Reducing Kids' Stress Simple as ABC
Medscape Medical News
December 05, 2014
A novel intervention that focuses on increasing parental nurturing and decreasing frightening behavior may provide long-term beneficial effects on diurnal cortisol rhythms in at-risk children, signifying decreased stress levels, new research suggests.
Results from a randomized controlled trial (RCT) of more than 100 preschoolers who were referred to protective services as infants because of neglect showed that those who received the 10-week parenting intervention called Attachment and Biobehavioral Catch-up (ABC) had more typical patterns of cortisol production 3 years later than those who received a parenting education intervention.
"I wasn't surprised, necessarily, but I was excited to see that intervening in a short but very targeted way could change parenting so that it actually sustains better self-regulation for kids over time," lead author Kristin Bernard, PhD, assistant professor of psychology at Stony Brook University in New York, told Medscape Medical News.
"I think for clinicians, the take-home message from this study and past literature is that earlier interventions are better. We need parents to be able to buffer their children from the effects of stress," added Dr Bernard, who was at the University of Delaware during the research.
The study was published online December 1 in JAMA Pediatrics.
Parents a Protective Factor
The investigators note that parental maltreatment and frequent stressful interactions can disrupt normative developmental processes and affect the hypothalamic-pituitary-adrenal (HPA) axis in children. "Disrupted patterns of HPA activity are associated with numerous behavioral and emotional problems," they write.
Cortisol is the "end product" of the HPA axis. It normally increases in the early morning, peaking approximately 30 minutes after waking. It then decreases throughout the day to near-zero levels at night.
The researchers report that several interventions for at-risk children have shown benefits for HPA activity immediately after treatment. They wanted to investigate whether these benefits are maintained over time.
They examined children of families who had been reported to child protective services when the kids were younger than 24 months. All were randomly assigned to receive 10 sessions of either the ABC intervention or a control intervention called Developmental Education for Families (DEF).
ABC was developed by the study's principal investigator, Mary Dozier, PhD, from the Department of Psychological and Brain Sciences at the University of Delaware, in Newark. It is a 10-week program designed to help parents become more nurturing, increase responsive interactions, and become less frightening. A guided manual and parent coaches were included.
"It's designed to help parents to really serve as a protective factor for their children from negative consequences of early life stress," said Dr Bernard.
"We were interested in whether having a sensitive parent could actually help children with cortisol regulation, by having parents act as sort of 'coregulators' early in development."
DEF focused on general information "about developmental milestones and suggested developmentally appropriate activities for parents to engage in with their child," write the researchers.
The ages of the 115 children (54 in the ABC intervention, 61 in DEF) available for the current follow-up analysis were 46 to 69 months (mean age, 50.7 months).
Salivary cortisol samples were collected by parents on three different days 30 minutes after waking and right before bedtime, for a total of 6 samples per child.
Long-Lasting Effect
The follow-up results showed that the ABC group of preschool children had significantly different cortisol production than the control group, and showed more typical production patterns.
The active treatment group had significantly higher mean waking cortisol levels (-0.87 ?g/dL vs -1.05 ?g/dL, respectively; P = .03). They also had a steeper mean decrease in cortisol across the day (-0.31 ?g/dL vs -0.12 ?g/dL, respectively; P = .02).
"Thus, children in the DEF group showed a more blunted diurnal cortisol pattern," noted the investigators.
There were no significant between-group differences in bedtime cortisol levels.
Overall, "this is encouraging evidence that the ABC intervention for Child Protective Services?referred children may have long-lasting effects on a physiological stress system critical for health and adjustment," write the investigators.
Dr Bernard added that although ABC is a short treatment, it is very targeted.
"It only focuses on changing aspects of parenting that have to do with attachment and self-regulation. I think that's important to why it works and how it works," she said.
"We're not trying to do everything. We're just trying to help parents be sensitive at the key developmental point when kids really need it."
The study authors have reported no relevant financial relationships.
JAMA Pediatr. Published online December 1, 2014. Abstract
Complete article
is attached for download / viewing / printing
Medscape Medical News
December 05, 2014
A novel intervention that focuses on increasing parental nurturing and decreasing frightening behavior may provide long-term beneficial effects on diurnal cortisol rhythms in at-risk children, signifying decreased stress levels, new research suggests.
Results from a randomized controlled trial (RCT) of more than 100 preschoolers who were referred to protective services as infants because of neglect showed that those who received the 10-week parenting intervention called Attachment and Biobehavioral Catch-up (ABC) had more typical patterns of cortisol production 3 years later than those who received a parenting education intervention.
"I wasn't surprised, necessarily, but I was excited to see that intervening in a short but very targeted way could change parenting so that it actually sustains better self-regulation for kids over time," lead author Kristin Bernard, PhD, assistant professor of psychology at Stony Brook University in New York, told Medscape Medical News.
"I think for clinicians, the take-home message from this study and past literature is that earlier interventions are better. We need parents to be able to buffer their children from the effects of stress," added Dr Bernard, who was at the University of Delaware during the research.
The study was published online December 1 in JAMA Pediatrics.
Parents a Protective Factor
The investigators note that parental maltreatment and frequent stressful interactions can disrupt normative developmental processes and affect the hypothalamic-pituitary-adrenal (HPA) axis in children. "Disrupted patterns of HPA activity are associated with numerous behavioral and emotional problems," they write.
Cortisol is the "end product" of the HPA axis. It normally increases in the early morning, peaking approximately 30 minutes after waking. It then decreases throughout the day to near-zero levels at night.
The researchers report that several interventions for at-risk children have shown benefits for HPA activity immediately after treatment. They wanted to investigate whether these benefits are maintained over time.
They examined children of families who had been reported to child protective services when the kids were younger than 24 months. All were randomly assigned to receive 10 sessions of either the ABC intervention or a control intervention called Developmental Education for Families (DEF).
ABC was developed by the study's principal investigator, Mary Dozier, PhD, from the Department of Psychological and Brain Sciences at the University of Delaware, in Newark. It is a 10-week program designed to help parents become more nurturing, increase responsive interactions, and become less frightening. A guided manual and parent coaches were included.
"It's designed to help parents to really serve as a protective factor for their children from negative consequences of early life stress," said Dr Bernard.
"We were interested in whether having a sensitive parent could actually help children with cortisol regulation, by having parents act as sort of 'coregulators' early in development."
DEF focused on general information "about developmental milestones and suggested developmentally appropriate activities for parents to engage in with their child," write the researchers.
The ages of the 115 children (54 in the ABC intervention, 61 in DEF) available for the current follow-up analysis were 46 to 69 months (mean age, 50.7 months).
Salivary cortisol samples were collected by parents on three different days 30 minutes after waking and right before bedtime, for a total of 6 samples per child.
Long-Lasting Effect
The follow-up results showed that the ABC group of preschool children had significantly different cortisol production than the control group, and showed more typical production patterns.
The active treatment group had significantly higher mean waking cortisol levels (-0.87 ?g/dL vs -1.05 ?g/dL, respectively; P = .03). They also had a steeper mean decrease in cortisol across the day (-0.31 ?g/dL vs -0.12 ?g/dL, respectively; P = .02).
"Thus, children in the DEF group showed a more blunted diurnal cortisol pattern," noted the investigators.
There were no significant between-group differences in bedtime cortisol levels.
Overall, "this is encouraging evidence that the ABC intervention for Child Protective Services?referred children may have long-lasting effects on a physiological stress system critical for health and adjustment," write the investigators.
Dr Bernard added that although ABC is a short treatment, it is very targeted.
"It only focuses on changing aspects of parenting that have to do with attachment and self-regulation. I think that's important to why it works and how it works," she said.
"We're not trying to do everything. We're just trying to help parents be sensitive at the key developmental point when kids really need it."
The study authors have reported no relevant financial relationships.
JAMA Pediatr. Published online December 1, 2014. Abstract
Complete article
is attached for download / viewing / printing
