Peer Problems Among Postinstitutionalized, Internationally Adopted Children: Relations to Hypocortisolism, Parenting Quality, and ADHD Symptoms

Understanding the prospective associations between neuro-developmental problems, bullying victimization, and mental health: Lessons from a longitudinal study of institutional deprivation

Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22-25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.

Previously institutionalized toddlers' social and emotional competence and kindergarten adjustment: Indirect effects through executive function

Longitudinal multimethod data across three time points were examined to explore the associations between previously institutionalized toddlers' (N = 71; 59% female) socioemotional skills (Time Point 1: 18 months to 3-years-old), executive functioning (i.e., attention, working memory, inhibitory control) in the preschool years (Time Point 2: 2-4-years-old), and adjustment in kindergarten (5-6-years-old). Children were from multiple regions (35% Eastern European, 31% Southeast Asian, 25% African, and 9% Latin American), and 90% of adoptive parents were White from the Midwestern United States. Socioemotional competency at Time Point 1 was associated with fewer attention problems and greater inhibitory control at Time Point 2, which were subsequently associated with more observed social competence, greater observed classroom competence, and less teacher-reported teacher-child conflict in kindergarten. Indirect effects from socioemotional competencies in toddlerhood to kindergarten adjustment via executive functioning during the preschool period emerged. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The role of stress in the biological embedding of experience

Exposure to early adversity is one of the most important and pervasive risk factors for the development of nearly all major mental disorders across the lifespan. In the search for the mediating mechanisms and processes that underlie long-term stability of these effects, changes to stress-associated hormonal and cellular signalling have emerged as prime candidates. This review summarises evidence showing that experience of early adversity in the form of childhood abuse or neglect and exposure to severe institutional deprivation influences multiple interconnected bio-behavioural, physiological and cellular processes. This paper focusses on dysregulations of hormonal stress regulation, altered DNA methylation pattern, changes to transcriptomic profiles in the context of stress-immune interplay, and mitochondrial biology. Consistent findings that have emerged include a relative cortisol hypoactivity and hyporeactivity in response to challenge, increased activity of pro-inflammatory genes, and altered mitochondrial function. The majority of investigations have focussed on single outcomes, but there is a clear rationale of conceiving the implicated physiological processes as interconnected parts of a wider stress-associated regulatory network, which in turn is connected to behaviour and mental disorders. This calls for integrated and longitudinal investigations to come to a more comprehensive understanding of the role of stress in the biological embedding of experience. The review concludes with considerations of how stress research can contribute to translational efforts through characterising subtypes of mental disorders which arise as a function of early adversity, and have distinct features of behavioral and biological stress processing.

Effects of foster care intervention and caregiving quality on the bidirectional development of executive functions and social skills following institutional rearing

Institutional rearing negatively impacts the development of children's social skills and executive functions (EF). However, little is known about whether childhood social skills mediate the effects of the foster care intervention (FCG) and foster caregiving quality following early institutional rearing on EF and social skills in adolescence. We examined (a) whether children's social skills at 8 years mediate the impact of the FCG on the development of EF at ages 12 and 16 years, and (b) whether social skills and EF at ages 8 and 12 mediate the relation between caregiving quality in foster care at 42 months and subsequent social skills and EF at age 16. Participants included abandoned children from Romanian institutions, who were randomly assigned to a FCG (n = 68) or care as usual (n = 68), and a never-institutionalized group (n = 135). At ages 8, 12, and 16, social skills were assessed via caregiver and teacher reports and EF were assessed via the Cambridge Neuropsychological Test Automated Battery. Caregiving quality of foster caregivers was observed at 42 months. FCG predicted better social skills at 8 years, which in turn predicted better EF in adolescence. Higher caregiver quality in foster care at 42 months predicted better social skills at 8 and 12 years, and better EF at 12 years, which in turn predicted 16-year EF and social skills. These findings suggest that interventions targeting caregiving quality within foster care home environments may have long-lasting positive effects on children's social skills and EF.

Autonomic reactivity to social rejection, peer difficulties, and the buffering effects of adolescent friendships following early psychosocial deprivation

Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal randomized controlled trial of foster care versus institutional care of abandoned children in Romania, we assessed whether altered sympathetic reactivity to peer rejection feedback in early adolescence mediated the relation between early institutional rearing and peer problems in later adolescence. We also assessed whether adolescent friendship quality or randomized placement in foster care early in life moderated these associations. Participants include 68 institutionalized children randomized to care as usual, 68 institutionalized children randomized to foster care, and 135 never-institutionalized children. At age 12, participants reported friendship quality with respect to a best friend and completed a social rejection task while electrocardiogram and impedance cardiography were recorded. Sympathetic nervous system reactivity to rejection feedback was assessed using preejection period (PEP). At ages 12 and 16, peer problems were reported by parents. Mediation analysis revealed that less PEP reactivity to social rejection at age 12 partially mediated the association between early institutionalization and greater peer problems at age 16. Further moderated mediation analysis revealed that this indirect effect was evidenced among previously institutionalized youths with low, but not high, quality friendships. We did not observe foster care intervention effects. These findings suggest that altered sympathetic reactivity to social rejection might be a mechanism linking early institutionalization to social difficulties into adolescence, however, positive adolescent friendships may buffer these effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cortisol Reactivity and Socially Anxious Behavior in Previously Institutionalized Youth

The current study investigated the association between cortisol stress reactivity to a social stressor and observed socially anxious behaviors both concurrently and over time among previously institutionalized (PI) (N = 132; ages 7-17) youth and a comparison non-adopted (NA) sample (N = 176). Cortisol reactivity was captured during the Trier Social Stress Test for Children (TSST-C; Yim et al., 2015) and youths' social anxiety behaviors were coded during the speech portion of the TSST-C. Autoregressive cross-lagged panel models with structured residuals showed that for PI youth, greater cortisol reactivity predicted increases in socially anxious behavior during the TSST-C across three sessions. However, greater cortisol reactivity was negatively associated with concurrent social anxiety behavior. Thus, increases in cortisol reactivity across adolescence may aid in behavioral control in social situations in the short-term but may exacerbate PI youths' socially anxious behavior over time. No significant associations emerged for NA youth.

Bullying victimization among internationally adopted adolescents: Psychosocial adjustment and moderating factors

Bullying constitutes a serious risk factor for the psychosocial adjustment of young people in both the general population and minority groups. Among minorities, international adoptees are likely to show a specific vulnerability to the experience of being bullied, moderated by specific risk and protective factors. This study aimed to investigate the association between adoptees' experience of bullying victimization and their psychosocial adjustment, and to explore the moderating role of adoptive identity and reflected minority categorization. An online, anonymous self-report questionnaire was completed by 140 adolescents (13-17 years), who were internationally adopted by Italian families. Findings showed that being victimized was associated with higher levels of emotional and behavioral difficulties, but that the strength of this relation varied according to the levels of adoptive identity and reflected minority categorization. Specifically, victimization was found to have a more detrimental and negative impact on psychological adjustment for adoptees who were highly identified with the adoptive group, and reported to be less perceived by others as members of the minority group. Results are discussed in relation to recommendations for further research as well as for professionals working with internationally adopted adolescents.

Pubertal stress recalibration and later social and emotional adjustment among adolescents: The role of early life stress

The current study investigated whether recalibration of the hypothalamic-pituitary -adrenocortical (HPA) axis stress response in youth who had previously experienced early life stress (ELS) would predict socioemotional adjustment in a follow-up assessment approximately 2-4 years later when youth were 12- to 21-years old. The sample consisted of previously institutionalized (PI) (N = 96) youth and a comparison non-adopted (NA) group (N = 117). Youth were 16 years old on average at the time of the follow-up assessment. Parent and youth-reported measures were used to assess youth's internalizing symptoms and emotion regulation. Parent-reported measures were used to assess youth's externalizing symptoms. We tested whether showing cortisol increases (vs. not) across the peripubertal period was associated with later social and emotional adjustment differently for PI and NA youth. Significant interactions emerged showing that for PI youth only, increases in cortisol reactivity across the peripubertal period was associated with poorer subsequent socioemotional functioning.

Longitudinal changes in amygdala, hippocampus and cortisol development following early caregiving adversity

Although decades of research have shown associations between early caregiving adversity, stress physiology and limbic brain volume (e.g., amygdala, hippocampus), the developmental trajectories of these phenotypes are not well characterized. In the current study, we used an accelerated longitudinal design to assess the development of stress physiology, amygdala, and hippocampal volume following early institutional care. Previously Institutionalized (PI; N = 93) and comparison (COMP; N = 161) youth (ages 4–20 years old) completed 1–3 waves of data collection, each spaced approximately 2 years apart, for diurnal cortisol (N = 239) and structural MRI (N = 156). We observed a developmental shift in morning cortisol in the PI group, with blunted levels in childhood and heightened levels in late adolescence. PI history was associated with reduced hippocampal volume and reduced growth rate of the amygdala, resulting in smaller volumes by adolescence. Amygdala and hippocampal volumes were also prospectively associated with future morning cortisol in both groups. These results indicate that adversity-related physiological and neural phenotypes are not stationary during development but instead exhibit dynamic and interdependent changes from early childhood to early adulthood.

Enhancing diurnal cortisol regulation among young children adopted internationally: A randomized controlled trial of a parenting-based intervention

Children who have been adopted internationally commonly experience institutional care and other forms of adversity prior to adoption that can alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. In particular, internationally adopted children tend to have blunted diurnal declines compared to children raised in their birth families. The Attachment and Biobehavioral Catch-Up (ABC) intervention was developed to enhance young children's biological and behavioral regulation by promoting sensitive parenting. The current study used a randomized controlled trial to assess whether ABC improved the diurnal functioning of the HPA axis among 85 children who had been adopted internationally when they were between the ages of 4 and 33 months (M = 16.12). Prior to the intervention, there were no significant differences in diurnal cortisol production between children whose parents were randomly assigned to receive ABC and children whose parents were randomly assigned to receive a control intervention. After the intervention, children whose parents had received the ABC intervention exhibited steeper declines in cortisol levels throughout the day than children whose parents had received the control intervention. These results indicate that the ABC intervention is effective in enhancing a healthy pattern of diurnal HPA axis regulation for young children who have been adopted internationally.

Associations between stress reactivity and behavior problems for previously institutionalized youth across puberty

Megan Gunnar's pubertal stress recalibration hypothesis was supported in a recent study of previously institutionalized (PI) youth such that increases in pubertal stage were associated with increases in cortisol stress reactivity. This work provides evidence that puberty may open up a window of recalibration for PI youth, resulting in a shift from a blunted to a more typical cortisol stress response. Using the same sample (N = 132), the current study aimed to elucidate whether increases in cortisol are associated with increases in adaptive functioning or whether they further underlie potential links to developmental psychopathology. Specifically, we examined the bidirectional associations between cortisol stress reactivity and both internalizing and externalizing symptoms across three timepoints during the pubertal period. Youth reported on their own internalizing symptoms and parents reported on youths' externalizing symptoms. Cortisol reactivity was assessed during the Trier social stress test. Analyses revealed no associations between cortisol reactivity and externalizing symptoms across puberty for PI youth. However, longitudinal bidirectional associations did emerge for internalizing symptoms such that increases in cortisol reactivity predicted increases in internalizing symptoms and increases in internalizing symptoms predicted increases in cortisol reactivity. Findings suggest that recalibrating to more normative levels of cortisol reactivity may not always be associated with adaptive outcomes for PI youth.

Community Characteristics, Victimization, and Psychological Adjustment Among School-Aged Adopted Children With Lesbian, Gay, and Heterosexual Parents

Little research has examined victimization among school-aged children raised in lesbian/gay (LG) parent households and almost no work has attended to the school and community contexts that may impact their victimization risk. This study examined predictors of parent-reported child victimization and child adjustment, and parent responses to victimization, in 43 two-mother, 37 two-father, and 56 mother–father families, with adopted children (median age = 8.6 years). Predictors included parent (sexual orientation), school (climate, public versus private) and community (urbanicity, percentage voted Democrat) factors, with parent and child demographics included as controls. A total of 47% of parents reported one or more child victimization experiences in the past year; there were no differences by family type. An exploratory interaction between family type and urbanicity indicated that in large urban areas, children with LG parents were predicted to experience less victimization than children with heterosexual parents; in more rural regions, children with LG parents were predicted to experience more victimization than children with heterosexual parents. School climate was related to victimization: Parents who reported more negative school climate reported more child victimization. Children with higher levels of parent-reported victimization had higher levels of parent-reported internalizing and externalizing symptoms. In large urban areas, children with LG parents were predicted to have fewer internalizing symptoms than children with heterosexual parents; in more rural areas, children with LG parents were predicted to have more internalizing symptoms than children with heterosexual parents. Regarding parents’ responses to victimization, LG parents were more likely to talk to school administrators, their children, and the bully, compared to heterosexual parents.

Cortisol and Parenting Predict Pathways to Disinhibited Social Engagement and Social Functioning in Previously Institutionalized Children

Previously institutionalized children on average show persistent deficits in physiological and behavioral regulation, as well as a lack of normative reticence towards strangers, or disinhibited social engagement (DSE). Post-adoption parenting, specifically a combination of supportive presence and structure/limit-setting, may protect against DSE over time via better adrenocortical functioning. This study examined the impact of adrenocortical activity and post-adoption parenting on DSE across the first two years post-adoption (age at adoption: 16-36 months) and observed kindergarten social outcomes in previously institutionalized children (n = 94) compared to non-adopted children (n = 52). Path analyses indicated a developmental cascade from institutional care (operationalized as a dichotomous group variable, age at adoption, and months of institutionalization) to blunted adrenocortical activity, increased DSE, and lower kindergarten social competence. Consistent with a permissive parenting style, higher parental support was associated with increased DSE, but only when not accompanied by effective structure/limit-setting. Further, parental structure reduced the association between blunted adrenocortical activity and DSE behaviors.

Exploring the Psychometric Properties of the Parent Daily Report - Toddler Version (PDR-T)

The present study examined the psychometric properties of a brief parent-report daily checklist of toddler behavior (Parent Daily Report - Toddler Version; PDR-T). Data were collected from three groups of 18-36 month-olds who were followed longitudinally for approximately 1 year: 1) internationally adopted children (n = 156), 2) children placed in foster care due to child maltreatment (n = 79), and 3) community comparison children raised by their biological families (n = 80). An exploratory factor analysis of this measure resulted in three factors, measuring aggressive/noncompliant, positive, and distress behaviors. While there were estimation issues with the positive and distress factors, the aggressive/noncompliant factor exhibited invariance across time and groups, and partial invariance between genders. Significant correlations were observed between this factor and measures of externalizing behavior and inhibitory control (r = .26-.56), but not shyness, fearfulness, or negative affect. This provides support for both convergent and discriminant validity. Reliability of this factor was adequate to good across time and group. Results provide preliminary support for the utility, reliability, and consistency of one factor of the PDR-T as an easy parent-report tool to assess daily patterns and changes in child aggressive/noncompliant behavior over time.

Early Deprivation Revisited: Contemporary Studies of the Impact on Young Children of Institutional Care

There is clear evidence that early deprivation in the form of early institutional care affects children both immediately and long after they are removed from the institution. This article reviews the modern literature on the impact of institutional care from animal models to longitudinal studies in humans. Importantly, we examine the current understanding of neuroendocrine regulation in the context of early deprivation. We discuss the opportunities and limitations of studying the effects of deprivation in previously institutionalized children, review behavioral findings and related neurobiological studies, and address the physical health ramifications of institutional care. Finally, we touch on future directions for both science and intervention.

Corticosterone administration targeting a hypo-reactive HPA axis rescues a socially-avoidant phenotype in scarcity-adversity reared rats

It is well-established that children from low-income, under-resourced families are at increased risk of altered social development. However, the biological mechanisms by which poverty-related adversities can “get under the skin” to influence social behavior are poorly understood and cannot be easily ascertained using human research alone. This study utilized a rodent model of “scarcity-adversity,” which encompasses material resource deprivation (scarcity) and reduced caregiving quality (adversity), to explore how early-life scarcity-adversity causally influences social behavior via disruption of developing stress physiology. Results showed that early-life scarcity-adversity exposure increased social avoidance when offspring were tested in a social approach test in peri-adolescence. Furthermore, early-life scarcity-adversity led to blunted hypothalamic-pituitary-adrenal (HPA) axis activity as measured via adrenocorticotropic hormone (ACTH) and corticosterone (CORT) reactivity following the social approach test. Western blot analysis of brain tissue revealed that glucocorticoid receptor levels in the dorsal (but not ventral) hippocampus and medial prefrontal cortex were significantly elevated in scarcity-adversity reared rats following the social approach test. Finally, pharmacological repletion of CORT in scarcity-adversity reared peri-adolescents rescued social behavior. Our findings provide causal support that early-life scarcity-adversity exposure negatively impacts social development via a hypocorticosteronism-dependent mechanism, which can be targeted via CORT administration to rescue social behavior.

Extending the toxic stress model into adolescence: Profiles of cortisol reactivity

The toxic stress model posits that extended activation of stress response systems in the absence of a supportive relationship with an adult may over time lead to physiological alterations to these same systems, and ultimately to poorer physical and mental health outcomes. However, empirical tests of model hypotheses in adolescence, a critical period of development, are lacking. This study expands the toxic stress model to include more developmentally-appropriate risk and protective factors for adolescents experiencing overwhelming and uncontrollable stressors. Data were collected for a study of early adolescents from urban low-income households (N = 101; 10-12 years old; 59% female). Participants and a caregiver completed questionnaires; youths completed the modified Trier Social Stress Task alone and provided six saliva samples. Using latent profile analysis, three profiles of cortisol reactivity were identified in early adolescents exposed to chronic environmental stress: Elevated and Reactive (11%), Moderate and Non-Reactive (26%), and Blunted and Non-Reactive (63%). In accordance with the toxic stress model, exposure to more community violence and less family support were associated with blunted cortisol reactivity, and Reactive profile membership was associated with fewer trauma symptoms. Overall, the findings provide empirical support for the extension of the toxic stress model in early adolescence through the application of developmentally-sensitive measures and provide implications for future interventions.

Affective attunement in peer dyads containing children adopted from institutions

Children who have experienced institutional care early in life tend to show deficits in behavioral and adrenocortical regulation that impact their ability to form friendships and have positive social interactions with peers. Understanding how post-institutionalized children interact with unfamiliar peers and the factors that predict the quality of these interactions may shed light on the processes contributing to the persistent, often increasing social deficits seen in post-institutionalized children. In this study, one child (either post-institutionalized or non-adopted; the "target") interacted with another non-adopted child (the "peer"; N = 58 dyads, M age = 9.65 years) through a series of competitive and cooperative games during which interaction quality and affect of each participant were coded. Three saliva samples were also collected from each participant to measure cortisol production across the session. No group differences in behavior, affect, or cortisol were found. However, non-adopted target children's affect was positively associated with their peers' affect and negatively associated with peers' change in cortisol across the session, while post-institutionalized target children's affect was not associated with their peers' affect or cortisol. Thus, future interventions may want to promote social skills in children exposed to early adversity by focusing on dyadic social contingencies rather than individual behavior.

Pubertal recalibration of cortisol reactivity following early life stress: a cross-sectional analysis

BACKGROUND

Children adopted from orphanages or other such institutions tend to display blunted reactivity to stressors - even years after arriving in their generally supportive and highly resourced postadoption homes. Puberty, a proposed sensitive period for environmental influences on stress-mediating systems, may provide an opportunity for postinstitutionalized children to recalibrate stress response systems in accordance with their now more supportive living situations.

METHODS

This cross-sectional study examined the hypothalamic-pituitary-adrenocortical (HPA)-axis reactivity of 280 children ages 7 through 14 years; 122 children were adopted from institutions in 14 countries between the ages of 6 months and 5 years, after spending an average of 95% of their lives in institutional care, and 158 children of similarly high socioeconomic status in their biological families served as the nonadopted comparison group. All of the children were assessed by nurses for Tanner stage and, on a different day, completed the Trier Social Stress Test for Children.

RESULTS

Using a linear mixed-effects model and seven measures of salivary cortisol, results indicated that early-pubertal postinstitutionalized children showed blunted HPA axis reactivity compared to nonadopted children, but mid/late-pubertal postinstitutionalized children displayed higher reactivity similar to the nonadopted comparison children.

CONCLUSIONS

This is the first evidence of possible pubertal recalibration of HPA axis reactivity to a psychosocial stressor in postinstitutionalized children, which provides a promising avenue for future research regarding the protective factors of the postadoption environment and subsequent physiological, behavioral, and psychopathological outcomes.

Stress, sensitive periods, and substance abuse

Research on the inter-relationship between drug abuse and social stress has primarily focused on the role of stress exposure during adulthood and more recently, adolescence. Adolescence is a time of heightened reward sensitivity, but it is also a time when earlier life experiences are expressed. Exposure to stress early in postnatal life is associated with an accelerated age of onset for drug use. Lifelong addiction is significantly greater if drug use is initiated during early adolescence. Understanding how developmental changes following stress exposure interact with sensitive periods to unfold over the course of maturation is integral to reducing their later impact on substance use. Arousal levels, gender/sex, inflammation, and the timing of stress exposure play a role in the vulnerability of these circuits. The current review focuses on how early postnatal stress impacts brain development during a sensitive period to increase externalizing and internalizing behaviors in adolescence that include social interactions (aggression; sexual activity), working memory impairment, and depression. How stress effects the developmental trajectories of brain circuits that are associated with addiction are discussed for both clinical and preclinical studies.

Investigating multilevel pathways of developmental consequences of maltreatment

The impact of maltreatment spreads across many developmental domains and extends across the entire life span. Identifying unidirectional or bidirectional drivers of developmental cascades of the effects of maltreatment experiences is critical to efficiently employing interventions to promote resilient development in maltreated children. This 1-year longitudinal study utilized a multiple-levels approach, investigating "bottom-up" and "top-down" cascades using structural equation modeling between cortisol regulation, externalizing behavior, and peer aggression. Neither a bottom-up model driven by cortisol regulation nor a top-down model driven by peer aggression fit the data well. Instead, lower rates of externalizing behavior at Year 1 most strongly predicted improvements at all levels of analysis (reduced cortisol, externalizing behavior, and peer aggression) at Year 2. These results provide initial indication of a mechanism through which interventions for maltreated children may be most effective and result in the most substantial positive changes across developmental domains.

The slope of cortisol from awakening to 30 min post-wake in post-institutionalized children and early adolescents

This study examined the association between early life adversity, in the form of early rearing in an institution (orphanage), and the slope of cortisol in the first thirty minutes after waking in 277 children, aged 7 through 15 years old, who had either been adopted between 6 and 60 months of age into well-resourced homes in the United States or born into similar homes. The adopted youth were divided at the median (age 16 months) into those adopted earlier (earlier-adopted, EA) and later (later-adopted, LA). The purpose of this study was to examine the post-waking slope in cortisol in post-institutionalized youth, predicting that it would be blunted, especially in later-adopted youth, when compared to the non-adopted (NA) youth. A secondary goal was to examine whether there would be some evidence of less blunting of the first 30 min of the cortisol awakening response among the children further along in pubertal development (i.e., Pubertal Recalibration Hypothesis). Pubertal stage was determined by nurse exam. Salivary cortisol was assessed at 0 and 30-min post-awakening on three days. The results showed that LA children had a blunted wake-30 min cortisol slope relative to NA and EA children. Neither the age by group nor pubertal stage by group analyses were significant. However, the majority of the sample were in early stages of puberty (56% in stages 1 & 2), thus the power was low for detecting such an interaction. This is the first year of a cohort-sequential longitudinal study examining early experiences and pubertal influences on the HPA axis, so it will be important to re-examine this question as the sample ages.

Parenting predicts Strange Situation cortisol reactivity among children adopted internationally

The functioning of the hypothalamic pituitary adrenal (HPA) axis can be altered by adverse early experiences. Recent studies indicate that children who were adopted internationally after experiencing early institutional rearing and unstable caregiving exhibit blunted HPA reactivity to stressful situations. The present study examined whether caregiving experiences post-adoption further modulate children's HPA responses to stress. Parental sensitivity during naturalistic parent-child play interactions was assessed for 66 children (M age = 17.3 months, SD = 4.6) within a year of being adopted internationally. Approximately 8 months later, children's salivary cortisol levels were measured immediately before as well as 15 and 30 min after a series of brief separations from the mother in an unfamiliar laboratory setting. Latent growth curve modeling indicated that experiencing more parental sensitivity predicted increased cortisol reactivity to the stressor. Although half the families received an intervention designed to improve parental sensitivity, the intervention did not significantly alter children's cortisol outcomes. These findings suggest that post-adoption parental sensitivity may help normalize the HPA response to stress among children adopted internationally.