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Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care

Published online by Cambridge University Press:  07 July 2008

Mary Dozier*
University of Delaware
Elizabeth Peloso
University of Delaware
Erin Lewis
University of Delaware
Jean-Philippe Laurenceau
University of Delaware
Seymour Levine
University of California, Riverside
Address correspondence and reprint requests to: Mary Dozier, Department of Psychology, 114 Wolf Hall, University of Delaware, Newark, DE 19716; E-mail:


Studies with nonhuman primates and rodents, as well as with human children, have suggested that early separations from caregivers are often associated with changes in the functioning of the hypothalamus–pituitary–adrenal (HPA) axis. On the basis of these findings, we designed a relational intervention that was intended to normalize HPA functioning among children in foster care. This paper presents findings from a randomized clinical trial that assessed the effectiveness of a relational intervention (Attachment and Biobehavioral Catch-up [ABC]) with regard to HPA functioning. The ABC intervention was intended to enhance children's ability to regulate physiology and behavior. The control intervention (Developmental Education for Families) was intended to enhance children's cognitive skills. A comparison group of children who had never been in foster care was also included. Children's cortisol production was assessed upon arrival at the lab, and 15 and 30 min following the Strange Situation. Random effects analyses of variance were performed to assess differences in initial values and change between children in the two intervention groups. Children in the ABC intervention and comparison group children showed lower initial values of cortisol than children in the treatment control group, considering arrival at lab as initial values (p < .05). Groups did not differ significantly in change over time. These results suggest that the ABC intervention is effective in helping children regulate biology in ways more characteristic of children who have not experienced early adversity.

Research Article
Copyright © Cambridge University Press 2008

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Support for this research was provided by NIMH R01 52135 and NIMH K02 74374 to the first author, and by NIMH Network Grant 65046 (Gunnar and Fisher, co-Principal Investigators). We acknowledge the support of the Philadelphia Department of Human Services and Delaware Division of Family Services and the caseworkers, foster families, and children at both agencies.


Abbott, D. H., Keverne, E. B., Bercovitch, F. B., Shively, C. A., Mendoza, S. P., Saltzman, W., et al. (2003). Are subordinates always stressed? A comparative analysis of rank differences in cortisol levels among primates. Hormones and Behavior, 43, 6782.CrossRefGoogle ScholarPubMed
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.Google Scholar
Barnard, K. (1999). Beginning rhythms: The emerging process of sleep wake behaviors and self-regulation. Seattle, WA: University of Washington, NCAST.Google Scholar
Brooks-Gunn, J., Klebanov, P. K., Liaw, F., & Spiker, D. (1993). Enhancing the development of low birth weight, premature infants: Changes in cognition and behavior over the first three years. Child Development, 64, 736753.CrossRefGoogle ScholarPubMed
Bruce, J., Davis, E. P., & Gunnar, M. R. (2002). Individual differences in children's cortisol response to the beginning of the new school year. Psychoneuroendocrinology, 27, 635650.CrossRefGoogle Scholar
Caldji, C., Tannenbaum, B., Sharma, S., Francis, D., Plotsky, P. M., & Meaney, M. J. (1998). Maternal care during infancy regulates the development of neural systems mediating the expression of behavioral fearfulness in adulthood in the rat. Proceedings of the National Academy of Sciences of the United States of America, 95, 53355340.CrossRefGoogle Scholar
Carlson, E. A. (1998). A prospective longitudinal study of attachment disorganization/disorientation. Child Development, 69, 11071128.CrossRefGoogle ScholarPubMed
Carlson, M., & Earls, F. (1997). Psychological and neuroendocrinological sequelae of early social deprivation in institutionalized children in Romania. Annals of the New York Academy of Sciences, 807, 419428.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Curtis, W. J. (2006). The developing brain and neural plasticity: Implications for normality, psychopathology, and resilience. In Cicchetti, D. & Cohen, D. (Eds.), Developmental psychopathology: Vol. 2. Developmental neuroscience (2nd ed., pp. 164). New York: Wiley.Google Scholar
Cicchetti, D., & Rogosch, F. A. (2001). Diverse patterns of neuroendocrine activity in maltreated children. Development and Psychopathology, 13, 677693.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Valentino, K. (2006). An ecological–transactional perspective on child maltreatment: Failure of the average expectable environment and its influence on child development. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation (2nd ed., pp. 129201). Hoboken, NJ: Wiley.Google Scholar
Cirulli, F., Berry, A., & Alleva, E. (2003). Early disruption of the mother–infant relationship: Effects on brain plasticity and implications for psychopathology. Neuroscience and Biobehavioral Reviews, 27, 7382.CrossRefGoogle ScholarPubMed
Davies, P. T., Sturge-Apple, M. L., Cicchetti, D., & Cummings, E. M. (2007). The role of child adrenocortical functioning in pathways between interparental conflict and child maltreatment. Developmental Psychology, 43, 918930.CrossRefGoogle Scholar
Dickerson, S. S., & Kimeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355391.CrossRefGoogle ScholarPubMed
Dozier, M., Higley, E., Albus, K. E., & Nutter, A. (2002). Intervening with foster infants' caregivers: Targeting three critical needs. Infant Mental Health Journal, 23, 541554.CrossRefGoogle Scholar
Dozier, M., Manni, M., Gordon, M.K., Peloso, E., Gunnar, M. R., Stovall-McClough, K. C., et al. (2006). Foster children's diurnal production of cortisol: An exploratory study. Child Maltreatment, 11, 189197.CrossRefGoogle ScholarPubMed
Dozier, M., Peloso, E., Lindhiem, O., Gordon, K., Manni, M., Sepulveda, S., et al. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62, 767785.CrossRefGoogle Scholar
Dozier, M., Stovall, K. C., Albus, K. E., & Bates, B. (2001). Attachment for infants in foster care: The role of caregiver state of mind. Child Development, 72, 14671477.CrossRefGoogle ScholarPubMed
Field, T., Hernandez-Reif, M., Diego, M., Feijo, L., Vera, Y., & Gil, K. (2004). Massage therapy by parents improves early growth and development. Infant Behavior & Development, 27, 435442.CrossRefGoogle Scholar
Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., & Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience, 115, 13971413.CrossRefGoogle ScholarPubMed
Field, T., Schanberg, S. M., Scafidi, F., Bauer, C. R., Vega-Lahr, N., Garcia, R., et al. (1986). Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics, 77, 654658.CrossRefGoogle ScholarPubMed
Fisher, P. A., Gunnar, M. R., Chamberlain, P., & Reid, J. B. (2000). Preventative intervention for maltreated preschool children: Impact on children's behavior, neuroendocrine activity, and foster parent functioning. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 13561364.CrossRefGoogle ScholarPubMed
Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology. 30, 10101016.CrossRefGoogle ScholarPubMed
Gordon, M. K., Peloso, E., Auker, A., & Dozier, M. (2005). The effect of flavored beverage crystals on salivary cortisol enzyme-immunoreactive assay measurements. Developmental Psychobiology, 47, 189195.CrossRefGoogle ScholarPubMed
Gunnar, M. R. (1998). Quality of early care and buffering of neuroendocrine stress reactions: Potential effects on the developing human brain. Preventive Medicine: An International Journal Devoted to Practice and Theory, 27, 208211.CrossRefGoogle ScholarPubMed
Gunnar, M. R., Brodersen, L., Krueger, K., & Rigatuso, J. (1996). Dampening of adrenocortical responses during infancy: Normative changes and individual differences. Child Development, 67, 877889.CrossRefGoogle ScholarPubMed
Gunnar, M. R., Brodersen, L., Nachmias, M., Buss, K., & Rigatuso, J. (1996). Stress reactivity and attachment security. Developmental Psychobiology, 29, 191204.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Gunnar, M. R., & Cheatham, C. L. (2003). Brain and behavior interface: Stress and the developing brain. Infant Mental Health Journal, 24, 195211.CrossRefGoogle Scholar
Gunnar, M. R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology, 27, 199220.CrossRefGoogle ScholarPubMed
Gunnar, M. R., Fisher, P. A., & The Early Experience, Stress, and Prevention Network (2006). Bringing basic research on early experience and stress neurobiology to bear on preventative interventions for neglected and maltreated children. Development and Psychopathology, 18, 651677.CrossRefGoogle ScholarPubMed
Gunnar, M. R., Larson, M. C., Hertsgaard, L., Harris, M. L., & Brodersen, L. (1992). The stressfulness of separation among nine-month-old infants: Effects of social context variables and infant temperament. Child Development, 63, 290303.CrossRefGoogle ScholarPubMed
Gunnar, M. R., Mangelsdorf, S., Larson, M., & Hertsgaard, L. (1989). Attachment, temperament, and adrenocortical activity in infancy: A study of psychoendocrine regulation. Developmental Psychology, 25, 355363.CrossRefGoogle Scholar
Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol in children adopted from Romanian orphanages. Development and Psychopathology, 13, 611628.CrossRefGoogle ScholarPubMed
Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145173.CrossRefGoogle ScholarPubMed
Gunnar, M. R., & Vazquez, D. M. (2001). Low cortisol and a flattening of expected daytime rhythm: Potential indices of risk in human development. Development and Psychopathology, 13, 515538.CrossRefGoogle Scholar
Gunnar, M. R., & White, B. P. (2001). Salivary cortisol measures in infant and child assessment. In Singer, L. T. & Zeskind, P. S. (Eds.), Biobehavioral assessment of the infant. New York: Guilford Press.Google Scholar
Hertsgaard, L., Gunnar, M., Erickson, M. F., & Nachmias, M. (1995). Adrenocortical responses to the strange situation in infants with disorganized/disoriented attachment relationships. Child Development, 66, 11001106.CrossRefGoogle Scholar
Hofer, M. A. (1994). Hidden regulators in attachment, separation, and loss. Mongraphs of the Society for Research in Child Development, 59, 192207.CrossRefGoogle ScholarPubMed
Howe, M. L., Cicchetti, D., & Toth, S. L. (2006). Children's basic memory processes, stress, and maltreatment. Development and Psychopathology, 18, 759769.CrossRefGoogle ScholarPubMed
Izard, C.E., Fine, S., Mostow, A., Trentacosta, C., & Campbell, J. (2002). Emotion processes in normal and abnormal development and preventative intervention. Development and Psychopathology, 14, 761787.CrossRefGoogle Scholar
Izard, C. E., Trentacosta, C. J., King, K. A., & Mostow, A. J. (2004). An emotion-based prevention program for Head Start children. Early Education and Development, 15, 407422.CrossRefGoogle Scholar
Kirschbaum, C., Pirke, K., & Hellhammer, D. H. (1993). The “Trier Social Stress Test”: A tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28, 7681.CrossRefGoogle Scholar
Kreppner, J. M., Rutter, M., Beckett, C., Castle, J., Colvert, E., Groothues, C., et al. (2007). Normality and impairment following profound early institutional deprivation: A longitudinal follow-up into early adolescence. Developmental Psychology, 43, 931946.CrossRefGoogle ScholarPubMed
Kudielka, B. M., Hellhammer, D. H., & Kirschbaum, C. (2007). Ten years of research with the Trier Social Stress Test—Revisited. New York: Guilford Press.Google Scholar
Larson, M., Gunnar, M. R., & Hertsgaard, L. (1991). The effects of morning naps, car trips, and maternal separation on adrenocortical activity in human infants. Child Development, 62, 362372.CrossRefGoogle ScholarPubMed
Larson, M., White, B. P., Cochran, A., Donzella, B., & Gunnar, M. R. (1998). Dampening of the cortisol response to handling at 3-months in human infants and its relation to sleep, circadian cortisol activity, and behavioral distress. Developmental Psychobiology, 33, 327337.3.0.CO;2-S>CrossRefGoogle Scholar
Levine, S., & Mody, T. (2003). The long-term psychobiological consequences of intermittent postnatal separation in the squirrel monkey. Neuroscience and Biobehavioral Reviews, 27, 8389.CrossRefGoogle ScholarPubMed
Lewis, M., & Ramsay, D. S. (1995). Developmental changes in infant responses to stress. Child Development, 66, 657670.CrossRefGoogle ScholarPubMed
Lyons-Ruth, K., Alpern, L., & Repacholi, B. (1993). Disorganized infant attachment and maternal psychsocial problems as predictors of hostile–aggressive behavior in the preschool classroom. Child Development, 64, 572585.CrossRefGoogle Scholar
McRae, A. L., Saladin, M. E., Brady, K. T., Upadhyaya, H., Back, S. E., & Timmerman, M. A. (2006). Stress reactivity: Biological and subjective responses to the cold pressor and trier social stressors. Human Psychopharmacology: Clinical and Experimental, 21, 377385.CrossRefGoogle Scholar
Meaney, M. J., & Szyf, M. (2005). Maternal care as a model for experience-dependent chromatin plasticity? Trends in Neurosciences, 28, 456463.CrossRefGoogle Scholar
Mirescu, C., Peters, J. D., & Gould, E. (2004). Early life experience alters response of adult neurogenesis to stress. Nature Neuroscience, 7, 841846.CrossRefGoogle ScholarPubMed
Nachmias, M., Gunnar, M., Mangelsdorf, S., & Parritz, R. H. (1996). Behavioral inhibition and stress reactivity: The moderating role of attachment security. Child Development, 67, 508522.CrossRefGoogle ScholarPubMed
Price, D. A., Close, G. C., & Fielding, B. A. (1983). Age of appearance of circadian rhythm in salivary cortisol values in infancy. Archives of Disease in Childhood, 58, 454456.CrossRefGoogle ScholarPubMed
Ramey, C. T., McGinness, G. D., Cross, L., Collier, A. M., & Barrie-Blackley, S. (1982). The Abecedarian approach to social competence: Cognitive and linguistic intervention for disadvantaged preschoolers. In Borman, K. (Ed.), The social life of children in a changing society (pp. 14174). Hillsdale, NJ: Erlbaum.Google Scholar
Ramey, C. T., Yeates, K. O., & Short, E. J. (1984). The plasticity of intellectual development: Insights from preventative intervention. Child Development. 55, 19131925.CrossRefGoogle Scholar
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
Sanchez, M. M., Ladd, C. O., & Plotsky, P. M. (2001). Early adverse experience as a developmental risk factor for later psychopathology: Evidence from rodent and primate models. Development and Psychopathology, 13, 419449.CrossRefGoogle ScholarPubMed
Sanchez, M. M., Noble, P. M., Lyon, C. K., Plotsky, P. M., Davis, M., Nemeroff, C. B., et al. (2005). Alterations in diurnal cortisol rhythm and acoustic startle response in nonhuman primates with adverse rearing. Biological Psychiatry, 57, 373381.CrossRefGoogle ScholarPubMed
Sapolsky, R. M., & Meaney, M. J. (1986). Maturation of the adrenocortical stress response: Neuroendocrine control mechanisms and the stress hyporesponsive period. Brain Research Reviews, 11, 6576.CrossRefGoogle Scholar
Schwartz, E. B., Granger, D. A., Susman, E. J., Gunnar, M. R., & Laird, B. (1998). Assessing salivary cortisol in studies of child development. Child Development, 69, 1503.CrossRefGoogle ScholarPubMed
Shafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147177.CrossRefGoogle Scholar
Snijders, T. A. B., & Bosker, R. J. (1999). Multilevel analysis. An introduction to basic and advanced multilevel modeling. London: Sage.Google Scholar
Southam-Gerow, M. A., & Kendall, P. C. (2002). Emotion regulation and understanding: Implications for child psychopathology and therapy. Clinical Psychology Review, 22, 189222.CrossRefGoogle ScholarPubMed
Spangler, G., & Grossman, K. E. (1993). Biobehavioral organization in securely and insecurely attached infants. Child Development, 64, 14391450.CrossRefGoogle ScholarPubMed
Stovall, K. C., & Dozier, M. (2000). The development of attachment in new relationships: Single subject analyses for ten foster infants. Development and Psychopathology, 12, 133156.CrossRefGoogle Scholar
Stovall-McClough, K. C., & Dozier, M. (2004). Forming attachments in foster care: Infant attachment behaviors in the first two months of placement. Development and Psychopathology, 16, 253271.CrossRefGoogle Scholar
Talge, N. M., Donzella, B., Kryzer, E., Gierens, A., & Gunnar, M. R. (2005). It's not that bad: Error introduced by oral stimulants in salivary cortisol research. Developmental Psychobiology, 4, 369376.CrossRefGoogle Scholar
Tarullo, A. R., & Gunnar, M. R. (2006). Child maltreatment and the developing HPA axis. Hormones and Behavior, 50, 632639.CrossRefGoogle ScholarPubMed
van den Boom, D. C. (1994). The influence of temperament and mothering on attachment and exploration: An experimental manipulation of sensitive responsiveness among lower-class mothers with irritable infants. Child Development, 65, 14571477.Google ScholarPubMed
van den Boom, D. C. (1995). Do first-year intervention effects endure? Follow-up during toddlerhood of a sample of Dutch irritable infants. Child Development, 66, 17981816.Google ScholarPubMed
van den Boom, D. C. (1997). Sensitivity and attachment: Next steps for developmentalists. Child Development, 68, 592594.CrossRefGoogle ScholarPubMed
Watamura, S. E., Donzella, B., Alwin, J., & Gunnar, M. R. (2003). Morning-to-afternoon increases in cortisol concentrations for infants and toddlers at child care: Age differences and behavioral correlates. Child Development, 74, 10061020.CrossRefGoogle ScholarPubMed