Cited by 338Child Abuse and TraumaStress Responses and CortisolChild and Adolescent Psychosocial and Emotional Development

The DOI matches its Crossref record; 85 of the 93 references it cites were found in a registry or an index, and 5 are not checked yet; none of the 88 sources its claims cite is checked for support yet.

The Differential Impacts of Early Physical and Sexual Abuse and Internalizing Problems on Daytime Cortisol Rhythm in School-Aged Children

Open access

Abstract

The impact of early physical and sexual abuse (EPA/SA) occurring in the first 5 years of life was investigated in relation to depressive and internalizing symptomatology and diurnal cortisol regulation. In a summer camp context, school-aged maltreated (n = 265) and nonmaltreated (n = 288) children provided morning and late afternoon saliva samples on 5 consecutive days. Child self-report and adult observer reports of child internalizing and depressive symptoms were obtained. Children experiencing EPA/SA and high depressive or internalizing symptoms uniquely exhibited an attenuated diurnal decrease in cortisol, indicative of neuroendocrine dysregulation. These results were specific to EPA/SA rather than later onset physical or sexual abuse or early occurring neglect or emotional maltreatment.

Checked 2026-10-06 · 5 references not checked yet

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This study tested whether physical or sexual abuse during the first five years of life, combined with high depressive or internalizing symptoms, predicts atypical daytime cortisol regulation in school-aged children. It found that only children with early physical/sexual abuse and high symptoms showed a flatter morning-to-afternoon cortisol decline, while other maltreatment timing and subtype features did not explain the pattern.

Key findings

  • Among 553 children (265 maltreated, 288 nonmaltreated), early physical/sexual abuse (EPA/SA; n = 60) was linked to more internalizing symptoms: 33.3% of EPA/SA children had high symptoms versus 14.9% of nonmaltreated children and 21.5% of other maltreated children.
  • A significant group × symptom level × time-of-day interaction, F(2,545) = 6.07, p = .002, showed that high-symptom EPA/SA children had a smaller cortisol decline from morning to late afternoon (0.12) than high-symptom NEPA/SA children (0.23) and nonmaltreated children (0.25).
  • Specificity analyses indicated that early neglect/emotional maltreatment and later-onset physical/sexual abuse did not show the same pattern; other maltreatment parameters such as onset, recency, chronicity, diversity, and perpetrator type were not significant moderators (p values ranged from .16 to .99).
  • Girls had a greater diurnal cortisol decrease than boys (0.27 vs. 0.22), and older children had a steeper decrease than younger children (0.29 vs. 0.19), but neither gender nor age moderated the main early-abuse/high-symptom effect.

Methods

  • School-aged children (ages 7–13; M = 10.02, SD = 1.87) attending a summer day camp provided morning (9 a.m.) and late afternoon (4 p.m.) saliva samples on five consecutive days; cortisol was assayed and log-transformed, then averaged across days.
  • Maltreatment status and subtype/timing were coded from Department of Human Services records using the Maltreatment Classification System; EPA/SA was defined as physical or sexual abuse before age 5, and comparisons included other maltreated children and nonmaltreated children.
  • Depressive/internalizing symptoms came from child self-report (Children’s Depression Inventory) and counselor report (Teacher Report Form internalizing scale); high symptoms were defined as scoring above the clinical cutpoint on either measure, yielding 19.3% classified as symptomatic. Analyses used repeated-measures ANCOVA and follow-up contrasts, covarying age and gender.

Limitations

  • The authors state that physical/sexual abuse could not be fully separated from neglect because the two overlap heavily, especially in low-income samples, so it remains unclear whether abuse-specific features or greater overall severity drove the findings.
  • The authors note that wake-up time was not measured, puberty stage data were not collected, and it is unknown whether the observed cortisol flattening predicts later physical or mental health problems.
  • The text also makes evident that the sample excluded children in foster care or out-of-home placement, likely omitting more extreme maltreatment cases, and the design was cross-sectional, so causal and longitudinal interpretations are limited.

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Integrity signals

Registry

Crossref · 10.1111/j.1467-8624.2009.01393.x

Cites

85 of 90 references verified0 citation errors · 0 not checkable

Statistics

25 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Verification

Claims the paper makes

59 Not checked yet · 59 Own result · 19 Own method · 15 Own interpretation · 3 Sources not found · 2 No basis given

Verify all 84 references — free account
  • It may state two separate claims as one. 42
  • Probably not a substantial claim. 47
78 of 78
  • The paper relies on this without support.

    DHS records provide complete and accurate information about children's maltreatment histories, including subtype and timing.

    “Comprehensive searches of DHS records were completed and maltreatment information was coded utilizing operational criteria from the maltreatment nosology specified in the Maltreatment Classification System”
    “The MCS codes all available information from DHS records, making independent determinations of maltreatment experiences.”
  • The paper relies on this without support.

    Absence of documented maltreatment in DHS records and maternal interview indicates no maltreatment history.

    “DHS record searches were completed for these families to verify the absence of any record of child maltreatment. Trained research assistants also interviewed mothers of children recruited for the nonmaltreatment group to confirm a lack of DHS involvement and prior maltreatment experiences”
    “Only children from families without any history of documented abuse or neglect were retained in the nonmaltreatment group.”
  • The paper relies on this without support.

    Camp counselors can observe behaviors similar to those teachers observe, making the TRF appropriate for use in the camp setting.

    “the measure was used in the present study, because camp counselors are able to observe similar behaviors to that of teachers.”
  • The paper relies on this without support.

    Children who experience early and extreme maltreatment are generally removed from their homes and placed in foster care.

    “Generally children who experience early and extreme maltreatment are removed from their homes and placed in foster care.”
  • The paper relies on this without support.

    Neglect is almost always present for maltreated children, especially in low-income samples.

    “The clinical reality is that there is an extremely high overlap and that neglect is almost a consistent experience for these children, particularly in low-income samples.”
  • The paper relies on this without support.

    Cortisol changes sharply in the first hour after waking and then declines gradually for the rest of the day.

    “Cortisol levels change markedly in the first hour after morning awakening and then gradually decrease over the remainder of the day.”
  • The paper relies on this without support.

    Cortisol levels track an individual's wake-up time more closely than clock time.

    “Levels are more closely related to the individual’s wake-up time than to clock time.”
  • The paper relies on this without support.

    Family disorganization would make children's reports of wake-up time error-prone.

    “We chose not to measure wake-up time because we anticipated errors in child reporting of this measure, given the high level of disorganization in many of the families' homes.”
  • The paper relies on this without support.

    Some older children in the sample were entering puberty.

    “Undoubtedly some of the older children in our study were entering puberty”
9 of 9

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?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

5 of 5

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upχ²(1) = 0.29reported p = .81 · recomputed p = .590

    “χ2 (1, N = 265) = .29, p = .81”

  • Doesn’t add upχ²(1) = 0.04reported p = .88 · recomputed p = .841

    “χ2 (1, N = 265) = .04, p = .88”

  • Doesn’t add upχ²(1) = 10.39reported p = .002 · recomputed p = .001

    “χ2 (1, N = 265) = 10.39, p = .002”

  • Doesn’t add upχ²(2) = 3.57reported p = .06 · recomputed p = .168

    “χ2 (2, N = 265) = 3.57, p = .06”

  • Doesn’t add upχ²(2) = 3.52reported p = .06 · recomputed p = .172

    “χ2 (2, N = 493) = 3.52, p = .06”

  • Consistentχ²(2) = 17.86reported p < .001 · recomputed p < .001

    “χ2 (2) = 17.86, p < .001”

  • Consistentχ²(1) = 4.48reported p = .03 · recomputed p = .034

    “χ2 (1, N = 553) = 4.48, p = .03”

  • ConsistentF(2, 550) = 2.62reported p = .07 · recomputed p = .074

    “F(2,550) = 2.62, p = .07”

  • ConsistentF(2, 550) = 9.14reported p < .001 · recomputed p < .001

    “F(2,550) = 9.14, p < .001”

  • Consistentχ²(2) = 11.71reported p = .003 · recomputed p = .003

    “χ2 (2, N = 553) = 11.71, p = .003”

  • Consistentχ²(1) = 11.34reported p = .001 · recomputed p < .001

    “χ2 (1, N = 348) = 11.34, p = .001”

  • ConsistentF(2, 550) = 1.52reported p = .22 · recomputed p = .220

    “F(2,550) = 1.52, p = .22”

  • ConsistentF(2, 550) = 0.07reported p = .94 · recomputed p = .932

    “F(2,550) = .07, p = .94”

  • ConsistentF(2, 545) = 6.07reported p = .002 · recomputed p = .002

    “F(2,545) = 6.07, p = .002”

  • ConsistentF(2, 441) = 0.81reported p = .45 · recomputed p = .446

    “F(2,441) = .81, p = .45”

  • ConsistentF(2, 104) = 5.94reported p = .004 · recomputed p = .004

    “F(2,104) = 5.94, p = .004”

  • ConsistentF(2, 101) = 4.27reported p = .017 · recomputed p = .017

    “F(2,101) = 4.27, p = .017”

  • Consistentt(551) = 2.83reported p = .005 · recomputed p = .005

    “t (551) = 2.83, p = .005”

  • Consistentt(551) = 0.74reported p = .46 · recomputed p = .460

    “t (551) = 0.74, p = .46”

  • Consistentt(551) = 2.41reported p = .02 · recomputed p = .016

    “t (551) = 2.41, p = .02”

  • Consistentt(551) = 6.12reported p < .001 · recomputed p < .001

    “t (551) = 6.12, p < .001”

  • Consistentt(551) = 0.56reported p = .58 · recomputed p = .576

    “t (551) = .56, p = .58”

  • ConsistentF(1, 204) = 13.13reported p < .001 · recomputed p < .001

    “F(1,204) = 13.13, p < .001”

  • ConsistentF(1, 204) = 7.29reported p = .007 · recomputed p = .008

    “F(1,204) = 7.29, p = .007”

  • ConsistentF(1, 94) = 11.87reported p = .001 · recomputed p < .001

    “F(1,94) = 11.87, p = .001”

25 of 25

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 93 references

Research works printed but not linked: 12

  1. Barnett, 1993, Child abuse, child development, and social policy, 7
  2. Bemporad, 1992, Rochester symposium on developmental psychopathology: Vol. 4. Developmental perspectives on depression, 351
  3. Cicchetti, 1991, Thinking clearly about psychology: Essays in honor of Paul E. Meehl: Personality and psychopathology, 346
  4. Cicchetti, 2007, A multi-level approach to resilience [Special issue], Development and Psychopathology, 19
  5. Cicchetti, 1990, Methods of family research: Families at risk, 87
  6. Cicchetti, 2003, Maternal Maltreatment Classification Interview
  7. Cicchetti, 2006, Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation, 129
  8. Dahl, 1996, Rochester symposium on developmental psychopathology: Vol. 7. Adolescence: Opportunities and challenges, 197
  9. Gunnar, 2006, Developmental psychopathology: Vol. 2. Developmental neuroscience, 533
  10. Sedlack, 1996, The Third National Incidence Study of Child Abuse and Neglect (NIS-3) final report
  11. Toth, 1993, Child abuse, child development, and social policy, 399
  12. U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, 2000, Child maltreatment 1998: Reports from the states to the National Child Abuse and Neglect Data System

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Metadata

Authors
Cicchetti, D., Rogosch, F. A., Gunnar, M. R., & Toth, S. L.
Affiliations
  • University of Minnesota (US)
  • University of Rochester (US)
Corresponding author
Cicchetti, Dante
Venue
Child Development
Published
2010-01-01
Volume
81
Issue
1
Pages
252-269
ISSN
  • 0009-3920 (ISSN-L)
  • 1467-8624
OpenAlex
W2158907250
Cited by
337
References
93
Citations by year
2026: 4 · 2025: 9 · 2024: 10 · 2023: 9 · 2022: 12 · 2021: 21 · 2020: 18 · 2019: 13 · 2018: 20 · 2017: 29 · 2016: 28 · 2015: 33 · 2014: 37 · 2013: 24 · 2012: 27
FWCI
32.24
Type
journal article
Language
en
Open access
Locations
  • Child Development (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (DA12903, DA17741, R01DA012903, R01DA017741)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
child abuse, internalizing problems, depressive symptoms, diurnal cortisol rhythm, neuroendocrine dysfunction, school-aged children, summer camps, neglect, psychological maltreatment
MeSH terms
Adaptation, Psychological, Adult, Anxiety, Child, Child Abuse, Child Abuse, Sexual, Child Behavior Disorders, Circadian Rhythm, Critical Period, Psychological, Depression, Female, Humans, Hydrocortisone, Internal-External Control, Male, Risk Factors, Saliva, Social Environment, Time Factors, Crime Victims

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