Puetz Vanessa B, Zweerings Jana, Dahmen Brigitte, Ruf Caroline, Scharke Wolfgang, Herpertz-Dahlmann Beate, Konrad Kerstin
Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK.
Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany.
J Neural Transm (Vienna). 2016 Sep;123(9):1095-106. doi: 10.1007/s00702-016-1509-6. Epub 2016 Feb 13.
It has been debated whether children who have experienced early life stress (ELS), such as early caregiver separation show elevated risk for stress-related psychiatric disorders and a multi-symptom psychopathological profile that is not fully reflected in categorical assessments. In this study, we investigated dimensional measures of stress-related psychopathology in children in permanent out-of-home care, taking into account potential neuroendocrine interactions. In the current study, 25 children who had been placed in permanent out-of-home care before age 3 (years) and 26 controls (aged 10.6 ± 1.75 years) were investigated with categorical (DSM-IV) and dimensional assessments (CBCL) of psychopathology and diurnal salivary cortisol levels were assessed. Semi-structured interviews (K-DIPS) revealed no significant group differences in full-scale psychiatric diagnoses, whereas dimensional assessment (CBCL) revealed significant group differences in externalizing and total problem behaviours within the clinical range for children with ELS. Only children with ELS showed a combined symptom profile of clinical-range internalizing and externalizing problems. Lower morning cortisol values and subsequent flatter decline was found in subjects with ELS children compared to controls, showing group differences in diurnal cortisol secretion. Lower morning cortisol values were associated with more problem behaviour in the ELS group. Results show that ELS children exhibited increased psychopathological symptom severity and complexity associated with lower morning cortisol levels, which was not fully reflected in categorical assessments. This highlights the importance of incorporating dimensional assessments and neurobiological factors into psychopathological evaluations of children in out-of-home care in order to facilitate early identification of children at high risk for stress-related disorders.
经历过早期生活压力（ELS）的儿童，比如早期与照料者分离，是否会出现与压力相关的精神障碍风险升高以及多症状心理病理特征，而这种特征在分类评估中并未得到充分体现，这一问题一直存在争议。在本研究中，我们调查了长期家庭外照料儿童中与压力相关的心理病理学维度指标，并考虑了潜在的神经内分泌相互作用。在当前研究中，对25名3岁前就被安置在长期家庭外照料机构的儿童以及26名对照组儿童（年龄10.6±1.75岁）进行了心理病理学的分类评估（DSM-IV）和维度评估（CBCL），并评估了日间唾液皮质醇水平。半结构化访谈（K-DIPS）显示，在全面精神疾病诊断方面两组无显著差异，而维度评估（CBCL）显示，在ELS儿童的临床范围内，外化问题和总问题行为方面两组存在显著差异。只有ELS儿童表现出临床范围内内化和外化问题的综合症状特征。与对照组相比，ELS儿童组早晨皮质醇值较低，随后下降较平缓，表明两组在日间皮质醇分泌方面存在差异。ELS组中早晨皮质醇值较低与更多问题行为相关。结果表明，ELS儿童表现出心理病理症状严重程度和复杂性增加，且与早晨皮质醇水平较低有关，这在分类评估中并未得到充分体现。这凸显了将维度评估和神经生物学因素纳入家庭外照料儿童心理病理学评估的重要性，以便于早期识别有压力相关障碍高风险的儿童。
