Interventions to Improve Cortisol Regulation in Children: A Systematic Review

Abstract

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

Childhood Trauma Exposure and Toxic Stress: What the PNP Needs to Know

“…Exposure to toxic stress in childhood is associated with physiologic dysregulation across multiple biological systems: immune, metabolic, and nervous (Slopen, McLaughlin, & Shonkoff, 2014). Felitti (2009) states that two broad mechanisms exist by which childhood trauma (toxic stress) exposure is translated into disease: disease caused by chronic stress mediated by chronic hypercortisolemia and cytokines (e.g., chronic headaches or back pain, primary pulmonary fibrosis, osteoporosis, or coronary artery disease) or disease that develops as the result of various coping mechanisms such as overeating, smoking, drug use, and risky sexual behaviors.…”

Causal effects of the early caregiving environment on development of stress response systems in children

“…Although physiological reactivity in humans can be altered in the short term by psychosocial interventions (34,35), including in children exposed to maternal deprivation (36,37), we are unaware of experimental research examining whether random assignment to a caregiving environment alters patterns of physiological reactivity later in development. Finally, although a sensitive period exists during which the environment has particularly strong influences on stress response system development in animals, studies that can rigorously identify such a period in humans are lacking.…”

The toxic stress and its impact on development in the Shonkoff’s Ecobiodevelopmental Theorical approach

“…Children exposed to stressful contexts showed higher cortisol levels (a hormone that regulates stress) than did children who were not (Slopen, McLaughlin, & Shonkoff, 2014). Cortisol is related to specific areas of the central nervous system responsible for memory, learning, emotions, and the immunological system (Shonkoff, Richter, van der Gaag, & Bhutta, 2012b).…”