Environmental determinants of physiological reactivity to stress: The interacting effects of early life deprivation, caregiving quality, and stressful life events

Abstract

Children who spend their early lives in institutions experience profound psychosocial deprivation that is associated with altered stress response system development. Here, we used data from a longitudinal randomized controlled trial of foster care for institutionally reared children to examine whether caregiving quality and stressful life events (SLEs) in early adolescence (age 12) influence patterns of hypothalamic–pituitary–adrenal (HPA) axis and sympathetic nervous system (SNS) reactivity. Controlling for the effect of institutional care, higher caregiving quality at age 12 was associated with heightened cortisol and SNS reactivity. However, moderation analysis revealed that the latter effect was only observed among never-institutionalized children, whereas ever-institutionalized children demonstrated a persistently blunted SNS response regardless of recent caregiving quality. Among institutionally reared children, SLEs interacted with prior random assignment to foster care, such that those placed in foster care early in development had a SNS response that approximated never-institutionalized children when SLEs at age 12 were low. In contrast, SNS reactivity was persistently blunted among those with prolonged deprivation, regardless of recent SLEs. Early-life deprivation is associated with persistent blunting of stress response systems, but normalization may be achievable if SLEs are limited following placement into enriched family-based care.

Toward a dimensional model of family-based resilience: Sensitivity, stimulation, and stability as moderators of early-life adversity.

“…For example, in the BEIP, institutionally reared children randomly assigned to family-based foster care in childhood were less responsive to the effects of stressful life events during adolescence on externalizing problems, while those with prolonged deprivation showed an increased risk of externalizing problems (Wade, Zeanah, et al, 2019). Similar buffering effects of family care have been demonstrated for markers of low-grade inflammation (Tang et al, 2020) and physiological reactivity to social stress (Wade, Sheridan, et al, 2020), with forthcoming evidence that these effects also manifest for behavioral and neural markers of cognitive control (Wade et al, 2021). Although we suspect that these results showcase the buffering effect of family-based stimulation following deprivation, it is important to note that the advent of entry into foster care from institutional care may be associated with increases in both stimulation and sensitivity, as well as enhanced stability (described below).…”

“…For example, in the BEIP, caregiving stability appears to promote at least partial recovery in domains such as mental health and executive functioning following extreme neglect and deprivation (Humphreys et al, 2020; Wade, Zeanah, et al, 2020). In contrast, the buffering effect of caregiving quality against exposure to severe deprivation appears to be less pronounced for markers of stress response system function (Wade, Sheridan, et al, 2020). Thus, while the presence of resilience-promoting factors may preserve function or facilitate recovery to a degree, some residual difficulties may persist that require more targeted intervention or social programming.…”

The Bucharest Early Intervention Project: Adolescent mental health and adaptation following early deprivation

“…The first is stress reactivity, where we have shown that children in the FCG demonstrated a level of neuroendocrine and sympathetic reactivity to social stress at 12 years that resembles children in the NIG, especially when foster placement occurred prior to age 24 months (McLaughlin et al, 2015). In contrast, children in the CAUG demonstrated persistently blunted reactivity to social stress (also see Wade, Sheridan, et al, 2020), strongly suggesting a sensitive period for recovering the adaptive stress response early in development. Moreover, this may have consequences for how these individuals respond to stressors during adolescence.…”

Caregiver-specific factors and orphanage-context factors contributing to maltreatment of children in institutional care: A multi-level analysis of 24 orphanages in Tanzania

“…Many children in orphanages suffer from attachment and behavioural problems like internalizing problems such as depression, anxiety and social withdrawal and externalizing problems such as aggression, defiance, hostility and poor impulse control (Adler et al, 2020; Brown et al, 2015; Huffhines et al, 2020) . Due to the lack of knowledge, children’s behaviour is often misunderstood by caregivers, which in turn can lead to more maltreatment of children (Smyke et al, 2002; Wade et al, 2020). Violent disciplinary methods are extremely widespread and due to their social acceptance, caregivers’ positive attitudes towards such methods, and lack of caregiver knowledge they are the most common form of violence experienced by children (Lansford et al, 670; UNICEF, 2010, United Nations Children’s Fund, 2014).…”