseline, Time 0), 25 min after arrival (Time 1), and 50 min after arrival (Time 2). Between Time 0 and Time 1, children were administered several cognitive tests. Results of hierarchical linear modeling analyses revealed that higher levels of maternal depressive symptoms were associated with lower baseline cortisol levels in their children (p < .05), while controlling for age, gender, and time since awakening. Higher levels of maternal depressive symptoms were associated with less of an increase in salivary cortisol to the arrival of the experimenters and subsequent cognitive testing (p < .05). All results were moderated by gender, with enhanced cortisol response in girls and no response in boys. These results suggest that among very low-income families, high maternal depressive symptoms are associated with hypoactivity of the HPA system in children, particularly boys.

Fearful Temperament and Stress Reactivity Among Preschool-Aged Children

In this study, we examined the relation between physiological stress-reactivity and temperamental fearfulness in 162 preschool-aged children. Both the autonomic and neuroendocrine arms of the mammalian stress system were examined. Larger stress responses were defined as greater sympathetic activation, parasympathetic withdrawal and cortisol increases to stressor tasks. Fearful temperament was examined using parent report and behavior in response to fear-evocative laboratory tasks. There was little evidence that larger sympathetic activation or parasympathetic withdrawal was associated with fearful temperament. Greater cortisol reactivity, however, was associated with fearful temperament. Additional analyses examined those children who were consistently fearful across all measures, and the results remained largely the same. However, there was some suggestion that consistently fearful compared to non-fearful children might be more likely to exhibit sympathetic activation to the fear-evocative stimuli. These findings provide support for the argument that fearful temperament is associated with greater stress reactivity in young children. Nonetheless the size of the associations was small and future studies will need to determine whether reactivity of stress-sensitive physiological systems contributes to the development of individual differences in fearful temperament or merely reflects these differences.

Attachment status and salivary cortisol in a normal day and during simulated interpersonal stress in young men

Attachment insecurity, as assessed via the adult attachment interview (AAI), may be expected to relate to basal hypothalamic-pituitary-adrenal (HPA) activity because it is retrodictive of stressful early experiences, which may influence HPA development. In addition, because AAI insecurity may reflect limitations on concurrent cognitive, emotional, and behavioral strategies for managing interpersonal distress, insecurity may also relate to cortisol reactivity specifically during inter-personal challenges. Nevertheless, only two studies have examined associations between AAI insecurity and cortisol, and in total only eight non-clinical men were included. To expand upon past research, the current study focused on college aged men and examined relations between attachment status (via categories and continuous scores) and cortisol levels during daily life and during interpersonal laboratory challenges, wherein subjects were asked to visualize and respond to hypothetical situations concerning loss, separation, and abandonment. Unlike prior research, salivary cortisol was measured during cognitive challenges (e.g. non-autobiographical memory tests), so as to inform questions concerning the specificity of effects. Contrary to expectations, only limited evidence suggested a relation between insecurity and basal HPA functioning. However, in keeping with expectations, associations between insecurity, and in particular dismissing idealization, and comparatively higher cortisol values following interpersonal challenges were observed.

The role of child adrenocortical functioning in pathways between interparental conflict and child maladjustment

This study examined the interplay between interparental conflict and child cortisol reactivity to interparental conflict in predicting child maladjustment in a sample of 178 families and their kindergarten children. Consistent with the allostatic load hypothesis (McEwen & Stellar, 1993), results indicated that interparental conflict was indirectly related to child maladjustment through its association with individual differences in child cortisol reactivity. Analyses indicated that the multimethod assessment of interparental conflict was associated with lower levels of child cortisol reactivity to a simulated phone conflict between parents. Diminished cortisol reactivity, in turn, predicted increases in parental reports of child externalizing symptoms over a 2-year period. Associations between interparental conflict, child cortisol reactivity, and child externalizing symptoms remained robust even after demographic factors and other family processes were taken into account.

Temperament and response to the Trier Social Stress Test

OBJECTIVE

The personality characteristics behavioural inhibition and neuroticism have been associated with mood and anxiety disorders and, in some studies, hypothalamic-pituitary-adrenal (HPA) axis hyperactivity. We recently reported that low levels of Novelty Seeking were associated with elevated plasma cortisol responses to the dexamethasone/corticotropin-releasing hormone (Dex/CRH) test in healthy adults with no psychiatric disorder. The present study tested the association between temperament and HPA axis function in the same group of subjects using a standardized psychosocial neuroendocrine stress test.

METHOD

Subjects completed diagnostic interviews, questionnaires, and the Trier Social Stress Test (TSST).

RESULTS

Novelty Seeking was inversely associated with plasma cortisol concentrations at baseline and throughout the TSST, but was not related to adrenocorticotropic hormone (ACTH) levels.

CONCLUSION

Results of this study extend our previous finding in the Dex/CRH test to a psychosocial stress test. Future investigations are needed to replicate these findings and further elucidate how temperament and personality are linked to HPA function.

Child maltreatment and the developing HPA axis

The developing HPA axis is under strong social regulation in infancy and early childhood and is vulnerable to perturbation in the absence of sensitive, responsive caregiving. Child maltreatment has complex, long-term influences both on basal cortisol levels and on HPA responsivity to pharmacological and psychological stressors, depending on current psychiatric status, current life adversity, age, and most likely, genetic factors. Among the more consistent findings, maltreated children with internalizing problems have elevated basal cortisol most often detected in early AM concentrations, whereas adults maltreated as children often exhibit low basal cortisol levels and elevated ACTH response to psychological stressors. To disentangle these complicated interactions, future research must take the above qualifiers into account, study the transition to puberty, explore the moderating role of candidate genes, and utilize animal models and pharmacological challenges, when ethical, to localize changes in the HPA axis. Post-institutionalized children may provide a model to separate early adverse care histories from current adversity.

Temperament and hypothalamic-pituitary-adrenal axis function in healthy adults

BACKGROUND

Traits such as behavioral inhibition and neuroticism have been linked to the development of mood and anxiety disorders. Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, a manifestation of the stress response, is often seen in major depression and has also been demonstrated in animals and humans with inhibited temperaments. A recent study found HPA hyperactivity in adults with high levels of neuroticism. The present study investigated associations of temperament and HPA function in 31 healthy adults.

METHODS AND MATERIALS

Subjects completed diagnostic interviews, questionnaires, and the dexamethasone-/corticotropin-releasing hormone (Dex/CRH) test. Temperament was assessed using the Tridimensional Personality Questionnaire (TPQ).

RESULTS

Novelty Seeking was inversely related to plasma cortisol concentrations in the Dex/CRH test. Harm Avoidance and Reward Dependence were not significantly associated with cortisol responses in the Dex/CRH test. The results were not accounted for by psychiatric symptoms or a history of stress or childhood maltreatment.

CONCLUSIONS

These findings are consistent with previous reports associating temperament factors with HPA axis hyperactivity. Further work is needed to replicate these observations and determine whether HPA axis dysfunction might account for some of the previously reported association of personality factors with mood and anxiety disorders.

Daycare attendance, stress, and mental health

OBJECTIVE

Daycare stress can be indexed by cortisol, and elevated levels of cortisol have been implicated in the onset and development of mental health disorders. Our objective was to quantify the associations between daycare and cortisol and to identify individual and environmental conditions under which daycare attendance is associated with cortisol concentrations.

METHODS

We used Cohen effect size statistics to quantify these associations and to compare them across 11 published studies that were identified with MEDLINE and PsycINFO.

RESULTS

Cortisol levels increased during the daycare day, whereas they decreased when children stayed at home. The mean effect size was d = 0.72. The magnitude of the daycare-stress relation seemed to vary under 3 specific conditions. First, the effect size was larger for children in low-quality daycare (d = 1.15), whereas there was essentially little or no effect for children in high-quality daycare (d = 0.10). Second, the effect size was larger for preschoolers (aged 39 to 59 months) (d = 1.17) than for infants (aged 3 to 16 months) (d = 0.11) or school-aged children (aged 84 to 106 months) (d = 0.09). Third, children with difficult temperaments in daycare were more likely to exhibit a rising pattern of cortisol, compared with children who were not difficult.

CONCLUSIONS

Our review suggests that daycare attendance in relatively low-quality daycare conditions and for children with difficult temperaments may result in atypical cortisol elevation. Although the link between atypical cortisol elevation and mental health requires further study, programs aimed at improving the quality of daycare services during the preschool years are expected to lead to better physiological adaptation to daycare and to reduce the risks of mental health problems.

Genetic predisposition to anxiety-related behavior determines coping style, neuroendocrine responses, and neuronal activation during social defeat

Genetic background may influence an individual's susceptibility to, and subsequent coping strategy for, an acute stressor. When exposed to social defeat (SD), rats bred for high (HAB) or low (LAB) trait anxiety, which also differ in depression-like behavior, showed highly divergent passive and active coping behaviors, respectively. HABs spent more time freezing and emitted more ultrasound vocalization calls during SD than LABs, which spent more time rearing and grooming. Although the behavioral data confirmed the prediction that heightened trait anxiety would make rats more prone to experience stress, adrenocorticotropin and corticosterone were secreted to a higher extent in LABs than in HABs. In the latter, Fos expression upon SD was enhanced in the amygdala and hypothalamic areas compared with LABs, whereas it was diminished in prefrontal and brainstem areas.

Environmental Control, Social Context, and Individual Differences in Behavioral and Cortisol Responses to Novelty in Infant Rhesus Monkeys

The effects of appetitive controllability on behavioral and cortisol reactivity to novelty in 12 infant rhesus monkeys were studied. Surrogate-peer-reared infants had homecage access to food treats contingently via lever pressing ("master") or noncontingently ("yoked") for 12 weeks from postnatal month 2. Masters lever-pressed more, but did not differ in baseline cortisol. At month 5, infants were exposed to a novel environment in social groups and individually. Masters were significantly more active and exhibited significantly lower cortisol reactivity to the novel environment, but only in the individual context. Also, individual differences in operant behavior were positively correlated with behavioral activity and negatively correlated with cortisol reactivity to the novel environment. The results reveal context-specific benefits of contingent stimulation in infancy.

Childcare as a stabilizing influence on HPA axis functioning: A reevaluation of maternal occupational patterns and familial relations

The influence of family relations, maternal occupational characteristics, and childcare1The UK terms "childcare," childcare centres' and "nurseries" are used throughout this paper to define group care for children prior to starting their first year of formal schooling at age 4 years and are used synonymously with the American terms "day-care" and "preschool." This form of group care is provided in a formal setting, outside the family home and excludes "childminding" (i.e., childcare that may be group based and offered at the home of the care provider/childminder). In the UK, this form of childcare is offered from zero to 4 years old. Children are separated according to their age into small groups usually consisting of 10-15 children. In the present study, all children were in the preschool-aged group (3-4 years old). Where childcare of a different or more generic form is referred to, then this has been made clear in the context or stated in the text. utilization on preschool children's cortisol production were investigated in 56 mother-child dyads. Family characteristics and maternal employment, childcare and child temperament were reported by mothers. Morning and evening levels of children's salivary cortisol were obtained. Children in highly expressive or reserved families exhibited higher cortisol levels compared to children in moderately expressive families. Elevated levels of cortisol were detected in children of mothers reporting low levels of job role quality or high levels of emotional exhaustion. Frequent childcare use was found to protect children against the physiological effects of low maternal job role quality and emotional exhaustion. Findings underscore the pervasive role of the family as set within an external support system and highlight the potential physiological impact of these interacting contexts for children. Further research is needed to fully understand current findings and to develop appropriate psycho-physiological interventions.

Long-term growth and puberty concerns in international adoptees

Growth delay is one of the most common and persistent findings in children who have been adopted from abroad. Although the cause is not clearly understood, it may be related to the observed phenomenon of psychosocial short stature described in children from abusive and neglectful settings in western countries. Fortunately, adopted children generally experience significant improvement in growth after joining their new family, but this may put girls at risk for early and rapidly progressing puberty. This review should help the health care team to understand these issues and work better with the adoptive parents to ensure a child's smooth transition into family life.

Psychological and stress hormone correlates in early life: a key to HPA-axis dysregulation and normalisation

Substantial recent research has focused on examining hormone indicators of psychosocial stress and on how relationships between stress and hormone changes might be linked to chronic illness. Particular attention has been paid to disease progression in cancer and HIV/AIDS. This focus has generated a plethora of research which has contributed both theoretically and clinically to the understanding of disease experience and the rate of disease progression. Measurement of salivary cortisol levels and diurnal variation has substantially advanced research methodology. Applying the unifying concept of allostasis and accumulated lifetime stress, this review attempts to assess the relevance of psychological and stress hormone correlates to disease resistance and health, through an examination of such correlates on the experience and outcomes of stress during childhood. Focus is on the role and importance of naturalistic social stress experiences such as school transition in healthy children, with emphasis on salivary cortisol as an endocrine marker of HPA-axis activation. It is argued that differing research perspectives offer valuable insight into the often assumed but largely unexplored links between early life experience and subsequent physical health outcomes in adulthood. Longitudinal studies incorporating measures of acute physical health outcome and of learning and memory are clearly needed.

Behavioral Inhibition: Linking Biology and Behavior within a Developmental Framework

Behavioral inhibition refers to a temperament or style of reacting that some infants and young children exhibit when confronted with novel situations or unfamiliar adults or peers. Research on behavioral inhibition has examined the link between this set of behaviors to the neural systems involved in the experience and expression of fear. There are strong parallels between the physiology of behaviorally inhibited children and the activation of physiological systems associated with conditioned and unconditioned fear. Research has examined which caregiving behaviors support the frequency of behavioral inhibition across development, and work on the interface of cognitive processes and behavioral inhibition reveal both how certain cognitive processes moderate behavioral inhibition and how this temperament affects the development of cognition. This research has taken place within a context of the possibility that stable behavioral inhibition may be a risk factor for psychopathology, particularly anxiety disorders in older children. The current chapter reviews these areas of research and provides an integrative account of the broad impact of behavioral inhibition research.

Context-specific freezing and associated physiological reactivity as a dysregulated fear response

The putative association between fear-related behaviors and peripheral sympathetic and neuroendocrine reactivity has not been replicated consistently. This inconsistency was addressed in a reexamination of the characterization of children with extreme fearful reactions by focusing on the match between distress behaviors and the eliciting context. Eighty 24-month-old children were observed in 4 mildly threatening contexts, and the relations among different measures of fear-related behaviors, reactive and basal cortisol levels, and baseline cardiac measures of heart rate, respiratory sinus arrhythmia, and preejection period (PEP) were examined. The hypothesis that only behaviors under the less threatening context would be associated with higher cortisol and sympathetic cardiac activity was confirmed; only task-specific freezing behavior predicted higher reactive and basal cortisol levels and resting PEP measured 1 week later. Implications for the conceptualization of dysregulated fear behaviors in the classification of extremely fearful children are discussed.

Moderate level alcohol during pregnancy, prenatal stress, or both and limbic-hypothalamic-pituitary-adrenocortical axis response to stress in rhesus monkeys

This study examined the relationship between moderate-level prenatal alcohol exposure, prenatal stress, and postnatal response to a challenging event in 6-month-old rhesus monkeys. Forty-one rhesus monkey (Macaca mulatta) infants were exposed prenatally to moderate level alcohol, maternal stress, or both. Offspring plasma cortisol and adrenocorticotrophic hormone (ACTH) were determined from blood samples before maternal separation and after separation. Behavioral observations were made repeatedly across separation. Moderate-level prenatal alcohol exposure was associated with significantly higher plasma ACTH response to maternal separation. Offspring exposed to prenatal alcohol, prenatal stress, and prenatal alcohol and stress showed reduced behavioral adaptation to stress compared with controls. Baseline, 2-hr, and 26-hr plasma ACTH levels were intercorrelated and predicted behavior during separation.

Evening Activities as a Potential Confound in Research on the Adrenocortical System in Children

The relation among children's evening activities, behavioral characteristics, and activity of the hypothalamic-pituitary-adrenocortical axis was assessed in normally developing children ages 7 to 10 years. Salivary cortisol at bedtime was compared on evenings when children had structured activities outside of the home with unstructured evenings at home in relation to parental reports of children's behavioral characteristics. Participating in evening activities, particularly sport activities, was associated with small increases in bedtime cortisol levels in boys but not in girls. Differences in cortisol on activity versus no-activity nights were negatively related to children's social isolation. These results show that in studies with children, nights on which participants engage in sport activities should be avoided when collecting ambulatory measures of salivary cortisol concentrations.

Stress reactivity in 15-month-old infants: Links with infant temperament, cognitive competence, and attachment security

In a sample of eighty-five 15-month-old infants, salivary cortisol was obtained prior to and following a potentially stressful episode in which the child was confronted with a stranger and with a frightening robot. Infant characteristics such as anger proneness, cognitive competence, and attachment security were expected to be related to cortisol reactivity during the stressful event. The results showed higher cortisol reactivity in more anger-prone infants and in infants with higher levels of cognitive development as assessed with the Bayley Scales of Infant Development (N. Bayley, 1969). Attachment security, assessed with the Attachment Q-Set (AQS; E. Waters, 1995), was found to moderate the relation between cognitive level and cortisol reactivity; the positive relation between cognitive development and cortisol response was found in only infants with low AQS security scores. The findings may have important implications for research in the development of self-regulation in humans as well as in studies with animals.

Peer rejection, temperament, and cortisol activity in preschoolers

In this study, we examined a model that describes both direct and indirect pathways between children's temperament and activity of the hypothalamic-pituitary-adrenal (HPA) axis when children are in peer-group settings. We hypothesize that in peer-group settings both shy, inhibited and exuberant, undercontrolled children would exhibit higher cortisol levels, but these associations would operate through different pathways. Sociometric measures of peer rejection, salivary cortisol, and teacher reports of temperament were collected on 82 preschoolers. Children who were rejected by classmates had higher cortisol levels than the other children. The combination of Surgency and Poor Effortful Control (Effortful Control, reverse scored) was associated with elevated cortisol through a pathway mediated by aggressive interactions with peers and peer rejection. With the indirect path explained, the combination of Surgency and Poor Effortful Control also was directly and negatively associated with classroom cortisol levels. These results help explain why temperament associations with HPA activity have been variable and difficult to discern when children are assessed in peer-group contexts. In these contexts, both direct and indirect pathways between temperament and cortisol need to be examined.

Morning-to-afternoon increases in cortisol concentrations for infants and toddlers at child care: age differences and behavioral correlates

This study examined salivary cortisol, a stress-sensitive hypothalamic-pituitary-adrenocortical (HPA) axis hormone in 20 infants (12 females; M age = 10.8 months) and 35 toddlers (20 females; M age = 29.7 months) in full-day, center-based child care. Samples were taken at approximately 10:00 a.m. and 4:00 p.m. at child care and at home. At child care, 35% of infants and 71% of toddlers showed a rise in cortisol across the day; at home, 71% of infants and 64% of toddlers showed decreases. Toddlers who played more with peers exhibited lower cortisol. Controlling age, teacher-reported social fearfulness predicted higher afternoon cortisol and larger cortisol increases across the day at child care. This phenomenon may indicate context-specific activation of the HPA axis early in life.

Children, stress, and context: integrating basic, clinical, and experimental prevention research

Findings from the Watamura, Donzella, Alwin, and Gunnar (this issue) study support the growing recognition of the importance of context on physiology and affective and behavioral regulation early in human development. This discussion focuses on the role of context and development on hypothalamic-pituitary-adrenal (HPA) axis regulation in young children. Discussed in this article are the Watamura et al. findings with regard to relevant animal studies, extension of these observations to samples of children at elevated risk for psychopathology, and experimental prevention studies with young children. It is contended that environmental factors operating at key points in development may shape affective and behavioral regulation as well as HPA axis function in children, much as environmental factors have been shown to shape HPA axis regulation in animals.

Right frontal brain activity, cortisol, and withdrawal behavior in 6-month-old infants

Although several studies have examined anterior asymmetric brain electrical activity and cortisol in infants, children, and adults, the direct association between asymmetry and cortisol has not systematically been reported. In nonhuman primates, greater relative right anterior activation has been associated with higher cortisol levels. The current study examines the relation between frontal electroencephalographic (EEG) asymmetry and cortisol (basal and reactive) and withdrawal-related behaviors (fear and sadness) in 6-month-old infants. As predicted, the authors found that higher basal and reactive cortisol levels were associated with extreme right EEG asymmetry. EEG during the withdrawal-negative affect task was associated with fear and sadness behaviors. Results are interpreted in the context of the previous primate work, and some putative mechanisms are discussed.

Predictors of children's cortisol activation during the transition to kindergarten

The purpose of the present study was to identify predictors of children's cortisol responses after the transition to kindergarten. Morning salivary cortisol was measured in 50 children 1 week before and 1 week after they began kindergarten. Children who experienced a greater degree of change between their preschool and kindergarten routines and who had infrequent preschool experiences exhibited the largest increases in morning cortisols after kindergarten entry. Children whose parents indicated that they would have an easier, rather than more difficult, time adapting to kindergarten also tended to be more reactive in their morning cortisol levels after kindergarten entry. Results provide new insight into experiential and individual-difference factors that predict children's physiological reactivity and self-regulation during times of transition and potential stress.

Listening effort and fatigue in school-age children with and without hearing loss

Parents, audiologists, and educators have long speculated that children with hearing loss must expend more effort and, therefore, fatigue more easily than their peers with normal hearing when listening in adverse acoustic conditions. Until now, however, very few studies have been conducted to substantiate these speculations. Two experiments were conducted with school-age children with mild-to-moderate hearing loss and with normal hearing. In the first experiment, salivary cortisol levels and a self-rating measure were used to measure fatigue. Neither cortisol measurements nor self-rated measures of fatigue revealed significant differences between children with hearing loss and their normal-hearing peers. In the second experiment, however, a dual-task paradigm used to study listening effort indicated that children with hearing loss expend more effort in listening than children with normal hearing. Results are discussed in terms of clinical application and future research needs.

Salivary cortisol concentrations before and after carbon-dioxide inhalations in children

BACKGROUND

Considerable research implicates over-activity of the hypothalamic-pituitary adrenal axis in the pathophysiology of adult mood and anxiety disorders. The current study evaluates the association between salivary cortisol concentrations and response to carbon-dioxide inhalation in children and adolescents with anxiety disorders, mood disorders, or no psychiatric illness. The central question was whether response to carbon-dioxide inhalation is associated with levels of hypothalamic-pituitary adrenal axis activation. If confirmed, this would relate hypothalamic-pituitary adrenal axis activation in juveniles, as in adults, and response to a well-studied respiratory procedure.

METHODS

Serial salivary cortisol samples were examined in 98 subjects (ages 9-17 years), including 62 subjects with an anxiety and/or mood disorder and 36 nonpsychiatrically ill comparisons. Samples were obtained upon arrival at the laboratory, following a tilt test, then before and immediately after a standard 5% carbon dioxide inhalation procedure.

RESULTS

Salivary cortisol levels pre-carbon-dioxide inhalation were significantly higher in patients sensitive to the anxiogenic effects of carbon dioxide (n = 20) than in patients who did not respond to carbon dioxide (n = 42) and in healthy subjects, none of whom were sensitive to carbon dioxide (n = 36); cortisol concentrations in the latter two groups were indistinguishable. Salivary cortisol did not increase during carbon-dioxide inhalation, irrespective of diagnostic group or degree of reactivity to the procedure.

CONCLUSIONS

The current data resemble data from studies of laboratory-induced panic among adult patients. In both groups, activation of the hypothalamic-pituitary adrenal axis is associated with the response to a standardized stressor. Similarly, as in adults, carbon-dioxide inhalation in juveniles does not produce a significant change in hypothalamic-pituitary adrenal axis activation.

Social regulation of the cortisol levels in early human development

Other papers in this special edition provide evidence to implicate activity of the limbic hypothalamic-pituitary-adrenocortical (L-HPA) system in the etiology of drug and alcohol abuse. Furthermore, studies in rodents and primates suggest that responsivity and regulation of this system later in life may be shaped by social experiences during early development. Cortisol is the major hormonal product of the L-HPA system in humans. Although it provides only a partial understanding of the activity of this neuroendocrine axis, its regulation may bear importantly on human growth and development. We review developmental studies of cortisol and behavior in human children, birth to approximately 5 years of age. We describe the development of social buffering of cortisol responses that produces a functional analogue of the rodent stress hyporesponsive period by the time children are about 12 months of age. We further describe the sensitivity of cortisol activity to variations in care quality among infants and toddlers, along with evidence that children with negative emotional temperaments may be most likely to exhibit elevations in cortisol under conditions of less than optimal care. Finally, the few studies of cortisol activity under conditions of neglectful and abusive care of young children are considered, noting that these often have yielded evidence of reduced rather than increased cortisol levels.