Doom Jenalee R, Cicchetti Dante, Rogosch Fred A
Institute of Child Development and the Center for Neurobehavioral Development, University of Minnesota, Minneapolis.
Institute of Child Development, University of Minnesota, and Mt. Hope Family Center, Rochester, NY.
J Am Acad Child Adolesc Psychiatry. 2014 Nov;53(11):1206-15. doi: 10.1016/j.jaac.2014.08.006. Epub 2014 Sep 3.
Child maltreatment is associated with dysregulation of stress-mediating systems and an increased risk of mental and physical health problems. Specifically, disruptions in hypothalamic-pituitary-adrenal (HPA) axis regulation have been reported in maltreated children. The current study investigates whether increased cortisol variability is responsible for inconsistent patterns in the literature.
This study modeled cortisol activity over 20 weeks in 187 maltreated and 154 nonmaltreated children (mean = 8.4 years, SD = 1.8 years) in order to capture week-to-week cortisol patterns. Maltreatment was assessed through coding of Department of Human Services records. Children attended an after-school program 1 day per week for 20 weeks, where saliva was collected at the same time each day and subsequently assayed for cortisol.
Multiple-group growth curves indicated that maltreated and non-maltreated children differ in longitudinal cortisol patterns. Maltreated children showed higher variance in the initial cortisol levels and slope over time compared to nonmaltreated children, indicating greater between-person variability in the maltreated group. Maltreated children with higher cortisol at the first assessment showed cortisol suppression over time, indicating potential HPA blunting after chronic high cortisol levels. The severity, timing, and number of subtypes of maltreatment predicted individuals' cortisol variability, and both maltreatment status and greater cortisol variability predicted more behavior problems.
Interventions for maltreated children may benefit from pre- and post-intervention HPA assessments to determine a component of treatment efficacy. As maltreatment dimensions predicted differential cortisol regulation, assessment of maltreatment experiences is necessary to understand alterations in behavior and HPA regulation post-intervention.
儿童虐待与应激调节系统失调以及身心健康问题风险增加有关。具体而言，已有报道称受虐待儿童的下丘脑 - 垂体 - 肾上腺（HPA）轴调节存在紊乱。本研究调查皮质醇变异性增加是否是文献中不一致模式的原因。
本研究对187名受虐待儿童和154名未受虐待儿童（平均年龄 = 8.4岁，标准差 = 1.8岁）20周内的皮质醇活动进行建模，以捕捉每周的皮质醇模式。通过对人类服务部记录进行编码来评估虐待情况。儿童每周参加一次课外项目，为期20周，每天在同一时间采集唾液，随后检测皮质醇。
多组生长曲线表明，受虐待儿童和未受虐待儿童在纵向皮质醇模式上存在差异。与未受虐待儿童相比，受虐待儿童在初始皮质醇水平和随时间变化的斜率上表现出更高的方差，表明受虐待组个体间变异性更大。在首次评估时皮质醇水平较高的受虐待儿童随时间出现皮质醇抑制，表明慢性高皮质醇水平后可能出现HPA轴钝化。虐待的严重程度、时间和亚型数量可预测个体的皮质醇变异性，虐待状态和更大的皮质醇变异性均预测更多行为问题。
对受虐待儿童的干预可能受益于干预前后的HPA评估，以确定治疗效果的一个组成部分。由于虐待维度预测了不同的皮质醇调节，因此评估虐待经历对于理解干预后行为和HPA调节的改变是必要的。
