Cortisol Levels In Children Research Articles

Positive Effects of Advanced Daylight Supply of Buildings on Schoolchildren—A Controlled, Single-Blinded, Longitudinal, Clinical Trial with Real Constructive Implementation

Sunlight controls endogen hormone balances and numerous health effects. Therefore, it is important to provide building users, such as schoolchildren, with sufficient daylight. Too much of it, however, leads to overheating, which is why shading systems are used. Consequently, these systems improve energy balance, but might not have positive effects on present people’s health. Within this study, shading systems were installed in classrooms of a middle school: common shading in two rooms, while two others were equipped with shading blades “Schlotterer RETROLux 80D” in an innovative design, reflecting more daylight indoors. The participating classes were divided between rooms with ordinary daylighting (n = 43) and advanced daylighting (n = 42). They spent, on average, 5 days weekly and 5–8 h daily in these classrooms. Saliva samples were collected during three semesters to detect hormonal changes. Questionnaires were collected to obtain more information about the mental alterations and, furthermore, to support the physiological results. A significant reduction in cortisol levels between 6:30 AM and 11:30 AM (p < 0.001) was observed within the group that had advanced daylighting. Questionnaires show that both groups sleep less as study duration increases (p < 0.001 time effect), but only the control group has a concurrent increase in daytime sleepiness according to relative treatment effects. The results show that increased daylight supply indoors leads to a significant greater reduction in cortisol levels of children and that those positive outcomes can be achieved by using innovative technologies for buildings.

Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery.

This study aimed to provide baseline information on the potential role of salivary cortisol in reflecting the stress response in children undergoing congenital heart surgery. Children underwent congenital cardiac surgery, aged between one and seventeen years were included. Saliva samples were collected pre- and postoperatively by the health caregiver immediately after the children woke up (07:00-09:00 am) and at 06:00 pm in the evening. Salivary cortisol levels were compared with the reference index values from a large database. Median baseline preoperative morning salivary cortisol levels were significantly lower than the reference values in both < 5-year-old females (p = 0.01) and males (p = 0.04) and in males between 11 and 20 years of age (p = 0.01). Median baseline preoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5 and 10 years of age (p = 0.04) and in between 11- and20-year-old males (p = 0.01). Median postoperative morning salivary cortisol levels were significantly lower than the reference value in both < 5-year-old females (p = 0.01) and males (p = 0.04) and females between 5 and 10 year of age (p = 0.04). Median postoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5- and 10-year-old females (p = 0.04). Diurnal variability of salivary cortisol levels in children undergoing congenital heart surgery may be different from normal reference values both in preoperative and postoperative periods that can be a predictive indicator of anxiety on pre- and postoperative period for children that undergoing cardiac surgery.

Impact of Emotional Expression of Parents on their Children who have Specific Learning Disorders and the Role of Parental Educational Counseling Program

&#x0D; Background: Children are the world’s real treasures; they should be cherished, well raised and given the chance to develop properly. Some of them in different countries all over the world are suffering from different forms of specific learning disorders, which can be extremely frustrating the school child especially if associated with parental high emotional expression.&#x0D; Objectives: The purpose of the study is to identify the relation between emotional expressions (EE) of parents and anxiety rate in their children with specific learning disorders (SLDs), and its correlation with serum cortisol level of the children. The effect of parental educational counseling program (PECP) on anxiety rate of children and parental emotional expression was studied.&#x0D; Methods: The study was carried out on 140 children with SLD to evaluate their anxiety rate by using Taylor anxiety scale of children, and measuring serum cortisol level. Data were collected from parents by emotional expression scale (EES). Taylor anxiety scale and EES were repeated for children and parents after conducting sessions of PECP.&#x0D; Results: Results of Taylor anxiety scale showed that 60% of studied children were suffering from morbid anxiety. Results of EES showed that 80% of parents were practicing high emotional expression. Scores of children on Taylor anxiety scale demonstrated significant drop from 33.06±10.4 to 25.85±10.4 after applying the intervention (P &lt; 0.001). More than two thirds of parents became practicing low EE after receiving sessions of the interventional program PECP. Scores of parents on EES showed significant drop from 61.31±16.84 to 36.51±13.89 after PECP (P &lt; 0.001). A statistically significant positive correlation between scores of Taylor anxiety scale and EES before PECP was found (R = 0.533), and also after PECP (R = 0.309).&#x0D; Average level of serum cortisol of children with SLD was 8.973+1.784 mcg/dl, and it was significantly higher in boys than girls (P &lt; 0.05). Serum cortisol level of studied children was higher in children with morbid and severe anxiety (P &lt; 0.001). Cortisol levels of children were significantly higher in those whose parents were practicing high EE. Serum cortisol level of children revealed positive correlation with each of their scores on Taylor anxiety scale (R = 0.771) and scores of parents on EES (R = 0.468).&#x0D; Conclusion: Results of this study proved presence of direct relation between anxiety in school children with specific learning disorders and high emotional expressions of their parents. Results concluded effectiveness of PECP in management of children’s anxiety and parental emotional expression.&#x0D; Key words: Specific learning disorders, Emotional expression, Anxiety disorder, Serum cortisol level.

The Impact of Emotional Expressions of Parents on their Children with Specific Learning Disorders: The Role of Parental Educational Counseling Program

BACKGROUND: Children are the world’s real treasures; they should be cherished, well raised, and given the chance to develop properly. Some of them in different countries worldwide are suffering from various forms of specific learning disorders (SLDs), which can be extremely frustrating the school child, especially if associated with parental high emotional expression (EE). OBJECTIVES: The purpose of the study is to identify the relation between parents’ EEs and anxiety rate in their children with SLDs and its correlation with serum cortisol level of the children. The effect of parental educational counseling program (PECP) on the anxiety rate of children and parental EE was studied. METHODS: The study was carried out on 140 children with SLD to evaluate their anxiety rate using Taylor anxiety scale of children, and measuring serum cortisol level. Data were collected from parents by EE scale (EES). Taylor anxiety scale and EES were repeated for children and parents after conducting sessions of PECP. RESULTS: Results of Taylor anxiety scale showed that 60% of studied children were suffering from morbid anxiety. Results of EES showed that 80% of parents were practicing high EE. Scores of children on Taylor anxiety scale demonstrated a significant drop from 33.06 ± 10.4 to 25.85 ± 10.4 after applying the intervention (p &lt; 0.001). More than two-thirds of parents became practicing low EE after receiving sessions of the interventional program PECP. Scores of parents on EES showed a significant drop from 61.31 ± 16.84 to 36.51 ± 13.89 after PECP (p &lt; 0.001). A statistically significant positive correlation between scores of Taylor anxiety scale and EES before PECP was found (r = 0.533) and after PECP (r = 0.309). Average level of serum cortisol of children with SLD was 8.973 ± 1.784 mcg/dl, and it was significantly higher in boys than girls (p &lt; 0.05). Serum cortisol level of studied children was higher in children with morbid and severe anxiety (p &lt; 0.001). Cortisol levels of children were significantly higher in those whose parents were practicing high EE. Serum cortisol level of children revealed a positive correlation with each of their scores on Taylor anxiety scale (r = 0.771) and scores of parents on EES (r = 0.468). CONCLUSION: Results of this study proved the presence of direct relation between anxiety in school children with SLDs and high EEs of their parents. Results concluded the effectiveness of PECP in the management of children’s anxiety and parental EE.

LEVELS OF SALIVARY CORTISOL IN ADULTS AND CHILDREN WITH BRUXISM DIAGNOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To evaluate the levels of salivary cortisol in adults and children diagnosed with bruxism. A search strategy was developed using the following terms: "cortisol", "bruxism" and "sleep bruxism". These were searched in databases: Medline, Embase, Scopus, Cochrane, Web of Science, LILACS and gray literature, for studies published until May 2020. We obtained a total of six primary studies, involving 854 participants, who met the criteria and were included in the present study. The analysis cortisol levels shows a significant difference favourable to the control group 1.10 (95% CI: 0.68-1.53), showing that patients with bruxism have higher values of salivary cortisol. Heterogeneity of I² = 4% (P = .31). It was concluded that despite the different methodologies adopted for the collection and analysis of salivary content, this review found significant results of higher levels of salivary cortisol in adult patients with bruxism.

DNA methylation in blood cells is associated with cortisol levels in offspring of mothers who had prenatal post-traumatic stress disorder.

Maternal stress during pregnancy is associated with differential DNA methylation in offspring and disrupted cortisol secretion. This study aimed to determine methylation signatures of cortisol levels in children, and whether associations differ based on maternal post-traumatic stress disorder (PTSD). Blood epigenome-wide methylation and fasting cortisol levels were measured in 118 offspring of mothers recruited from the Kosovo Rehabilitation Centre for Torture Victims. Mothers underwent clinically administered assessment for PTSD using Diagnostic and Statistical Manual of Mental Disorders. Correlations between offspring methylation and cortisol levels were examined using epigenome-wide analysis, adjusting for covariates. Subsequent analysis focussed on a priori selected genes involved in the hypothalamic-pituitary-adrenal (HPA) axis stress signalling. Methylation at four sites were correlated with cortisol levels (cg15321696, r=-0.33, cg18105800, r=+0.33, cg00986889, r=-0.25, and cg15920527, r=-0.27). In adjusted multivariable regression, when stratifying based on prenatal PTSD status, significant associations were only found for children born to mothers with prenatal PTSD (p<0.001). Several sites within HPA axis genes were also associated with cortisol levels in the maternal PTSD group specifically. There is evidence that methylation is associated with cortisol levels, particularly in offspring born to mothers with prenatal PTSD. However, larger studies need to be carried out to independently validate these findings.

Change in toddlers’ cortisol activity during a year in childcare. Associations with childcare quality, child temperament, well-being and maternal education

Elevated levels of the stress hormone cortisol have been found in toddlers in childcare. Measuring cortisol may provide an indication of children’s experiences in childcare and help to adjust practices better to their needs. To the best of our knowledge, toddlers’ cortisol levels in childcare have not yet been investigated longitudinally. Furthermore, it is unclear which child and childcare factors contribute to cortisol elevation in toddlers. Using linear mixed model analyses, we investigated the full-day cortisol activity (10.00 h, 15.00 h, 18.00 h) of 156 toddlers (81 female, 56 male) during a year in childcare (September, January, June). We also investigated child cortisol levels at home in January. In addition, we tested the relation between cortisol activity and changes in cortisol activity across the year and childcare quality, temperament, well-being in childcare, and maternal education. We found increasing evening cortisol levels through the year while controlling for age. Afternoon cortisol levels were stable, but above morning cortisol levels in September and January and only slightly below morning cortisol levels in June. At home in January, afternoon levels were significantly below morning levels. Higher well-being in childcare was associated with lower overall cortisol levels and less increase in evening cortisol levels through the year in childcare. Further, less active toddlers seemed to accumulate some stress during the childcare day, indicated by higher evening cortisol levels. Rising evening cortisol levels may indicate accumulating stress across the year. Results point toward childcare being demanding for toddlers and their need for consideration from caregivers and parents, also after a longer period of childcare attendance. The findings underline the importance of observing, promoting, and further researching children’s well-being in childcare.

Effect of iodine-bromine baths on stress-systems indicators in children with autism spectrum disorders

To evaluate the effect of iodine-bromine baths on stress-system indicators in children with ASD. The study involved 74 children with ASD (F84) aged 3 to 14 years (mean age 6.23±0.37 years) included in the main group (MG). The control group (CG) consisted of 25 healthy children.The examination included detailed history taking, examination by specialists, assessment of disease severity using CARS scale, evaluation of β-endorphin, adrenocorticotropic hormone (ACTH), and cortisol levels in blood serum by ELISA. Thirty-four (45.9%) children had a moderate autism level (total score 30-37), and 40 (54.1%) children had severe autism (total score 37-60). In the MG, there were 27 (36.5%) children with mild symptoms of hyperactivity (subgroup A) and 47 (63.5%) children with severe aggression, tantrums, and increased hyperactivity (subgroup B). All MG patients were assigned into two subgroups by randomization: Subgroup 1: 30 children with ASD received health resort treatment (HRT) without iodine-bromine baths (IB); Subgroup 2: 44 children with ASD received similar HRT and IB. Statistically significant increase of β-endorphin, ACTH and cortisol levels (p<0.01, p<0.05, p<0.01, respectively) in children with ASD (compared to those in CG children) was identified. In children without hyperactivity, a moderate increase of these parameters was noted; significantly higher values were observed in children with severe hyperactivity, impulsiveness, and aggression (p<0.05, p<0.001, respectively). After treatment, there was a statistically significant increase in β-endorphin level in subgroup 1 children who received HRT without IB, while in children of subgroups A and B (p<0.05, p<0.05, p<0.01, respectively), there was a decrease in ACTH level (p<0.05, p<0.01, p<0.001 respectively) and a trend towards a cortisol level decrease. Inclusion of IB in HRT course associated with a significant decrease of β-endorphin level in children of subgroups A and B (p<0.001), a decrease of ACTH level (p<0.001) and cortisol (p<0.001, p<0.01, p<0.001, respectively), which resulted in vicious circle breaking and normalization of relations between stress-limiting and stress-releasing parts of pathogenesis. Most children with autism spectrum disorders showed significant increases in β-endorphin, adrenocorticotropic hormone, and cortisol levels, indicating dysfunction between the stress-limiting and stress-releasing systems, as well as between the central and peripheral parts of the stress-releasing chain. The tonic effect of resort treatment was noted, limiting its use in children with autism spectrum disorders, increased hyperactivity, and aggression. The inclusion of iodine-bromine baths in resort treatment has a calming non-medicinal effect and can be recommended for use in children with symptoms of severe hyperactivity.

Maternal cannabis use is associated with suppression of immune gene networks in placenta and increased anxiety phenotypes in offspring

While cannabis is among the most used recreational drugs during pregnancy, the impact of maternal cannabis use (mCB) on fetal and child development remains unclear. Here, we assessed the effects of mCB on psychosocial and physiological measures in young children along with the potential relevance of the in utero environment reflected in the placental transcriptome. Children (∼3 to 6 y) were assessed for hair hormone levels, neurobehavioral traits on the Behavioral Assessment System for Children (BASC-2) survey, and heart rate variability (HRV) at rest and during auditory startle. For a subset of children with behavioral assessments, placental specimens collected at birth were processed for RNA sequencing. Hair hormone analysis revealed increased cortisol levels in mCB children. In addition, mCB was associated with greater anxiety, aggression, and hyperactivity. Children with mCB also showed a reduction in the high-frequency component of HRV at baseline, reflecting reduced vagal tone. In the placenta, there was reduced expression of many genes involved in immune system function including type I interferon, neutrophil, and cytokine-signaling pathways. Finally, several of these mCB-linked immune genes organized into coexpression networks that correlated with child anxiety and hyperactivity. Overall, our findings reveal a relationship between mCB and immune response gene networks in the placenta as a potential mediator of risk for anxiety-related problems in early childhood.

Polymorphisms in the FKBP5 gene are associated with attention deficit and hyperactivity disorder in Korean children

Attention deficit hyperactivity disorder (ADHD) is a common and heritable childhood psychiatric disorder. Recently, many studies reported a down-regulated hypothalamus–pituitary–adrenal axis (HPA-axis) with low cortisol levels in children with ADHD. The FK506 binding protein 5 or FKBP5 gene regulates the negative feedback of the HPA-axis, and genetic variants in this gene showed an association with ADHD. We investigated the genetic association between FKBP5 gene polymorphisms and susceptibility to ADHD in Korean children. We conducted a case-control study with 150 ADHD children and 322 controls. Genotyping of FKBP5 rs9394309 and rs7748266 was performed by using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). Our results showed that rs7748266 polymorphism has significant genotype (p = 0.021) and allele (p = 0.009) frequency differences between children with ADHD and the control group. CT genotype [odds ratio (OR) 1.70, 95 % confidence interval (CI) 1.134–2.540, p = 0.010] and T allele (OR 1.54, 95 % CI 1.114–2.117, p = 0.009) were associated with increased risk of ADHD. In addition, dominant (p = 0.006) and over-dominant genetic (p = 0.016) models showed significant associations with ADHD. In the stratified analysis, a significant result was obtained from the girl samples (p = 0.048). The OR of the girls with ADHD with CT genotype was 2.29 (95 % CI 1.170–4.469, p = 0.014). In contrast to rs7748266 polymorphism, rs9394309 polymorphism did not show any significant result (p > 0.05). Haplotype analysis also revealed a significant difference of the TG haplotype for rs7748266 – rs9394309 (p = 0.028, global haplotype association p-value of 0.0091). Conclusively, we confirmed that FKBP5 gene polymorphisms were associated with ADHD in Korean children. These results suggested that FKBP5 may factor in the development of ADHD.

Associations of hair cortisol concentrations with paediatric appendicitis

The pathogenesis of paediatric appendicitis is still an enigma. In recent years, it has become more evident that our inherent immunological responses affect the trajectory of the disease course. Long-term stress has an impact on our immune system; however, it is practically and ethically challenging to prospectively track blood measurements of cortisol-levels in asymptomatic children should an acute appendicitis episode develop. The aim of this case–control study was therefore to evaluate the effect of increased stress measured as historical imprints in hair (hair cortisol concentrations [HCC]), on the risk of developing appendicitis and complicated appendicitis. 51 children (aged < 15 years) with appendicitis (34 with complicated appendicitis), were compared to 86 healthy controls. HCC reflecting the activity of the HPA-axis 0–3 and 4–6 months prior to sampling was evaluated and compared between groups as well as between the two measurements of each study subject. In the univariate analysis with both cases and controls, an increase in HCC between the measurement timepoints was associated with a substantial increase in risk of appendicitis (OR 7.52 [95% CI 2.49–22.67], p = 0.001). This increased risk remained in the multivariate analysis after adjustment for age, sex and season (aOR OR 10.76 [95%CI 2.50–46.28], p = 0.001). When comparing the cases of uncomplicated and complicated appendicitis through a multivariate analysis, adjusted for age and sex, the children with an increased HCC prior to appendicitis had a substantial and statistically significant increase in risk of complicated appendicitis (aOR 7.86 [95% CI 1.20–51.63], p = 0.03). Biological stress, measured as an increase in HCC, seems to be associated with an increased risk of paediatric appendicitis and a more complicated disease course.

Aggression in ADHD: relation to salivary cortisol

BackgroundStudy of cortisol levels in patients with ADHD in correlation with aggressive behaviors associated with ADHD has received limited research attention. This factor is essential for comprehending the psychopathophysiology of ADHD and its comorbidities. The present study aimed to investigate the cortisol level in ADHD children and its relation to severity of symptoms and associated aggressive behavior in those children. The sample consisted of 129 patients and 80 healthy controls evaluated by administering the Mini International Neuropsychiatric Interview for Children, The Wechsler Intelligence Scale for Children, Conners’ parent rating scale, problem scale of C.B.C.L., and Socioeconomic Status Scale. Salivary cortisol was measured using radio-immune assay.ResultsSalivary cortisol level in our ADHD subjects was significantly lower (11.826 ng/ml) than in the control group (19.619 ng/ml with P-value 0.001). Our results failed to find any correlation between ADHD symptoms severity and salivary cortisol levels. Severity of delinquent, aggressive, and externalizing behaviors of ADHD children positively correlated with cortisol salivary levels.ConclusionSalivary cortisol levels are lower in children with ADHD relative to age- and sex-matched healthy controls. In addition, there is no obvious correlation between severity of ADHD symptoms and basal salivary cortisol levels. We also concluded that there is positive correlation between delinquent, aggressive, and externalizing behaviors in children with ADHD and their basal salivary cortisol levels.

The effect of dairy products and non-dairy snacks on food intake, subjective appetite and cortisol levels in children: a randomized control study.

Dairy snacks are available in various physical forms and their consumption is linked to improved metabolic health. The objective of this study was to determine the effect of dairy snacks of different physical forms on short-term food intake (FI), subjective appetite, and the stress hormone, cortisol, in children. Following a repeated-measures crossover design, 40 children aged 9-14 years randomly consumed 1 of 5 isoenergetic (180 kcal) snacks per study session. These snacks included solid (potato chips, cookies, and cheese), semi-solid (Greek yogurt), and fluid (2% fat milk) snacks. FI was measured 120 min after snack consumption. Subjective appetite was measured at 0 (immediately before the snack), 15, 30, 45, 60, 90, and 120 min. Salivary cortisol (n = 18) was measured after the Greek yogurt and cookie snacks at 0, 30, 60, 90, and 120 min. FI did not differ between snacks (P = 0.15). The Greek yogurt (P < 0.0001) and cheese (P = 0.0009) snacks reduced average appetite compared with the 2% fat milk snack. Salivary cortisol levels were not affected by snack (P = 0.84). This study demonstrates that dairy snacks are as effective as other popular snacks at influencing subsequent FI. However, solid and semi-solid dairy snacks are more effective at repressing subjective appetite than a fluid dairy snack. Registered at ClinicalTrials.gov (NCT02484625). Novelty: Milk, Greek yogurt and cheese have a similar effect on short-term food intake in children as popular potato chips and cookie snacks. Solid, semi-solid and liquid snacks have a similar effect on short-term food intake in children.

Cortisol salival en niños con y sin bruxismo

Objetivo: evaluar y comparar valores de facetas de desgaste y de cortisol salival en niños con y sin bruxismo posible y con bajos y altos niveles de inestabilidad emocional. Métodos: Se recolectaron datos en 17 niños sanos con bruxismo posible (B) según la lista de comportamientos orales de los Criterios Diagnósticos para Trastornos Temporomandibulares, diferenciando bruxismo de sueño (BS) y de vigilia (BV). Se aparearon por género y edad con un grupo control, sin reporte de bruxismo (C). Cinco odontopediatras identificaron facetas de desgaste con el índice de desgaste dentario (IDD) (kappa interobservador 0,94). El dosaje de cortisol se realizó con saliva completa matinal mediante electro-quimio-luminiscencia. La inestabilidad emocional (Ie) se evaluó en los mayores de 8 años con el cuestionario “Big Five” de personalidad para niños y adolescentes. Resultados: La edad media fue 11,3±2,7, con 59,6 % de género femenino. En el grupo de bruxismo; Original35,3 % reportó BS, 35,3 % BS + BV y 29,4 % BV. No se hallaron diferencias en el desgaste promedio para dientes primarios (p=0,3858) ni para permanentes (p=0,7478) entre ambos grupos. La media de cortisol salival fue 0,181 ± 0,183 para el grupo de estudio y 0,183 ± 0,161 para el grupo control (p=0,9863). Para la Inestabilidad emocional baja la media de niveles de cortisol fue 0,142 ± 0,08 ug/dl y en Ie alta 0,149 ± 0,07 (p=0,0437). Todos los pacientes con BS + BV, presentaron inestabilidad emocional alta (p= 0,006). Conclusiones: El desgaste en ambas denticiones no mostró diferencias significativas. Los valores de cortisol salival obtenidos en este estudio no permitirían considerarlo factor relevante para el diagnóstico de bruxismo. En condiciones de inestabilidad emocional extremas se hallaron diferencias en los niveles de cortisol salival y en la frecuencia que reportan ambos tipos de bruxismo.

Relationship Between Parental Attachment and Stress Elevation and Synchrony in Pediatric Occupational Therapy Patient–Parent Dyads

Populations already experiencing chronic stress, such as families with children who are neurologically atypical, are at particular risk for developing stress-related disease. To establish feasibility of collecting salivary samples from pediatric occupational therapy patients and their parents in a clinical setting and at home and to examine associations among parental attachment style, parent self-reported stress, and physiological stress (i.e., cortisol) in pediatric occupational therapy patients who were neurologically atypical and their parents (N = 10 dyads). Cross-sectional pilot study to test feasibility. Sliding-scale university clinic. Participants were 10 children undergoing occupational therapy treatment and their parent. Families were approached and told the study was voluntary and would not affect their treatment. Families provided informed consent. Parents completed measures to assess their own attachment style, general and parenting stress, and stress in their child. Children and parents provided saliva samples during an occupational therapy clinic visit and collected samples at home to measure cortisol level. Parent attachment avoidance was related to increased parent cortisol levels in the clinic and increased child cortisol levels at home. Parent and child cortisol levels had a strong, positive relationship in the clinic but not at home. We did not observe a difference between cortisol levels in children or parents in the clinic or at home. We concluded that this protocol is feasible and provide suggestions for future research. Stress physiology in pediatric occupational therapy clients should be considered within the context of the family system. Family-based interventions may be particularly helpful for reducing client stress in this population.

A Model of Intervention and Implementation of Quality Building and Quality Control in Childcare Centers to Strengthen the Mental Health and Development of 1-3-Year Olds: Protocol for a Randomized Controlled Trial of Thrive by Three.

BackgroundUniversal, high-quality childcare offers a unique opportunity to prevent developmental trajectories leading to mental health problems. Yet, growing evidence has shown that the process quality of Norwegian childcare centers varies considerably, and that research-based models for quality building are significantly lacking.ObjectiveTo examine whether a model for quality building in childcare centers, Thrive by Three, increases the quality of child–caregiver interactions, and promotes child development, well-being, and mental health.MethodsThe Thrive by Three study is a clustered randomized controlled trial involving 187 toddler groups in childcare centers across 7 municipalities within southern and central Norway. Each center is randomly allocated to the intervention or wait-list control group. Data are collected at 4 points: preintervention (T1), midway (T2), postintervention (T3), and 1-year postintervention (T4). Primary outcomes are changes in childcare quality measured by the Classroom Assessment Scoring System toddler version (CLASS), Student–Teacher Relationship Scale, Short Form (STRS-SF), and Life in Early Childhood Programs (LECP), as well as child development and mental health measured by The Brief Infant Toddler Social and Emotional Assessment (BITSEA, parent and teacher report), the Caregiver–Teacher Report Form (C-TRF), and Child Behavior Checklist (parent report) from the Achenbach System of Empirically Based Assessment (ASEBA) from 1.5 to 5 years, and child well-being measured by the Leiden Inventory for Child’s Well-Being in Day Care (LICW-D). Secondary outcomes are child cortisol levels, assessed in a subsample of 372 children.ResultsAs of August 2020, a total of 1531 children and 769 staff from 187 toddler groups were recruited. Because of turnover, the recruitment of staff will be ongoing until August 2020. As of January 2020, the intervention group has been working with Thrive by Three for 1.5 years. Data at T1, T2, and T3 from both the intervention and control groups have been completed and T4 will be completed in August 2020.ConclusionsThis study makes an important contribution to the field of quality building in childcare centers. The results will provide greater insight into how high quality can be obtained and the effects of high-quality early childcare on child mental health. This in turn will be significant for policymakers and to the Norwegian society at large.Trial RegistrationClinicalTrials.gov NCT03879733; https://clinicaltrials.gov/ct2/show/NCT03879733 and Norwegian Research Council 260624/H10; https://prosjektbanken.forskningsradet.no/#/project/NFR/260624/Sprak=enInternational Registered Report Identifier (IRRID)DERR1-10.2196/17726

Individual and social environment characteristics associated to children's cortisol levels at school entry

Individual and social environment characteristics associated to children's cortisol levels at school entry

Parent's anxiety links household stress and young children's behavioral dysregulation.

Young children rely heavily on their caregivers to gain information about the environment, especially during times of duress. Therefore, considering parental assessments of behavior in the context of stressful environments may better facilitate our understanding of the longstanding association between early environmental stressors and changes in child behavior and physiology. Confirming many previous reports, a higher degree of household stress exposure was associated with elevated mental health symptoms in 2- to 6-year-old children (N=115; anxiety and externalizing behaviors), which were verified in a subset of children with laboratory-based behaviors (N=46). However, these associations were mediated by parental anxiety symptoms, which were also associated with increased cortisol levels in children. A closer look at the stressors indicated that it was the adult-targeted, and not the child-targeted, stressors that correlated most with children's behavior problems. These results highlight the importance of considering the mediating effect of parents, when examining associations between household stress and young children's behavioral development.

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

BackgroundNurturing 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.MethodsIn 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.ResultsA 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; I2: 47.5%), and for caregivers it was 0.04 (95%CI: − 0.22 to 0.30; I2: 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.ConclusionExisting 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.

Maternal early life maltreatment and psychopathology affect the next generation: Alterations in post-awakening cortisol levels of primary school-aged children.

Early life maltreatment (ELM) has severe and lasting effects on the individual, which might also impact the next generation. On an endocrine level, the hypothalamus-pituitary-adrenal axis has been suggested to play an important role in the interplay between ELM and the development of mental disorders. Several studies have revealed that maternal post-awakening cortisol concentration, maternal sensitivity, maternal ELM and psychopathology are associated with children's cortisol levels. We investigated the post-awakening cortisol concentrations in 6- to 11-year-old children (N=53) whose mothers either had experienced ELM and had developed a lifetime mental disorder (N=15 ELM and disorder group), had experienced ELM without developing a mental disorder (N=12 ELM-only group), or had neither experienced ELM nor developed a mental disorder (N=26 HC-group). Furthermore, we assessed maternal post-awakening cortisol concentrations, maternal psychopathology, and sensitivity. Multilevel analysis revealed higher cortisol at awakening (S1) levels in children of mothers with ELM and disorder. Maternal cortisol at awakening (S1) also predicted the child's cortisol at awakening (S1), and no effect of maternal sensitivity could be found. The current results replicate an attunement of cortisol levels (S1) between mothers and children and suggest an association between the children's endocrine stress system and maternal factors such as ELM and psychopathology.