Multidimensional assessment of neuroendocrine and psychopathological profiles in maltreated youth

Abstract

It has been debated whether children who have experienced early life stress (ELS), such as early caregiver separation show elevated risk for stress-related psychiatric disorders and a multi-symptom psychopathological profile that is not fully reflected in categorical assessments. In this study, we investigated dimensional measures of stress-related psychopathology in children in permanent out-of-home care, taking into account potential neuroendocrine interactions. In the current study, 25 children who had been placed in permanent out-of-home care before age 3 (years) and 26 controls (aged 10.6 ± 1.75 years) were investigated with categorical (DSM-IV) and dimensional assessments (CBCL) of psychopathology and diurnal salivary cortisol levels were assessed. Semi-structured interviews (K-DIPS) revealed no significant group differences in full-scale psychiatric diagnoses, whereas dimensional assessment (CBCL) revealed significant group differences in externalizing and total problem behaviours within the clinical range for children with ELS. Only children with ELS showed a combined symptom profile of clinical-range internalizing and externalizing problems. Lower morning cortisol values and subsequent flatter decline was found in subjects with ELS children compared to controls, showing group differences in diurnal cortisol secretion. Lower morning cortisol values were associated with more problem behaviour in the ELS group. Results show that ELS children exhibited increased psychopathological symptom severity and complexity associated with lower morning cortisol levels, which was not fully reflected in categorical assessments. This highlights the importance of incorporating dimensional assessments and neurobiological factors into psychopathological evaluations of children in out-of-home care in order to facilitate early identification of children at high risk for stress-related disorders.

Keywords: Adoption; Aggression; CBCL; Cortisol; DSM; Dimensional assessments; Early caregiver separation; Early-life stress (ELS); Maltreatment.

Fig. 1

Distribution of T values for each of the CBCL syndrome scales per group (ELS group n = 25; controls n = 26). Note that the value for aggressive behaviour for ELS youths in the sample fell within the borderline clinical range and the average total value fell within the clinical range (syndrome scale values <65 fall within the normal range, values between 65 and 69 fall within the borderline range and values >69 fall within the clinical range. Total scale values <60 fall within the normal range, values between 60 and 63 fall within the borderline range and values >63 fall within the clinical range)

Fig. 2

Scatterplots depicting the association between internalizing and externalizing scores for a control children and b ELS youths with and without categorical DSM-IV diagnoses. Vertical and horizontal lines mark the clinical range cut-off (T = 63). Note that none of the control youths (a) shows a combined symptom profile of externalizing and internalizing problems within the clinical range which is evident in n = 6 ELS youths (b)

Fig. 3

Cortisol release pattern over the three measurement points for ELS and control youths. The morning cortisol release is significantly lower in ELS youths than controls