How to help children “catch up” biologically

Children who are neglected and exposed to maltreatment during childhood are at greater risk for mental and physical health problems for the rest of their life. Thanks to a few decades of systematic research and the participation of thousands of people, we have good reason to believe that these long term negative consequences of childhood adversity occur through the development of our biological stress response system. I won’t go into the mechanics, but essentially we have a system that helps us redistribute energy throughout the body when we need to protect ourselves from a threat, and this system’s output in called cortisol. Every day the cortisol in your body should be highest in the morning and lowest at night. When your cortisol values vary from this pattern, it’s likely an indicator that something in your physiological system isn’t working properly. Kids who have been maltreated often don’t show this normal pattern of cortisol across the day. Instead, they have lower cortisol in the morning, which doesn’t decline across the day. This is an important phenomenon for researchers to understand because cortisol that is too low or too high can get in the way of healthy development, and even cause medical conditions. We’ve talked about some of this before, here and here and here.

Before I completely depress you about the prognosis for maltreated children, you may wonder whether there’s anything that helps. Luckily, Dr. Kristen Bernard at SUNY Stony Brook recently published results of an intervention study that gives us hope that some of these effects of maltreatment can be helped.

To do this, she recruited 101 children between the ages of 5 months and 3 years who were already involved in child protective services to prevent them from going into the foster system. Children in this sample were enrolled in social services for a number of reasons including a parent’s history of maltreating another child, homelessness, parent substance abuse, and domestic violence. These children and their parents were then randomly assigned to one of two interventions: Attachment and Biobehavioral Catchup (ABC) or a control condition called Developmental Education for Families (DEF).

ABC was a ten session intervention where parenting coaches led parents through a series of topics including: learning the lesson that children need their parents even when they fail to signal their needs clearly, how to follow the child’s lead or “synchrony,” how to help parents not be intrusive or frightening, and how to identify “voices from the past” that affect their parenting. The goal of this intervention was to promote the attachment between parent and child in an effort to minimize opportunities for child neglect or maltreatment.

In comparison, DEF was also a ten session intervention that has been shown in previous studies to enhance intellectual functioning. In this intervention, parents were taught about developmental milestones and how to play and interact with their child using age-appropriate activities. After the intervention was over, each child provided saliva samples when they woke up and at bedtime for two to three days. Cortisol was then measured from within these saliva samples.

Children in the DEF condition had low cortisol in the morning and slight decreases in cortisol at bedtime. In comparison, children in the ABC condition had much higher cortisol in the morning and a clear decline in cortisol across the day. Thus, something about the attachment focused intervention served to “normalize” these at-risk youth’s physiological stress system, while merely providing education to parents about their child’s development didn’t.

So what, you say? Most importantly, this intervention study gives me reassurance that kids who are born into risky family environments can be helped. Unfortunately, these children weren’t necessarily maltreated, simply at risk for maltreatment, so we can’t use this study to say that the negative physiological consequences of child maltreatment are reversible with therapy, yet. Instead, we can be confident that the system is resilient, and some of these lifelong consequences of child adversity aren’t inevitable.

More pertinent to our daily lives, I expect that the active elements of the ABC intervention are relevant to everyone on a continuum, and we could all be a little bit better at caregiving if we resolve to work on any of these skills a little bit each day. For example, it’s very difficult to follow a child’s lead all of the time. One of the hardest skills for many of my families to learn has been child-directed play (here’s a resource), but it makes a world of difference; not only in the child’s ability to learn but in the relationship between the child and caregiver. Similarly, most adults have been intrusive and/or frightening at some point in their lives, especially if they spend the majority of their time interacting with adults. A lot of adult interactions are intrusive and potentially frightening to a child. Just because you and other adults don’t think you’re intrusive, doesn’t mean kids don’t feel intruded on or frightened, and it's our jobs to be in tune with that.

I could go on and on and on, but instead I will just leave you with the reminder that children are influenced by the adults in their environment in more ways than you could ever count, and some of those influences will last a lifetime. Let’s make them good ones.

Bernard, K., Dozier, M., Bick, J., & Gordon, M. K. (2014). Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial. Development and Psychopathology, 1-13.