Intervention Effects on Morning and Stimulated Cortisol Responses Among Toddlers in Foster Care.

Toddlers in child welfare often have a dysregulated stress response. We tested whether toddlers with caregivers randomized to a 10-week attachment-based intervention, Promoting First Relationships (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008) would show post-intervention change in stimulated salivary cortisol patterns during a research home visit involving a separation-reunion procedure, compared to a condition including child development and resource advice, but no attachment strategies. At baseline and post intervention, toddlers with a caregiver change within 7 weeks of enrollment (n=48, age 10-25 months) provided 4 saliva samples during a 1.5-hour research visit, and samples the next morning. The categorical dependent variable was the pattern of cortisol activity during the course of the post-intervention research visit: Flat, Decreasing, Increasing. Multinomial logistic regression was used to test for post-intervention group differences in cortisol patterns, controlling for time of day, child's age, morning cortisol level, and baseline cortisol pattern. At baseline and post-intervention 92% of children demonstrated atypically low morning cortisol (< .21 ig/dL); Post-intervention, Flat, Decreasing and Increasing patterns were exhibited by 70%, 15%, and 15% of the sample, respectively. Significantly more children in the PFR condition showed an Increasing pattern. This may signal an intervention effect on separation-based stress response physiology.