Child cortisol moderates the association between family routines and emotion regulation in low-income children

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

Perceived social support mitigates the associations among household chaos and health and well-being in rural early adolescents

PURPOSE

Previous studies have demonstrated that early adolescents residing in chaotic households experience adverse health and well-being outcomes. However, the potential protective factors that mitigate the relationship between household chaos and early adolescents' health and well-being remain unknown. Accordingly, this study aims to investigate whether perceived social support moderates the link between household chaos and the health and well-being among Chinese rural early adolescents.

METHODS

Physical health difficulties were assessed using two measures: general health and allostatic load (AL). Mental health difficulties were measured by depression. Well-being was reflected by life satisfaction. Specifically, this study included early adolescents (N = 337; Mage  = 10.88 ± 1.36 years) from rural counties in China who reported their household chaos, perceived social support, general health, depression, and life satisfaction. AL scores were determined based on six physiological indices.

RESULTS

Household chaos exhibited a negative relationship with the general health and life satisfaction while a positive correlation with depression. Moreover, perceived social support was found to moderate the association between household chaos and these health and well-being indicators of early adolescents. Specifically, early adolescents who reported higher levels of perceived social support exhibited weaker negative connections among household chaos and their general health, depression, and life satisfaction. Furthermore, no significant relationships were observed between the adolescents' AL and household chaos, perceived social support, or their interactions.

CONCLUSIONS

Household chaos poses a significant risk to health and well-being. Furthermore, the findings indicate that perceived social support can mitigate these negative effects.

The role of parenting practices in parent and child mental health over time

BACKGROUND

Parent and child mental health has suffered during the pandemic and transition phase. Structured and shared parenting may be intervention targets beneficial to families who are struggling with parent or child mental health challenges.

AIMS

First, we investigated associations between structured and shared parenting and parent depression symptoms. Second, we investigated associations between structured and shared parenting and depression, hyperactivity/inattention and irritability symptoms in children.

METHOD

A total of 1027 parents in two-parent households (4797 observations total; 85.1% mothers) completed online surveys about themselves and their children (aged 2-18 years) from April 2020 to July 2022. Structured parenting and shared parenting responsibilities were assessed from April 2020 to November 2021. Symptoms of parent depression, child depression, child hyperactivity and inattention, child irritability, and child emotional and conduct problems were assessed repeatedly (one to 14 times; median of four times) from April 2020 to July 2022.

RESULTS

Parents who reported higher levels of shared parenting responsibilities had lower depression symptoms (β = -0.09 to -0.32, all P < 0.01) longitudinally. Parents who reported higher levels of shared parenting responsibilities had children with fewer emotional problems (ages 2-5 years; β = -0.07, P < 0.05), fewer conduct problems (ages 2-5 years; β = -0.09, P < 0.01) and less irritability (ages 13-18 years; β = -0.27, P < 0.001) longitudinally. Structured parenting was associated with fewer conduct problems (ages 2-5 years; β = -0.05, P < 0.05).

CONCLUSIONS

Shared parenting is beneficial for parent and child mental health, even under chaotic or inflexible life conditions. Structured parenting is beneficial for younger children.

Salivary Cortisol Reaction Norms in Zoo-Housed Great Apes: Diurnal Slopes and Intercepts as Indicators of Stress Response Quality

Simple Summary

Changes in cortisol fluctuations are used for stress monitoring. Methodologically, this is straight forward, because sample collection is simple and analytical methods advanced, but since cortisol is primarily a hormone that facilitates energy allocation, the interpretation of these measures is often complex. Acute elevations in cortisol levels are not per se bad, but may constitute an adaptive coping mechanism. Likewise, low cortisol levels do not always indicate the absence of a stressor. To distinguish between stress response qualities, a more fine-grained analyses of cortisol fluctuations is warranted. Cortisol excretion follows a diurnal pattern with high levels in the morning, decreasing throughout the day. Two regression coefficients describe this curve: the intercept (the constant with which levels change throughout the day) and the slope (curve steepness and direction). We assessed salivary cortisol intercepts and slopes in zoo-housed apes on routine days, enrichment days, and in the new ape house. While cortisol excretion increased on enrichment days, the daily decline of cortisol levels was not affected. The move to the new house seemingly was a major stressor as cortisol levels increased slightly and the circadian cortisol decrease was impaired. The combination of intercept and slope measures can differentiate between stress responses, thereby constituting a useful tool for stress monitoring.

Abstract

Monitoring changes in cortisol levels is a widespread tool for measuring individuals’ stress responses. However, an acute increase in cortisol levels does not necessarily denote an individual in distress, as increases in cortisol can be elicited by all factors that signal the need to mobilize energy. Nor are low levels of cortisol indicative for a relaxed, healthy individual. Therefore, a more fine-grained description of cortisol patterns is warranted in order to distinguish between cortisol fluctuations associated with different stress response qualities. In most species, cortisol shows a distinct diurnal pattern. Using a reaction norm approach, cortisol levels across the day can be described by the two regression coefficients: the intercept and the slope of the curve. We measured immunoreactive salivary cortisol in three zoo-housed ape species under three conditions (routine days, enrichment days, and after the move to a new house). We examined salivary cortisol intercepts (SCI) and salivary cortisol slopes (SCS) of the diurnal curves. SCI and SCS were independent from each other. SCI was highest on enrichment days and lowest on routine days. SCS was steep on routine days and blunted after the move. Only SCI was species-specific. Our study provides evidence that combining SCI and SCS measures allows us to differentiate between types of stress responses, thereby constituting a useful tool for welfare assessment.

Exploring Associations of Household Chaos and Child Health Behaviors in Rural Families

Objectives: Regular physical activity (PA) and limited sedentary behavior (SB) and screen-time are essential for children's health, and rural children are more likely to have overweight and obesity. Household chaos (HHchaos), defined as disorganization characterized by noise and crowding, is associated with negative behavioral outcomes in children. In this study, we examined associations between HHchaos and PA, SB, and screen-time among rural children. Methods: Parent/child dyads (N=105) were enrolled in NU-HOME, a family-based, obesity prevention randomized-controlled trial. We used hierarchical regression analyses of baseline data to examine unadjusted and adjusted (child age, sex, BMI z-scores and economic assistance) associations between HHchaos and outcomes. Results: Children were 8.96 ± 1.06 years old; 58% were female; and 53% were categorized as normal weight. Total daily PA, SB, and weekday screen-time were 259.1 ± 58.22 minutes, 499.9 ± 77.46 minutes, and 1.79 ± 1.48 hours, respectively. Unadjusted HHchaos scores (mean = 5.04 ± 3.6; range = 0-15 with higher score indicating more chaos) were not associated with child PA or SB. HHchaos was positively associated with child screen-time in all models (p<.05), except the fully adjusted model for weekday screen-time. Conclusions: Our findings suggest that decreasing household chaos may be useful in reducing child screen-time. Our findings align with current literature in viewing household chaos as a risk factor for children's health.

Pathways from Food and Housing Insecurity to Adolescent Behavior Problems: The Mediating Role of Parenting Stress

Unmet basic needs in childhood predict a range of behavior problems, but long-term pathways from childhood food and housing insecurity to adolescent behavior problems are not well understood. Applications of the Family Stress Model suggest parenting stress may mediate this relationship in the transition to adolescence. The present study tested whether the links from childhood food and housing insecurity to adolescent aggressive and depressive behaviors were mediated by parenting stress over 10 years. The analytic sample included 2454 mother-child dyads and skewed socioeconomically disadvantaged. The majority (78%) of mothers were nonwhite, half had not received beyond a high school education, and 60% were single. The first wave of data for the present study occurred when children (48% female) were approximately five years old, with follow-ups at age nine and 15. Structural equation modeling with latent variables showed direct associations from housing insecurity to both behavioral outcomes, and indirect associated from food insecurity to both outcomes via parenting stress. The findings point to the need for screening and supports for food and housing problems in order to prevent long-term mental health consequences.

Cortisol in early childhood moderates the association between family routines and observed affective balance in children from low-income backgrounds

The study of emotion regulation often addresses control of negative emotion. Researchers have proposed that affective balance is an indicator of emotion regulation that incorporates the role of positive emotion in the context of negative emotional experiences. Environmental and individual factors, such as family processes and biological stress regulation, are known to shape emotion regulation. The present study investigated whether child diurnal cortisol, an indicator of biological stress regulation, moderated the association between family routines and observed affective balance. Children (N = 222; M age = 4.70 years, SD = 0.60) from low-income households provided saliva samples to measure diurnal cortisol and completed a behavioral task designed to elicit negative emotions. Affective balance was defined as the difference score between the proportion of positive and negative emotional expressions displayed during the task. A higher affective balance score indicated greater positive compared with negative emotional displays. Simple slope analyses indicated that for children with a low morning cortisol intercept, more frequent family routines were associated with more affective balance. This pattern was not observed in children with average or high morning cortisol. Positive family routines may play an important role in shaping affective balance among children with disrupted cortisol levels from low-income backgrounds.

Social cognition and cortisol in the general population: A systematic review and meta-analysis

This systematic review examines the evidence on the association between social cognition and cortisol in the general population. Literature was searched in six databases. Of the 401 studies identified, meta-analyses were conducted on 46 effect sizes (Pearson's correlation coefficients) from 19 studies, supplemented by a narrative review. Pooled estimates suggest that better emotion control is associated with increased cortisol concentrations [r = 0.083, 95% CI (0.033, 0.132)]. Emotion recognition or empathy were not significantly associated with cortisol concentrations [r = 0.072, 95% CI (-0.020, 0.165) and r = 0.004, 95% CI (-0.061, 0.068) respectively]. Subgroup analyses showed that the association between emotion control and cortisol concentrations is significant in males, for morning cortisol, when the cortisol data are transformed to correct for skewed distributions, or when participants are instructed to avoid food and drink intake for at least one hour before sample collection. There was no evidence for an association between social cognition with diurnal cortisol slope or cortisol awakening response. More validation work with greater standardization of methodological procedures is required.

Influence of Childhood Family Routines on Adult Depression: A Cross Sectional Study

In order to explore the influence of childhood family routines on adult depression and the mediating role of tolerance of uncertainty and rumination, the current study tested 818 participants by adopting four questionnaires. The results of structural equation modeling revealed that (1) family routines had a negative effect on depression among Chinese college students; (2) family routines were found to have a positive effect on tolerance of uncertainty, and tolerance of uncertainty was a bridge linking family routines and depression; (3) family routines had a significant effect on depression through rumination; (4) the relationship between family routines and depression was partially mediated by the chain of tolerance of uncertainty and rumination. The result reveals not only the fact that childhood family routines have significant influence on college students' depression but also the mechanism of childhood family routines that affect college students' depression. The limitations and implications of our study were also discussed.

Early adversity and children's regulatory deficits: Does postadoption parenting facilitate recovery in postinstitutionalized children?

Children reared in orphanages typically experience the lack of stable, reliable caregivers and are at increased risk for deficits in regulatory abilities including difficulties in inhibitory control, attention, and emotion regulation. Although adoption results in a radical shift in caregiving quality, there remains variation in postadoption parenting, yet little research has examined postadoption parenting that may promote recovery in children experiencing early life adversity in the form of institutional care. Participants included 93 postinstitutionalized children adopted between 15 and 36 months of age and 52 nonadopted same-aged peers. Parenting was assessed four times during the first 2 years postadoption (at 2, 8, 16, and 24 months postadoption) and children's regulation was assessed at age 5 (M age = 61.68 months) and during kindergarten (M age = 71.55 months). Multiple parenting dimensions including sensitivity/responsiveness, structure/limit setting, and consistency in routines were examined. Both parental sensitivity and structure moderated the effect of preadoption adversity on children's emotion regulation while greater consistency was associated with better inhibitory control and fewer attention problems. Results support the notion that postadoption parenting during toddlerhood and the early preschool years promotes better regulation skills following early adversity.

Hair cortisol moderates the association between obstetric complications and child wellbeing

Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.

Sex Differences in the Association between Household Chaos and Body Mass Index z-Score in Low-Income Toddlers

Background: Associations between household chaos and childhood overweight have been identified, but the mechanisms of association are not clearly established in young children, with some studies linking higher chaos to increased obesity risk, whereas other studies link higher chaos to lower obesity risk. Given the lack of consistent findings and early sex differences in vulnerability to chaos, we examined child sex as a moderator of the chaos-child overweight association. We also tested these associations with self-regulation, as self-regulation has been implicated in understanding the chaos-obesity risk association in low-income toddlers. Methods: Parent-reported household chaos and observed child self-regulation were collected at baseline [n = 132; M age 23.0 months (standard deviation 2.8)]. Children's body mass index z-score (BMIz) was measured at 33 months. Multivariate linear regression models were used to assess whether child sex moderated the chaos-BMIz association. A three-way interaction between chaos, child sex, and self-regulation was also tested. Results: Child sex moderated the chaos-BMIz association (b = -0.11, p = 0.04) such that chaos was positively associated with BMIz among boys (b = 0.12, p = 0.003), but unrelated in girls (b = 0.01, p = 0.78). A three-way interaction with self-regulation indicated that a positive chaos-BMIz association existed only for boys with average (b = 0.12, p = 0.004) and low (b = 0.22, p < 0.001) self-regulation. Conclusions: Boys with poor self-regulation may be particularly vulnerable to obesogenic effects of chaotic households.

The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review

BACKGROUND

Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.

METHODS

We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.

RESULTS

One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).

CONCLUSION

There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.

Family entropy: understanding the organization of the family home environment and impact on child health behaviors and weight

Child obesity is a major public health issue with a high disease burden. Although numerous contributing factors have been identified, the family home environment is a central context of influence that requires deeper understanding. The level of organization in the family home environment may influence obesity and obesogenic behaviors, but the literature has suffered from the lack of a strong overarching construct and model to guide this area of research. Family entropy is a conceptual framework that fills this gap by representing the level of organization across the home environment. The current study empirically assesses family entropy using factor analysis in a longitudinal sample of 968 children measured yearly from Grades 3 to 6 as part of the NICHD Study of Early Child Care and Youth Development. Mixed modeling using MPLUS examined the influence of family entropy on child weight both directly and indirectly through weight-related health behaviors (i.e., sleep and physical activity), and considered the moderating role of socioeconomic status (SES). Results suggest that family entropy is comprised of distinct elements of household organization and disorganization, which are moderately related. Household disorganization may be particularly detrimental to child sleeping behavior both concurrently and over time in families of both high and low SES. The study concludes with recommendations for advancing understanding of the home environment by using nuanced measurement strategies, and incorporating support for household organization within child obesity prevention and intervention efforts.

Anger and Sadness Regulation in Refugee Children: The Roles of Pre- and Post-migratory Factors

Pre- and post-migratory factors have been implicated in refugee children's mental health. However, findings regarding their unique and joint roles are inconsistent or nonexistent. We examined the main and interactive relations of pre-migratory life stressors and post-migratory daily hassles and routines to emotion regulation-a key marker of mental health-in 5- to 13-year-old Syrian refugee children (N = 103) resettling in Canada. Mothers and children completed questionnaires assessing pre-migratory life stressors and post-migratory daily hassles. Mothers also reported their children's adherence to family routines and emotion regulation abilities (i.e., anger and sadness regulation) via questionnaire. Overall, children who more frequently engaged in family routines showed better anger regulation. Pre- and post-migratory factors also interacted, such that greater post-migratory daily hassles were associated with worse sadness regulation for children with lower levels of pre-migratory life stressors, but were unassociated with the sadness regulation of children who experienced higher levels of pre-migratory life stressors. Results suggest that pre- and post-migratory factors play unique and joint roles in refugee children's emotion regulation during resettlement.

Adolescent Suicide as a Failure of Acute Stress-Response Systems

Suicide is the second leading cause of death worldwide for adolescents. Despite decades of research on correlates and risk factors for adolescent suicide, we know little about why suicidal ideation and behavior frequently emerge in adolescence and how to predict, and ultimately prevent, suicidal behavior among youths. In this review, we first discuss knowledge regarding correlates, risk factors, and theories of suicide. We then review why adolescence is a period of unique vulnerability, given changing biology and social network reorganization. Next, we present a conceptual model through which to interpret emerging findings in adolescent suicide research. We suggest that a promising area for future research is to examine adolescent suicide as a failure of biological responses to acute stress in the proximal moments of a suicidal crisis. After reviewing initial evidence for this conceptualization, we review future directions for studies on adolescent suicide.

Family conflict, chaos, and negative life events predict cortisol activity in low-income children

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7-10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.

Links between the organization of the family home environment and child obesity: a systematic review

Due to increasingly high rates of child overweight and obesity, it is important to identify risk and protective factors that may inform more effective prevention and intervention. The degree of organization in the family home environment is a studied, but not well-specified, factor that may impact child weight. Prior research on household organization has examined an array of constructs, including family routines, limit setting, household chaos, crowding and the broad home environment. This study systematically reviews literature on organization within the family home environment and weight among children ages 2-12. Six hundred thirty-seven studies were reviewed by four coders for eligibility, and 32 studies were included in the final synthesis. Overall, 84% of studies provided evidence for relations between at least one indicator of organization within the family home environment and child weight. Studies provided compelling evidence across several constructs, suggesting that the relevance of household organization to child weight extends beyond a single indicator. Directions for future work include (i) examining the mediating role of health behaviours, (ii) examining the moderating role of socioeconomic factors, (iii) broadening this evidence base across cultures and nationalities and (iv) integrating constructs to develop a comprehensive model of organization within the home environment.