Normalizing the development of cortisol regulation in maltreated infants through preventive interventions

Probably not a substantial claim: may not pass S3 (load-bearing).

Maternal education and number of children were not significantly correlated with cortisol levels at any assessment period.

“Maternal education and number of children were not significantly correlated with cortisol levels at any of the periods of assessment, and thus, these variables were not considered further.”

The quote only partly states this claim.

Starting at mid-intervention, the groups diverged in their morning cortisol trajectories.

“Beginning at mid-intervention, divergence was found among the groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The groups differed on number of children, with nonmaltreated comparison mothers having fewer children than maltreated intervention and community standard mothers.

“Finally, the groups differed on the number of children to whom the mothers had given birth, F (2,140) = 21.65, p < .001. Post hoc tests indicated that mothers in the NC group had fewer children than the mothers in the MI and CS groups.”

May combine two claims.

Among infants with individual-level maltreatment, none had been sexually abused, 10.8% had been physically abused, 83.1% had been neglected, and 69.2% had been emotionally maltreated.

“For these infants with individual level maltreatment, none had been sexually abused, whereas 10.8% had been physically abused, 83.1% had been neglected, and 69.2% had been emotionally maltreated.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The majority of these infants, 55.4%, had experienced more than one subtype of maltreatment.

“The majority of these infants, 55.4%, had experienced more than one subtype of maltreatment.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The sample families are characterized by poverty, relatively large family size, and single parent mothers.

“Overall, the families in the sample are characterized by poverty, relatively large family size, and single parent mothers.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The remaining subgroup of infants, 28.6%, were living in families where legally documented abuse and neglect had been experienced by siblings, i.e., at the family level only.

“The remaining subgroup of infants (28.6%) in the maltreatment sample were living in families where legally documented abuse and neglect had been experienced by siblings, i.e., at the family level only.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The groups differed on maternal education, with the maltreated intervention and community standard groups having more mothers with less than a high school education than the nonmaltreated comparison group.

“However, a difference among the groups emerged, χ2 (2, N = 143) = 6.30, p = .04. The MI and the CS groups had more mothers with less than a high school education than the NC group.”

May combine two claims.

The community standard group showed progressively lower morning cortisol and statistically differed from the maltreated intervention and nonmaltreated comparison groups.

“the CS group progressively evinced lower levels of morning cortisol, statistically differing from the MI and NC groups.”

May combine two claims.

Average cortisol slope for the MI and NC groups differed significantly from the CS group (z = 1.97 and 2.27), but the MI and NC groups did not differ from each other (z = 0.79).

“pairwise parameter comparisons of the average slope values across the three groups also revealed that slopes for the MI and NC groups were significantly different from the CS group (z’s = 1.97 and 2.27, respectively), and were not statistically different from one another (z = 0.79).”

May combine two claims.

There were no significant differences among the MI, CS, and NC groups in baseline cortisol intercept values, with z values from 0.13 to 1.66, indicating similar basal cortisol levels at baseline.

“pairwise parameter comparisons among the different groups revealed no significant differences in intercept values (z’s ranged from 0.13 to 1.66) suggesting that across the three conditions, children evidenced similar basal cortisol levels at baseline assessments.”

May combine two claims.

Latent intercept values for cortisol were positive and significantly different from zero at baseline across groups, with means ranging from .25 to .29 and p < .05.

“Latent intercept values across the different groups were positive and significant (μαs range from .25 - .29; p < .05), suggesting that cortisol values differed from zero at baseline”

May combine two claims.

The maltreated intervention, community standard, and nonmaltreated comparison groups were comparable on a range of demographic variables, including child gender, child minority race/ethnicity, age at initial assessment, maternal age, maternal minority race/ethnicity, current TANF receipt, total family income, and marital status.

“The MI, CS, and NC groups were comparable on a range of demographic variables, as shown in Table 1. The groups did not differ on child gender, child minority race/ethnicity, or age at the initial assessment. Furthermore, the groups did not differ on maternal age, maternal minority race/ethnicity, current receipt of TANF, total family income, or marital status.”

May combine two claims.

Chronically elevated cortisol during development affects brain development by influencing neurotropic factors and gene transcription, thereby affecting how neural circuits perceive environmental threat and future stress responses.

“Levels of cortisol, the final hormonal product of the neuroendocrine system, that are chronically elevated during development, when neural circuits are still in the process of maturing, exert an impact on brain development by affecting neurotropic factors and regulating gene transcription, thereby influencing the manner in which neural circuits perceive and interpret environmental threat and the”

• cites Tarullo & Gunnar, 2006Not checked yet

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May combine two claims.

Sensitive and emotionally secure parental caregiving protects the hypothalamic-pituitary-adrenal axis in human infants and young children, whereas abused and neglected youngsters' axis is not safeguarded against stress.

“Likewise, sensitive and emotionally secure parental caregiving also has been demonstrated to protect the HPA axis in human infants and young children, whereas the HPA axis of youngsters who do not receive responsive caregiving, such as those who are abused and neglected, is not safeguarded against stress (Brand, Brennan, Newport, Smith, Weiss, & Stowe, 2010; Bugental, Martorell, & Barraza, 2003;”

• cites Brand et al., 2010Not checked yet

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• cites Bugental et al., 2003Not checked yet

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• cites Hart et al., 1995Not checked yet

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May combine two claims.

Both Child-Parent Psychotherapy and Psychoeducational Parenting Intervention were efficacious in improving secure attachment and decreasing disorganized attachment in maltreated toddlers.

“At post-intervention, both CPP and PPI were found to be efficacious in improving secure attachments and in decreasing disorganized attachment (Cicchetti, Rogosch, & Toth, 2006).”

• Also stated in: § Preventive Interventions · plain

  “Both the CPP and PPI interventions were found to be efficacious in fostering securing attachment in toddlers in maltreating families (Cicchetti et al., 2006).”

• cites Cicchetti et al., 2006Not checked yet

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May combine two claims.

Chronic stressors such as child maltreatment initially evoke hyperactivity of the hypothalamic-pituitary-adrenal axis, followed by later hypoactivity.

“Consequently, chronic stressors such as child maltreatment initially evoke hyperactivity of the HPA axis, followed by later hypoactivity (Trickett et al., 2010).”

• cites Trickett et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Other investigators have shown that the Maltreatment Classification System is reliable and valid for classifying maltreatment.

“Other investigators have demonstrated that the MCS is reliable and valid in classifying maltreatment (Bolger, Patterson, & Kupersmidt, 1998; Dubowitz, Pitts, Litrownik, Cox, Runyan et al., 2005; English, Upadhyaya, Litrownik, Marshall, Runyan, et al., 2005; Manly, 2005; Smith & Thornberry, 1995).”

• cites Bolger, Patterson, & Kupersmidt, 1998Not checked yet

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• cites Dubowitz, Pitts, Litrownik, Cox, Runyan et al., 2005Not checked yet

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• cites English, Upadhyaya, Litrownik, Marshall, Runyan, et al., 2005Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

Both hyper- and hypo-cortisolism can reflect allostatic load.

“Both hyper- and hypo-cortisolism can reflect allostatic load, typically defined as the result of chronic exposure to fluctuating or heightened neural or neuroendocrine responses that emerge in response to chronic environmental challenges that are perceived as especially stressful (McEwen & Stellar, 1993).”

• cites McEwen & Stellar, 1993Not checked yet

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Classified as probably not a substantial claim.

Infants from maltreating families were randomly assigned to one of three intervention conditions: Child-Parent Psychotherapy, Psychoeducational Parenting Intervention, or community standard services.

“Thirteen-month-old infants from maltreating families (N = 91) and their mothers were randomly assigned to one of three intervention conditions: 1. Child-Parent Psychotherapy (CPP); 2. Psychoeducational Parenting Intervention (PPI); and 3. a control group involving standard community services (CS).”

• Also stated in: § Participants · plain

  “Following completion of baseline assessments, the mothers and infants recruited for the maltreatment sample were randomly assigned to one of three groups: Child-Parent Psychotherapy (CPP), Psychoeducational Parenting Intervention (PPI), and standard services typically provided in the community, Community Standard (CS).”

May combine two claims. The quote only partly states this claim.

In Fisher et al. (2007), foster children who received a family-based therapeutic intervention exhibited cortisol activity that became comparable to nonmaltreated comparison children over the intervention, whereas children who received routine foster care displayed an increasingly flattened pattern of early morning to evening cortisol activity.

“Fisher and colleagues (2007) found that the foster children who received the family-based therapeutic intervention exhibited cortisol activity that became comparable to the nonmaltreated comparison children over the course of the intervention. In contrast, children who received routine services in state foster care (e.g., weekly individual psychotherapy; developmental screening for delays with the”

• cites Fisher et al., 2007Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

Child maltreatment is characterized by severe parenting dysfunction and substantial parent-child relationship disturbance that may lead to aberrant biological and psychological development and psychopathology across the lifespan.

“Child maltreatment is characterized by severe dysfunction in parenting and a substantial disturbance in the parent-child relationship that may eventuate in aberrant biological and psychological development and psychopathology across the lifespan (Azar, 2002; Cicchetti & Valentino, 2006; Cyr, Euser, Bakermans-Kranenburg, & van IJzendoorn, 2010; Rogosch, Cicchetti, Shields, & Toth, 1995; Toth, Cicc”

• cites Azar, 2002Not checked yet

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• cites Cicchetti & Valentino, 2006Not checked yet

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• cites Cyr et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Both Child-Parent Psychotherapy and Psychoeducational Parenting Intervention were manualized, with central components specified, and fidelity checks were conducted throughout the intervention.

“Both the CPP and PPI interventions were manualized, with central components and core principles of each approach specified. Therapists participated in individual and group supervision on a weekly basis, and checks on the fidelity of the intervention implementation for each approach were conducted throughout the course of intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Cortisol was assayed in duplicate using an enzyme immunoassay with a lower limit of sensitivity of 0.007 μg/dl and average intra- and inter-assay coefficients of variation less than 5.0% and 10.0%, respectively.

“Cortisol was assayed in duplicate by Salimetrics, Inc using an enzyme immunoassay (Salimetrics, State College, PA). This assay has a lower limit of sensitivity of 0.007 μg/dl (range up to 1.8 μg/dl), and average intra-and inter-assay coefficients of variation less than 5.0% and 10.0%, respectively.”

May combine two claims.

The hypothalamic-pituitary-adrenal axis in maltreated children is highly likely to show dysregulation, which may involve both hyper- and hypo-functioning.

“Research on the impact of early caregiving adversity in humans has revealed that the HPA axis is highly likely to exhibit evidence of dysregulation and that this dysregulation may entail both hyper- and hypo-functioning (Cicchetti & Rogosch, 2001; Cicchetti, Rogosch, Gunnar, & Toth, 2010; Gunnar & Vazquez, 2001; Heim, Newport, Mletzko, Miller, & Nemeroff, 2008).”

• cites Cicchetti & Rogosch, 2001Not checked yet

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• cites Cicchetti et al., 2010Not checked yet

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• cites Gunnar & Vazquez, 2001Not checked yet

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May combine two claims.

Infants in the CS group are likely to have fewer self-righting capabilities, which bodes poorly for resilient functioning.

“Moreover, the infants in the CS group are likely to have fewer self-righting capabilities and this bodes poorly for their ability to function in a resilient fashion (Cicchetti, 2010).”

• cites Cicchetti, 2010Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Mothers in the intervention may have become better able to cope with rearing demands, pay greater attention, and be more responsive to infant and toddler needs.

“In addition, mothers in the intervention may have become better able to cope with the demands of rearing infants and toddlers. As a consequence, these mothers could have become more able to pay greater attention and become more responsive to infant/toddler needs.”

May combine two claims.

For infants in the MI group, cortisol levels were normalized, meaning not different from the NC group, and remained so at the one-year post-intervention follow-up.

“Finally, for infants in the MI group, cortisol levels were normalized (i.e., not different from the NC group) and remained so even at the one-year post-intervention follow-up period.”

• AssumptionRests on an assumption: Non-maltreated comparison children provide a normative reference for typical cortisol regulation.

Probably not a substantial claim: may not pass S2 (checkable).

The efficacy of any preventive intervention may ultimately depend on the nervous system's ability to be modified by experience at cellular, metabolic, or anatomical levels.

“Thus, it is conceivable that the efficacy of any preventive intervention ultimately depends on the ability of the nervous system, either at the cellular, metabolic, or anatomical level, to be modified by experience.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The consistency in time of cortisol collection across the four assessment waves was remarkable.

“Nonetheless, the consistency in the time of collection across the four assessment waves is remarkable.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study did not include other biomarkers of allostatic load assessed throughout the RCT.

“In addition, we did not include other biomarkers of allostatic load assessed throughout the duration of the RCT.”

Probably not a substantial claim: may not pass S4 (based).

The interventions likely reduced stress in the child rearing environment.

“The interventions likely reduced the stress experienced in the child rearing environment.”

May combine two claims.

Infants in the CS group, who showed a steady decrease in morning cortisol over two years, are at high risk for future mental and physical health problems.

“In contrast, the infants in the community standard intervention group, who exhibited a steady decrease in morning cortisol levels over a two-year period, are at high-risk for developing future mental and physical health problems”

• cites Danese, Caspi, Williams, Ambler, Sugden et al., 2011Not checked yet

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• cites Danese, Moffitt, Pariante, Ambler, Poulton, & Caspi, 2008Not checked yet

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• cites Danese, Pariante, Caspi, Taylor, & Poulton, 2007Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable).

Identification of stress-sensitive neural processes may provide a firm empirical basis for developing interventions to prevent and ameliorate the deleterious effects of early maltreatment.

“The identification of stress-sensitive neural processes may provide a firm empirical basis for the development of interventions to prevent and to ameliorate the deleterious effects of early maltreatment experiences.”

May combine two claims.

The intervention received by the MI group served a protective function by preventing prolonged allostatic load and may have helped avoid longer-term physical and mental health problems typically accompanying hypocortisolism.

“Furthermore, the intervention received by the MI group served not only a protective function by preventing prolonged allostatic load, but also may have helped to avoid the longer-term physical and mental health problems typically accompanying hypocortisolism (Cicchetti & Rogosch, 2001; Gunnar & Vazquez, 2001).”

• cites Cicchetti & Rogosch, 2001Not checked yet

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• cites Gunnar & Vazquez, 2001Not checked yet

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May combine two claims.

Tollenaar et al. (2010) provided normative data on cortisol levels in 300 infants over the first year, with multiple assessments at 11:00 a.m. at ages 6 weeks, 5 months, and 10-12 months.

“A recent study has provided normative data on cortisol levels in 300 infants over the first year, with multiple assessments obtained at 11:00 a.m. at age 6 weeks, 5 months, and 10-12 months (Tollenaar, Jansen, Beijers, Risken-Walraven, & de Weerth, 2010).”

• cites Tollenaar et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

As it is increasingly demonstrated that the nervous system can be modified by experience, successful preventive interventions could be conceptualized as examples of experience-dependent neural plasticity.

“As it is increasingly demonstrated that the nervous system can be modified by experience, then successful preventive interventions could be conceptualized as examples of experience-dependent neural plasticity (Cicchetti & Curtis, 2006).”

• cites Cicchetti & Curtis, 2006Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

Changes in parenting or mother-child relational processes may have promoted positive self-representations in caregivers and infants, improving child HPA axis functioning through reduced relational stress.

“Likewise, changes in parenting or mother-child relational processes may have promoted positive self-representations in the caregiver as well as positive representations of her infant/toddler, resulting in improved functioning of the child’s HPA axis through the concomitant reduction in relational stress.”

May combine two claims.

The treatment effect on basal cortisol was evident at the first post-intervention assessment and maintained throughout the study.

“These results indicated that the treatment effect on basal cortisol was evident at the first assessment post-intervention and maintained throughout the course of the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was not able to delineate definitive mechanisms of change contributing to differential patterns of cortisol regulation over time.

“Moreover, we were not able to delineate definitive mechanisms of change contributing to our differential patterns of cortisol regulation over time.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The positive effects obtained in the RCT may be epigenetic in nature and illustrate how an altered environment can influence methylation and modify gene expression.

“In this regard, the positive effects obtained in our RCT may be epigenetic in nature and illustrative of the processes by which a markedly altered environment (i.e., achieved through intervention) can influence methylation and modify gene expression (Meaney, 2010).”

• cites Meaney, 2010Not checked yet

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May combine two claims.

Infants in the CS group are highly likely not to improve in self-righting abilities, succumbing to allostatic load and showing sequential worsening of morning cortisol regulation over time.

“In contrast, infants in the CS group are highly likely not to manifest improvement in their self-righting abilities, succumbing to allostatic load processes and exhibiting a sequential worsening of morning cortisol regulation over time (Cicchetti & Rogosch, 2001).”

• cites Cicchetti & Rogosch, 2001Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A general decline in cortisol levels was observed across the longitudinal assessments in Tollenaar et al.

“A general decline in cortisol levels was observed across these longitudinal assessments.”

• cites Tollenaar et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The growing body of research demonstrating that behavioral interventions may positively alter psychological and neurobiological functioning has important implications for social policy.

“The growing body of research demonstrating that behavioral interventions may positively alter not only psychological processes, but also neurobiological functioning, possesses important implications for the social policy arena.”

May combine two claims.

Infants in the MI group very likely develop enhanced self-righting capacities that may promote resilient functioning.

“Infants in the MI group very likely develop enhanced self-righting capacities that may promote the development of resilient functioning (Cicchetti, 2010; Cicchetti & Rogosch, 1997).”

• cites Cicchetti, 2010Not checked yet

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• cites Cicchetti & Rogosch, 1997Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Only one cortisol sample was collected and assayed at each time period assessed.

“Only one cortisol sample was collected and assayed at each time period assessed.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Such nervous system modifications are adaptive for ongoing survival and optimal functioning of the organism.

“Such modifications are adaptive for the ongoing survival and optimal functioning of the organism (Cicchetti & Curtis, 2006; Huttenlocher, 2002; Stiles, 2008).”

• cites Cicchetti & Curtis, 2006Not checked yet

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• cites Huttenlocher, 2002 sourceNot checked yet

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• cites Stiles, 2008 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

The nonmaltreated comparison group was screened to rule out documented child maltreatment and further validated by maternal interview.

“DHS and preventive records were thoroughly screened to rule out the existence of documented child maltreatment in these families. Mothers also were interviewed utilizing the Maternal Maltreatment Classification Interview (Cicchetti, Toth, & Manly, 2003) regarding maltreatment and any DHS involvement to further validate nonmaltreatment status.”

• cites Cicchetti, Toth, & Manly, 2003Not checked yet

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Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Findings such as those reported may ultimately increase the availability of resources directed toward prevention of child abuse and neglect and treatment needs of vulnerable children.

“Because resources may be more readily expended for the prevention of negative physical rather than mental health consequences, findings such as those reported herein may ultimately increase the availability of resources that can be directed toward the prevention of child abuse and neglect and toward the extensive treatment needs of these vulnerable children.”

May combine two claims.

Psychosocial interventions can avert decline in normative neuroendocrine regulation and normalize HPA functioning in high-risk infants receiving RCT preventive interventions.

“Psychosocial interventions can avert decline in normative neuroendocrine regulation, normalizing HPA functioning in high-risk infants receiving RCT preventive interventions.”