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