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Growth delay as an index of allostatic load in young children: Predictions to disinhibited social approach and diurnal cortisol activity

  • Anna E. Johnson (a1), Jacqueline Bruce (a2), Amanda R. Tarullo (a3) and Megan R. Gunnar (a1)

The goal of this study was to examine whether growth delay can serve as an index of allostatic load during early development, as it is well known that the activity of stress-mediating systems inhibits growth. The participants were children adopted internationally from institutional care (n = 36), children adopted internationally from foster care (n = 26), and nonadopted children (n = 35). For the adopted children, height for age and weight for height were assessed at adoption; for all children, disinhibited social approach (DSA; termed elsewhere as “indiscriminate friendliness”) and diurnal cortisol were assessed at 6–8 years (M = 6.9 years). For internationally adopted children in general, and postinstitutionalized children specifically, linear growth delay assessed at the time of adoption was associated with more dysregulated behavior in response to an unfamiliar adult (i.e., greater DSA) and a more dysregulated diurnal cortisol rhythm (i.e., higher late afternoon and evening values). Further, among the most growth-delayed children, higher cortisol levels later in the day were correlated with DSA. The potential for using growth delay as an allostatic load indicator and the possible problems and limitations in its use in child populations are discussed.

Corresponding author
Address correspondence and reprint requests to: Megan R. Gunnar, Institute of Child Development, 51 East River Parkway, University of Minnesota, Minneapolis, MN, 55455; E-mail:
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Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Review Neuroscience, 10, 410422.
Awerman, J. L., & Romero, L. M. (2010). Chronic psychological stress alters body weight and blood chemistry in European starlings (Sturnus vulgaris). Comparative Biochemistry and Physiology Part A: Molecular and Integrative Physiology, 156, 136142.
Barker, D. J. (1997). Maternal nutrition, fetal nutrition, and disease in later life. Nutrition, 13, 807813.
Barker, D. J. (2007). The origins of the developmental origins theory. Journal of Internal Medicine, 261, 412417.
Blizzard, R. M., & Bulatovic, A. (1996). Syndromes of psychosocial short stature. In Lifshitz, F. (Ed.), Pediatric endocrinology (3rd ed., pp. 8393). New York: Marcel Dekker.
Bruce, J., Tarullo, A. R., & Gunnar, M. R. (2009). Disinhibited social behavior among internationally adopted children. Development and Psychopathology, 21, 151171.
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.
Chisholm, K. (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development, 69, 10921106.
Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5, 374381.
Cicchetti, D., & Gunnar, M. R. (Eds.). (2008). Integrating biological processes into the design and evaluation of preventive interventions. Development and Psychopathology, 20, 7371022.
Cicchetti, D., & Sroufe, L. A. (2000). The past as prologue to the future: The times, they've been a changin'. Development and Psychopathology, 12, 255264.
Cicchetti, D., & Toth, S. L. (2009). The past achievements and future promises of developmental psychopathology: The coming of age of a discipline. Journal of Child Psychology and Psychiatry, 50, 1625.
Cicchetti, D., & Tucker, D. (1994). Development and self-regulatory structures of the mind. Development and Psychopathology, 6, 533549.
Clements, A. D., & Parker, R. C. (1998). The relationship between salivary cortisol concentrations in frozen versus mailed samples. Psychoneuroendocrinology, 23, 613616.
Dautzenberg, F. M., Kilpatrick, G. J., Hauger, R. L., & Moreau, J. (2001). Molecular biology of the CRH receptors—In the mood. Peptides, 22, 753760.
Dobrova-Krol, N. A., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Cyr, C., & Juffer, F. (2008). Physical growth delays and stress dysregulation in stunted and non-stunted Ukrainian institution-reared children. Infant Behavior and Development, 31, 539553.
Fernald, L. C., & Grantham-McGregor, S. M. (1998). Stress response in school-age children who have been growth retarded since early childhood. American Journal of Clinical Nutrition, 68, 691698.
Fuglestad, A. J., Lehmann, A. E., Kroupina, M. G., Petryk, A., Miller, B. S., Iverson, S. L., et al. (2008). Iron deficiency in international adoptees from Eastern Europe. Journal of Pediatrics, 153, 272277.
Ganzel, B. L., Morris, P. A., & Wethington, E. (2010). Allostasis and the human brain: Integrating models of stress from the social and life sciences. Psychological Review, 117, 134174.
Gohlke, B. D., Khadilkar, V. V., Skuse, D., & Stanhope, R. (1998). Recognition of children with psychosocial short stature. Journal of Pediatric Endocrinology and Metabolism, 11, 509517.
Gunnar, M. R. (2000). Early adversity and the development of stress reactivity and regulation. In Nelson, C. A. (Ed.), The effects of adversity on neurobehavioral development. The Minnesota Symposia on Child Psychology (Vol. 31, pp. 163200). Mahwah, NJ: Erlbaum.
Gunnar, M. R., Frenn, K., Wewerka, S., & Van Ryzin, M. J. (2009). Moderate versus severe early life stress: Associations with stress reactivity and regulation in 10- to 12-year-old children. Psychoneuoendocrinology, 34, 6275.
Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol levels in children adopted from Romanian orphanages. Development and Psychopathology, 13, 611628.
Gunnar, M. R., & Quevedo, K. M. (2007a). The neurobiology of stress and development. Annual Review of Psychology, 58, 145173.
Gunnar, M. R., & Quevedo, K. M. (2007b). Early care experiences and HPA axis regulation in children: A mechanism for later trauma vulnerability. Progress in Brain Research, 167, 137149.
Himes, J. H., Park, K., Iverson, S. L., Mason, P., Federici, R., & Johnson, D. E. (2008). Physical growth and sexual maturation of severely deprived children reared in Romanian orphanages. In Ashizawa, K. & Cameron, N. (Eds.), Advances in the study of human growth and development (pp. 93–98). London: Smith–Gordon.
Hodges, J., & Tizard, B. (1989). IQ and behavioural adjustment of ex-institutional adolescents. Journal of Child Psychology and Psychiatry and Allied Disciplines, 30, 5375.
Johnson, D. E., Guthrie, D., Smyke, A. T., Koga, S. F., Fox, N. A., Zeanah, C. H., et al. (2010). Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care. Archives of Pediatric and Adolescent Medicine, 164, 507516.
Juster, R.-P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience and Biobehavioral Reviews, 35, 216.
Kertes, D. A., & Gunnar, M. R. (2004). Evening activities as a potential confound in research on the adrenocortical system in children. Child Development, 75, 193204.
Kertes, D. A., Gunnar, M. R., Madsen, N. J., & Long, J. (2008). Early deprivation and home basal cortisol levels: A study of internationally adopted children. Development and Psychopathology, 20, 473491.
Kumsta, R., Kreppner, J., Rutter, M., Beckett, C., Castle, J., Stevens, S., et al. (2010). III. Deprivation-specific psychological patterns. Monographs of the Society for Research in Child, 75, 4878.
Loman, M. M., Wiik, K. L., Frenn, K. A., Pollak, S. D., & Gunnar, M. R. (2009). Post-institutionalized children's development: Growth, cognitive, and language outcomes. Developmental and Behavioral Pediatrics, 30, 426434.
McEwen, B. S. (2006). Protective and damaging effects of stress mediators: Central role of the brain. Dialogues in Clinical Neuroscience, 8, 367381.
McEwen, B. S., & Gianaros, P. J. (2010). Central role of the brain in stress and adaptation: Links to socioeconomic status, health, and disease. Annals of the New York Academy of Science, 118, 190222.
McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153, 20932101.
McEwen, B. S., & Wingfield, J. C. (2010). What is in a name? Integrating homeostasis, allostasis and stress. Hormones and Behavior, 57, 105111.
Meaney, M. J., & Szyf, M. (2005). Environmental programming of stress responses through DNA methylation: Life at the interface between a dynamic environment and a fixed genome. Dialogues in Clinical Neuroscience, 7, 103123.
Mehta, A., Hindmarsh, P. C., Stanhope, R. G., Turton, J. P., Cole, T. J., Preece, M. A., et al. (2005). The role of growth hormone in determining birth size and early postnatal growth, using congenital growth hormone deficiency (GHD) as a model. Clinical Endocrinology, 63, 223231.
Miller, L. C., & Hendrie, N. W. (2000). Health of children adopted from China. Pediatrics, 105, 16.
O'Connor, T. G., Bredenkamp, D., & Rutter, M. (1999). Attachment disturbances and disorders in children exposed to early severe deprivation. Infant Mental Health Journal, 20, 1029.
Olney, R. C. (2009). Mechanisms of impaired growth: Effect of steroids on bone and cartilage. Hormone Research, 72(Suppl. 1), 3035.
Provence, S., & Lipton, R. C. (1962). Infants in institutions: A comparison of their development with family reared infants during the first year of life. New York: International Universities Press.
Repetti, R., Taylor, S. E., & Seeman, T. (2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128, 330366.
Rice, C. J., Sandman, C. A., Lenjavi, M. R., & Baram, T. Z. (2008). A novel mouse model for acute and long-lasting consequences of early life stress. Endocrinology, 149, 48924900.
Rivier, C., & Vale, W. (1985). Involvement of corticotropin-releasing factor and somatostatin in stress-induced inhibition of growth hormone secretion in the rat. Endocrinology, 117, 24782482.
Romero, L. M., Dickens, M. J., & Cyr, N. E. (2009). The reactive scope model: A new model integrating homeostasis, allostasis, and stress. Hormones and Behavior, 55, 375389.
Rutter, M., Colvert, E., Kreppner, J., Beckett, C., Castle, J., Groothues, C., et al. (2007). Early adolescent outcomes for institutionally-deprived and non-deprived adoptees. I: disinhibited attachment. Journal of Child Psychology and Psychiatry, 48, 1730.
Rutter, M., Kreppner, J., & Sonuga-Barke, E. (2009). Emanuel Miller Lecture: Attachment insecurity, disinhibited attachment, and attachment disorders: Where do research findings leave the concepts? Journal of Child Psychology and Psychiatry, 50, 529543.
Rutter, M., & O'Connor, T. G. (2004). Are there biological programming effects for psychological development? Findings from a study of Romanian adoptees. Developmental Psychology, 40, 8194.
Sameroff, A. J. (1989). Models of developmental regulation: The environtype. In Cicchetti, D. (Ed.), Rochester Symposium on Developmental Psychopathology: The emergence of a discipline (Vol. 1, pp. 4168). Hillsdale, NJ: Erlbaum.
Sánchez, 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.
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, 15031513.
Seeman, T., Gruenewald, T., Karlamangla, A., Sidney, S., Liu, K., McEwen, B., et al. (2010). Modeling multisystem biological risk in young adults: The Coronary Artery Risk Development in Young Adults Study. American Journal of Human Biology, 22, 463472.
Seeman, T., Singer, B. H., Rowe, J., Horwitz, R. I., & McEwen, B. (1997). Price of adaptation—Allostatic load and its health consequences. Archives of Internal Medicine, 157, 22592268.
Sonuga-Barke, E. J., Beckett, C., Kreppner, J., Castle, J., Colvert, E., Stevens, S., et al. (2008). Is sub-nutrition necessary for a poor outcome following early institutional deprivation? Developmental Medicine and Child Neurology, 50, 604671.
Sonuga-Barke, E. J., Schlotz, W., & Kreppner, J. (2010). V. Differentiating developmental trajectories for conduct, emotion, and peer problems following early deprivation. Monographs of the Society for Research in Child Development, 75, 102124.
Sonuga-Barke, E. J., Schlotz, W., & Rutter, M. (2010). VII. Physical growth and maturation following early severe institutional deprivation: Do they mediate specific psychopathological effects? Monographs of the Society for Research in Child Development, 75, 143166.
Spitz, R. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. In Freud, A., Hartmann, H., & Kris, E. (Eds.), The psychoanalytic study of the child (Vol. 1, pp. 5374). New York: International Universities Press.
Sterling, P., & Eyer, J. (1988). Allostasis: A new paradigm to explain arousal pathology. In S. Fisher & J. Reason (Eds.), Handbook of life stress, cognition and health (pp. 629–649). New York: Wiley.
Thompson, B. L., & Levitt, P. (2010). Now you see it, now you don't—Closing in on allostasis and developmental basis of psychiatric disorders. Neuron, 65, 437439.
Tizard, B. (1977). Adoption: A second chance. London: Open Books.
Tizard, B., & Rees, J. (1975). The effect of early institutional rearing on the behavioural problems and affectional relationships of four-year-old children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 16, 6173.
Turner-Cobb, J. M. (2005). Psychological and stress hormone correlates in early life: A key to HPA-axis dysregulation and normalisation. Stress, 8, 4757.
Van den Dries, L., Juffer, F., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2010). Infants' physical and cognitive development after international adoption from foster care or institutions in China. Journal of Developmental and Behavioral Pediatrics, 31, 114150.
van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Juffer, F. (2007). Plasticity of growth in height, weight, and head circumference: Meta-analytic evidence of massive catch-up after international adoption. Journal of Developmental and Behavioral Pediatrics, 28, 334343.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed.). San Antonio, TX: Psychological Corporation.
Wismer Fries, A. B., Shirtcliff, E. A., & Pollak, S. D. (2008). Neuroendocrine dysregulation following early social deprivation in children. Developmental Psychobiology, 50, 588599.
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