Cited by 208Stress Responses and CortisolChild Abuse and TraumaResilience and Mental Health

Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease

Open access
Kuhlman, Kate Ryan, Chiang, Jessica J., Horn, Sarah, Bower, Julienne E.·2017·Neuroscience & Biobehavioral Reviews

Abstract

Childhood adversity has been repeatedly and robustly linked to physical and mental illness across the lifespan. Yet, the biological pathways through which this occurs remain unclear. Functioning of the inflammatory arm of the immune system and the hypothalamic-pituitary-adrenal (HPA)-axis are both hypothesized pathways through which childhood adversity leads to disease. This review provides a novel developmental framework for examining the role of adversity type and timing in inflammatory and HPA-axis functioning. In particular, we identify elements of childhood adversity that are salient to the developing organism: physical threat, disrupted caregiving, and unpredictable environmental conditions. We propose that existing, well-characterized animal models may be useful in differentiating the effects of these adversity elements and review both the animal and human literature that supports these ideas. To support these hypotheses, we also provide a detailed description of the development and structure of both the HPA-axis and the inflammatory arm of the immune system, as well as recent methodological advances in their measurement. Recommendations for future basic, developmental, translational, and clinical research are discussed.

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Written from the paper’s full text.

TL;DR

This review proposes that childhood adversity shapes later disease risk through the HPA-axis and inflammatory immune pathways, but argues that effects depend on adversity type and developmental timing. It maps physical threat, disrupted caregiving, and unpredictability onto candidate animal models and highlights infancy and adolescence as possible sensitive periods.

Key findings

  • The review argues that treating adversity as a single dose-response exposure obscures distinct biological signatures. Physical trauma/injury may be linked to exaggerated acute HPA-axis and inflammatory reactivity; disrupted caregiving may impair glucocorticoid negative feedback and promote glucocorticoid insensitivity; unpredictable environments may elevate basal/diurnal cortisol and inflammation through heightened threat vigilance.
  • Proposed animal analogs are repeated social defeat (RSD; e.g., 2-hour daily defeat episodes for one week) for physical trauma, maternal separation for caregiving disruption, and chronic variable stress (CVS; varied stressors twice daily for 15–30 days) for unpredictability. RSD reportedly produces anxiety-like behavior in about two-thirds of rodents; CVS can raise hippocampal IL-6, IL-1β, and TNF-α.
  • Timing is central: the HPA-axis and immune system develop from gestation through adolescence. Infancy, especially the first two years, and adolescence are highlighted as possible sensitive periods; early adversity may program pro-inflammatory tendencies, while adolescent adversity may relate to lower cortisol and elevated inflammation.
  • The review notes that childhood adversity is reported to account for roughly one-third of psychiatric disorders and that C-reactive protein above 3.0 mg/L is considered predictive of cardiovascular disease risk. It calls for measures capturing adversity subtypes and timing, plus repeated multi-system assessments.

Methods

  • Narrative translational review, not a primary study or meta-analysis. It synthesizes animal and human literature on HPA-axis and inflammatory correlates of childhood adversity.
  • Organizes evidence by three proposed adversity elements—physical threat, disrupted caregiving, and unpredictable environment—and by developmental timing, pairing each element with a candidate rodent model (RSD, maternal separation, CVS).
  • Reviews measurement approaches for HPA-axis function (salivary cortisol, area under the curve, cortisol awakening response, diurnal rhythm) and inflammation (circulating cytokines and CRP, cellular and intracellular assays), and discusses developmental physiology.

Limitations

  • Stated: rodent-to-human translation is indirect; some human adversities lack animal analogs; sexual abuse is grouped with physical trauma despite likely distinct neurodevelopmental correlates; animal models omit human psychological features, such as abuse by a known caregiver versus a novel intruder; RSD and CVS are adult-animal models while maternal separation is infancy-only; the framework is narrow in developmental and physiological scope and excludes prenatal programming, direct sympathetic-health pathways, brain development, and genetic risk.
  • Evident from the text: many proposed pathways remain untested; human evidence is often cross-sectional, retrospective, or uses broad adversity windows; timing effects are difficult to separate from duration and ongoing stress; measurement tools rarely capture biologically salient subtypes or precise timing; few studies measure HPA-axis and inflammation together or distinguish reactivity from recovery.

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Registry

Crossref · 10.1016/j.neubiorev.2017.05.020

Cites

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Statistics

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Claims the paper makes

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  • Premisecitation

    Childhood adversity is a robust risk factor for mental and physical illness.

    “Childhood adversity has been repeatedly and robustly linked to physical and mental illness across the lifespan.”
    • Also stated in: § 1.1 Introduction · plain
      “Childhood adversity is a robust risk factor for mental and physical illness (Chapman et al., 2004; Felitti et al., 1998) as well as earlier mortality (Chen et al., 2016).”
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    Healthy, typically developing humans show their highest cortisol concentrations in the morning and their lowest in the evening.

    “Healthy, typically-developing humans should demonstrate their highest cortisol concentrations in the morning and their lowest in the evening (Clements, 2012).”
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    • cites Clements, 2012 source

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  • Premisecitation

    Childhood adversity is associated with alterations in the inflammatory arm of the immune system.

    “and the inflammatory arm of the immune system (Carpenter et al., 2010; Danese et al., 2011; Danese, Pariante, Caspi, Taylor, & Poulton, 2007; Slopen, Kubzansky, McLaughlin, & Koenen, 2013; Taylor, Lehman, Kiefe, & Seeman, 2006).”
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  • Premisecitation

    Coordination of the sympathetic nervous system, HPA-axis, and inflammatory arm of the immune system in response to acute stress is essential to development, survival, and well-being.

    “Coordination of the sympathetic nervous system (SNS), HPA-axis, and the inflammatory arm of the immune system, particularly in response to acute stress, is essential to development, survival, and well-being (Chrousos, 1995; Gunnar and Quevedo, 2007; Lopez-Duran et al., 2009).”
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  • Interpretationreasoning

    A dose-response approach limits what is known to the overlap between heterogeneous adversity exposures.

    “This approach limits what we know to the overlap between heterogeneous adversity exposure (See Figure 1), and few studies have considered the role of timing, thus limiting our understanding in the context of human development.”
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    • Rests on an assumption: Few studies have considered the role of timing in the association between childhood adversity and health.
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    Premisecitation

    Acceleration of cortisol increase after stress may reflect the intensity of excitatory input into the axis from the limbic system, whereas cortisol regulation after peak more likely reflects glucocorticoid receptor density and sensitivity in the hippocampus.

    “For example, acceleration of cortisol increase following stress could reflect the intensity of excitatory input into the axis from the limbic system, whereas cortisol regulation following peak more likely reflects the density and sensitivity of GRs, primarily in the hippocampus (Sapolsky, Meaney, & McEwen, 1985).”
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    Premisecitation

    Abnormally high diurnal cortisol can indicate chronic hypothalamic CRH/AVP hypersecretion, pituitary ACTH hypersecretion, or repeated activation of the acute stress system.

    “Abnormally high diurnal cortisol can be an indicator of several dysregulations in the axis; for example, this could indicate chronic hypersecretion of CRH/AVP by the hypothalamus, or hypersecretion of ACTH by the pituitary (Aguilera, 2012), or repeated activation of the acute stress system (Kidd et al., 2014).”
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    Premisenone given

    Glucocorticoids are essential to the maintenance, duration, and down-regulation of the stress response and regulate CRH and ACTH secretion.

    “Glucocorticoids are essential to the maintenance, duration, and down-regulation of the stress response, regulating CRH secretion from the hypothalamus and ACTH secretion by the pituitary.”
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    Premisecitation

    Binding of glucocorticoids to glucocorticoid receptors in the hippocampus is associated with regulation of the acute stress response.

    “Binding of glucocorticoids to GRs in the hippocampus is associated with regulation of the acute stress response (Aguilera, 2012; De Kloet, 1991; Sapolsky et al., 2000; Smith & Vale, 2006).”
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    Premisecitation

    The HPA-axis maintains homeostasis and promotes adaptation to environmental stress through a hormonal cascade.

    “The purpose of the HPA-axis is to maintain homeostasis and promote successful adaptation to environmental stress through a complex hormonal cascade (Aguilera, 2012; Selye, 1950).”
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    Premisecitation

    The cortisol awakening response reflects a mounting of physiological resources for the day and appears to measure adrenal sensitivity to ACTH.

    “CAR is believed to reflect a mounting of physiological resources to meet the demands of the day (Adam and Gunnar, 2001), and also appears to be a measure of adrenal sensitivity to ACTH (Clow et al., 2010).”
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    Premisecitation

    ACTH stimulates the adrenal gland to increase production and release of glucocorticoids.

    “ACTH stimulates the adrenal gland to increase production and release of glucocorticoids (cortisol in humans) (See Gunnar & Vazquez, 2006).”
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    • cites Gunnar & Vazquez, 2006

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    Interpretationnone given

    The biologically salient and distinguishable elements of adversity are physical trauma, disrupted caregiving, and unpredictable environment.

    “The biologically salient and distinguishable elements of adversity we identify are: physical trauma, disrupted caregiving, and unpredictable environment.”
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    Interpretationreasoning

    Taken together, exposure to physical abuse and trauma during childhood exaggerates both inflammatory activity and HPA-axis reactivity to stress until adolescence.

    “Taken together, exposure to physical abuse and trauma during childhood exaggerate both inflammatory activity and HPA-axis reactivity to stress until adolescence.”
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    Premisecitation

    C-reactive protein concentrations greater than 3.0 mg/L are considered reliably predictive of cardiovascular disease risk.

    “concentrations greater than 3.0 mg/L are considered reliably predictive of cardiovascular disease risk (See Ridker, 2003 for review).”
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    Premisecitation

    Measurement limited to circulating peripheral cytokines is criticized for failing to localize the source of inflammatory cytokines and for sensitivity to confounders including SES, BMI, age, and sex.

    “Measurement limited to circulating peripheral cytokines is often criticized for failing to localize the source of inflammatory cytokines and for being sensitive to several confounding factors, including SES, BMI, age, and sex (M.-F. O’Connor et al., 2009).”
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    Premisecitation

    Animals injured during repeated social defeat exhibit glucocorticoid-resistant immune cells, systemic increases in glucocorticoids, exaggerated inflammatory responses, and increased pro-inflammatory gene expression in immune cells.

    “Animals that sustain an injury during attack by the aggressor (Merlot et al., 2003) exhibit glucocorticoid resistant immune cells, systemic increases in glucocorticoids, exaggerated inflammatory responses (Avitsur et al., 2001; Stark et al., 2001), and increases in pro-inflammatory gene expression in immune cells (Powell et al., 2013).”
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    Interpretationreasoning

    Well-characterized animal models may serve as useful analogs for child adversity elements and provide causal models for distinct pathways from developmental stress to disease.

    “To better understand the downstream physiological consequences, we consider well-characterized animal models that may serve as useful analogs for these child adversity elements and provide informative causal models for understanding the distinct pathways from different types of developmental stress to disease.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Well-characterized animal models of repeated social defeat, maternal separation, and chronic variable stress are valid analogs for the corresponding elements of human childhood adversity.
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    Premisecitation

    Physical trauma, caregiving disruption, and unpredictability are each salient to central nervous system development with implications for learning and downstream physiological adaptations.

    “Each of these elements has been identified as salient to the development of the central nervous system with implications for learning and downstream physiological adaptations (Gunnar and Vazquez, 2006; McLaughlin et al., 2014b; Teicher et al., 2003).”
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    Interpretationreasoning

    Maternal separation may be more closely linked to impaired regulation of the stress response once initiated, whereas physical trauma appears linked to exaggerated activation of stress response systems.

    “Yet, maternal separation may be more closely linked to impaired regulation of the stress response once initiated whereas physical trauma appears to be linked to exaggerated activation of stress response systems.”
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    Premisecitation

    Childhood abuse significantly accelerates biological aging and all-cause mortality.

    “Indeed, childhood abuse significantly accelerates biological aging (Tyrka et al., 2010) and all-cause mortality (Chen et al., 2016).”
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    Premisecitation

    Threat perception causes the sympathetic nervous system to release noradrenaline, which mobilizes stem cells from bone marrow and activates immune gene transcription in white blood cells, organs, and tissues.

    “When threat is perceived, the SNS releases noradrenaline, which promotes mobilization of stem cells from the bone marrow and activates immune gene transcription within white blood cells, organs, and tissues (Irwin and Cole, 2011).”
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    Premisecitation

    Physical trauma is linked to elevated circulating markers of inflammation and inflammatory diseases.

    “Several studies indicate a link between physical trauma and both elevated circulating markers of inflammation and inflammatory diseases (Friedman et al., 2015b).”
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    • cites Friedman et al., 2015b

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    Interpretationreasoning

    Simultaneous examination of circulating, cellular, and intracellular measurements of inflammatory processes may drive progress in understanding environmental and psychological stress effects on this system.

    “Further, the simultaneous examination of circulating, cellular, and intracellular measurements of inflammatory processes may drive progress in our understanding of environmental and psychological stress on this system.”
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    Premisecitation

    Allostatic load is a process through which failure to adapt to repeated or chronic stress leads to wear-and-tear on the body.

    “allostatic load, a process through which an individual’s failure to adapt to conditions of repeated or chronic stress leads to wear-and tear on the body (McEwen, 2013; McEwen, 1998).”
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    Premisecitation

    Exposure to physical abuse is related to exaggerated HPA-axis responses to acute psychosocial stress and to viewing violent films among young adolescents.

    “Exposure to physical abuse is also related to exaggerated HPA-axis responses to acute psychosocial stress (Kuhlman et al., 2015) and to viewing violent films among young adolescents (Ivanov et al., 2011).”
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    Interpretationreasoning

    Each element of adversity may differ in biological salience and therefore affect physiological systems differently.

    “It is possible that each element of adversity (based on the degree of physical threat, caregiving disruption, and unpredictability) differs in biological salience and therefore affects the system differently.”
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    Interpretationcitation

    Living in an unpredictable environment as a child likely promotes upregulation of both diurnal cortisol and peripheral inflammatory markers.

    “Living in an unpredictable environment as a child likely promotes upregulation of both diurnal cortisol and peripheral inflammatory markers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The frequency and magnitude of threat response system activation are reflected in cortisol and inflammatory markers.
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    Premisecitation

    Testosterone bound to androgen receptors can downregulate synthesis of proinflammatory cytokines and stimulate secretion of anti-inflammatory cytokines.

    “When bound to androgen receptors, testosterone can downregulate synthesis of proinflammatory cytokines (D’Agostino et al., 1999; Li et al., 1993; Trigunaite et al., 2015), and stimulate secretion of anti-inflammatory cytokines (Liva and Voskuhl, 2001).”
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    Interpretationreasoning

    Disrupted caregiving may be more related to poor down-regulation of glucocorticoids across contexts and low glucocorticoid sensitivity in immune cells and brain.

    “Disrupted caregiving, in comparison, may be more related to poor down-regulation of glucocorticoids across many contexts and low glucocorticoid sensitivity in both immune cells and the brain.”
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    Interpretationcitation

    The inconsistency in newborn inflammatory responses may reflect differences in inflammatory sensitivity to different ligands or bacteria across the human lifespan.

    “which may be an inconsistency that reflects differences in inflammatory sensitivity to different ligands or bacteria across the human lifespan (Levy et al., 2004; Mohamed et al., 2007).”
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    Premisecitation

    Systemic inflammation induced during infancy results in impaired axonal growth and demyelination, decreased hippocampal neurogenesis, repetitive behaviors, and deficits in social memory during the juvenile period.

    “In particular, systemic inflammation induced during infancy resulted in impaired axonal growth and demyelization, decreased hippocampal neurogenesis, repetitive behaviors, and deficits in social memory during the juvenile period (Lee et al., 2016).”
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    • cites Lee et al., 2016

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    Interpretationcitation

    Inflammatory processes in early life are distinct from those in adulthood and may continue to change into adolescence.

    “Inflammatory processes in early life are distinct from those in adulthood, and may continue to exhibit change into adolescence.”
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    Interpretationcitation

    Disrupted caregiving may impair coordination between glucocorticoids and immune cells, such as glucocorticoid insensitivity contributing to elevated circulating inflammation despite the presence of glucocorticoids.

    “Disrupted caregiving may impair coordination between glucocorticoids and immune cells, such as glucocorticoid insensitivity in immune cells that may contribute to elevated circulating inflammation despite the presence of glucocorticoids (Cole, 2008; Cole et al., 2012).”
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    • cites Cole, 2008 source

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    Interpretationreasoning

    Inflammatory processes are immature during infancy, maturing throughout childhood, and interact with gonadal hormones during adolescence.

    “In sum, inflammatory processes are immature during infancy, maturing throughout childhood, and interact with gonadal hormones during adolescence.”
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    Premisecitation

    Total early trauma exposure is associated with elevated C-reactive protein, driven by exposure to emotional abuse.

    “Consistent with this, total early trauma exposure was associated with elevated CRP, which was driven by exposure to emotional abuse (Rooks et al., 2012).”
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    Premisecitation

    PBMC production of IL-12 in response to bacterial challenge increases with age, but stimulated production of IL-12 by 12 years of age is still substantially lower than in adults.

    “In a study of infants, 5-year-olds, 12-year-olds, and adults, PBMC production of IL-12 in response to bacterial challenge was shown to increase with age; however, stimulated production of IL-12 by 12 years of age was still substantially lower than in adults (Upham et al., 2002).”
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    Interpretationreasoning

    In the context of elevated and poorly regulated glucocorticoids, observed heightened markers of inflammation may reflect glucocorticoid-insensitive immune cells.

    “In the context of elevated and poorly-regulated glucocorticoids, the observed heightened markers of inflammation may reflect the presence of glucocorticoid insensitive immune cells.”
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    Interpretationreasoning

    Based on the CVS model, youth exposed to unpredictable environments are expected to show chronic up-regulation of diurnal cortisol and elevated neuroinflammation that may indirectly increase peripheral inflammatory markers.

    “Based upon this translational model, we expect youth exposed to an unpredictable environment to demonstrate chronic up-regulation of diurnal cortisol, and elevated neuroinflammation that may indirectly increase peripheral inflammatory markers.”
    Quote in the paperSubstantial claim
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    Premisecitation

    Chronic childhood stressors such as parent psychopathology, low socioeconomic status, and parent separation are prospectively associated with elevated inflammation when adolescent girls become depressed, and inflammatory markers remain elevated after symptoms recover.

    “There is also an emerging body of evidence that more chronic childhood stressors such as parent psychopathology (e.g., MDD), low SES, and parent separation are prospectively associated with elevated inflammation when adolescent girls become depressed, and that inflammatory markers remain elevated even after symptoms recover (Miller and Cole, 2012).”
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    Interpretationreasoning

    It may be that adversity exposure during infancy leads to a hypersensitive HPA-axis whereas adversity exposure during adolescence may lead to hyposecretion of cortisol.

    “It may be that adversity exposure during infancy leads to a hypersensitive HPA-axis whereas adversity exposure during adolescence may lead to hyposecretion of cortisol.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    There are some forms of childhood adversity that have no animal model analog.

    “Further, there are some forms of childhood adversity that have no animal model analog.”
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    Interpretationnone given

    Exposure to adversity may have especially strong consequences during infancy and adolescence, periods when the HPA-axis and inflammatory processes undergo major changes.

    “Exposure to adversity may be especially consequential during infancy and adolescence when major changes occur in the HPA-axis and inflammatory processes.”
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    Interpretationreasoning

    Timing of adversity exposure may contribute to the variation in the effects of adversity on HPA-axis and inflammatory processes.

    “We also proposed that timing of adversity exposure may contribute to the variation in the effects of adversity on HPA-axis and inflammatory processes.”
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    Premisecitation

    Adversity exposure during infancy is related to higher CRP at age 15 but not at age 10.

    “Adversity exposure during infancy was related to higher CRP at age 15 but not at age 10, which raises the question of why adversity during infancy would be related to inflammation during mid-adolescence but not late childhood.”
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    Interpretationnone given

    Repeated social defeat (RSD) may be a useful animal analog for understanding the physiological consequences of childhood adversity involving physical trauma and injury.

    “We proposed that repeated social defeat (RSD) may be a useful animal analog for understanding the physiological consequences of childhood adversity involving physical trauma and injury, maternal separation may be useful for understanding disrupted caregiving environments, and chronic variable stress (CVS) may be useful for understanding the physiological consequences of living in an unpredictable”
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    Premisecitation

    Childhood adversity accounts for approximately 1/3 of all psychiatric disorders and contributes significantly to chronic physical conditions.

    “Childhood adversity accounts for approximately 1/3 of all psychiatric disorders (Kessler et al., 2010) and contributes significantly to chronic physical conditions (Scott et al., 2011).”
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    Interpretationnone given

    Chronic variable stress (CVS) may be useful for understanding the physiological consequences of living in an unpredictable developmental environment.

    “We proposed that repeated social defeat (RSD) may be a useful animal analog for understanding the physiological consequences of childhood adversity involving physical trauma and injury, maternal separation may be useful for understanding disrupted caregiving environments, and chronic variable stress (CVS) may be useful for understanding the physiological consequences of living in an unpredictable”
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    Premisecitation

    The brain and body may have a compensatory mechanism that downregulates cortisol secretion after an initial period of hypersecretion.

    “Alternatively, the brain and body may have a compensatory mechanism that downregulates cortisol secretion after an initial period of hypersecretion (Heim et al., 2000; Miller et al., 2007).”
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    Interpretationreasoning

    The inflammatory consequences of adversity during development may vary as a function of timing of adversity exposure.

    “Nevertheless, there are studies hinting that the inflammatory consequences of adversity during development may vary as a function of timing of adversity exposure and these associations warrant further investigation.”
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    Interpretationnone given

    Maternal separation may be useful for understanding disrupted caregiving environments.

    “We proposed that repeated social defeat (RSD) may be a useful animal analog for understanding the physiological consequences of childhood adversity involving physical trauma and injury, maternal separation may be useful for understanding disrupted caregiving environments, and chronic variable stress (CVS) may be useful for understanding the physiological consequences of living in an unpredictable”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationnone given

    Adversity during infancy may result in exaggerated cortisol early in life, which over time could lead to glucocorticoid receptor insensitivity.

    “In particular, adversity during infancy may result in exaggerated cortisol early in life, which over time could lead to glucocorticoid receptor insensitivity.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Translation of rodent models to humans is never direct.

    “First, translation of rodent models to humans is never direct.”
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    Premisecitation

    There is wealth of evidence establishing direct pathways between the SNS and physical health.

    “There is also wealth of evidence establishing direct pathways between the SNS and physical health (Danese and McEwen, 2012; McLaughlin et al., 2014a; Seeman et al., 2001).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Danese and McEwen, 2012 source

      Not checked in the free run.

    • cites McLaughlin et al., 2014a

      Not checked in the free run.

    • cites Seeman et al., 2001 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Because cortisol binding to glucocorticoid receptors on immune cells downregulates inflammation, glucocorticoid receptor insensitivity may contribute to heightened inflammation observed in relation to early adversity.

    “Because binding of cortisol to glucocorticoid receptors on immune cells downregulate inflammation, glucocorticoid receptor insensitivity may also contribute to heightened inflammation that we observe in relation to early adversity.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Early adversity during childhood and adolescence is related to greater expression of inflammatory-related genes and in vitro stimulation of inflammation, but not to circulating markers of inflammation in adolescents.

    “Two studies have shown that early adversity during childhood and adolescence was related to greater expression of inflammatory-related genes and in vitro stimulation of inflammation, but not to circulating markers of inflammation in adolescents (Miller et al., 2009; Miller and Chen, 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Miller et al., 2009

      Not checked in the free run.

    • cites Miller and Chen, 2010

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Adversity during adolescence may prime immune cells and potentially have persistent effects on inflammation.

    “Given that adolescence is another period of significant biological and psychosocial development, adversity during adolescence may prime immune cells and potentially have persistent effects on inflammation.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Interpretationnone given

    The maternal separation/deprivation paradigm is particularly useful for understanding disruptions in the early caregiving environment.

    “the maternal separation/deprivation paradigm for understanding disruptions in the early caregiving environment”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The maternal separation/deprivation paradigm is a valid model of disruptions in the early caregiving environment.
  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The RSD paradigm and its physiological effects are particularly useful for understanding physical trauma.

    “we identify the RSD paradigm and its physiological consequences as particularly helpful for understanding physical trauma”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The RSD paradigm is a valid model of physical trauma.
  • May combine two claims.

    Premisecitation

    Candidate genetic risk factors have functional roles in serotonin transport, HPA-axis activation via CRH, glucocorticoid sensitivity, and BDNF production.

    “Candidate genetic risk factors play functional roles in serotonin transport, activation of the HPA-axis via corticotropin releasing hormone (CRH), glucocorticoid sensitivity, and production of brain derived neurotrophic factors (BDNF).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Nugent et al., 2011 source

      Not checked in the free run.

    • cites Tyrka et al., 2013 source

      Not checked in the free run.

55 of 55
  • The paper relies on this without support.

    Few studies have considered the role of timing in the association between childhood adversity and health.

    “and few studies have considered the role of timing, thus limiting our understanding in the context of human development.”
  • The paper relies on this without support.

    Well-characterized animal models of repeated social defeat, maternal separation, and chronic variable stress are valid analogs for the corresponding elements of human childhood adversity.

    “we consider well-characterized animal models that may serve as useful analogs for these child adversity elements and provide informative causal models for understanding the distinct pathways from different types of developmental stress to disease.”
  • The paper relies on this without support.

    Different types of childhood adversity commonly co-occur.

    “In the face of co-occurrence of multiple adversities, which is more common than not, these effects may converge for multi-systemic vulnerability to disease across the lifespan.”
  • The paper relies on this without support.

    Existing models have not directly examined whether physiological consequences vary across different types of adversity.

    “Existing models have yet to directly examine whether physiological consequences vary across different types of adversity, limiting our understanding of the varying biological salience of different experiences during development.”
  • The paper relies on this without support.

    No study has examined inflammatory responses to acute stress between physically abused and non-abused peers.

    “however, no study to our knowledge has examined inflammatory responses to acute stress between physically abused and non-abused peers.”
  • The paper relies on this without support.

    Information linking disrupted caregiving and inflammatory functioning is scarce.

    “Information linking disrupted caregiving and inflammatory functioning is scarce, but still informative.”
  • The paper relies on this without support.

    Elevated diurnal cortisol and inflammation serve as intermediate phenotypes linking childhood adversity to later disease.

    “similar intermediate phenotype, elevated inflammation and atypical functioning of the HPA-axis.”
  • The paper relies on this without support.

    The frequency and magnitude of threat response system activation are reflected in cortisol and inflammatory markers.

    “elevated cortisol throughout the day and circulating inflammation are indicative of a threat sensitive system that activates frequently.”
  • The paper relies on this without support.

    Innate immunity is the primary defense against infection in early life because adaptive immunity takes longer to develop.

    “Innate immunity remains the primary defense against infection, as adaptive immunity takes much longer to develop.”
  • The paper relies on this without support.

    Circulating immune cells, including macrophages, and lymphoid tissue cells express receptors for gonadal hormones.

    “Circulating immune cells, including macrophages, and lymphoid tissue cells express receptors for gonadal hormones.”
  • The paper relies on this without support.

    Youth exposed to sexual abuse rarely experience this abuse in the absence of other adversities.

    “Unfortunately, youth exposed to sexual abuse rarely experience this abuse in the absence of other adversities.”
  • The paper relies on this without support.

    The neurodevelopmental correlates of childhood sexual abuse are different from other types of abuse.

    “Further exploration of the pathways outlined in this framework may further explain and contextualize observations that the neurodevelopmental correlates of childhood sexual abuse are different from other types of abuse.”
  • The paper relies on this without support.

    Physical abuse of children is most commonly perpetrated by their parents or a known adult, while the RSD paradigm makes use of a new intruder each time.

    “For example, physical abuse of children is most commonly perpetrated by their parents or a known adult, while the RSD paradigm makes use of a new intruder each time.”
  • The paper relies on this without support.

    Animal models of adversity can elucidate HPA-axis and inflammatory pathways that are relevant to human childhood adversity and disease.

    “The purpose of this review was to drive progress in the field by proposing that the challenges of characterizing the impact of childhood adversity on health may be addressed by drawing upon well-characterized animal models through which distinct HPA-axis and inflammatory pathways can be elucidated within a developmental framework.”
  • The paper relies on this without support.

    The RSD paradigm is a valid model of physical trauma.

    “we identify the RSD paradigm and its physiological consequences as particularly helpful for understanding physical trauma”
  • The paper relies on this without support.

    The maternal separation/deprivation paradigm is a valid model of disruptions in the early caregiving environment.

    “the maternal separation/deprivation paradigm for understanding disruptions in the early caregiving environment”
  • The paper relies on this without support.

    The CVS paradigm is a valid model of growing up in an unpredictable environment.

    “the CVS paradigm for understanding the physiological sequelae of growing up in an unpredictable environment”
  • The paper relies on this without support.

    The predominant model in the field examines genetic vulnerability to disease in the context of cumulative life stress.

    “the predominant model to date has been to examine genetic vulnerability to disease in the context of cumulative life stress”
18 of 18

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Puberty/adolescence represents the second particularly sensitive and vulnerable period with a new major change in HPA axis activity.

    “The later developmental stage of puberty/adolescence represents the second particularly sensitive and vulnerable period with a new major change in HPA axis activity.”

    From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [101]

    Section 3.2.1 says the HPA axis undergoes major change during adolescence and pubertal development, with increased sensitivity to the environment. Section 3.2.2 says puberty and adolescence may also be a sensitive period for enduring effects of adversity; it does not establish the claim’s more definite characterization of this as a particularly vulnerable period. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • Infancy and early childhood (age 0-5 years) represent one of the most vulnerable periods in brain development.

    “Infancy and early childhood (age 0–5 y.o.a.) represent one of the most vulnerable periods in brain development (6, 101, 103, 104).”

    From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [101]

    Section 3.2.1 says the central nervous system develops significantly during infancy and childhood and is vulnerable to glucocorticoids. But the paper does not identify ages 0–5 as a distinct period or establish that it is among the most vulnerable periods for brain development. In §4.2, it describes rapid neural development as extending from before birth through adolescence. Page numbers were unavailable in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • ELS/CT during the first hypo-sensitive 2 years of life may lead to hyper-activity and hyper-responsiveness of the HPA axis, while ELS/CT during the hyper-active phase of adolescence may lead to a hypo-active and hypo-responsive HPA axis.

    “Summarizing, ELS/CT during the first hypo-sensitive 2 years of life may lead to a hyper-activity and -responsiveness of HPA axis, while ELS/CT during the hyper-active phase of adolescence to a hypo-active and hypo-responsive HPA axis (101).”

    From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [101]

    Section 3.2.2 (page not provided) links adversity in the first two years to elevated cortisol and reports lower baseline or blunted stress responses after recent adversity in youth aged 9–12. But section 3.2.1 says the HPA axis is responsive in the first months and becomes relatively hyporesponsive by about 12 months, rather than throughout the first two years. Section 3.2.2 also cautions that little is known about the effects of adolescent adversity independent of earlier exposure, so the proposed adolescent pattern is less established than the sentence implies. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Positive ELS/CT history is an independent risk factor for peripheral immune dysregulation and long-term, low-grade inflammatory excess (a pro-inflammatory phenotype) in adulthood.

    “There is growing evidence suggesting that positive ELS/CT history is an independent risk factor for peripheral immune dysregulation and long-term, low-grade inflammatory excess (i.e., a pro-inflammatory phenotype) in adulthood (101, 164–172).”

    From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [101]

    Section 3.3.2 (page unavailable) suggests that early adversity may prime immune cells toward enduring inflammation, including in the periphery. But the paper treats the persistence of elevated circulating inflammation into adulthood as uncertain; section 2.2.2 also says physical and sexual abuse are not consistently linked to elevated adult inflammation after accounting for BMI and smoking. It therefore does not establish childhood adversity as an independent risk factor for a long-term adult pro-inflammatory phenotype. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • ELS/CT exposure during the first hypo-sensitive 2 years of life may lead to a hyper-activity and -responsiveness of the HPA axis and accordingly higher risk for developing depression than PTSD.

    “ELS/CT exposure during the first hypo-sensitive 2 years of life may lead to a hyper-activity and -responsiveness of HPA axis and accordingly higher risk for developing depression than PTSD, while”

    From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [101]

    Section 3.2.2 (page unavailable) says adversity in infancy may heighten basal cortisol and stress responses, supporting the HPA-axis portion of the claim. It does not establish that this leads to a higher risk of depression than PTSD. Section 3.2.1 also describes hyporesponsivity as developing over the first year, rather than characterizing the entire first two years as hyporesponsive. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

18 of the 288 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Chapman, 2007, Adverse childhood events as risk factors for negative mental health outcomes, Psychiatr. Ann., 37, 359
  2. Raposa, 2014, A developmental pathway from early life stress to inflammation the role of negative health behaviors, Psychol. Sci., 25, 1268, 10.1177/0956797614530570 · DOI

Cited by

Sorted by citations

Authors
Kuhlman, K. R., Chiang, J. J., Horn, S., & Bower, J. E.
Affiliations
  • University of California, Los Angeles (US)
  • Northwestern University (US)
  • University of Oregon (US)
Corresponding author
Kuhlman, Kate Ryan
Venue
Neuroscience & Biobehavioral Reviews
Publisher
Elsevier BV
Published
2017-09
Volume
80
Pages
166-184
ISSN
0149-7634 (ISSN-L)
OpenAlex
W2620868499
Cited by
208
References
288
Citations by year
2026: 13 · 2025: 14 · 2024: 25 · 2023: 31 · 2022: 31 · 2021: 23 · 2020: 26 · 2019: 22 · 2018: 20 · 2017: 2 · 2016: 1
FWCI
1.69
Type
journal article
Language
en
Open access
Locations
  • Neuroscience & Biobehavioral Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Mental Health (K08MH112773, T32MH015750)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
Keywords
childhood adversity, hypothalamic-pituitary-adrenal axis, unpredictable environments, physical threats, developmental framework
MeSH terms
Animals, Humans, Hypothalamo-Hypophyseal System, Inflammation, Pituitary-Adrenal System, Adult Survivors of Child Abuse

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-02.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-02.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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