Thursday, February 24, 2011

Behavior and Cortisol Levels in Children Part 1

There is a new research study from Concordia University that examines the effects of cortisol and the behavior patterns of children. This is an area of interest for me because when Genea first came to us she had been diagnosed with something similar to Addison's Disease. Her body was only minimally able to produce cortisol and we had a very strict medication schedule to follow. There were several pages of possible events where we were to increase her medications in detailed increments, and for such things as vomiting or a broken bone we were to inject her with the medicine. It is a disease that is manageable, but potentially fatal if you were to fail to administer the medication correctly.
No one knew what caused it. There was speculation that she may have been given steroids in the orphanage in Ukraine and overuse caused her cortisol production to shut down. Otherwise, it is extremely rare in children and without a family history no one could say for sure what the etiology was.
Cortisol is a hormone that the body produces when it is stressed. There are several functions to it and if you are interested, there is detailed information here, at Cortisol- from Wikipedia. The biological purpose seems to be to give the body an extra boost to blare through the stressful event whether physical, situational or emotional.
The article I read shows that children who show intense behavioral problems have unusually high levels of cortisol. However, as they get older the levels go down until the result is lower than normal levels of cortisol. Here is the press release:

Behavior Problems Linked to Cortisol Levels

Now, Concordia University did not perform this study with me in mind, and there are a lot of details I would have liked addressed. However, I think that for parents with children from trauma, neglect and abuse the results of this study can give us some ideas and direction.

Here comes my opinion, and lots of it. The authors state that where some children have abnormally high levels of cortisol and some have abnormally low levels even when they are externalizing the same forms of negative behavior, it is the length of time the negative behavior has been occurring that makes the difference. The research does not appear to have been done with any particular "class" of children, so whether the child shows signs of mental illness, has a spectrum disorder, or has experienced trauma they seem to have been evaluated all the same. Since there is no mention of excluding children from trauma I am going to go ahead and assume we can include them.

I am going to make a further assumption that children who have been adopted from situations of neglect, or abuse or trauma have experienced events long enough to have spiked the extremely high levels and  have the resulting reduced levels, lower than normal, of cortisol in their bodies. This may or may not apply to your child or all children, or any children for that matter. I am pulling bits of information from this article and pooling it together with the books and articles and other research I have done, as well as my own experience to make my own conclusions. This is my blog, not a scientific journal. Consider that your disclaimer.

Here are two important notes in the article:

  • "“It seems the body adapts to long-term stress, such as depression, by blunting its normal response,” says coauthor Lisa Serbin, a psychology professor who is Ruttle’s PhD supervisor and Concordia University Research Chair in Human Development."

  • "Individuals with a blunted response to stress may not respond to things that would – and should – make other people nervous. For example, children with long-term behaviour problems perform poorly in school. Because of their blunted stress response, these youngsters may not be worried about exams, so they don’t bother to prepare as much as their peers."

From here, I am going to make a few leaps again with my opinion. Children who have attachment disorders have experienced significant abuse, or neglect, or trauma or all of those. Therefore, children with attachment disorders can be assumed to have experienced long term high levels of stress and have had increased levels of cortisol for an unknown period of time as a result. Whether this manifests as externalized or internalized behaviors in the child is not particularily relevant, only that the events did occur and a physiological response did as well.

Children who are unconcerned about school performance are showing a blunted stress response, as the quote above says. I believe we can take that exponentially further. A child who does not feel worried or anxious about minor things is not going to respond to basic behavior modification techniques. The majority of the techniques involve minor rewards and mild consequences meant to shape a childs behavior over a period of time. Using a take away system, where the adult removes popular toys or privileges from the child will not work if the child does not have the physiological ability to worry about the result. That doesn't mean that the child won't be angry or upset about say for example, losing video games for the day. It means, I believe, that the child will not be able to worry that their behavior will cause that loss, therefore cannot curtail their behavior based on the potential of that loss.

More popular these days are systems where people in charge believe that they are rewarding only positive behaviors. An example might be, if you brush your teeth every night for three days you will earn this small toy. I think those systems are great, I really do. I think that emphasizing the good things a child does is motivating in the long term and the typical child will seek out more ways to feel good about themselves by doing things that are positive. However, inherent in that system is the threat of a loss for not completing the task. We may think that we are promoting only good behavior in a loving way, but I think the self talk a child engages probably goes like this, "oops, it's 7 o'clock I better go brush my teeth or I won't get my toy". Catch that "or I won't get"? That's the piece that is missing in an attachment disordered child and that is why such methods like using rewards or sticker charts are going to be useless. The child is not able to produce concern over not getting the reward. Therefore, is not going to perform the desired task per the program. Those dots will not connect.

There has always been the question in my mind, how is is that my child does not run into the street every time the door is opened. If she is able to learn that, than she should be able to learn other, less extreme things. It proves she can learn, and it proves I can teach her. The point that always followed logically was that she was choosing not to learn the other things I tried to teach her, or show her or provide her with knowledge of for her own self preservation. Further evidence to that is if I ask her about stealing cookies for example, or why did she not come inside from playing when I told her to, she is able to comprehensively describe to me all the correct answers. Maybe I should say, she is able to parrot back to me the reasons I have given her. She knows what things are wrong to do and why because she can tell me. Having a blunted physiological response to stress however, would mean that she does not have the ability to be concerned about it. Putting it simply, she is not feeling it.  That's a hard place to go and is difficult to accept, though it would explain a lot.

Then what, you may wonder, as I did, is there to do about it? The authors of the study believe that early intervention in children showing strongly negative behaviors is the key. However, when you are the adoptive parent of an older child where the experiences happened long ago, you are going to be fighting an uphill battle with both hands tied behind your back. The damage has been done and for the record, I do believe that neglect and trauma cause brain damage. The question is, can that damage be reversed or repaired. My answer is, God I hope so.

I do believe that the burned out cortisol can return to more normal levels. With Genea, she was on the medication for about a year and a half before she came to us, and for another year with us. Then, her little 5 year old body regained it's ability and began to produce cortisol on its own again. That is my one and only experience and so whether or not it is typical or unusual I do not know. I do know that it does not seem to have reduced much in the way of her own personal issues and behavioral reactions so in our case, I believe there are many factors. I think this is where we have to "parent outside the box". Our children can and will learn, it will not be by the usual methods.

If you made it to the bottom of this lengthy post, reward yourself! Now, what do you think? Opinions? Reactions? Disagreement?

Coming soon: Part 2

30 comments:

  1. Spot on! Thanks for sharing! I believe it's possible for everyone to get burned out and blunted...including parents trying to raise burned out kids. That's why I believe it is SOOO important for us to take care of us.

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  2. good info! would love to post a link to this on my blog

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  3. I made it to the end and rewarded myself by making the sucking sound from the bottom of a cup, which made all the kids give me the stink eye ~Smile~ Great info and I very much agree that neglect and trauma cause brain damage.

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  4. Thank you so much for sharing....this is so timely for me, as I am getting "threatening" e-mails from Maxim's present Independent Living family, saying if he doesn't get his math grades up they are going to kick him out. That just stresses ME out....it is I who worry about his grades and his living situation. Not him. He's had no control for so long, and been at the mercy of people who don't love him for so long - I can see him just waiting. He feels he has no control - over math or anything.

    I have TOTALLY NO CONTROL over math myself, so I can relate. If they'd required Algebra II in my day, I'd be working at a Walmart now.

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  5. This makes total sense to me (and would explain my kids' seeming inability to care about potential consequences), but I have a question. In a past evaluation by the school, we were told my daughter, who'd been living in our stable home for over 2 years at that point, was still exhibiting signs of stress comparable to living in a war zone. Seems like this is saying that her cortisol levels would be totally burned out long ago and therefore she wouldn't be exhibiting hypervigilant, stressed out behaviors anymore (which is certainly not the case)?

    Mary in TX

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  6. Woah. Ok. Huh. Um yup.

    (that was my intelligent response, in case you were wondering)

    I am going to reread this a couple of times. Yes. Yes. and Yes.

    I too, believe that trauma, etc. can cause the brain to be altered and damaged. I also think it's possible to heal lots. But there's not a formula of what will work for each kid, because everyone is different combined with different experiences, blah, blah, blah.

    Suffice to say, I think this post was spot on, unless I wake up at 3am with a question or disagreement. Thanks in advance for the 3am tossings.

    Me, being the granola girl, has to wonder what can be done with diet, vitamins, and supplements to support the bodies cortisol regulation. Any thoughts on that? Cause, gosh darn, I'd sure love to know for me, but also for my kiddo.

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  7. Woah. Ok. Huh. Um yup.

    (that was my intelligent response, in case you were wondering)

    I am going to reread this a couple of times. Yes. Yes. and Yes.

    I too, believe that trauma, etc. can cause the brain to be altered and damaged. I also think it's possible to heal lots. But there's not a formula of what will work for each kid, because everyone is different combined with different experiences, blah, blah, blah.

    Suffice to say, I think this post was spot on, unless I wake up at 3am with a question or disagreement. Thanks in advance for the 3am tossings.

    Me, being the granola girl, has to wonder what can be done with diet, vitamins, and supplements to support the bodies cortisol regulation. Any thoughts on that? Cause, gosh darn, I'd sure love to know for me, but also for my kiddo.

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  8. Why did that post twice? Now I look like the hyper, over eager adult over here. Sigh...

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  9. Wow, that is amazing. What insight. It just goes to show how sometimes we have to parent outside the box like you said. thank you for taking the time to explain this so clearly.

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  10. Yes, yes, and yes. My child also "does not feel it". He can learn certain things, but not others. And why would he care about a treat tomorrow or loss of video games later? He is busy surviving Right. NOW. Whether it can all be tied back to cortisol? I don't know. But I do know that trauma has caused some MASSIVE changes in the way his brain works. His ability to understand the world around him, and most especially his ability to comprehand cause-and-effect are severely affected, and I am sure the constant stress and trauma is to blame.

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  11. So much great info!!!!! I'm going to read this 3 or 4 times so that I can keep processing. Also agree with wholetthishapen on supplements,etc.

    I've read some on cortisol baths on a fetus and how it can cause brain processing problems later. Wondering if there is much difference?

    Thanks so much for posting this!!!

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  12. I think school IS like a war zone for a lot of kids!

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  13. This is a lot of food for thought -- thanks! I agree with your belief in the brain damage thing.

    I suspect that the cortison/burn-out thing is maybe one piece of a really complex puzzle. (I.e., no magic bullets, unfortunately.)

    Have to think further on this.

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  14. Interesting theory. I can certainly relate to the lack of effect of behavior programs with my DD. She gets upset in the moment, but not enough for her to not have the exact same behavior and the exact same consequence the next time ... and the next, and the next and the next. But she CAN learn. I can't figure out how to link those two together either.

    Not sure about the cortisol link ... or what that would mean for my situation.

    But definitely food for thought!

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  15. I just typed out a long response, only to have my computer eat it! Boo! I'll try again.
    marythemom: You don't say if your daughter's evaluation was done in a new school or not. new school = new situation which could result in a "respike" of the cortisol because it's new. That's my thought process on it at least. I use that same line of thought with my daughter, age 6 years, but home with me for only 2 months. Her cortisol levels evened/bottomed back out in her previous living condition BUT have spiked again when she came home to me. I don't know if that's accurate, but that's my thought on it.
    There is literature out there on ways to reduce cortisol naturally. I was just reading about it earlier this week, in fact! Omega 3s and Vitamin C were both listed as well as other natural/herbal supplements you can use. For us, we're pumping MORE Omega 3s for now!

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  16. Bruce Perry's latest book has a ton of stuff about the effects of cortisol on the brain. It matches what you said. It's worth a read! (in all your free time of course)

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  17. I agree, sometimes you have to parent outside the box and people do not always get that. I'm going to read this over again when I am alone and have no interruptions. Also discuss with my husband. There is a lot of insight here. Thanks for posting.

    Molly

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  18. I think that there are some forms of brain injury from trauma/neglect/environmental exposure that repair themselves over time and there are some that don't. For example, if a child does not physically develop the part of the brain during development that controls empathy, that child will never develop the capability of being empathetic. And there is only a window of time in a child's physical development in which that part of the brain will grow. That is why early intervention is so important. Cortisol production should be able to repair though as it is a hormone output issue and should regenerate over time.

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  19. Looking forward to the second installment. This is a very interesting take on something we see every day.

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  20. I was physically and mentally abused by my mother as a child. A while back, I had a complete physical to search for possible reasons why I was sick. The Dr. said my cortisol levels were extremely low. I do deal with having very deadened emotions and have had depression since I was a small child. I think your post really opened my eyes to understanding some things about myself. Thanks, and God bless you and your love for your children.

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  21. My child has the same meds and injections as your child... also the same behavior I would love to talk to someone in the same boat. Thanx

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  22. Boy, would I love some advice. I was abused my entire childhood. I've moved on from it, my life is awesome, and I didn't think I was depressed, but, my cortesol levels are SKY HIGH. Every time I see a new doc, they think I have a pituitary tumor. The problem is with my son. He is a sweet kid! But, for some reason he has a very hard time controlling his temper. This started about the same time that his father was deployed for a year. We noticed that our usually skinny kid had gained alot around his tummy and he started having problems with his friends and siblings. Any little thing will set him off. He growls and scowles, and just goes brezerk when ever he gets mad. I'm able to keep him pretty much under controll at home, but at school and on the bus... his teacher says she's afraid of him :S He's a sunny bunny one moment and freaking out the next. His outbursts are short, but definately impacting his life at school, scouts, church, etc.

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  23. My childhood was EXTREMELY stressfull, living with a violent, addicted mother. But, I've moved on, far far away, and have a really great life. The problem is, my cortisol levels are SKY HIGH. It's really impacted my health. I'm wondering if my high levels of cortisol have affected my children. My son was just a sunny bunny for his first year. He's still a pretty happy kid. The problem is his extremely short temper. He just goes off at the slightest provication. I'm able to controll him at home, but at school, church, on the bus, at cubs, he growls, glares, and just freaks out when ever any small thing sets him off. He's always embarassed afterwards, but the frequency of this is just escelating. It started becoming a problem last year when his dad deployed for a year. He's gained weight around his tummy and has eczcema. I'm wondering if this could be a cortisol problem??? I'm at a loss. He's such a good kid when he isn't over-reacting to something.

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    1. I'm so not an expert, but as no one has replied...

      I dimly remember reading somewhere that children when they develop can be affected by the stress levels of the pregnant mother? I can remember no useful details, but perhaps you can do searches on your own from there? Maybe he's acquired bad physiological regulation from your cortisol levels in utero?

      Good luck. ;)

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  24. Part 1:
    " A child who does not feel worried or anxious about minor things is not going to respond to basic behavior modification techniques. etc, etc, etc..."


    It's more basic than that. A child who hashad to be hyperventilate against domestic violence, screaming adults and potential predators simply has no extra emotional energy to worry about "omg my exams!". They arerelieved to be in a safe environment for at least 5 to 6 hours a day.

    Admittedly you do not claim to be an expert. And I applaud your attempt to understand. I too am trying to understand: why I didn't react to my crazy situation like many social workers expected. I was never self destructive. I always knew I was NOT at fault(the prevailing assumption is that ALL children blame themselves--from talking with others this is BS. I suspect the self blamers are a self selecting group who reach out for therapy more than the rest of us). I lived in constant fear from when I was 4 to when I was 13 and big enough to defend myself. While I wasn't adopted, I did have a sudden psychological break with the parent(mother) as a result of one of her screaming 'sodes, the result of which was I became acutely aware I was on my own and for all emotional purposes raised myself(took care of my own needs, never reached out to crazy parent) from that point forward.

    But, after talking to others who tended to have more problems setting boundaries with the dysfunctional parent, why it was so easy for me. It was also easy for me to stare down potential pedos--they don't like creepy self aware children(at the time I didn't know exactly what they wanted, just that it was weird and creepy. Go away creep, and they went. I was 12). I lived in my head and learned affection from cats. I was so terrible in school, however, that by third grade I was put in a class for "the retarded". It was obvious there was nothing wrong with me--except I couldn't focus. Just happy to be away from the crazy people that, CSD/ teachers somehow can't figure out are incompetent parents.

    It wasn't until 7th grade I got tired of people thinking I was stupid and buckled down to get my maths up to scratch(My reading was at college level by 6th grade)

    So my experience is that I was ALONE from 4 years old on. People wondered why I'm not a welfare queen crack addict dead in a ditch. Okay, not exactly, but the condescension when finding out my background, as if the ONLY WAY a child with these challenges can turn out is a drug addict.. BUT, they have a point. Statistically I should be dead. Some of it is luck: incompetent parental unit was too dependent on public services to completely isolate me. My temperament is introverted: I think and plan before I act. I like to read. I am perfectly capable of physically defending myself and others,but have no urge to lash out in a way that would get me on the wrong side of the law.
    ........

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    1. Part 2:

      Having that temperament is luck. But the missing piece of the puzzle might be the cortisol connection. It could be the decisive factor in keeping the brainwashing most abused kids internalize out of my head. Not so good on the educational or socializing front. I was never sexually abused, nor did I get into physically abusive relationships. I think I may be "immune" to emotional manipulation/negging etc. There is a downside: I have a great blindspots with certain types of personalties. They don't register as physical threats, so I'm slow to recognize their toxicity. But that could be typical from having to ignore a crazy person for 13 years.

      I'm taking away is the elevated cortisol might have had a shielding effects from the worst of psychological damage, but at the expense of delayed social development. Sounds bad, but I'd rather live with asberger traits any day, than live with being molested or otherwise victimized as a child. Years later, I am horrified at how much danger I was semi-regularly in. All I knew is if I didn't feel in control of a situation, I never got involved. Eventually I went into the military and was baffled why the rest of the girls were so weepy about boot camp--it is the military, you did agree to be yelled at. At least they're paying us....

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    2. Part 3:
      Thank you for the opportunity to sound off. No one seems interested in understanding our experience because it disturbs their ideal of the passive child. They'd rather think of us as poor dead drug addicts in a ditch who didn't have a chance instead of childdren forced into premature agency who know they are in danger every day and battle it the best they can until someone notices or they escape.

      As for "brain damage": I have most of the works of Shakespeare--I never went to university, I just like history. I play chess. But even feeling insulted I understand it's 'not wrong': the constant stress levels force thoughts into a "fight /flight" pattern. This is not conducive to school learning. The child MUST be removed from the stressful environment. Even if you do that instantly, it will be YEARS before they decompress and get to an EMOTIONAL level where they can make steady progress learning. If you're lucky, the child will be a native introvert like me who likes to learn about stuff in books they like. For me it was history, astronomy, dinosaurs, and fairtales. But even then, to this day it's hard to stay steady over the long course. I work around this by working in short bursts and scheduling other things accordingly. Weight training is a perfect exercise because that's exactly how it works: a few days of heavy intense lifting followed by lots of rest. I have to work at running. Running is a steady thing, something people like me aren't adapted for.

      I'm a working artist. I have absolutely no contact with that parental unit. I am very safe. But I am also alone and often lonely. It is preferable to some alternatives, but that's what comes of fighting a childhood war for your sanity, by yourself, even if you win. I have good friends, but I'm not adapted to family or group life. I do not have children by choice. I believe had someone intervened before puberty, I would have been much better socialized and have less blind spots.

      Or would the cortisol would have gotten in the way. I was never a child you had to hit. Talking to me worked. But threaten me and I was your enemy for life. Periodically, well meaning adult(often male) would "lay down the law". They saw the unhealthy situation and, somehow worried delinquency would magically appear, would get overly stern about consequences. Instead the message I got was "This complete stranger is threatening me for no good reason. Best humour them and avoid their company". Years later, am still appalled at their cluelessness. Children in shitty situations do not need to be "over disciplined". What they need to know, more than anything else, is they are safe.

      Again thank you for the opportunity to rant, and I appreciate your attempts to understand.
      [apologies for 3 parts-blogger wordcount would not approve 2 parts!]

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    3. *hyper vigilante

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    4. Thank you for your comments, it gives me some things to think about. f
      Lowered Cortisol "shielding the worst" of the abuse is a fascinating idea I hadn't thought of.
      Very recently, in the past month or so, I saw new research showing that "resilience" is genetic. So a person is either born with the tendency or not born with it. Of course there is a lot out there about parenting that contributes to resilience as well.
      Anyway, I thought that might be an interesting piece for you as well.

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    5. Part 2
      (lol, I forgot to say...) I meant the term "brain damaged" in more of an organic way, instead of as a learning or developmental disability. Neuro-chemical flooding (new phrase I just invented) responding to trauma seems to change the structure of the brain over time. It is probably an adaptation to the situation, but seems to hang on long past the actual need and does not adapt again (by itself) to a stable situation.
      Again, the only thing I'm an expert on is dirty laundry. Seriously.

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