Salivary cortisol levels in children adopted from Romanian orphanages

Abstract

Six and a half years after adoption, 6- to 12-year-old children reared in Romanian orphanages for more than 8 months in their first years of life (RO, n = 18) had higher cortisol levels over the daytime hours than did early adopted (EA, ≤ 4 months of age, n = 15) and Canadian born (CB, n = 27) children. The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean plus 2 SD of the EA and CB levels. Furthermore, the longer beyond 8 months that the RO children remained institutionalized the higher their cortisol levels. Cortisol levels for EA children did not differ in any respect from those of CB comparison children. This latter finding reduces but does not eliminate concerns that the results could be due to prenatal effects or birth family characteristics associated with orphanage placement. Neither age at cortisol sampling nor low IQ measured earlier appeared to explain the findings. Because the conditions in Romanian orphanages at the time these children were adopted were characterized by multiple risk factors, including gross privation of basic needs and exposure to infectious agents, the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic–hypothalamic–pituitary– adrenal axis directly or were mediated by differences in parent–child interactions or family stress occasion by behavioral problems associated with prolonged orphanage care in this sample.

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

“…This pervasive pattern of stress response system hyporesponsivity is inconsistent with patterns observed in the rodent literature following maternal deprivation (1)(2)(3)46) and challenges some prevailing conceptual models of early-life adversity and stress response system development, which argue that adverse environments should lead to elevated physiological reactivity (47,48). The observed pattern of cortisol hyporesponsivity is consistent with several prior studies in humans documenting an association between early-life deprivation and low levels of morning cortisol and blunted cortisol responses to social challenge (20,28,32), although other work has found elevated basal cortisol and heightened cortisol reactivity in children who have experienced social deprivation (17,27). The experimental design of the current study clarifies these inconsistencies in prior observational studies.…”

“…Reconciling these inconsistencies has proved challenging for several reasons. First, there is considerable heterogeneity in the type, frequency, severity, and cooccurrence of early-life adversities in human studies, including both abuse and neglect (15,18,19,21,22), poverty (24-26), institutional rearing followed by international adoption (17,20,27,28), or accumulation of multiple adversities, ranging from marital conflict to parental psychopathology (29)(30)(31). These exposures not only differ widely from each other, they also vary in their resemblance to the exposure used in animal studies: maternal deprivation.…”

“…These exposures not only differ widely from each other, they also vary in their resemblance to the exposure used in animal studies: maternal deprivation. Lower morning cortisol and blunted cortisol reactivity are the most commonly reported patterns in studies of maternal deprivation related to neglect or institutional rearing following by international adoption (20,28,32), although elevated basal cortisol and cortisol reactivity have also been observed (17,27). Second, existing human research has been unable to identify causal effects of the rearing environment on stress response system development.…”

Decreased cortisol awakening response after early loss experience

“…In one study, children adopted from Romania who spent more than eight months in their first years of life in an orphanage demonstrated increased salivary cortisol concentrations 15 to 30 minutes after awakening when compared to control children (Gunnar et al, 2001). In another study in children, the diurnal decline in salivary cortisol concentrations was found to be negatively correlated with out-of-home placements and the extent of emotional deprivation, suggesting elevated diurnal cortisol secretion (Kaufman, 1991).…”

“…Importantly, with the exception of the study by Gunnar et al (2001), the above studies reporting either increased or decreased early morning cortisol levels in ELE collected samples at fixed time points, e.g. at 8 a.m., and did not consider potential effects of different times of awakening on the results.…”