The persistent associations between early institutional care and diurnal cortisol outcomes among children adopted internationally

Abstract

Young children in institutional care experience conditions that are incompatible with their needs for attachment relationships. As a result, early institutionalization is expected to have lasting effects on the regulation of the hypothalamic–pituitary–adrenocortical (HPA) axis. The current study tested whether early institutionalization has persistent consequences for diurnal HPA axis outcomes among 130 children who had been adopted internationally between the ages of 6 and 48 months. Daily cortisol samples were collected from children at two time points: shortly after adoption (average of 5.3 months after adoption) and approximately 3 years later (average of 39.2 months after adoption). Shortly after adoption, children who had experienced a long duration of institutional care had lower morning cortisol levels and more blunted declines in cortisol across the day than children who experienced minimal or no institutional care. Three years later, children who had experienced a long duration of institutionalization continued to exhibit low morning cortisol levels and also exhibited low bedtime cortisol levels. Altogether, these results support the idea that early adversity results in the downregulation of the HPA axis and suggest that the effects of institutionalization on HPA axis functioning may persist several years after children are adopted into highly enriched families.

Introduction to the SEED Science special issue

“…While many of the findings reviewed so far relate to perturbations in normal rearing conditions, Isenhour et al. (2022) extend this examination to the persistent impact of early institutional care in an internationally adopted sample. These authors report that both immediately following adoption and 3 years later, children with early‐life institutional care showed blunted morning cortisol (where higher values are normative).…”

“…Building on findings reviewed in the prenatal section,Dufford et al (2022) report that postnatal anxiety symptoms in caregivers were associated with less resting-state functional connectivity between the left amygdala and right ACC in 2-year-olds, and further that lower functional connectivity was associated with infant cognitive development. While many of the findings reviewed so far relate to perturbations in normal rearing conditions,Isenhour et al (2022)…”

Forty years of research on stress and development: What have we learned and future directions.

“…The intervention increased morning cortisol levels and resulted in a more normal, less blunted, diurnal rhythm even for those children over 24 months of age. This was the case despite the fact that Dozier’s group also had evidence of blunted diurnal activity after adoption that lasted at least several years (Isenhour et al, 2020). Of course, sensitive periods for reactivity as assessed by the BEIP group and the diurnal rhythm as assessed by the Dozier group may be distinct.…”