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1.
Psychoneuroendocrinology ; 135: 105578, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34741981

RESUMO

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.

2.
Child Dev Perspect ; 15(4): 249-256, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34925549

RESUMO

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.

3.
Pharmacol Biochem Behav ; 210: 173272, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34509501

RESUMO

The effect of experiences in infancy on human development is a central question in developmental science. Children raised in orphanage-like institutions for their first year or so of life and then adopted into well-resourced and supportive families provide a lens on the long-term effects of early deprivation and the capacity of children to recover from this type of early adversity. While it is challenging to identify cause-and-effect relations in the study of previously institutionalized individuals, finding results that are consistent with animal experimental studies and the one randomized study of removal from institutional care support the conclusion that many of the outcomes for these children were induced by early institutional deprivation. This review examines the behavioral and neural evidence for altered executive function, declarative memory, affective disorders, reward processing, reactivity to threat, risk-taking and sensation-seeking. We then provide a brief overview of the neurobiological mechanisms that may transduce early institutional experiences into effects on brain and behavior. In addition, we discuss implications for policy and practice.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34410535

RESUMO

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.

5.
Child Dev ; 92(5): e904-e906, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34432319

Assuntos
COVID-19 , Humanos , SARS-CoV-2
6.
Dev Psychobiol ; 63(6): e22146, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34053063

RESUMO

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.

7.
Infancy ; 26(3): 455-468, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33687780

RESUMO

Institutional care has been shown to increase the risk of attention problems in children, but some children are more sensitive to their environment, both for better and for worse. With this in mind, the current study examined the moderating role of temperament (falling reactivity) between early adversity and attention skills. Six- to 15-month-old infants residing in institutions (n = 63) and infants reared by their biological families from low socioeconomic environments (n = 59) were recruited. The infants' attention skills were measured by calculating the length of time they spent looking at toys. The infants' temperaments were measured by a subscale of the Infant Behavior Questionnaire (falling reactivity/rate of recovery from distress). The findings were in line with the differential susceptibility theory. Compared to infants with high levels of falling reactivity, infants with lower levels of falling reactivity had better attention skills if they were in a family group, but they had lower attention skills if they were residing in institutions. The attention skills of the infants who had higher scores for falling reactivity did not appear to be affected by the adverse environment.

8.
Dev Cogn Neurosci ; 48: 100922, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33517108

RESUMO

Psychosocial acceleration theory and other frameworks adapted from life history predict a link between early life stress and accelerated maturation in several physiological systems. Those findings led researchers to suggest that the emotion-regulatory brain circuits of previously-institutionalized (PI) youth are more mature than youth raised in their biological families (non-adopted, or NA, youth) during emotion tasks. Whether this accelerated maturation is evident during resting-state fMRI has not yet been established. Resting-state fMRI data from 83 early adolescents (Mage = 12.9 years, SD = 0.57 years) including 41 PI and 42 NA youth, were used to examine seed-based functional connectivity between the amygdala and ventromedial prefrontal cortex (vmPFC). Additional whole-brain analyses assessed group differences in functional connectivity and associations with cognitive performance and behavior. We found group differences in amygdala - vmPFC connectivity that may be consistent with accelerated maturation following early life stress. Further, whole-brain connectivity analyses revealed group differences associated with internalizing and externalizing symptoms. However, the majority of whole-brain results were not consistent with an accelerated maturation framework. Our results suggest early life stress in the form of institutional care is associated with circuit-specific alterations to a frontolimbic emotion-regulatory system, while revealing limited differences in more broadly distributed networks.


Assuntos
Experiências Adversas da Infância , Adolescente , Tonsila do Cerebelo/diagnóstico por imagem , Mapeamento Encefálico , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Vias Neurais , Córtex Pré-Frontal
9.
Dev Psychopathol ; 33(1): 301-312, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32124708

RESUMO

Stressful experiences affect biological stress systems, such as the hypothalamic-pituitary-adrenal (HPA) axis. Life stress can potentially alter regulation of the HPA axis and has been associated with poorer physical and mental health. Little, however, is known about the relative influence of stressors that are encountered at different developmental periods on acute stress reactions in adulthood. In this study, we explored three models of the influence of stress exposure on cortisol reactivity to a modified version of the Trier Social Stress Test (TSST) by leveraging 37 years of longitudinal data in a high-risk birth cohort (N = 112). The cumulative stress model suggests that accumulated stress across the lifespan leads to dysregulated reactivity, whereas the biological embedding model implicates early childhood as a critical period. The sensitization model assumes that dysregulation should only occur when stress is high in both early childhood and concurrently. All of the models predicted altered reactivity, but do not anticipate its exact form. We found support for both cumulative and biological embedding effects. However, when pitted against each other, early life stress predicted more blunted cortisol responses at age 37 over and above cumulative life stress. Additional analyses revealed that stress exposure in middle childhood also predicted more blunted cortisol reactivity.


Assuntos
Experiências Adversas da Infância , Hidrocortisona , Adulto , Criança , Pré-Escolar , Humanos , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Saliva , Estresse Psicológico
10.
Dev Psychobiol ; 63(1): 31-41, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32643150

RESUMO

Socioeconomic status (SES) appears to be an important contextual factor in children's developmental outcomes, including their responses to stress. However, some children are more susceptible to its effects than others. Hair cortisol is a newer method of assessing the activity of the HPA axis, providing cumulative cortisol levels. The present article examined whether temperament (negative emotionality) moderates the association between an SES index and the hair cortisol concentration (HCC) of infants. Sixty infants from 6 to 15 months of age were recruited, of which 49 had sufficient hair for cortisol analysis. The SES index was calculated from the education levels of the mothers, family income, and a scale measuring the quality of the home environment. Negative emotionality was measured with the three sub-scales of the Infant Behavior Questionnaire (falling reactivity, distress to limitations, and fear). Among infants low in negative emotionality, there was no association between SES and cortisol. In contrast, among those high in negative emotionality, a significant association was obtained. These infants showed lower levels of HCC in lower-SES environments. The findings suggest that there are individual differences in reacting to the environment, and low levels of cortisol (not high) were found in susceptible infants in lower-SES families.

11.
Dev Psychobiol ; 63(5): 851-863, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33249563

RESUMO

Early adverse care has long-term impacts on physical and mental health. The influence of rearing conditions on the infant's gut microbiota and its relationship with developmental health has become more evident. The microbiome is essential for normal growth and metabolism, and the signaling from the gut to the brain may underlie individual differences in resilience later in life. Microbial diversity and composition were determined using 16S rRNA gene amplicon sequencing in fecal samples from 17 adolescents adopted internationally from orphanages into the United States and 18 adolescents reared in birth families who had similar educational and income levels. Analyses focused on diversity of the microbial community structure and differences in the abundance of specific bacterial taxa. Blood samples were used to immunophenotype the numbers of several T-cell subsets and cytomegalovirus (CMV) seropositivity. Negative binomial regression analysis revealed several operational taxonomic units that were significantly different based on early rearing conditions and CMV seropositivity. There were significant associations between the relative abundance of certain taxa, the percentages of T-cell subsets in circulation, and CMV seropositivity. These findings demonstrate a possible link between the gut microbiota and associations with immune alterations initiated by early life adversity.

12.
Psychoneuroendocrinology ; 125: 105111, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33341502

RESUMO

INTRODUCTION: The Trier Social Stress Test (TSST) is the most widely used protocol for activating a stress response of the hypothalamic-pituitary-adrenocortical (HPA) axis and other stress-mediating systems. A number of variants of the TSST exist, including ones for children, groups, and virtual reality. All of these versions, though, require in-person assessment. The COVID-19 pandemic has made in-person assessment impossible or extremely difficult and potentially dangerous. The purpose of this study was to validate a completely remote, online, version of the TSST for children. METHOD: A sample of 68 (27 female) 15- and 16-year old participants were administered the TSST-Online (TSST-OL) during the late afternoon hours (3-6 p.m. start time). The participants, judges (one male, one female), and experimenter (female) all joined the assessment from their own homes via the online platform, ZOOM™. Two sessions were conducted, one to obtain consent, explain procedures, work with the family to arrange the computer and room set-up for the TSST-OL and one within two weeks to conduct the procedure. The participants were trained to take their own saliva samples and a saliva sampling kit was mailed to the home in between the first and second session. The samples were then mailed to the researchers within a day of collection. The participant was observed during saliva collection to determine correct procedures were followed. Salivary cortisol, salivary α-amylase and self-reports of stress were measured multiple times over the second session. RESULTS: rmANOVAs yielded a significant effect of trials, for cortisol, F(1.37,90.46) = 15.13, p = .001, sAA, F(2.75,146.68) = 6.91, p = .001, and self-rated stress, F(3.43,222.69) = 118.73, p = .001. There were no significant sex by trials interactions for any measure, although females reported more stress than males, F(1,65) = 9.14, p = .004. For cortisol, from baseline to expected peak (30 min after the onset of speech preparation), the Cohen's effect size was dz = 0.57. Using 1.5 nmol/l (or 0.54 µg/dl) as the criterion for a response (Miller, Plessow, Kirschaum, & Stalder, 2013), 63% of the participants produced a significant increase in cortisol. CONCLUSIONS: The responses to the TSST-OL are consistent with in-person responses among children and adolescents (see recent meta-analysis (Seddon et al., 2020). The protocol is a viable way of assessing reactivity of the HPA axis and other stress systems without needing to bring the participant into the research laboratory. This method will be useful during periods of widespread infection. It should also work to study populations who all live too far from the research laboratory to be assessed in person.


Assuntos
Internet , Testes Psicológicos , Psicologia do Adolescente/métodos , Estresse Psicológico/diagnóstico , Telemedicina/métodos , Adolescente , COVID-19/epidemiologia , COVID-19/psicologia , Feminino , História do Século XXI , Humanos , Hidrocortisona/análise , Masculino , Sistemas On-Line , Pandemias , Testes Psicológicos/normas , SARS-CoV-2 , Saliva/química , alfa-Amilases Salivares/análise , Manejo de Espécimes/métodos
13.
Infancy ; 26(2): 204-222, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33378584

RESUMO

The influence of socioeconomic variability on language and cognitive development is present from toddlerhood to adolescence and calls for investigating its earliest manifestation. Response to joint attention (RJA) abilities constitute a foundational developmental milestone that are associated with future language, cognitive, and social skills. How aspects of the family home environment shape RJA skills is relatively unknown. We investigated associations between family socioeconomic status (SES) -both parent education and family percentage of the federal poverty level (FPL)- parent depressive and anxiety symptoms and infant RJA performance in a cross-sectional sample of 173 infants aged 8-18 months and their parents from a variety of socioeconomic backgrounds. Results suggest that, correcting for age and receptive language, infants in families with greater economic resources respond to relatively less redundant, more sophisticated cues for joint attention. Although parent depressive and anxiety symptoms are negatively correlated with SES, parent depressive and anxiety symptoms were not associated with infant RJA. These findings provide evidence of SES-related differences in social cognitive development as early as infancy, calling on policymakers to address the inequities in the current socioeconomic landscape of the United States.

14.
Psychoneuroendocrinology ; 124: 105065, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33278786

RESUMO

This study examined whether early life adversity (ELA) limited to infancy was associated with an increase in circulating levels of proinflammatory cytokines and cellular cytokine responses to three stimulants [lipopolysaccharide (LPS), phytohemagglutinin (PHA), and phorbol myristate acetate plus ionomycin (PMA/IO)]. Participants were previously institutionalized (PI) youth (N = 45, 56 % female) who had spent their first years in institutional care (e.g., orphanages, baby homes) before being adopted into well-resourced homes (median age at adoption = 13 mos) and non-adopted comparisons (NA; N = 38, 55 % female). Their age range was 13.3-21.2 years (M = 16.3 years). This analysis followed up an earlier report on these youth (Reid et al., 2019a) that identified an increase in terminally differentiated CD8 + CD57 T cells among the PI relative to the NA youth. Cytokine levels in circulation were not highly correlated and thus examined separately. PI youth had higher circulating levels of Tumor Necrosis Factor-alpha (TNFα), but not Interleukin-1ß (IL-1ß) or Interleukin-6 (IL-6). Cytokine responses to in vitro activation within each stimulant condition were highly correlated and were thus combined to generate an index of the inflammatory reaction to each stimulant. Using Multivariate Analysis of Covariance, there was a highly significant multivariate effect of group, which was carried primarily by the PMA/IO condition, with PI youth exhibiting a larger inflammatory response than NA youth. Tests of mediation showed that both the early rearing effects on circulating TNFα and the composite inflammatory index of PMA/IO responsiveness were mediated in the statistical model by the percentage of CD8 + CD57+ TEMRA cells in circulation, a marker of replicative senescence in T cells. Sex differences were also found in circulating levels of IL-6 and TNFα, with males having higher levels than females.

15.
J Abnorm Child Psychol ; 48(9): 1115-1128, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32607754

RESUMO

Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.


Assuntos
Adoção/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança Acolhida/psicologia , Criança Institucionalizada/psicologia , Cognição/fisiologia , Encéfalo/fisiopatologia , Criança Acolhida/estatística & dados numéricos , Criança Institucionalizada/estatística & dados numéricos , Pré-Escolar , Eletroencefalografia/métodos , Potenciais Evocados/fisiologia , Função Executiva , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Risco , Tempo
16.
Horm Behav ; 125: 104816, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32649929

RESUMO

As a period of heightened plasticity, puberty may provide a window of opportunity for recalibration of the hypothalamic-pituitary-adrenal (HPA) axis to current conditions. Our group has recently documented evidence for pubertal recalibration of HPA axis reactivity among children internationally adopted as infants from institutions into supportive, well-resourced homes. As a first step at examining potential mechanisms by which puberty may facilitate recalibration of the HPA axis, the current study assessed whether previously-institutionalized (PI) children differed from non-adopted (NA) comparison children in levels of the adrenal steroid hormone dehydroepiandrosterone (DHEA) and in its intra-individual covariation (coupling) with cortisol by adrenal pubertal stage. In an accelerated longitudinal design, 7- to 15-year-olds completed up to 3 annual assessments, which included nurse-conducted pubertal staging and the Modified Trier Social Stress Test for Children (TSST-M). Adrenal (pubic hair) rather than gonadal pubertal stage scores were used in the analysis. Paired salivary cortisol-DHEA samples were available at 60-80 min post-TSST-M. NA and PI children did not differ in DHEA levels, which were higher among children at more advanced pubertal stages (averaged across the sessions) for both groups. For NA children, post-stressor cortisol and DHEA were positively coupled across sessions at all average adrenal pubertal stages. For PI children who were, on average, at earlier adrenal pubertal stages, post-stressor cortisol and DHEA were not coupled, but PI children who were at later pubertal stages demonstrated positive cortisol-DHEA coupling similar to that of the NA children. We suggest that these findings provide insights into processes which may underlie pubertal recalibration of the HPA axis.


Assuntos
Criança Adotada , Criança Institucionalizada , Desidroepiandrosterona/metabolismo , Hidrocortisona/metabolismo , Puberdade/metabolismo , Adolescente , Adoção/psicologia , Criança , Criança Adotada/psicologia , Estudos de Coortes , Desidroepiandrosterona/análise , Feminino , Humanos , Hidrocortisona/análise , Sistema Hipotálamo-Hipofisário/metabolismo , Estudos Longitudinais , Masculino , Sistema Hipófise-Suprarrenal/metabolismo , Testes Psicológicos , Puberdade/fisiologia , Puberdade/psicologia , Saliva/química , Saliva/metabolismo , Estresse Psicológico/metabolismo
19.
Int Rev Neurobiol ; 150: 41-76, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32204834

RESUMO

Adverse experiences during childhood can have long-lasting impacts on physical and mental health. At the heart of most theories of how these effects are transduced into health impacts is the activity of stress-mediating systems, most notably the hypothalamic-pituitary-adrenocortical (HPA) axis. Here we review the anatomy and physiology of the axis, models of stress and development, the development of the axis prenatally through adolescence, the role of experience and sensitive periods in shaping its regulation, the social regulation of the axis at different points in development, and finally conclude with suggestions for future research. We conclude that it is clear that early adversity sculpts the stress system, but we do not understand which dimensions have the most impact and at what points in early development. It is equally clear that secure attachment relationships buffer the developing stress system; however, the mechanisms of social buffering and how these may change with development are not yet clear. Another critical issue that is not understood is when and for whom adversity will result in hypo- vs hyperactivity of stress-mediating systems. These and other issues are important for advancing our understanding of how early adversity "gets under the skin" and shapes human physical and mental health.


Assuntos
Experiências Adversas da Infância , Encéfalo , Desenvolvimento Humano/fisiologia , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisário , Relações Interpessoais , Apego ao Objeto , Efeitos Tardios da Exposição Pré-Natal , Estresse Psicológico , Adolescente , Encéfalo/anatomia & histologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/anatomia & histologia , Sistema Hipotálamo-Hipofisário/crescimento & desenvolvimento , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipotálamo-Hipofisário/fisiopatologia , Lactente , Gravidez , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Efeitos Tardios da Exposição Pré-Natal/patologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Estresse Psicológico/complicações , Estresse Psicológico/metabolismo , Estresse Psicológico/fisiopatologia
20.
Child Youth Serv Rev ; 1102020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32153312

RESUMO

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.

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