Cortisol Production Patterns in Young Children Living With Birth Parents vs Children Placed in Foster Care Following Involvement of Child Protective Services

Bernard, Kristin; Butzin-Dozier, Zachary; Rittenhouse, Joseph; Dozier, Mary

doi:10.1001/archpediatrics.2010.54

Cited by 148 publications

(116 citation statements)

References 21 publications

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“…47 The majority of studies were RCTs (n = 13) 44,45,[47][48][49][50][51][52][53][54][55][56][57][58] ; quasi experiments were less common (n = 4). [59][60][61][62] The sample sizes ranged from 12 53 to 1197, 61 with a median of 126 participants. Twelve studies took place in the United States; the others were carried out in Canada, 57 Mexico, 61 the Netherlands, 52 Romania, 47 and Sweden.…”

Section: Search Results and Description Of Included Studiesmentioning

confidence: 99%

“…Twelve studies took place in the United States; the others were carried out in Canada, 57 Mexico, 61 the Netherlands, 52 Romania, 47 and Sweden. 60 Studies in young children were most common; 7 studies restricted enrollment to children younger than 2 years, [47][48][49]54,57,58,62 whereas 3 studies enrolled children aged 7 or older. 53,55,60 Samples were selected on the basis of the following: institutionalization or involvement with foster care (n = 5), 44,47,49,50,59 maltreatment history (n = 2), 56,62 maternal depression (n = 2), 57,58 and other family characteristics associated with developmental risk (eg, parental loss, 55 poverty, 61 maternal drug use 48 ; n = 6); and 2 studies used samples of children from the…”

Section: Search Results and Description Of Included Studiesmentioning

confidence: 99%

“…53,60 Among the 15 studies with samples identified on the basis of exposure to adversity, 8 studies included a nonexposed comparison group in addition to the control group. 44,[48][49][50]56,58,59,62 Intervention duration ranged from ,1 month (n = 1) 53 to .1 year (n = 6), 44,47,[54][55][56]58,61 and it was most common for studies to assess outcomes within #6 months after the intervention began (n = 8) [48][49][50]53,57,59,62 or .1 year after intervention initiation (n = 8). 28,33,39,41,43,44,46,55 Fifteen studies included intervention components that involved both parents and children, and 2 studies tested interventions that involved only children.…”

Section: Figurementioning

confidence: 99%

“…Diurnal cortisol was the most common type of cortisol measure (n = 10), and cortisol reactivity (n = 5) or single cortisol assessments (n = 2) were less common. Two of the 17 studies reported intra-and interassay CVs for cortisol samples above the recommended 10% threshold, 44,62 and 5 studies did not report this information. 47,48,57,59,60 Only 1 study met all 6 of the study quality criteria, 55 although 7 studies fulfilled 5 of the 6 criteria.…”

Section: Figurementioning

confidence: 99%

“…Across the 12 studies that collected diurnal cortisol, [44][45][46][47][50][51][52][57][58][59][60]62 substantial variation existed in how the data were analyzed. Some studies evaluated differences in slope [44][45][46]50,51,58,59,62 ; others examined area under the curve (AUC), 52,57 individual components of diurnal measures separately (eg, AM and PM), 44,47,51,58,60,62 or average cortisol across morning and evening measures.…”

Section: Diurnal Cortisol Assessmentmentioning

confidence: 99%

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Interventions to Improve Cortisol Regulation in Children: A Systematic Review

2014

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Childhood adversity is associated with physiologic dysregulation across multiple biological systems; however, relatively little is known about whether these changes are reversible with intervention. The objective of this review was to examine evidence for the effectiveness of interventions to promote healthy cortisol regulation in children. We selected articles from English-language publications in PubMed and EBSCO databases through 2012. Two independent reviewers assessed articles against eligibility criteria. Eligible studies were randomized controlled or quasi-experimental studies designed to improve relationships, environments, or psychosocial functioning in children and examined cortisol as an outcome. We identified 19 articles. There was substantial heterogeneity across studies with regard to age, selection criteria, intervention design, cortisol assessment, and follow-up duration. Eighteen of the 19 articles reported at least 1 difference in baseline cortisol, diurnal cortisol, or cortisol responsivity between intervention and control participants. Importantly, however, there was remarkable inconsistency with regard to how the interventions influenced cortisol. Therefore, studies that included a low-risk comparison group (n = 8) provided critical insight, and each found some evidence that postintervention cortisol levels in the intervention group approximated the low-risk comparison group and differed from children receiving usual care. In conclusion, existing studies show that cortisol activity can be altered by psychosocial interventions. These findings are promising, not only because they indicate physiologic plasticity that can be leveraged by interventions but also because they suggest it may be possible to repair regulatory systems after childhood adversity, which could inform strategies for reducing health disparities and promoting lasting improvements in health. Pediatrics 2014;133:312-326

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