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

Childhood poverty, social support, immigration background and adolescent health and life satisfaction: A population-based longitudinal study

OBJECTIVES

This study examined whether poverty (neighborhood and household) was associated with future health or life satisfaction outcomes and whether the association operated through social support (adult support at home, adult support at school, peer belonging), or differed by the immigration background (nonimmigrant family or immigrant family) of the family.

METHODS

This study utilized a retrospective, longitudinal, population-based cohort that included self-reported survey data from the Middle Years Development Instrument (MDI) completed by children at age 9 and age 12, linked to administrative records. Participants included 5906 children in British Columbia, Canada. Neighborhood and household poverty were observed at age 8. Social support from adults and peers was self-reported at age 9. Outcomes (overall health; life satisfaction) were self-reported at age 12. Adjusted multi-level multiple linear regression analyses and parallel mediation analyses were utilized. The interaction between poverty exposure and immigration background was also examined.

RESULTS

Exposure to either poverty type was associated with lower levels of life satisfaction and overall health at age 12, though household poverty appeared to be associated with lower outcomes in comparison to neighborhood poverty. The indirect effects of poverty on outcomes appeared to operate primarily through adult support at home and peer belonging. Children in immigrant families had a larger negative association between neighborhood poverty and life satisfaction.

CONCLUSIONS

Household poverty had a larger negative association to outcomes in comparison to neighborhood poverty. The association of poverty to outcomes differed by immigration background and operated partially through adult support at home and peer belonging.

Hypothalamic-pituitary-adrenal axis function in the offspring of parents with bipolar disorder and the impact of the family environment: A pilot study of the Reducing Unwanted Stress in the Home (RUSH) prevention program

BACKGROUND

The home environment of offspring of parents with bipolar disorder (OBD) has been characterized by high levels of stress and disorganization, which may impact development of the hypothalamic-pituitary-adrenal (HPA) axis and their subsequent risk for affective disorders. The present study examined the effects of a family-based preventative intervention on the OBD's HPA axis functioning and whether intervention-related changes in the home environment might have driven change in the HPA axis.

METHODS

Fifty-five children (6-11 years) were recruited from families having a parent with bipolar disorder (n=26) or families having two parents with no current mental disorders (n=29). Only those families with a parent having bipolar disorder participated in the preventative intervention. Both groups completed assessments at baseline, post-prevention, 3-, and 6-months post-prevention. At each assessment, family organization, control, cohesion, conflict, and expressiveness, in addition to childhood internalizing problems, were measured, and offspring saliva samples were collected across two consecutive days.

RESULTS

Hierarchical Linear Modelling found no significant differences in HPA axis functioning between groups at baseline or across time. Improvements in family organization, however, were associated with elevations in participants' cortisol awakening response (CAR; p =.004) and total daily output (p =.023), and a steepening of their diurnal slope (p =.003) across time. Similar findings were obtained for family cohesion with respect to CAR (p <.001) and, to a lesser degree, diurnal slope (p =.064).

DISCUSSION

HPA axis functioning did not differ between the OBD and healthy controls at baseline or in response to the preventative intervention. However, intervention-related improvements in family organization and, to a lesser degree, cohesion, were associated with adaptive changes in HPA functioning over time.

Adaptation and validation for use in Brazil of the Confusion, Hubbub, and Order Scale (CHAOS)

BACKGROUND

The Confusion, Hubbub, and Order Scale (CHAOS in English Version) was originally developed in the USA by Matheny et al (Bringing order out of chaos: psychometric characteristics of the confusion, hubbub, and order scale. Journal of Applied Developmental Psychology 16(3):429-444, 1995) to measure chaos in the family environment, characterized by confusion, lack of routine, and organization.

OBJECTIVE

To present evidence of content validity, internal structure validity, and validity based on relationships with external measures of an adapted version of the CHAOS into Brasilian Portuguese with adolescents sample in São Paulo - Brasil.

METHOD

Study 1 involved the translation/back-translation and adaptation of the scale into Brazilian Portuguese [here named "Escala de Confusão, Alvoroço e Ordem no Sistema familiar" (CAOS)], assessed by 5 judges. In Study 2, we conducted an exploratory factor analyses (EFA) to determine the scale's factor structure (N = 180 adults). In Study 3, we carried out confirmatory factor analyses (CFA) to confirm the internal validity of the scale, along with complete structural equation modeling to explore convergent validity in another sample (N = 239 adolescents).

RESULTS

The CAOS scale displayed content validity, and the EFA and CFA showed a unifactorial structure (with some scale adjustments) with an acceptable fit. The family chaos latent factor was associated with externalizing symptoms and perceived stress in adolescents.

CONCLUSION

Overall, the Brazilian version of the scale presented evidence of construct, internal, and concurrent validity that indicate its usefulness in Brazil.

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.

Childhood unpredictability research within the developmental psychopathology framework: Advances, implications, and future directions

Greater unpredictability in childhood from the level of the caregiver-child dyad to broader family, home, or environmental instability is consistently associated with disruptions in cognitive, socioemotional, behavioral, and biological development in humans. These findings are bolstered by experimental research in non-human animal models suggesting that early life unpredictability is an important environmental signal to the developing organism that shapes neurodevelopment and behavior. Research on childhood unpredictability has surged in the past several years, guided in part by theoretical grounding from the developmental psychopathology framework (shaped largely by Dr. Dante Cicchetti's innovative work). The current review focuses on future directions for unpredictability research, including probing intergenerational effects, the role of predictability in resilience, cultural and contextual considerations, and novel developmental outcomes that should be tested in relation to childhood unpredictability. We urge the integration of multidisciplinary perspectives and collaborations into future research on unpredictability. We also provide ideas for translating this research to real-world practice and policy and encourage high-quality research testing whether incorporating predictability into interventions and policy improves developmental outcomes, which would support further dissemination of these findings.

Variation in coupling across neural and cardiac systems of regulation is linked to markers of anxiety risk in preschool

Both cortical and parasympathetic systems are believed to regulate emotional arousal in the service of healthy development. Systemic coordination, or coupling, between putative regulatory functions begins in early childhood. Yet the degree of coupling between cortical and parasympathetic systems in young children remains unclear, particularly in relation to the development of typical or atypical emotion function. We tested whether cortical (ERN) and parasympathetic (respiratory sinus arrhythmia [RSA]) markers of regulation were coupled during cognitive challenge in preschoolers (N = 121). We found no main effect of RSA predicting ERN. We then tested children's typical and atypical emotion behavior (context-appropriate/context-inappropriate fear, anxiety symptoms, neuroendocrine reactivity) as moderators of early coupling in an effort to link patterns of coupling to adaptive emotional development. Negative coupling (i.e., smaller ERN, more RSA suppression or larger ERN, less RSA suppression) at age 3 was associated with greater atypical and less typical emotion behaviors, indicative of greater risk. Negative age 3 coupling was also visible for children who had greater Generalized Anxiety Disorder symptoms and blunted cortisol reactivity at age 5. Results suggest that negative coupling may reflect a maladaptive pattern across regulatory systems that is identifiable during the preschool years.

Physical Activity and Chronic Stress in Early Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort

BACKGROUND

The association of physical activity through early childhood on children's chronic stress still is unclear. Therefore, the aim of the present study is to test the association of physical activity through early childhood (1-4 y) with chronic stress, measured by hair cortisol at age 4.

METHODS

Longitudinal study including children from the 2015 Pelotas (Brazil) Birth Cohort. Cortisol at age 4 was measured using a hair sample, which provided cortisol concentration from the past months. Physical activity was measured using accelerometers at 1, 2, and 4 years. Linear regression models were used to assess the association between physical activity and chronic stress. Trajectory models were also applied to examine chronic stress in relation to physical activity patterns throughout early childhood.

RESULTS

Children with valid physical activity and hair cortisol data were included in the analyses (N = 1475). Three groups of physical activity trajectories between 1 and 4 years were identified: low, medium, and high. No association between physical activity at 1, 2, and 4 years and chronic stress at age 4 was observed. However, children in the "high" physical activity trajectory presented low cortisol concentration; the magnitude of the regression coefficient was slightly larger in girls (β = -0.125; 95% confidence interval, -0.326 to 0.074) than boys (β = -0.051; 95% confidence interval, -0.196 to 0.09).

CONCLUSION

There was no clear association between physical activity and chronic stress in early childhood. Trajectories models suggest that higher activity throughout early childhood may positively impact chronic stress; however, more studies are needed to confirm that hypothesis.

How household chaos affects social withdrawal of rural children: the indirect role of executive function and receptive language ability

Executive function (EF) and receptive language ability play an important role in the relationship between household chaos and social withdrawal. Young children are neglected in household chaos research and suffer from the negative outcomes of households in China. However, few studies have focused on the relationship between household chaos and social withdrawal in young Chinese children and the chain mediating effect of EF and receptive language ability. This study included 922 preschool-age children (62.58 ± 8.03 months) and their primary caregivers and their teachers were recruited from 21 rural preschools in Guangdong Province in China. Our results show a positive direct effect of household chaos and social withdrawal. Furthermore, an indirect sequential effect of household chaos and social withdrawal on EF and receptive language ability was found. Our findings (a) highlight the significance of paying more attention to household chaos and revealing a better understanding of the effect of EF and receptive language ability on households at an early age and (b) indicate that interventions should be provided to improve the home environment when children are young.

The longitudinal association between potential stressful life events and the risk of psychosocial problems in 3-year-old children

Background

Experiencing certain potentially stressful life events can impact psychosocial well-being among school-aged children and adolescents. This study aims to evaluate the association between life events occurring before age 2 and risk of psychosocial problems at 3 years of age.

Methods

All parents invited for the regular well-child visit when their child was 2 years of age by the preventive Youth Health Care in the Rotterdam-Rijnmond area, the Netherlands, were invited to participate in this study. In total 2,305 parents completed the baseline questionnaire at child age 2-years; 1,540 parents completed the questionnaire at child age 3-years. The baseline questionnaire included a life events assessment (12 items), and tension caused by the event (range 0-3). At child age 3-years the questionnaire included the Strengths and Difficulties Questionnaire (SDQ) to assess risk of psychosocial problems. Logistic regression models were applied.

Results

In the current study 48.5% of families experienced ≥1 life event before child age 2 years. Divorce and problems in the relationship between the parents received the highest perceived severity score [respectively 2.1 (SD = 0.8) and 2.0 (SD = 0.7)]. Children experiencing ≥1 event before the age of 2 years were at higher risk of psychosocial problems at 3 years of age, compared to children that had experienced no life event (1-2 events OR = 1.50, 95%CI: 1.09; 2.06, and >2 events OR = 2.55, 95%CI 1.64; 4.00, respectively). When life events caused high perceived levels of tension, there was also an association with an increased risk of psychosocial problems at age 3-years (OR = 2.03, 95%CI 1.43; 2.88).

Conclusions

Approximately half of children in our study experienced a potential stressful life event before the age of 2 years. Results suggest an association between experiencing a life event and risk of psychosocial problems at child age 3-years. These findings emphasize the need for child health care professionals to pay attention to life events taking place in the life of young children in order to provide appropriate support.

Early Adversity and Changes in Cortisol and Negative Affect in Response to Interpersonal Threats in the Laboratory

Adverse childhood experiences, such as abuse and neglect, are associated with poor health outcomes. This association may be partially explained by differences in stress physiology. Though most early adverse experiences occur within the context of interpersonal relationships, stress exposures manipulated in the laboratory rarely involve interpersonal interactions beyond the mere presence of others. This study examines whether adverse childhood experiences are associated with differences in affective and cortisol reactivity to two stressors which may more closely resemble the powerlessness and the lack of control characteristic of many adverse childhood experiences: a dominant (vs. submissive) interaction partner and lower (vs. higher) social status. We also manipulate social-evaluative threat as a test of whether these interpersonal stressors are more germane to stress reactivity associated with early adversity than the performance anxiety evoked by more traditional laboratory stressors, such as the Trier Social Stress Test. The results partially support the hypothesis that participants with greater early adversity may be more reactive to interpersonal stressors reminiscent of early adverse experience. Given the interpersonal nature of most adverse childhood experiences, conceptualizing and measuring associations with stress physiology in an interpersonal context may more closely capture the psychological and biological embedding of these early experiences.

Effects of the healthy start randomized intervention on psychological stress and sleep habits among obesity-susceptible healthy weight children and their parents

Poor sleep and psychological stress are obesity determinants that are rarely included in obesity prevention programs. The aim was to report the effects of the Healthy Start randomized intervention on the secondary outcomes psychological stress and sleep duration and onset latency. Data was obtained from the Healthy Start randomized intervention conducted in 2009–2012 among Danish healthy weight children aged 2–6 years, who had either a high birth weight (>4,000 g), high maternal pre-pregnancy body mass index (>28 kg/m2), or low maternal educational level (≤10 years of schooling) and their parents. The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep habits, and reduction of psychological family stress. The average intervention period was 15 months. Children with information on a 7-day sleep record, sleep onset latency, Strengths and Difficulties Questionnaire (SDQ), and a modified version of Parenting Stress Index (PSI) were included. The effects of the intervention on sleep habits, PSI scores, SDQ Total Difficulties (SDQ-TD) and Pro-social Behavior scores, and 95% Confidence Intervals (95% CI) were analyzed using linear regression intention-to-treat (n = 543 (intervention group n = 271, control group n = 272)) analyses. No statistically significant effects on sleep duration, sleep onset latency, PSI score, or SDQ Pro-social Behavior score were observed. Values both before and after the intervention were within the normal range both for children in the intervention and children in the control group. Mean change in SDQ-TD was 0.09 points (95% CI -0.57;0.59) in the intervention group, and -0.69 points (95% CI -1.16; -0.23) in the control group (p = 0.06). In conclusion, there were no intervention effects in relation to sleep duration, sleep onset latency, PSI score, or SDQ Pro-social behavior. There was an indication that children in the intervention group had slightly more behavioral problems than the control group after the intervention, but values were within normal range both before and after the intervention, and the difference is not considered to be clinically meaningful.

A mother's touch: Preschool-aged children are regulated by positive maternal touch

Positive maternal touch plays an important role in the development of children's physiological regulation and cognitive development in infancy, as well as the development of sociality in early childhood. However, few studies have looked beyond infancy to consider the possible continuing impact of positive maternal touch on child stress reactivity during early childhood. A diverse community sample of mothers (N = 114, M_age  = 33.52 years, SD = 5.33) and their preschool-aged children (M_age  = 41.68 months, SD = 4.67; 49.1% female) participated in the study. Basic demographics were reported by mothers. We coded maternal touch behaviors during an emotionally charged laboratory conversation task and assessed children's physiological reactivity to stressful laboratory tasks with salivary cortisol. Results reveal a significant negative association between positive maternal touch and child salivary cortisol reactivity. In addition, family income, adjusted for family size, and child sex were significantly associated with child cortisol stress reactivity. Findings are discussed in terms of persistent downregulating effects of positive maternal touch on child stress reactivity, as well as possible links of stress reactivity with family income, a proxy for economic stress, and child sex.

Infant diurnal cortisol predicts sleep

The sleep-wake system is immature at birth and develops in parallel with the hypothalamic-pituitary-adrenal axis, a biological stress system of which the end product is cortisol. Perturbations in one system during infancy can maladaptively influence the maturation of the other system, leading to lasting sleep and cortisol system dysregulation and heightening the risk of enduring health problems. To better understand the early interplay between these systems, we examined whether actigraphy-derived measures of night-time sleep duration and onset were associated with cumulative exposure to cortisol, indexed by hair cortisol concentration, in 12-month-old children. Overall, early sleep onset predicted lower hair cortisol above and beyond sleep duration, family income and chaos experienced at home. Furthermore, both sleep and cortisol levels vary day to day, and temporal dependencies between daily sleep and cortisol regulation are not well understood. Thus, we assessed how the sleep characteristics on a particular evening related to salivary cortisol levels the following day and how daytime and evening cortisol related to the sleep characteristics on the same night. Lower total exposure to cortisol on a particular day was related to longer night-time sleep duration the same night, but not sleep onset. Lower salivary cortisol levels on a given evening related to earlier sleep onset the same night, but not to night-time sleep duration. Sleep duration and onset on a given night were unrelated to total cortisol exposure the following day. Findings suggest that in early development, the day-to-day relation between sleep and cortisol is not bidirectional, but more driven by diurnal cortisol.

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.

Prior night sleep moderates the daily spillover between conflict with peers and family and diurnal cortisol

We investigated whether daily experiences of conflict with family and peers were associated with fluctuations in diurnal cortisol, and whether sleep buffers the associations between conflict and diurnal cortisol. A racially diverse sample of 370 adolescents (ages 11-18; 57.3% female) provided daily diaries for 5 days and saliva samples for 4 days. Hierarchical linear models tested how peer and family conflict were associated with diurnal cortisol (i.e., total cortisol output, cortisol slope, and cortisol awakening response) the next day, and whether these associations were moderated by sleep duration the previous night. When adolescents experienced peer conflict, they showed higher area under the curve (AUC) the next day if they had slept less the night prior to conflict, but relatively lower cortisol awakening response (CAR) and flatter cortisol slope the next day if they had slept more the night prior to conflict. When adolescents experienced family conflict, they also showed higher AUC the next day if they had slept less the night prior to conflict, but higher CAR the next day if they had slept more the night prior to conflict. Family conflict and sleep were not directly or interactively related to cortisol slope.

The causal effect of household chaos on stress and caregiving: An experimental study

The correlational nature of previous studies on household chaos does not allow claims about causal effects of household chaos. The present study used an experimental design to assess the causal effect of household chaos on stress, negative emotions, and caregiving. Ninety-six female students (18–25 years) participated in our study. They took care of an infant simulator in a normal living room (neutral condition), and a chaotic living room (chaos condition), while caregiver sensitivity was observed, operationalized as perceiving, correctly interpreting, and responding accurately and promptly to the infant's signals. Participants reported on their current emotional state, and saliva was collected four times for analysis of salivary alpha-amylase (sAA). Results showed that there were no significant time or condition effects on negative emotional state. Yet, sAA levels were higher in the chaos condition compared to the neutral condition. We found no evidence for negative emotional state or sAA mediating the relation between household chaos and caregiver sensitivity. Because household chaos affected physiological stress in a parenting situation, it should not be ignored when using interventions aimed at reducing stress in parents. More research is needed on the effect of reduced (as opposed to increased) levels of household chaos on physiological stress levels in families with young children.

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Household chaos is causally related to physiological stress in a caregiving context.

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Household chaos does not affect self-reported negative emotions.

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No evidence for stress mediating the relation between household chaos and caregiving.

Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals

Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.

Children's fingernail cortisol among BaYaka foragers of the Congo Basin: associations with fathers' roles

Children and mothers' cortisol production in response to family psychosocial conditions, including parenting demands, family resource availability and parental conflict, has been extensively studied in the United States and Europe. Less is known about how such family dynamics relate to family members' cortisol in societies with a strong cultural emphasis on cooperative caregiving. We studied a cumulative indicator of cortisol production, measured from fingernails, among BaYaka forager children (77 samples, n = 48 individuals) and their parents (78 samples, n = 49) in the Congo Basin. Men ranked one another according to locally valued roles for fathers, including providing resources for the family, sharing resources in the community and engaging in less marital conflict. Children had higher cortisol if their parents were ranked as having greater parental conflict, and their fathers were seen as less effective providers and less generous sharers of resources in the community. Children with lower triceps skinfold thickness (an indicator of energetic condition) also had higher cortisol. Parental cortisol was not significantly correlated to men's fathering rankings, including parental conflict. Our results indicate that even in a society in which caregiving is highly cooperative, children's cortisol production was nonetheless correlated to parental conflict as well as variation in locally defined fathering quality. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

The differential calibration of the HPA axis as a function of trauma versus adversity: A systematic review and p-curve meta-analyses

Although there is an abundance of evidence linking the function of the hypothalamic-pituitary-adrenal (HPA) axis to adverse early-life experiences, the precise nature of the association remains unclear. Some evidence suggests early-life adversity leads to cortisol hyper-reactivity, while other evidence suggests adversity leads to cortisol hypo-reactivity. Here, we distinguish between trauma and adversity, and use p-curves to interrogate the conflicting literature. In Study 1, trauma was operationalized according to DSM-5 criteria; the p-curve analysis included 68 articles and revealed that the literature reporting associations between trauma and blunted cortisol reactivity contains evidential value. Study 2 examined the relationship between adversity and cortisol reactivity. Thirty articles were included in the analysis, and p-curve demonstrated that adversity is related to heightened cortisol reactivity. These results support an inverted U-shaped function relating severity of adversity and cortisol reactivity, and underscore the importance of distinguishing between "trauma" and "adversity".

Perceived stress is linked to heightened biomarkers of inflammation via diurnal cortisol in a national sample of adults

Exposure to and perceptions of stress have been associated with altered systemic inflammation, but the intermediate processes by which stress links to inflammation are not fully understood. Diurnal cortisol slopes were examined as a pathway by which self-reported psychosocial stress is associated with inflammation [i.e., C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, E-Selectin, and Intercellular Adhesion Molecule-1 (ICAM-1)] in a large sample of adults (the Midlife in the US study; N = 914; 55.9% female; aged 34-84 years). Structural equation modeling indicated that perceived psychological stress was associated with flattened diurnal cortisol slopes and flatter diurnal cortisol slopes were, in turn, associated with heightened inflammation in these cross-sectional analyses (index of indirect pathway, ω = 0.003, 95% CI [0.001, 0.004], ωSTD = 0.027; with covariates, ω = 0.001, [0.0002, 0.002], ωSTD = 0.011). A similar indirect effect was evident for self-reported traumatic life events (ω = 0.007, [0.004, 0.012], ωSTD = 0.030); however, inclusion of covariates (i.e., age, gender, race, ethnicity, body mass index, and other factors associated with physical health) accounted for this finding (ω = 0.001, [-0.001, 0.004], ωSTD = 0.005). These results support an allostatic load model of psychosomatic health, in which cortisol (along with other stress-responsive signaling molecules) is a necessary component for understanding links between stress exposure, perceived stress, and immune functioning.

Cortisol and socioeconomic status in early childhood: A multidimensional assessment

The hypothalamic-pituitary-adrenal (HPA) axis is sensitive to early life stress, with enduring consequences for biological stress vulnerability and health (Gunnar & Talge, 2008). Low socioeconomic status (SES) is associated with dysregulation of the stress hormone cortisol in early childhood. However, a mechanistic understanding of this association is lacking. Multidimensional assessment of both SES and cortisol is needed to characterize the intricate relations between SES and cortisol function in early childhood. We assessed parent-reported family income, parent education, occupational prestige, neighborhood risk, food insecurity, and household chaos for 12-month-old infants (N = 90) and 3.5-year-old children (N = 91). Hair cortisol concentration (HCC) was obtained from parent and child, indexing chronic biological stress, and diurnal salivary cortisol was measured in the children. Controlling for parent HCC, parent education uniquely predicted infant and child HCC and, in addition, neighborhood risk uniquely predicted infant HCC. Household chaos predicted bedtime salivary cortisol concentration (SCC) for both infants and children, and infant daily cortisol output. Food insecurity was associated with flattened cortisol slope in 3.5-year-old children. Parental sensitivity did not mediate relations between SES and cortisol. Results highlight the utility of SES measures that index unpredictable and unsafe contexts, such as neighborhood risk, food insecurity, and household chaos.

Parental sensitivity mediates the sustained effect of Attachment and Biobehavioral Catch-up on cortisol in middle childhood: A randomized clinical trial

IMPORTANCE

Parenting interventions have been found to normalize cortisol regulation among high-risk children early in development; it is important to investigate the sustainability of these effects and their mechanisms, given the maladaptive outcomes associated with cortisol dysregulation.

OBJECTIVE

To determine whether the Attachment and Biobehavioral Catch-up (ABC) intervention, implemented in infancy, predicts cortisol regulation in middle childhood via changes in early parental sensitivity.

DESIGN

Double blind randomized clinical trial design; started January 2006, the follow-up for this project concluded March 2016.

SETTING

Parents of children under age 2 referred from child protective services agencies in a large, mid-Atlantic city.

PARTICIPANTS

103 parent-child dyads (45.6% female children) with histories of child protective services involvement, randomly assigned to receive ABC (n = 45) or a control intervention (n = 58); in infancy, the children's ages ranged from 1.60 to 25.30 months (M = 9.87 months); at the middle childhood follow-up, they ranged from 8.0 to 11.0 years old (M = 8.52 years).

INTERVENTIONS

Both conditions included 10-week, in-home, manualized interventions. The experimental condition, ABC, has 3 primary targets for parents: increasing nurturance to child distress, increasing following the child's lead, and decreasing frightening behavior. The control intervention, Developmental Education for Families (DEF), is an adaptation of a program focused on enhancing cognitive and language development.

MAIN OUTCOMES AND MEASURES

Parental sensitivity was coded from a semi-structured interaction task between the parent and child in early childhood. Middle childhood diurnal cortisol slopes were modeled by collecting salivary cortisol samples from children at wake-up and bedtime over the course of 3 consecutive days.

RESULTS

ABC participation in infancy was associated with increased parental sensitivity post-intervention, β = 0.28, p = .004, and this increased sensitivity predicted steeper decline across the day in children's cortisol concentration in middle childhood, β = -.53, p = .002. The indirect effect of ABC on cortisol regulation via sensitivity was significant, β = -0.15, p = .038.

CONCLUSIONS AND RELEVANCE

ABC has an indirect effect on middle childhood diurnal cortisol regulation via parental sensitivity; future research should seek to determine how this enhanced neurobiological regulation relates to children's behavioral, socioemotional, and psychological outcomes.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT02093052.

Child diurnal cortisol differs based on profiles of maternal emotion socialization in high risk, low income, and racially diverse families

Young children's physiological and emotional regulation depend on supportive caregiving, especially in the context of stress and adversity. Experiences of child maltreatment become biologically embedded by shaping stress physiology. Maternal emotion socialization may have an important influence on children's limbic-hypothalamic-pituitary-adrenal (LHPA) functioning. Grounded in theories of caregiver emotion socialization, a person-centered latent profile analysis was utilized to identify profiles of maternal emotion socialization among a high risk, low income, and racially diverse group of 248 mothers and their young children (M_age  = 4.39 years, SD = 1.10). The majority of the mothers (n = 165) had a history of involvement with the Department of Child Services for substantiated cases of child maltreatment. A latent profile analysis was conducted revealing three emotion socialization profiles: disengaged, engaged, and engaged + supportive. Emotion socialization profile differences in children's diurnal cortisol levels and slope (using area under the curve with respect to ground and increase, respectively) were examined. Children's diurnal cortisol levels were higher, and slopes were flatter, when mothers used more disengaged emotion socialization strategies. Mothers who neglected their children were more likely to fit the disengaged profile than the engaged profile. Implications for the socialization of regulation in children exposed to adversity are discussed.

Parent's anxiety links household stress and young children's behavioral dysregulation

Young children rely heavily on their caregivers to gain information about the environment, especially during times of duress. Therefore, considering parental assessments of behavior in the context of stressful environments may better facilitate our understanding of the longstanding association between early environmental stressors and changes in child behavior and physiology. Confirming many previous reports, a higher degree of household stress exposure was associated with elevated mental health symptoms in 2- to 6-year-old children (N = 115; anxiety and externalizing behaviors), which were verified in a subset of children with laboratory-based behaviors (N = 46). However, these associations were mediated by parental anxiety symptoms, which were also associated with increased cortisol levels in children. A closer look at the stressors indicated that it was the adult-targeted, and not the child-targeted, stressors that correlated most with children's behavior problems. These results highlight the importance of considering the mediating effect of parents, when examining associations between household stress and young children's behavioral development.

Severe Poverty and Growth in Behavioral Self-Regulation: The Mediating Role of Parenting

This study examined how exposure to severe poverty related to behavioral self-regulation growth during early childhood as mediated by parenting practices. Ethnic differences were tested. Data were collected across 4 waves from 359 low-income African American and Latino families. The frequency of exposure to severe poverty was indicated by how many times family income fell below 50% of the federal poverty line across 4 waves. Behavioral self-regulation was assessed when children were 3½, 6, and 7 years old (Wave 2-4), and parenting was observed when children were age 2½ years old (Wave 1). More frequent exposure to severe poverty was associated with slower behavioral self-regulation growth, and the effect was partially mediated through less sensitive and supportive parenting practices for Latino families. The mediation was not observed for African American families. Targeting the promotion of sensitive and supportive parenting practices may be an effective strategy for accelerating self-regulation development.

Childhood socio-economic disadvantage predicts reduced myelin growth across adolescence and young adulthood

Socio-economic disadvantage increases exposure to life stressors. Animal research suggests early life stressors impact later neurodevelopment, including myelin developmental growth. To determine how early life disadvantage may affect myelin growth in adolescence and young adulthood, we analysed data from an accelerated longitudinal neuroimaging study measuring magnetisation transfer (MT), a myelin-sensitive marker, in 288 participants (149 female) between 14 and 25 years of age at baseline. We found that early life economic disadvantage before age 12, measured by a neighbourhood poverty index, was associated with slower myelin growth. This association was observed for magnetization transfer in cortical, subcortical and core white matter regions, and also in key subcortical nuclei. Participant IQ at baseline, alcohol use, body mass index, parental occupation and self-reported parenting quality did not account for these effects, but parental education did so partially. Specifically, positive parenting moderated the effect of socio-economic disadvantage in a protective manner. Thus, early socioeconomic disadvantage appears to alter myelin growth across adolescence. This finding has potential translational implications, including clarifying whether reducing socio-economic disadvantage during childhood, and increasing parental education and positive parenting, promote normal trajectories of brain development in economically disadvantaged contexts.

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 Chaos and Asthma Control

OBJECTIVES

Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes.

METHODS

Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support.

RESULTS

Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship.

CONCLUSIONS

Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.

Weight status moderates stress-eating in the absence of hunger associations in children

OBJECTIVE

The association between stress and eating remains unclear in children potentially due to factors that may moderate the association. We examined whether weight status or sex moderated associations between response to a stress induction and eating in the absence of hunger (EAH), among low-income children.

METHOD

Children (n = 223; M age = 7.8 years, SD = 0.7 years) participated in a stress induction protocol (modified Trier Social Stress Test for Children [TSST-C]) during which behavioral coding of observed anxiety and change in self-reported distress were measured. Afterwards, participants completed a standardized EAH protocol where they were offered palatable foods. Total kilocalories consumed during the EAH protocol was calculated. Weight and height were measured and weight status calculated as overweight (BMI ≥ 85th percentile for age and sex) vs. not overweight. Multivariate linear regression models adjusting for covariates were conducted to test whether child weight status or sex moderated the stress response-EAH association, for both stress response variables.

RESULTS

Weight status moderated the association between observed stress response and EAH such that children with overweight engaged in more EAH as observed anxiety increased, whereas children without overweight engaged in less EAH as observed anxiety increased (β_interaction = 0.48; p = .010). Weight status did not moderate associations between self-reported distress and EAH. Child sex was not a significant moderator.

CONCLUSIONS

After exposure to stress, children with overweight in middle childhood may eat more palatable food compared to children without overweight, possibly due to hypersensitization to food cues or weight stigma experienced by youth with overweight. It may be helpful to encourage youth with overweight to engage in stress-management techniques that do not involve eating as a response to stress.

An investigation of maternal food intake and maternal food talk as predictors of child food intake

Though parental modeling is thought to play a critical role in promoting children's healthy eating, little research has examined maternal food intake and maternal food talk as independent predictors of children's food intake. The present study examines maternal food talk during a structured eating protocol, in which mothers and their children had the opportunity to eat a series of familiar and unfamiliar vegetables and desserts. Several aspects of maternal talk during the protocol were coded, including overall food talk, directives, pronoun use, and questions. This study analyzed the predictors of maternal food talk and whether maternal food talk and maternal food intake predicted children's food intake during the protocol. Higher maternal body mass index (BMI) predicted lower amounts of food talk, pronoun use, and questions. Higher child BMI z-scores predicted more first person pronouns and more wh-questions within maternal food talk. Mothers of older children used fewer directives, fewer second person pronouns, and fewer yes/no questions. However, maternal food talk (overall and specific types of food talk) did not predict children's food intake. Instead, the most robust predictor of children's food intake during this protocol was the amount of food that mothers ate while sitting with their children. These findings emphasize the importance of modeling healthy eating through action and have implications for designing interventions to provide parents with more effective tools to promote their children's healthy eating.