Intervening to enhance cortisol regulation among children at risk for neglect: Results of a randomized clinical trial

Abstract

The hypothalamus-pituitary-adrenal axis is particularly sensitive to conditions of maltreatment. In particular, neglected children have shown a flatter slope with lower wake-up values relative to nonneglected children. An intervention, the Attachment and Biobehavioral Catch-Up (ABC), was developed to enhance biological and behavioral regulation in young children at risk for neglect. The effectiveness of the intervention was assessed in a randomized clinical trial for children with involvement with Child Protective Services. Following the intervention, children receiving the ABC intervention (n = 49) showed more typical cortisol production, with higher wake-up cortisol values and a steeper diurnal slope, than children receiving the control intervention (n = 51). These results suggest that the ABC intervention is effective in enhancing biological regulation.

Figures

Figure 1

Consolidated Standards of Reporting Trials flow diagram. *We report numbers of children enrolled in ABC (n = 100) and DEF (n = 112) following completion of pre-intervention baseline visits. However, participants were randomly assigned to group upon consenting (N = 260; ABC n = 129, DEF n = 131), at which time the intervention group sample sizes were more similar. Follow-up numbers include participants seen for any post-intervention visits. More specific information is provided in Method section.

Figure 2

Cortisol patterns for neglected children who received the ABC intervention versus neglected children who received the control (DEF) intervention. Error bars represent SE.