Cortisol Response In Children Research Articles

Cortisol response in children with cancer and fever during chemotherapy: A prospective, observational study using random serum cortisol levels

Cortisol response in children with cancer and fever during chemotherapy: A prospective, observational study using random serum cortisol levels

Study protocol for a randomized controlled trial investigating the effect of online interpretation bias intervention on stress reactivity in the children of parents with depression: the CoCo study

BackgroundCurrent preventive interventions for the children of parents with depression demonstrate modest effects on depression incidence. This may be because existing interventions tend to comprise general psychotherapeutic tools, rather than targeting the specific mechanisms underlying familial transmission. Improved theoretical models of familial transmission could enhance the development of targeted interventions. Although existing models assume that cognitive and biological vulnerability factors influence one another, the precise mechanisms are unknown. This project is the first to experimentally test whether negative interpretation bias has an impact on cortisol response in children of parents with depression. This study protocol reports a randomised controlled trial of an interpretation bias intervention which aims to shift participants’ interpretation bias in a more positive direction and thereby alter their stress response.MethodsChildren aged 10–14 years who have i) one parent with a current or previous depression diagnosis, with at least one episode occurring during the child’s lifetime and ii) do not have a current or previous psychiatric diagnosis themselves, will be assigned to one of two conditions: an interpretation bias intervention (n = 50) or a structurally similar placebo intervention (n = 50). The interpretation bias intervention consists of a short lab-based cognitive reappraisal of interpretations training, a four-week app-based Cognitive Bias Modification of Interpretations intervention and interpretation bias specific if–then plans. Interpretation bias will be assessed before and after the intervention using the Scrambled Sentences Task. The effect of the intervention on participants’ stress response will be assessed by salivary cortisol collected at five different time points: from immediately before until 45 min after administering the Trier Social Stressor Test for Children. Stress reactivity will be measured via baseline to peak cortisol and stress recovery will be measured via the 45 min cortisol marker. We hypothesise that children who participate in the interpretation bias intervention will display a positive shift in interpretation bias and this, in turn, will alter their stress response. Children who receive the placebo intervention are expected to show a smaller positive shift in interpretation bias and stress reactivity.DiscussionThe findings of the present study will contribute to models of familial depression transmission as well as informing preventive interventions. If training a more positive interpretation bias subsequently alters participants’ stress response, then incorporating such tools may increase the efficacy of existing preventive interventions.Trial registrationDeutsches Register Klinischer Studien DRKS00028842. Registered August 19, 2022.

Prenatal Tobacco and Cannabis Exposure: Associations with Cortisol Reactivity in Early School Age Children.

The study examined the association between prenatal tobacco or co-exposure to tobacco and cannabis and children's cortisol reactivity at kindergarten age and the role of child sex, maternal negative mood (depression/perceived stress), and parenting behavior during play interactions as moderators of this association. The sample was 238 mother-child dyads (67 tobacco users, 83 co-users of tobacco and cannabis, and 88 non-users). Data used were obtained from pregnancy assessments and six postnatal assessments at 2, 9, 16, 24, and 36months and kindergarten age. Infant cortisol was measured in response to two laboratory stress paradigms. Co-exposed children had a significantly greater decrease from pre-stressor to post-stressor and overall lower cortisol response compared with non-exposed children. This association was moderated by maternal harshness during play interactions across early childhood. Co-exposed children had flatter cortisol responses regardless of the mother's level of harshness or stress/depression. However, non-exposed children who experienced low harshness had the normative cortisol peak 20min post-stressor, while non-exposed children with high maternal harshness had a flatter cortisol pattern. Similarly, non-exposed children with more depressed/stressed mothers had higher pre-stressor cortisol levels, while those who experienced low maternal depression/stress had lower pre-stressor cortisol but peaked post-stress. Results suggest that prenatal polysubstance exposure is associated with greater risk for lower cortisol response in children and highlight the role of parenting behavior for non-exposed but not the co-exposed children.

Cortisol Response in Children After Second Cardiopulmonary Bypass.

A surge in cortisol levels is seen after surgery with cardiopulmonary bypass (CPB). Based on evidence of attenuation of the cortisol response to repeated stress in other settings, we hypothesized that the magnitude of cortisol increase in children after a second exposure to CPB would be reduced. Serial cortisol levels were measured at three time points after each CPB: immediately (day 0), on the first morning (day 1), and second morning (day 2). Forty-six children underwent two surgeries with CPB during the study period. The mean age (standard deviation) at first and second surgery was 3.5 (6.3) months and 10.4 (9.9) months, respectively. Cortisol levels at the first surgery were 109 (105)µg/dl, 29 (62)µg/dl, and 17 (12)µg/dl on day 0, 1, and 2, respectively; similarly at second surgery, it was 61 (57)µg/dl on day 0 to 20 (16)µg/dl and 11 (10)µg/dl on day 1 and 2, respectively. After log-transformation and adjusting for time interval between surgeries, cortisol levels at the second surgery were lower by 42% on day 0 (p = 0.02), and 46% lower on day 2 (p = 0.02). A second exposure to CPB in children with congenital heart disease is associated with an attenuated cortisol release.

Acute Salivary Steroid Hormone Responses in Juvenile Boys and Girls to Non-physical Team Competition

Little psychoneuroendocrine research has focused on steroid hormone responses to non-physical competition in middle childhood. This study sought to observe testosterone, estradiol, dehydroepiandrosterone (DHEA), androstenedione, and cortisol responses in children during a mixed-sex, team, academic competition. Salivary steroid hormones were collected, along with measures of performance, Body Mass Index, and pubertal development in ethnically Chinese boys (n = 18) and girls (n = 27), aged 9–10 years, during a math competition (N = 45). Testosterone and estradiol levels were generally low and unmeasurable. Nearly every competitor experienced decreases in cortisol and cortisol/DHEA molar ratio. Pre- and post-match DHEA and androstenedione did not significantly change. Exploratory analyses revealed a positive correlation between DHEA change and team performance among non-active participants (i.e. did not attempt to answer a question). ANCOVAs revealed differences in percentage change in androstenedione between active (n = 20) and non-active participants (n = 25) and among winners (n = 7) and losers (n = 38), and positive associations with age. Percentage change in cortisol was significantly lower among losers compared to winners. Performance measures were positively correlated with DHEA change and percentage change in androstenedione. Despite girls having higher pre-match androstenedione, both sexes exhibited similar patterned hormone responses. Only cortisol and cortisol/DHEA molar ratio decreased during the competition. However, DHEA, androstenedione, and cortisol match changes were partially related to psychosocial variables (e.g., performance, outcome, participation). These findings provide new insight into factors which may underpin steroid hormone responses during middle childhood non-athletic competition.

Children's cortisol responses to a social evaluative laboratory stressor from early to middle childhood.

This study examined the stability of children's cortisol responses to a social evaluative laboratory stressor from early to middle childhood. Ninety-six children (51 males) completed stress-inducing laboratory tasks and provided five salivary cortisol samples in early (W1) and middle (W2) childhood. Although W1 cortisol responses did not predict W2 cortisol responses, children's cortisol responses demonstrated change: compared to their W1 cortisol responses, children's W2 cortisol responses demonstrated an increased slope and more negative quadratic curvature. Furthermore, child psychiatric symptoms at W1 moderated the stability of children's cortisol responses. Children with fewer preschool psychiatric symptoms demonstrated greater inter-individual and intra-individual stability, whereas children with higher preschool psychiatric symptoms and comorbidity demonstrated systematic inter-individual and intra-individual instability in cortisol responses over time. Findings suggest a developmental shift toward increasing cortisol stress responses from early to middle childhood and highlight preschool psychopathology as a moderator of stability in children's cortisol responses over time.

Neuroendocrine and behavioral response to social rupture and repair in preschoolers with autism spectrum disorders interacting with mother and father

BackgroundPreschoolers with autism spectrum disorder (ASD) exhibit difficulties in handling social stress and utilizing efficient emotion regulation (ER) strategies to manage high arousal. While researchers called to assess ER in ASD, few studies utilized direct observations. We tested children’s behavioral and cortisol response to maternal and paternal unavailability and hypothesized that children with ASD will employ less complex ER strategies and their parents would show increased regulation facilitation effort to accommodate their child’s difficulties.MethodsForty preschoolers with ASD were matched with 40 typically developing (TD) preschoolers. Children were seen twice for identical battery with mother or father in the face-to-face-still-face paradigm, a three-episode paradigm where parent-child play (free play (FP)) is interrupted by elimination of communication (still face (SF)) followed by resuming play (reunion (RE)). Micro-coding of parent and child’s social behavior and ER strategies was conducted. Parent and child’s cortisol was assessed at baseline, following stress, and at recovery.ResultsChildren with ASD exhibited the typical SF effect, indexed by an increase in negative affect and decrease in positive communications, but employed more simple regulatory behavior (self-soothing, proximity-seeking) and less complex strategies involving attention redirection and substitutive play. Their parents used more regulation-facilitation behavior, both simple and complex. All children showed initial cortisol response to novelty, which declined over time. However, maternal presence suppressed initial cortisol response in children with ASD.ConclusionsChildren with ASD form typical expectations of parental availability and their parents increase effort to help repair social rupture. Among children with ASD, maternal presence and regulation facilitation provide social buffering for the child’s HPA stress response in a manner similar to mammalian neonates. Results highlight the importance of assessing ER by combining direct observations and physiological measures and including fathers in empirical studies and intervention efforts for children with ASD during sensitive periods for social growth.Electronic supplementary materialThe online version of this article (doi:10.1186/s13229-015-0007-2) contains supplementary material, which is available to authorized users.

Dismissing child attachment and discordance for subjective and neuroendocrine responses to vulnerability

Emerging evidence suggests that as with adults, dismissing children underreport their psychological distress relative to physiological indicators of their experience (startle response, neural signals). In this report, we extend these observations to neuroendocrine reactivity. One hundred and six 8-12-year-old children completed the Child Attachment Interview and a computer-based paradigm comprised of vignettes reflecting vulnerability in interpersonal contexts. Dismissing children's cortisol responses remained comparable from pre-to-post paradigm, while secure children's cortisol responses decreased from pre-to-post paradigm. Furthermore, compared to secure children, dismissing children reported less distress than their cortisol response would suggest. Implications for dismissing children's coping and self-regulation are discussed.

Arterial bicarbonate may be a useful indicator of inadequate cortisol response in children with catecholamine resistant septic shock

To study the clinical and biochemical parameters that can predict cortisol insufficiency in children with septic shock. prospective, observational study. Tertiary health-care center. Fifty children admitted with the catecholamine resistant septic shock to a tertiary health-care center. At the time of hospitalization all patients underwent detailed clinical evaluation including, history and physical examination, evaluation with the complete blood count, serum cortisol, renal function tests, liver function tests, prothrombin time activated partial thromboplastin time, arterial blood gas analysis, urine analysis, chest roentgenogram, ultrasonography of the abdomen and chest, urine, and blood culture for bacteria and fungi. Out of 50 children with the catecholamine resistant septic shock, seven had adrenal insufficiency (serum cortisol <18 μg/dl). Of all parameters studied, only arterial bicarbonate at the time of admission to intensive care predicted adrenal insufficiency. On Receptor operative characteristic curve analysis, a bicarbonate level of 10.9 mEq/L had the best accuracy to predict adrenal insufficiency. Arterial bicarbonate may be used as a rapid test for provisional identification of adrenal insufficiency among children with the catecholamine resistant septic shock.

Cortisol response to synacthen stimulation is attenuated following abusive head trauma

Child abuse and other early-life environmental stressors are known to affect the hypothalamic-pituitary-adrenal axis. We sought to compare synacthen-stimulated cortisol responses in children who suffered inflicted or accidental traumatic brain injury (TBI). Children with a history of early-childhood TBI were recruited from the Starship Children's Hospital database (Auckland, New Zealand, 1992-2010). All underwent a low-dose ACTH(1-24) (synacthen 1μg IV) test, and serum cortisol response was compared between inflicted (TBI(I) ) and accidental (TBI(A) ) groups. We assessed 64 children with TBI(I) and 134 with TBI(A) . Boys were more likely than girls to suffer accidental (P<0·001), but not inflicted TBI. TBI(I) children displayed a 14% reduction in peak stimulated cortisol in comparison with the TBI(A) group (P<0·001), as well as reduced cortisol responses at+30 (P<0·01) and+60min (P<0·001). Importantly, these differences were not associated with severity of injury. The odds ratio of TBI(I) children having a mother who suffered domestic violence during pregnancy was 6·2 times that of the TBI(A) group (P<0·001). However, reported domestic violence during pregnancy or placement of child in foster care did not appear to affect cortisol responses. Synacthen-stimulated cortisol response is attenuated following inflicted TBI in early childhood. This may reflect chronic exposure to environmental stress as opposed to pituitary injury or early-life programming.

Cortisol responses in children and adults with attention deficit hyperactivity disorder (ADHD): a possible marker of inhibition deficits

Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disease whose neurobiological background is not completely understood. It has been proposed that deficits of the inhibitory function with an underactive behavioral inhibition system (BIS) may be in the core of ADHD. In this regard, this review summarizes all studies that examine the involvement of cortisol in ADHD. Differences in cortisol responses from different ADHD subtypes, hyperactive/impulsive, inattentive, and combined, are analyzed. In addition, we examine the role of comorbidities as confounding factors in the study of cortisol in ADHD, including comorbid disruptive behavioral disorder (DBD), as well as anxiety and depressive disorders. Because ADHD is a neurodevelopmental condition and approximately half of the children enter adulthood with the disorder, we review cortisol studies in adults and children separately. Two diverse patterns of cortisol have been reported both in children and adults with ADHD. Blunted cortisol responses to stress are associated with comorbid DBD, whereas high cortisol responses are associated to comorbid anxiety disorders. Nevertheless, the inhibitory deficits in ADHD do not appear to be related directly to cortisol deficits in either children or adults. This review increases our understanding of the heterogeneity of ADHD and could help in determining new strategies for the treatment of these patients. Future studies including gender and a more systematic methodology to study the cortisol response are needed.

Salivary α-amylase stress reactivity across different age groups

tract Salivary alpha-amylase (sAA) increases rapidly in response to psychosocial stress in young adults, but no direct comparisons between different age groups across the life span have been made. Secretion of sAA and cortisol was assessed in children, young adults, and older adults after exposure to the Trier Social Stress Test. Additionally, cardiovascular activity was measured in both adult groups. Older adults showed attenuated sAA, heart rate (HR), and heart rate variability (HRV) responses. Furthermore, we found higher sAA but lower cortisol at baseline as well as lower sAA and cortisol responses in children. Age x sex interactions were observed only for cortisol with higher responses in older male participants. No associations between the parameters were found. These results implicate sAA as an alternative or additional sympathetic stress marker throughout the life span, with marked and rapid stress responsiveness in three relevant age groups.

Lower cortisol levels in children with asthma exposed to recurrent maternal distress from birth

Existing evidence supports associations between exposure to maternal distress and the development of childhood asthma, between exposure to maternal distress and an increased cortisol response in children, and between childhood asthma and an attenuated cortisol response. To investigate the association between children's cortisol levels and the combined predictors of exposure to maternal distress and childhood asthma. Serum cortisol levels were examined at age 7 to 10 years in relation to asthma status and exposure to maternal distress in a representative sample of children (n = 503) born in 1995. Data from health care and prescription databases were linked with additional data collected in this longitudinal study. Maternal distress was defined as a physician diagnosis of a depressive or anxiety disorder or a prescription history of related medications as reported in the mothers' health care records. Children's asthma status was determined via examination by 2 pediatric allergists. A multiple linear regression analysis revealed that exposure to maternal distress restricted to the first year of life predicted elevated cortisol levels in children, regardless of asthma status (>40% increase). A significant interaction was discovered in the group of children exposed to maternal distress extending beyond the postnatal period such that no asthma predicted a 25.9% increase in cortisol and a diagnosis of asthma predicted a 5.2% decrease in cortisol. Cortisol levels were further lowered in atopic and bronchial hyperresponsive asthma. Among children exposed to recurrent maternal distress, an elevation in cortisol levels occurs in response to an acute stressor when there is no accompanying diagnosis of asthma, whereas, in comparison, children with asthma tend to exhibit lower cortisol levels.

Inhibited temperament and parent emotional availability differentially predict young children's cortisol responses to novel social and nonsocial events

Preschool-aged children (n = 274) were examined in the laboratory to assess behavioral and cortisol responses to nonsocial and social threat. Parents also responded to scales on the Children's Behavior Questionnaire reflecting exuberant approach to novel/risky activities (reversed scored) and shyness. Multi-method measures of Nonsocial and Social Inhibition were computed. Parents and children were observed engaging in a series of interactive tasks and the Emotional Availability scales were scored for parental sensitivity, nonintrusiveness, nonhostility, and structuring. These scores were factored to yield one measure of Parenting Quality. Analyses revealed that Nonsocial and Social Inhibition could be distinguished and that associations with cortisol response were stressor specific. Moderation analyses revealed that parenting quality buffered cortisol elevations for extremely socially, but not nonsocially inhibited children. These findings are consistent with evidence that sensitive, supportive parenting is an important buffer of the HPA axis response to threat in infants and toddlers, and extends this finding to the preschool period.

Children's and adults’ salivary cortisol responses to an identical psychosocial laboratory stressor

Many studies have investigated hypothalamus-pituitary-adrenal (HPA) axis responses to psychosocial stress in adults. In children, much less is known about HPA axis reactivity, and a sizable number of studies has not detected a significant cortisol response. Moreover, there is a lack of studies comparing adults' and children's responses to identical stressors. The aim of the present study was to modify an existing laboratory stressor to serve as a potent stressor in children and to allow for direct comparison between children's and adults' stress responses. Thirty children, ages 9-12 (14 female), and 31 young adults, ages 18-25 (17 female), were exposed to the modified protocol (TSST-M). A significant increase in salivary cortisol was observed in response to the TSST-M, F(2.5,125.4)=19.65, p<.001, eta(2)=.28, and overall, no differences were found between children's and adults' responses, F(2.5,125.4)=.31, n.s. Children and adults also showed similar changes in negative and positive affect, both F<1.18, n.s. and reported a similar amount of distress during the TSST-M, F(1,57)=.97, n.s. Children did, however, exhibit a significantly greater number of behaviors indicative of distress, F(1,50)=6.59, p=.01, eta(2)=.12. This study provides preliminary evidence that the TSST-M is a useful laboratory procedure to induce significant cortisol responses in children. It also suggests comparable responses in cortisol and self-reported affect in young adults and children.

Reliability of the Low Dose Synacthen Test in Children Undergoing Pituitary Function Testing

There are few data in the paediatric literature on the normal cortisol response to stimulation during the low dose synacthen test (LDST) (1 microg). To examine the cortisol responses in children, subsequently presumed to be normal, who had an LDST during anterior pituitary function tests (APFTs). A retrospective review of results in children with short stature and normal growth hormone levels. Of 33 children tested, seven had suboptimal cortisol responses based on accepted criteria (peak <500 nmol/l)--a false positive rate of 21%. Only three of these children had a repeat LDST, which was normal in all cases. The peak cortisol response (median 633, range, 417-1052 nmol/l) was inversely correlated with age (r = -0.44, p < 0.05). One in five tests did not meet normal criteria. This false positive rate (21%) should be borne in mind when interpreting synacthen tests to prevent overdiagnosis of adrenal insufficiency.

Associations Between Sleep and Cortisol Responses to Stress in Children and Adolescents: A Pilot Study

A growing body of animal and human research suggests reciprocal associations between sleep and activity of the hypothalamic pituitary adrenocortical (HPA) axis. However, few studies have examined associations between sleep and stress-induced cortisol responses in children and adolescents. This pilot study examined associations among 3 sleep parameters (sleep–wake behavior problems, daytime sleepiness, sleep quantity) and cortisol responses to stress in 31 participants ages 10 to 17 (15 males, 16 females). During a "rest" session in which participants habituated to the laboratory, daytime sleepiness, sleep–wake behavior problems, and sleep quantity were assessed using a modified Sleep Habits Survey. On a separate day, participants completed a laboratory stress session involving 3 performance stressors. Salivary cortisol was collected during baseline, stress, and recovery periods. Significant associations between participant reported sleep–wake behavior problems and cortisol reactivity were found, with greater sleep–wake behavior problems associated with decreased cortisol responses. No associations emerged between sleep quantity and cortisol responses to stress; daytime sleepiness showed a trend toward an effect on cortisol reactivity. Although preliminary, results suggest there may be important influences of sleep quality but not quantity on HPA regulation and responses to daytime stressors in children and adolescents, and further study is warranted.

Predictors of children's cortisol activation during the transition to kindergarten.

The purpose of the present study was to identify predictors of children's cortisol responses after the transition to kindergarten. Morning salivary cortisol was measured in 50 children 1 week before and 1 week after they began kindergarten. Children who experienced a greater degree of change between their preschool and kindergarten routines and who had infrequent preschool experiences exhibited the largest increases in morning cortisols after kindergarten entry. Children whose parents indicated that they would have an easier, rather than more difficult, time adapting to kindergarten also tended to be more reactive in their morning cortisol levels after kindergarten entry. Results provide new insight into experiential and individual-difference factors that predict children's physiological reactivity and self-regulation during times of transition and potential stress.

Pituitary–adrenal reactivity in a child psychiatric population: salivary cortisol response to stressors

The aim of this explorative study was to investigate whether physical and psychological challenges are effective in inducing a cortisol response in psychiatric and control children, and if so whether the cortisol response can discriminate between diagnostic groups and is related to psychiatric symptoms. Fifty-two patients, including children with dysthymia, oppositional defiant disorder/conduct disorder, pervasive developmental disorder, not otherwise specified (PDDNOS) and attention deficit hyperactivity disorder, were compared to 15 healthy control children. Symptomatology was scored using the Child Behaviour Checklist. The response to both psychological and physical challenges was assessed by measuring salivary cortisol and heart rate. Physical challenge, but not psychological challenge, resulted in an overall increase in heart rate and saliva cortisol. Dysthymic and PDDNOS patients showed a diminished cortisol response, in spite of a significant increase in heart rate. These groups scored highest on the symptom factor withdrawal. Withdrawal was negatively correlated with the cortisol response. Thus, physical exercise is effective in inducing a salivary cortisol response in children. Dysthymic and PDDNOS patients have a disturbed pituitary-adrenal function in relation to physical stress, that may be associated with withdrawal.