Trier Social Stress Test For Children Research Articles

Multifactorial stress reactivity to virtual TSST-C in healthy children and adolescents—It works, but not as well as a real TSST-C

A virtual version of the Trier Social Stress Test (TSST) has been increasingly used in stress research. Benefits of the virtual TSST include that it is more economical, and offers improved control of context and enhanced flexibility of use. Many studies have confirmed the applicability of virtual TSSTs in stress research, but only in adulthood. In the present study, we aimed to experimentally verify the transferability of a virtual TSST to adolescence. A total of 73 healthy adolescents (aged 11–17 years) of both sexes completed either a real (IV-TSST-C) or virtual (VR-TSST-C) TSST for children. The surveyed stress parameters included salivary cortisol and alpha amylase concentrations, heart rate, heart rate variability, and subjective stress ratings across test sessions, as well as a pre- to post-TSST-C comparison. All parameters revealed significant stress responses over time. We observed significant effects of group on cortisol and subjective stress ratings, with the VR-TSST-C inducing less stress than the IV-TSST-C. In alpha amylase, heart rate, and heart rate variability, we found no significant difference between TSST versions, but only significant equivalence for alpha amylase. Some parameters may have been influenced by an expectancy effect and the participant’s sex. In conclusion, among adolescents, a virtual TSST-C effectively elicits stress at multiple levels (endocrinological, autonomic, and subjective); however, the magnitude is not always comparable to with the real TSST-C, which should be considered when applied.

Vulnerability to anxiety differently predicts cortisol reactivity and state anxiety during a laboratory stressor in healthy girls and boys

BackgroundChildren diagnosed with anxiety disorders show altered cortisol and state anxiety reactivity to stressful situations. To date, it remains unclear whether these dysregulations emerge after the pathology or whether they are also detectable in healthy children. If the latter is true, this may provide insight into children's vulnerability to develop clinical anxiety. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) increase youth's vulnerability to develop anxiety disorders. This study aimed to examine whether vulnerability to anxiety was associated with cortisol reactivity and state anxiety in healthy youth. Methods114 children (8–12 y/o) were exposed to the Trier Social Stress Test for Children (TSST-C), where saliva samples were collected for cortisol quantification. State anxiety was assessed 20 min before and 10 min after the TSST-C using the state form of the State-Trait Anxiety Inventory for Children. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. ResultsHigher vulnerability to anxiety was associated with enhanced cortisol reactivity in boys. Irrespective of vulnerability level, girls reported greater changes in state anxiety in response to the TSST. LimitationsGiven the correlational nature of this study, the directionality of the results remains to be elucidated. ConclusionsThese results indicate that endocrine patterns characterizing anxiety disorders are detectable in healthy boys who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing anxiety disorders.

Neuroendocrine System Adaptation during Consecutive Extrinsic Stimuli: A Pilot Dynamic Study.

This pilot repeated measures study aims to evaluate the dynamics of the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal (HPA) axis, and/or their interplay with low-level inflammation in healthy schoolchildren during consecutive extrinsic stimuli. Twenty healthy schoolchildren and adolescents aged 11-14 years (12.5 ± 1.5) were consecutively exposed to an oral task (#2) and an arithmetic task (#3) (Trier Social Stress Test for Children (TSST-C)), lasting 5 min each, and a three-minute cellular phone call (#4). Salivary cortisol (SC) was sampled at baseline (#1) and immediately after each exposure (#2, 3, and 4). Baseline serum high-sensitivity C-reactive protein (hsCRP) and cortisol levels were also assessed. ANS dynamics and complexity were measured using Sample Entropy (SampEn) at each experimental time period (#1-4). Baseline serum hCRP and cortisol correlated negatively to each other, while the ANS and HPA axis acute reactions to the three consecutive stimuli differed over time. The ANS adaptation to these stimuli included complexity modulation, which was not dependent on baseline hsCRP or cortisol, and weakened during the third stimulation. However, baseline hsCRP and cortisol had a weakening and an increasing effect on the HPA axis over time, respectively. We conclude that low-level inflammation and baseline morning cortisol level have no effect on ANS dynamics but influence the HPA axis response to consecutive external stimuli.

Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment

BackgroundMucosal secretory immunoglobulin A (s-IgA) is an antibody protein-complex that plays a crucial role in immune first defense against infection. Although different immune biomarkers have been associated with stress-related psychopathology, s-IgA remains poorly studied, especially in youth. ObjectivesThe present study investigated how s-IgA behaves in front of acute psychosocial stress in children and adolescents, including possible variability associated with developmental stage and history of childhood maltreatment (CM). Methods94 children and adolescents from 7 to 17 years (54 with a current psychiatric diagnostic and 40 healthy controls) drawn from a larger Spanish study were explored (EPI-Young Stress Project). To assess biological reactivity, participants provided five saliva samples during an acute laboratory-based psychosocial stressor, the Trier Social Stress Test for Children (TSST-C). Samples were assayed for s-IgA, as well as for cortisol. Pubertal development was ascertained by Tanner stage and CM following TASSCV criteria. ResultsWe observed s-IgA fluctuations throughout the stressor, indicating the validity of TSST-C to stimulate s-IgA secretion (F(4,199) = 6.200, p <.001). Although s-IgA trajectories followed a reactivity and recovery pattern in adolescents, children exhibited no s-IgA response when faced with stress (F(4,197) = 3.406, p =.010). An interaction was found between s-IgA and CM (F(4,203) = 2.643, p =.035). Interestingly, an interaction between developmental stage, CM history and s-IgA reactivity was identified (F(12,343) = 2.036, p =.017); while children non-exposed to maltreatment exhibited no s-IgA changes to acute stress, children with a history of CM showed a similar response to adolescents, increasing their s-IgA levels after the psychosocial stressor. ConclusionAcute psychosocial stress stimulates s-IgA secretion, but only after puberty. However, children with a history of maltreatment exhibited a response resembling that of adolescents, suggesting an early maturation of the immune system. Further studies are needed to clarify the validity of s-IgA as an acute stress biomarker, including additional measures during stress exposure.

Secretory IgA reactivity to acute psychosocial stress in children and adolescents: the influence of childhood maltreatment and psychopthology

Secretory immunoglobulin A (sIgA) has been proposed as a biomarker of stress-related psychopathology (PP), although it remains poorly studied in youth. The present study investigated sIgA acute psychosocial stress (APS) reactivity in children and adolescent and possible s-IgA alterations associated with childhood maltreatment (CM) and PP. 93 youth (7-17 years) were recruited in the EPI young stress project. To explore sIgA variability, participants gave five saliva samples during Trier Social Stress Test for Children (TSST-C). CM was evaluated following TASSCV criteria, PP via K-SDADS-PL and pubertal development by Tanner stage. We observed sIgA fluctuations indicating the validity of TSST-C to stimulate sIgA secretion (F=4.061,p=.004). Although sIgA trajectories followed a reactivity and recovery pattern in adolescents (F=2.552,p=.042) these responses were blunted in children. No global interaction were found between sIgA and CM or PP. Our findings suggest that APS stimulates sIgA secretion, but only after puberty, and it seems to be non-affected by CM or PP. However, further studies are needed to clarify the validity of IgA as a biomarker including additional measures immediately after APS.

Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose-response relationship in children and adolescents.

This study investigates the impact of childhood maltreatment (CM) on hypothalamic-pituitary-adrenal (HPA)-axis functioning and on anxiety perception. Moreover, the influence of CM severity and frequency was also explored. In total, 187 participants aged 7-17 were assessed for CM history using validated questionnaires and ad hoc interviews to be classified according to the criteria of the Tool for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV). Psychopathology was ascertained using the K-SADS-PL5. To assess HPA-axis functioning, salivary cortisol samples were collected throughout a normal day and during an acute psychosocial stressor, the Trier Social Stress Test for children (TSST-C). Subjective anxiety was evaluated using STAI/-C. Youth with a CM history had higher overall diurnal cortisol levels (p = 0.001), blunted cortisol response to acute psychosocial stress (p = 0.002) and greater perceived anxiety (p = 0.003), than those without CM. Specifically, participants exposed to moderate/severe or often/frequent CM showed the greater diurnal cortisol output (pseverity = 0.002; pfrequency = 0.003), and blunted cortisol response during the TSST-C (pseverity = 0.006; pfrequency = 0.008). Meanwhile, youth with low CM severity/frequency exhibited a similar cortisol response to those without CM. However, perceived anxiety was higher in those exposed to CM (p < 0.001), regardless of its severity/frequency. Disturbances in HPA-axis functioning are already evident early after CM exposure, while psychological and physiological responses to an acute stressor are dissociated in youth exposed to CM. The dose-response relationship described in this paper highlights the need to comprehensively evaluate CM so that vulnerable children can be identified and assigned to proper interventions.

Biased Perception of Physiological Arousal in Child Social Anxiety Disorder Before and After Cognitive Behavioral Treatment.

A biased perception of physiological hyperreactivity to social-evaluative situations is crucial for the maintenance of social anxiety disorder (SAD). Alterations in interoceptive accuracy (IAc) when confronted with social stressors may play a role for SAD in children. We expected a biased perception of hyperarousal in children with SAD before treatment and, consequently, a reduced bias after successful cognitive behavioral therapy (CBT). In two centers, 64 children with the diagnosis of SAD and 55 healthy control (HC) children (both 9 to 13 years) participated in the Trier Social Stress Test for Children (TSST-C), which was repeated after children with SAD were assigned to either a 12-week group CBT (n = 31) or a waitlist condition (n = 33). Perception of and worry about physiological arousal and autonomic variables (heart rate, skin conductance) were assessed. After each TSST-C, all children further completed a heartbeat perception task to assess IAc. Before treatment, children with SAD reported both a stronger perception of and more worry about their heart rate and skin conductance than HC children, while the objective reactivity of heart rate did not differ. Additionally, children with SAD reported heightened perception of and increased worry about trembling throughout the TSST-C compared to HC children, but reported increased worry about blushing only after the stress phase of the TSST-C compared to HC children. Children with and without SAD did not differ in IAc. Contrary to our hypothesis, after treatment, children in the CBT group reported heightened perception of physiological arousal and increased worry on some parameters after the baseline phase of the TSST-C, whereas actual IAc remained unaffected. IAc before and after treatment were significantly related. Increased self-reported perception of physiological arousal may play a role in childhood SAD and could be an important target in CBT. However, further studies should examine if this is an epiphenomenon, a temporarily occurring and necessary condition for change, or indeed an unwanted adverse intervention effect.

Implicit motives and children's salivary cortisol reactivity to an adapted version of the Trier Social Stress Test for Children (TSST-C)

This research addresses the interplay between two implicit motives, that are power (nPow) and affiliation (nAff), and the cortisol reactivity (CR) to a psychosocial stressor (an adaption of the Trier Social Stress Test for Children; TSST-C; Buske-Kirschbaum et al., 1997) in 89 healthy children (45 female; Mage = 7.74, SDAge = 0.46). We assessed implicit motives by a 6-image Picture Story Exercise (PSE) and cortisol by 6 saliva samples. As hypothesized, the procedure triggered a significant cortisol reaction, F(1.44, 127.05Greenhouse-Geisser) = 8.22, p = .002, η2part = 0.09. Contrary to our hypothesis, children high in nPow showed no significant increase in CR (β = 0.06, p = .60). However, our results were in line with the findings of Wegner, Schüler, and Budde (2014) that a high implicit affiliation motive is associated with an attenuated CR (β = −0.21, p = .05). Perspectives for future research on implicit motives and children's CR to psychosocial stress are discussed.

Maternal B12, Folate and Homocysteine Concentrations and Offspring Cortisol and Cardiovascular Responses to Stress.

ContextImbalances in maternal 1-carbon nutrients (vitamin B12, folate) have been shown to be associated with higher offspring cardiometabolic risk markers in India.ObjectiveWe examined the hypothesis that low plasma vitamin B12 (B12) and high folate and homocysteine concentrations in the mother are associated with higher hypothalamic–pituitary–adrenal axis (cortisol) and cardiovascular responses during the Trier Social Stress Test for Children (TSST-C) in an Indian birth cohort.MethodsAdolescents (n = 264; mean age: 13.6 years), whose mothers’ plasma B12, folate and total homocysteine concentrations had been measured during pregnancy, completed 5-minutes each of public speaking and mental arithmetic tasks in front of 2 unfamiliar “judges” (TSST-C). Baseline and poststress salivary cortisol concentrations were measured. Heart rate, blood pressure, stroke volume, cardiac output, and total peripheral resistance were measured continuously at baseline, during the TSST-C, and for 10 minutes after the TSST-C using a finger cuff; beat-to-beat values were averaged for these periods, respectively. ResultsMaternal low B12 status (plasma B12 < 150 pmol/L) was associated with greater cortisol responses to stress in the offspring (P < .001). Higher homocysteine concentrations were associated with greater offspring heart rate response (P < .001). After adjustment for multiple comparisons, there were nonsignificant associations between higher maternal folate concentrations and offspring total peripheral resistance response (P = .01).ConclusionOur findings suggest that maternal 1-carbon nutritional status may have long-term programming implications for offspring neuroendocrine stress responses.

Acute psychosocial stress and working memory performance: the potential of physical activity to modulate cognitive functions in children

BackgroundResearch suggests that physical activity (PA) enhances cognitive performance and prevents stress-related impairments of higher order cognitive functions like working memory (WM) performance. The aim of the current study was to investigate the effect of PA on WM performance after acute stress exposure in preadolescent children.MethodsRegular PA was assessed for seven consecutive days during a typical school week using accelerometers in a sample of 44 preadolescent children (14 girls, Mage = 11.29 years, SDage = 0.67). Following this period, participants performed an automated operational span (OSPAN) task immediately after being exposed to the Trier Social Stress Test for Children (TSST-C).ResultsChildren exhibited prototypical response slopes in salivary cortisol and salivary α-amylase as markers of the endocrine and autonomic stress response immediately after psychosocial stress induction. A subsequent two-way ANOVA comparing high- and low-stress responders revealed a significant interaction between group affiliation and PA level on WM performance for both stress markers. Interestingly, best WM performance was demonstrated in children showing both high PA levels and high cortisol (or low α-amylase, respectively) stress responses.ConclusionsThough patterns differed for salivary cortisol and salivary α-amylase, overall findings suggest that PA buffers the negative effects of stress on cognitive performance in children.

An inactive control of the ‘Trier Social Stress Test’ for Youth 10–17 years: Neuroendocrine, cardiac, and subjective responses

The Trier Social Stress Test for children (TSST-C) adapted from TSST is one of the most commonly used laboratory paradigms for investigating the effects of stress on cognitive, affective and physiological responses in children and adolescents. Considering that laboratory procedures generate a significant amount of stress to children and adolescents, even in the absence of a stress paradigm, it is important to validate TSST-C against an inactive control condition in which the stress components were absent. Using a randomized design, we tested an inactive control condition, which replaced the TSST-C with a benign video clip (nature scenes viewed while standing), thus removing the stress associated components of the TSST-C. Eighty-eight youth between the ages of 10 and 17 years were randomly assigned to complete the TSST-C or the Inactive Control (IC). Subjective anxiety rating, salivary cortisol, systolic and diastolic blood pressure, and heart rate were collected at eight time points. Subjects in the Inactive Control condition showed no significant changes in blood pressure and heart rate, and decreased anxiety rating and salivary cortisol level throughout the study. Subjects in the stress condition (TSST-C) showed increased anxiety ratings, salivary cortisol, systolic and diastolic blood pressure, and heart rate immediately following TSST-C stress induction. Our findings validated that the TSST-C induced a systemic stress response, and that the Inactive Control can be a promising standardized control condition for the TSST-C and a tool for future psychobiological research. Our results also showed that anxiety reactivity decreased with age while HR reactivity increased with age. Cortisol reactivity did not fall in a linear relationship with age but rather via a quadratic curve, suggesting the mid-age adolescents had the highest cortisol responses to stress compared to their younger and older peers, potentially due to a dual factor of pubertal development and self-control and emotion regulation capacity.

A Review of Behavioral Observation Coding Approaches for the Trier Social Stress Test for Children.

The Trier Social Stress Test (TSST) has become one of the most widely-used protocols for inducing moderate psychosocial stress in laboratory settings. Observational coding has been used to measure a range of behavioral responses to the TSST including performance, reactions to the task, and markers of stress induced by the task, with clear advantages given increased objectivity of observational measurement over self-report measures. The current review systematically examined all TSST and TSST-related studies with children and adolescents published since the original work of Kirschbaum et al. (1993) to identify behavioral observation coding approaches for the TSST. The search resulted in 29 published articles, dissertations, and master's theses with a wide range of coding approaches used. The take-home finding from the current review is that there is no standard way to code the Trier Social Stress Test for Children (TSST-C), which appears to stem from the uniqueness of investigators' research questions and sample demographics. This lack of standardization prohibits conclusive comparisons between studies and samples. We discuss relevant implications and offer suggestions for future research.

Cortisol Impacted on Explicit Learning Encoding, but Not on Storage and Retrieval, and Was Not Associated With Sleep Patterns-Results From the Trier Social Stress Test for Children (TSST-C) Among 9-Years Old Children.

Background: Learning is the relatively permanent change of behavior as a result of experience and tightly related to memory and cognition. Learning is particularly important for children. Further, restoring sleep is associated both with improved learning performance and lower cortisol levels as a proxy of the so-called hypothalamus-pituitary-adrenocortical axis activity (HPA-AA). With the present study, we investigated, if and to what extent explicit learning performance was associated with cortisol levels at baseline and under challenge conditions and with objective sleep dimensions among 9-years old children.Methods: A total of 39 children (mean age = 9.5 years; 39% females) took part in the study. Verbal and figural working and long-term memory were tested before and after the Trier Social Stress Test for Children (TSST-C). Further, children underwent sleep-EEG assessment, and cortisol awakening response (CAR) was assessed.Results: Higher cortisol levels were associated with lower explicit learning encoding (verbal, but not figural learning). Higher verbal and figural working and long-term memory performance predicted lower cortisol secretion under the TSST-C, along with higher verbal and figural working and long-term memory performance after the TSST-C. Cognitive test performances were not mediated by cortisol secretion under the TSST-C. Cognitive performance, cortisol secretion under challenge (TSST-C) and basal conditions (morning) and sleep patterns were unrelated.Conclusions: The pattern of results suggests that among a sample of 9-years old children cortisol secretion and stages of memory processes (encoding, storage, retrieval) are associated in a complex and bi-directional way. Further, it appears that cognitive-emotional processes underlying cognitive performance and its evaluation might impact on subsequent cortisol secretion as a proxy of neuroendocrinological response to cognitive-emotional processes. Last, cognitive performance and cortisol secretion under challenge conditions were not related to objective sleep patterns and baseline cortisol secretion.

Interparental conflict and child HPA-axis responses to acute stress: Insights using intensive repeated measures.

Interparental conflict is a common source of psychosocial stress in the lives of children. The purpose of this study was to examine the association between recent interparental conflict and one component of the physiological stress response system, the hypothalamic-pituitary-adrenal (HPA)-axis. Parents of 42 children (ages 8-13 years) completed daily diaries of interparental conflict for 8 weeks. At the end of the 8 weeks, youth participated in the Trier Social Stress Test for Children (TSST-C) while providing 2 pre- and 4 poststress salivary cortisol samples. Youth whose fathers reported a pattern of increasing interparental conflict over the past 8 weeks demonstrated an exaggerated HPA-axis response to acute stress. Mother-reported interparental conflict was not associated with children's HPA-axis responses without accounting for fathers' reports. When accounting for fathers' reports, the offspring of mothers reporting higher average daily interparental conflict demonstrated an attenuated HPA-axis response to the stressor. By estimating both average exposure and recent patterns of change in exposure to conflict, we address the circumstances that may prompt attenuation versus sensitization of the HPA-axis in the context of interparental conflict. We conclude that the HPA-axis is sensitive to proximal increases in interparental conflict which may be one pathway through which stress affects health across development, and that incorporating father's reports is important to understanding the role of the family environment in stress responses. This study further demonstrates the value of using intensive repeated measures and multiple reporters to characterize children's psychosocial environment. (PsycINFO Database Record

Polygenic risk score of SERPINA6/SERPINA1 associates with diurnal and stress-induced HPA axis activity in children

PurposeCorticosteroid-binding globulin (CBG) transports glucocorticoids in blood. Variation in genes SERPINA6 encoding for CBG, SERPINA2 and SERPINA1 (serpin family A member 6, 2, and 1) have been shown to influence morning plasma cortisol and CBG in adults. However, association of this genetic variation with diurnal and stress-induced salivary cortisol remain unknown. This study aims to investigate the effect of genetic variation in SERPINA6/2/1 loci on diurnal and stress-induced salivary cortisol in children. MethodsWe studied 186, 8-year-old children with genome-wide genotyping. We generated weighted polygenic risk score (PRS) based on 6 genome-wide significant SNPs (rs11621961, rs11629171, rs7161521, rs2749527, rs3762132, rs4900229) derived from the CORNET meta-analyses. Salivary cortisol was measured across one day and in response to the Trier Social Stress Test for Children (TSST-C). ResultsMixed models, adjusted for covariates, showed that the PRS x sampling time interactions associated with diurnal (P < 0.001) and stress-induced (P = 0.009) salivary cortisol. In the high PRS group (dichotomized at median) the diurnal salivary cortisol pattern decreased less from awakening to bedtime than in the low PRS group (standardized estimates of sampling time −0.64 vs. −0.73, P < 0.0001 for both estimates). In response to stress, salivary cortisol increased in the high PRS group while it remained unchanged in the low PRS group (standardized estimates of sampling time 0.12, P = 0.015 vs. −0.06, P = 0.16). These results were mainly driven by minor alleles of rs7161521 (SERPINA6) and rs4900229 (SERPINA1). ConclusionsGenetic variation in SERPINA6/2/1loci may underpin higher hypothalamic-pituitary-adrenocortical axis activity in children.

Family conflict, chaos, and negative life events predict cortisol activity in low-income children.

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7-10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.

Adiposity and Cortisol Response to Stress in Indian Adolescents

ObjectiveWe examined associations of different adiposity measures with cortisol responses during the Trier Social Stress Test for children (TSST-C).DesignDescriptive study.SettingHoldsworth Memorial Hospital, Mysore, India.ParticipantsAdolescents aged 13.5y from a birth cohort were recruited (N=269, 133 boys).MethodsThe stressor (TSST-C) was 5-minutes each of public speaking and mental arithmetic tasks in front of two unfamiliar ‘judges’. Salivary cortisol concentrations were measured at baseline and at regular intervals after TSST-C. Weight, height, sub scapular and triceps skinfold thickness, and waist and hip circumference were measured, and percentage body fat was estimated (fat%; bioimpedance). Body mass index (BMI) and Waist-to-hip ratio (WHR) were calculated. All variables were converted into within-cohort SD scores before analysis. Stressinduced change in cortisol concentrations from baseline (cortisol response) was examined in relation to adiposity.ResultsStress increased cortisol concentrations significantly from baseline (mean (SD): 5.5 (6.4) ng/mL; P<0.001). Higher WHR was associated with lower cortisol response at 20 and 30-minutes after stress (~0.13 SD decrease in cortisol response per SD higher WHR, P<0.05). Higher fat% was also associated with lower cortisol response only in girls 20-minutes post-stress (0.23 SD lower response per SD higher fat%, P=0.004). Sum of skinfold thickness and BMI were not associated with cortisol responses.ConclusionsAbdominal adiposity is associated with reduced hypothalamic-pituitary-adrenal axis reactivity to stress in this adolescent population.

Anxiety and physiological responses to the Trier Social Stress Test for Children in adolescents with cyclic vomiting syndrome.

This study compared anxiety and physiological responses during the Trier Social Stress Test for Children (TSST-C) in adolescents. 38 subjects (26 females) were enrolled: 11 cyclic vomiting syndrome (CVS), 11 anxiety, and 16 controls. Salivary cortisol, α-amylase and heart rate variability (HRV) were assessed during the TSST-C. Anxiety was measured by the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), Anxiety Disorders Interview Schedule, and State-Trait Anxiety Inventory for Children (STAI-C). 11 anxiety and 7 CVS subjects had ≥1 anxiety disorder. 82% in the anxiety and CVS groups met criteria for an anxiety disorder on the SCARED. Combining groups, cortisol increased from baseline to recovery during the TSST-C (p=0.0004) and the stressor to recovery (p=0.005). α-amylase did not differ during the TSST-C for the total sample, but increased for anxiety compared to controls from baseline to recovery (p=0.01). HRV decreased during the stressor (p=0.0001) and increased at recovery (p=0.004). No associations were found between biomarkers and trait anxiety. Associations were found between baseline HRV and pre-test state anxiety (r=-0.406, p=0.012) and between recovery HRV and post-test state anxiety (r=-0.501, p=0.002) for the total sample. Anxiety is prevalent in CVS warranting screening. HRV may serve as a biomarker for evaluating stress as a potential trigger for CVS episodes. State but not trait anxiety was associated with changes in HRV, suggesting acute anxiety may be more relevant in linking stress and CVS episodes.

Effect of Pet Dogs on Children's Perceived Stress and Cortisol Stress Response.

The present study tested whether pet dogs have stress-buffering effects for children during a validated laboratory-based protocol, the Trier Social Stress Test for Children (TSST-C). Participants were 101 children aged 7-12 years with their primary caregivers and pet dogs. Children were randomly assigned in the TSST-C to a pet present condition or one of two comparison conditions: parent present or no support figure present. Baseline, response, and recovery indices of perceived stress and cortisol levels were computed based on children's self-reported feelings of stress and salivary cortisol. Results indicated that in the alone (no social support) condition, children showed the expected rise for both perceived stress and cortisol response to stress. Pet dog presence significantly buffered the perceived stress response in comparison to children in the alone and parent present conditions. No main condition effect was observed for cortisol; however, for children experiencing the stressor with their pet present, lower cortisol response to stress was associated with more child-initiated petting and less dog proximity-seeking behavior. The results support the notion that pet dogs can provide socio-emotional benefits for children via stress buffering.

The Association of Cortisol Stress Response with Early Adversity and Diabetes Control in Adolescents with Diabetes

1.1 Objectives: The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the relationship between increased stress and poor diabetes control in children with type 1 diabetes mellitus (T1DM). The objectives of this study were two-fold: (1) To evaluate the effectiveness of the Trier Social Stress Test for Children (TSST-C) in inducing psychosocial stress in children with T1DM; (2) To investigate predictors of the cortisol stress response to the TSST-C. 1.2 Methods: Seventeen adolescents with T1DM were exposed to the TSST-C. Salivary cortisol was sampled pre-TSST-C and at six 10-minute intervals following the stress procedure. Measures of anxiety, depression, family functioning and early adversity were completed. 1.3 Results: The TSST-C induced a significant increase in cortisol response (p<.01). Early adversity predicted cortisol response to the stressor (p=.01). Early adversity was also associated with poorer diabetes control (p=.05). 1.4 Conclusion: The TSST-C was effective in producing a stress response in children with diabetes. Whereas previous research has emphasized psychological pathways which contribute to the relationship between psychosocial stressors and poor diabetes control, this study suggests that biological dysfunction may also underlie the association.