Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis

Abstract

Background Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children’s and caregivers’ cortisol levels, and meta-analyzed the results. Methods In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies – randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children’s morning and evening cortisol levels, as well as change across the day. Results A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: − 0.14 to 0.16; I 2 : 47.5%), and for caregivers it was 0.04 (95%CI: − 0.22 to 0.30; I 2 : 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found. Conclusion Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.

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

“…Together, these findings suggest a role for parenting sensitivity, as well as for individual differences within children, in the development of a coordinated physiological cortisol response (Blair et al, 2015). Finally, past research has documented null associations between young children's cortisol reactivity and overall positive parenting (i.e., warmth; Hackman et al, 2018) and a lack of discernible associations between parent-training interventions (none of which expressly focused on touch) and child cortisol levels (Martins et al, 2020). These findings, in combination with the strong associations between stress physiology and the more targeted behavior of positive physical touch in infancy (Feldman et al, 2014), lead us to evaluate whether positive touch in particular is associated with lower cortisol reactivity to stressors in early childhood.…”

Conduct Problems and Hair Cortisol Concentrations Decrease in School-Aged Children after VIPP-SD: A Randomized Controlled Trial in Two Twin Cohorts

“…We replicated these results in a well-powered twin study, implementing a parenting intervention based on attachment theory and the social learning model of coercive cycles [ 1 , 37 ]. A recent meta-analysis of 19 parenting intervention studies found no significant effect on salivary cortisol [ 12 ]. The difference may be explained by the fact that salivary cortisol provides a snapshot of cortisol levels at a specific time or day, and cortisol levels are known to fluctuate substantially during and across days [ 13 ].…”

“…Also, in 1- to 3-year-old children with high externalizing behavior, diurnal cortisol production as measured in saliva samples decreased after the VIPP-SD, specifically in carriers of the DRD4 7-allele [ 11 ]. However, in a recent meta-analysis of 19 parenting intervention studies, no overall significant effect of parenting interventions on child salivary cortisol levels was found [ 12 ]. Further work is needed to provide more robust evidence for the effectiveness of attachment-based parenting interventions on child externalizing behavior and stress regulation.…”

Stress across the Lifespan: From Risk to Management—Conference Report on the Inaugural Canadian Stress Research Summit

“…The Stress and Developmental symposium discussed the feasibility of pivoting stress research in children to remote platforms and the role of parental care and childhood adversity on the regulation of stress-sensitive systems [ 27 , 28 , 29 , 30 ]. Presenters showed that stress reactivity in young children is not only moderated by the child’s mental health risk status but may also be buffered by parental presence during stress induction [ 29 ].…”

“…Presenters showed that stress reactivity in young children is not only moderated by the child’s mental health risk status but may also be buffered by parental presence during stress induction [ 29 ]. Although current findings are inconclusive [ 28 ], parental training interventions to enhance nurturing care have been proposed to help regulate stress-sensitive systems and to foster the wellbeing of the developing child. A sex and gender lens was also incorporated into this symposium, showing that early childhood maltreatment is robustly associated with revictimization among women; however, a more nuanced exploration of the type of maltreatment, the perpetrator (i.e., maternal or paternal), and sexual identity (monosexual vs. plurisexual) is integral to understanding how early childhood maltreatment may result in revictimization later in adulthood [ 30 ].…”