Pubertal stress recalibration reverses the effects of early life stress in postinstitutionalized children.

Nonhuman animal models reveal that the hypothalamic-pituitary-adrenocortical (HPA) axis calibrates to the harshness of the environment during a sensitive period in infancy. Humans exposed to depriving institutional care in infancy show reduced HPA axis responsivity, even years after they are placed in supportive, well-resourced families. This study examined whether puberty opens a window of opportunity to recalibrate the HPA axis toward more typical reactivity when children shift from harsh deprived conditions in infancy into supportive conditions in childhood and adolescence. Participants (n = 129 postinstitutionalized, 68.2% female; n = 170 comparison, 52.4% female) completed 3 annual sessions beginning at ages 7 to 15 (M = 11.28, SD = 2.31). Each session assessed pubertal stage via nurse examination and cortisol reactivity to the Trier social stress test for children. The linear mixed-effects model controlling for sex and between-individual differences in pubertal stage showed a significant group by pubertal stage interaction: within-individual increases in pubertal stage were associated with increases in cortisol stress reactivity for postinstitutionalized youth but not nonadopted comparison youth. This study indicates that pubertal development reopens a window of opportunity for the HPA axis to recalibrate based on significant improvements in the supportiveness of the environment relative to that in infancy. The peripubertal period may be an important time in development where the caregiving environment has a substantial impact on the HPA axis and, perhaps, other stress-mediating systems. Future research is needed to examine the mechanisms of recalibration and whether HPA recalibration impacts physical and psychological health.

Pubertal transition with current life stress and support alters longitudinal diurnal cortisol patterns in adolescents exposed to early life adversity.

Current and early life stress (ELS) are associated with diurnal cortisol patterns, which themselves are associated with mental and physical health. The pubertal recalibration hypothesis suggests that the social environment can impact dysregulated cortisol patterns for previously ELS-exposed youth as they transition through puberty. This study examined longitudinal change in cortisol awakening response (CAR) and diurnal slope (DS) across puberty as a function of ELS in infancy, current stress, and social support (N = 290, 7-17 years). The CAR and DS were examined thrice annually with an accelerated longitudinal design with nurse-assessed puberty to assess associations between diurnal cortisol and pubertal recalibration with ELS and the current social environment. Exposure to ELS was associated with less steep DS but not changes in CAR, and no evidence of pubertal calibration was found. The DS became less steep for youth in later pubertal stages and as youth progressed through puberty. The CAR was steeper for youth in later pubertal stages. Across the cohort, current life stress and support were associated with changes in the DS and the CAR through the pubertal transition. The pubertal stage and the peripubertal and pubertal social environment may have important implications for adrenocortical functioning with or without exposure to ELS.

Lifetime stressors, hair cortisol, and executive function: Age-related associations in childhood.

Extant research is mixed regarding the relations among lifetime exposure to stressors, adrenocortical activity, and executive function (EF), particularly in children. Aggregate measures of adrenocortical activity like hair cortisol concentration (HCC), timing of stress exposure, and age at assessment may clarify these associations. This cross-sectional study examined the association among parent-reported exposure to stressors, hair cortisol concentration (HCC), and children's EF via a tablet task in a community sample (n = 318, 52.5% female) of children across a wide age range (4-13 years, M = 9.4, SD = 2.3). Path analyses revealed that parent-reported child lifetime exposure to stressors, but not past-year stressful life events, negatively predicted HCC. There was also a marginally significant moderation by age such that HCC was associated negatively with EF for younger children (age < 9.7 years) but not older children. HCC did not significantly mediate the association between lifetime exposure to stressors and EF. Findings are consistent with the proposition that chronically high cortisol production has a neurotoxic effect on brain regions supporting EF. However, lifetime exposure to stressors predicted relatively lower cumulative cortisol production, consistent with a stress inoculation effect in this normative-risk sample.

A systematic review of caregiver-child physiological synchrony across systems: Associations with behavior and child functioning.

Extensive research has established a positive association between caregiver-child behavioral synchrony and child developmental functioning. Burgeoning research examining physiological synchrony has yet to elucidate its impact for children's developing self-regulation. The objectives of this systematic review were to: 1) determine whether there is evidence that caregiver-child physiological synchrony promotes positive child development, 2) examine developmental differences in physiological synchrony and its correlates, and 3) explore whether context, risk, and/or stress influence patterns of synchrony. Sixty-nine studies met the following criteria on PubMed and PsycINFO: 1) peer-reviewed empirical articles in English that 2) examine autonomic, hypothalamic-pituitary-adrenocortical, and/or central nervous system activity 3) for caregivers and children 4) in response to a task and 5) directly examine the association between caregiver and child physiology. Findings varied based on developmental period and current behavioral context. Functional differences may exist across physiological systems and contexts. Synchrony may have different developmental consequences for dyads with and without certain risk factors. Few studies examine physiological synchrony across multiple systems or contexts, nor do they measure child characteristics associated with synchrony. Statistical and methodological challenges impede interpretation. Findings generally support the idea that physiological synchrony may support children's developing self-regulation. Longitudinal research is needed to examine child developmental outcomes over time.

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.

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.

Brief Stress Reduction Strategies Associated with Better Behavioral Climate in a Crisis Nursery: A Pilot Study.

Approximately 3.5 million children in the United States were reported to Child Protective Services in 2016. Effective, developmentally-informed programs are critically necessary to support under-resourced families at risk of child abuse. This study implemented a module of mindfulness-based stress reduction strategies in partnership with a community organization whose goal is to keep families together while reducing the risk of child abuse by providing short-term (3-day) overnight crisis care for birth through 6-year-olds. Group-level assessment of child behaviors was used to assess child functioning at the program level. Children's Services staff were trained in brief stress reduction strategies, with the intention that they be used with the children regularly throughout the day to help the children be emotionally calm and behaviorally regulated. Ordinal logistic regressions suggested that, over the six months preceding implementation (April - September 2017) compared to six months following completion of implementation (February - July 2018), the introduction of stress-reduction strategies was associated with significantly increased self-regulatory behavior and coping skills, but not decreased aggressive behavior. Additionally, staff frequently (approximately 65% of the time) endorsed the strategies as being effective. Though the evidence is preliminary, the unique context of the crisis nursery coupled with the measurement of program-level outcomes furthers our understanding of the scalable impact mindfulness-based stress reduction strategies can have with children experiencing chronic stress and/or trauma in a very hard-to-reach population. Implementation challenges are discussed, as are the implications of stress reduction strategies as a useful, efficient method to improve self-regulation in children experiencing adversity.

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.

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

Seventy-eight postinstitutionalized (PI) children adopted at ages 17-36 months were assessed 2, 8, 16, and 24 months postadoption on measures of cortisol and parenting quality, and compared to same-aged children adopted from foster care (FC, n = 45) and nonadopted children (NA, n = 45). In kindergarten (Mage  = 6.0 years), teachers, parents, and trained observers completed measures of peer relationships and attention deficit hyperactivity disorder (ADHD) symptoms. PI children had more peer problems and ADHD symptoms according to teachers and observers than NA children with FC children in between, whereas both PI and FC children were at significantly greater risk of hypocortisolism (i.e., blunted cortisol diurnal rhythm and reactivity). Hypocortisolism and ADHD symptoms mediated the association between preadoption adversity and peer difficulties. Higher postadoption parenting quality was protective.

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.

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.

The Pubertal Stress Recalibration Hypothesis: Potential Neural and Behavioral Consequences.

Recent research has suggested that the pubertal period provides an opportunity for recalibrating the stress-responsive systems in youth whose responses to stress have been altered by early adversity. Such recalibration may have cascading effects that affect brain and behavioral development. In this article, we consider a large, cross-species literature to demonstrate the potential importance of pubertal stress recalibration for understanding the development of psychopathology following early deprivation by caregivers. We review the evidence for recalibration of the hypothalamic-pituitary-adrenal axis in humans, examine research on rodents that has established mechanisms through which stress hormones affect brain structure and function, and summarize the literature on human neuroimaging to assess how these mechanisms may translate into changes in human behavior. Finally, we suggest ideas for elucidating the consequences of pubertal stress recalibration that will improve our understanding of adaptive and maladaptive adolescent behavior following early adversity.

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.

Benevolent Childhood Experiences (BCEs) in homeless parents: A validation and replication study.

This study extends the validity and replicability of the Benevolent Childhood Experiences (BCEs) scale, a novel instrument for adults with childhood adversity. The BCEs scale assesses 10 favorable childhood experiences, yielding a total score similar to the Adverse Childhood Experiences (ACEs) scale (Centers for Disease Control and Prevention, 2017; Felitti et al., 1998). The current study examined the BCEs scale in a sample of homeless parents and hypothesized that higher levels of total BCEs would predict lower odds of psychological distress, sociodemographic risk, and parenting stress after accounting for ACEs. Participants were 50 ethnically diverse parents (42 birth mothers, 5 birth fathers, 1 stepfather, and 2 grandmothers in the primary caregiver role; M = 32.50 years, SD = 9.29, range = 21-62 years; 66% African American, 12% White, 12% American Indian, 10% biracial/other) residing at a homeless shelter with their children. Parents completed the BCEs and ACEs scales and instruments on psychological distress, sociodemographic risk, and parenting stress. Higher levels of BCEs predicted lower odds of psychological distress, as expected. Higher levels of ACEs predicted higher sociodemographic risk. However, neither BCEs nor ACEs predicted parenting stress. Mean levels of total BCEs and item frequencies were strikingly similar to the pilot sample, although homeless parents reported significantly lower predictable home routines in childhood. BCEs and ACEs were only modestly negatively associated, underscoring the independence of adverse and positive early experiences. The BCEs scale is a promising, brief and culturally sensitive index of childhood experiences linked to long-term resilience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Comparison of Institutionally Reared and Maltreated Children on Socioemotional and Biological Functioning.

The current study compared behavioral and adrenocortical functioning of maltreated (N = 91) and comparably aged (1.5-3 years) institutionally-reared children soon after (1.5-2.5 months) placement in foster care or adoptive homes, respectively. Foster and adoptive parents reported on the children's socioemotional competence and behavior problems, experimenters scored fear and positive affect to laboratory tasks, and diurnal cortisol measures were obtained. We sought to address whether these early contexts, characterized by different types of neglect and deprivation, have differential effects on young children's development. We found little support for the argument that either context results in uniformly poorer functioning soon after removal from adversity. Maltreated children were less fearful and more positive when exposed to both positive and novel events than institutionally-reared children. However, maltreated children were reported to have more behavior problems than did institutionally-reared children, and institutionally-reared children showed more typical declines in cortisol throughout the day than the maltreated children. These findings increase our ability to construct more targeted and effective interventions for these populations.

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.

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.

Attachment security buffers the HPA axis of toddlers growing up in poverty or near poverty: Assessment during pediatric well-child exams with inoculations.

Poverty is associated with poor physical and emotional development. Activation of the hypothalamic-pituitary-adrenocortical (HPA) axis is argued to be one of the pathways through which poverty acts on these outcomes. While studies of school-aged children have found some evidence for this, there is little evidence for this hypothesis early in development. This may be, in part, because for very young children, the security of their attachment relationships with parents moderates the impact of poverty on HPA axis functioning. The current study investigated the relations between family income as a percentage of the federal poverty limit (FPL), salivary cortisol and attachment (Attachment Q-sort) during well-child checkups with inoculations in 177 toddlers between 12- and 22-months of age. Approximately half of the toddlers were in families living below 150% FPL, with 47% of these classified as securely attached, compared to 72% of toddlers in families living above 150% FPL. Cortisol levels increased in response to the inoculation and this did not differ by poverty or attachment security. Overall, however, beginning at clinic arrival toddlers in families living below 150% FPL who had an insecure attachment had significantly higher cortisol compared to toddlers living in poverty or near poverty with secure attachments. This finding held when we removed toddlers with high levels of negative life events in their families and primary caregivers who exceeded the screening cutoff for depressive symptoms. Thus, attachment was a significant moderator of the association between poverty and HPA axis activity, with significant implications for screening and referral of caregiving dyads at risk.