Effect of Responsive Care on the Cortisol Levels in Foster Children

International Journal of Medical Science

© 2025 by SSRG - IJMS Journal

Volume 12 Issue 4

Year of Publication : 2025

Authors : Ahaana Jain

10.14445/23939117/IJMS-V12I4P101

How to Cite?

Ahaana Jain, "Effect of Responsive Care on the Cortisol Levels in Foster Children," SSRG International Journal of Medical Science, vol. 12,  no. 4, pp. 1-5, 2025. Crossref, https://doi.org/10.14445/23939117/IJMS-V12I4P101

Abstract:

Foster children often encounter exacerbated psychological difficulties due to early unfavorable experiences, making their mental wellbeing a grave concern. These children are at heightened risk for emotional and behavioral challenges, which can extend into adolescence and adulthood. These unpleasant experiences often lead to enhanced rates of mental dysregulation, anxiety, and behavioral challenges as compared to children raised in biologically intact families. A vital biological mechanism affected by chronic stress in foster children is the hypothalamic-pituitary-adrenal (HPA) axis, which controls the production of cortisol, the body's prime stress hormone. Foster children often exhibit dysregulated cortisol levels indicative of chronic stress. This abnormal regulation of the cortisol hormone can impair the immune system, emotional regulation, and physical growth. This article highlights the effect of responsive care on the cortisol levels of foster children. Interestingly, constant and receptive caregiving has been shown to mitigate these effects by inducing healthier cortisol patterns and offering a steady, nurturing environment that facilitates emotional control. Responsive care fosters secure attachments, enhances emotional resilience, and supports neurobiological development in brain regions involved in stress regulation. Thus, addressing HPA axis regulation through supportive caregiving is crucial for diminishing stress linked health risks and augmenting the overall wellbeing of foster children.

Keywords:

HPA axis, Mental health, PTSD, Stress.

References:

[1] Nafisa Asif, Courtney Breen, and Robert Wells, “Influence of Placement Stability on Developmental Outcomes of Children and Young People in Out‑of‑home Care: Findings from the Pathways of Care Longitudinal Study,” Child Abuse & Neglect, vol. 149, 2024.
[CrossRef] [Google Scholar] [Publisher Link]
[2] Kristin Bernard et al., “Cortisol Production Patterns in Young Children Living with Birth Parents vs Children Placed in Foster Care Following Involvement of Child Protective Services,” JAMA Pediatrics, vol. 164, no. 5, pp. 438-443, 2010.
[CrossRef] [Google Scholar] [Publisher Link]
[3] Johanna Bick et al., “Childhood Adversity and DNA Methylation of Genes Involved in the Hypothalamus‑pituitary‑adrenal Axis and Immune System: Whole‑genome and Candidate‑gene Associations,” Development and Psychopathology, vol. 24, no. 4, pp. 1417 1425, 2012.
[CrossRef] [Google Scholar] [Publisher Link]
[4] Jennifer E. Blakeslee, Brianne H. Kothari, and Rebecca A. Miller, “Intervention Development to Improve Foster Youth Mental Health by Targeting Coping Self‑efficacy and Help‑seeking,” Children and Youth Services Review, vol. 144, 2023.
[CrossRef] [Google Scholar] [Publisher Link]
[5] Marc H. Bornstein, “Parenting and Child Mental Health: A Cross‑cultural Perspective,” World Psychiatry, vol. 12, no. 3, pp. 258 265, 2013.
[CrossRef] [Google Scholar] [Publisher Link]
[6] Jacqueline Bruce et al., “Morning Cortisol Levels in Preschool‑aged Foster Children: Differential Effects of Maltreatment Type,” Developmental Psychobiology, vol. 51, no. 1, pp. 14–23, 2009.
[CrossRef] [Google Scholar] [Publisher Link]
[7] Jodi C. Coon, Helena Bush, and John T. Rapp, “Eight Months of Telehealth for a State-funded Project in Foster Care and Related Services: Progress Made and Lessons Learned,” Behavior Analysis in Practice, vol. 15, pp. 1348–1360, 2022.
[CrossRef] [Google Scholar] [Publisher Link]
[8] Philip A. Fisher, and Mike Stoolmiller, “Intervention Effects on Foster Parent Stress: Associations with Child Cortisol Levels,” Development and Psychopathology, vol. 20, no. 3, pp. 1003–1021, 2008.
[CrossRef] [Google Scholar] [Publisher Link]
[9] Philip A. Fisher, Mark J. Van Ryzin, and Megan R. Gunnar, “Mitigating HPA Axis Dysregulation Associated with Placement Changes in Foster Care,” Psychoneuroendocrinology, vol. 36, no. 4, pp. 531–539, 2011.
[CrossRef] [Google Scholar] [Publisher Link]
[10] Gill Francis et al., “Play-based Interventions for Mental Health: A Systematic Review and Meta-analysis Focused on Children and Adolescents with Autism Spectrum Disorder and Developmental Language Disorder,” Autism & Developmental Language Impairments, 2022.
[CrossRef] [Google Scholar] [Publisher Link]
[11] Dylan G. Gee, and Emily M. Cohodes, “Leveraging the Developmental Neuroscience of Caregiving to Promote Resilience Among Youth Exposed to Adversity,” Development and Psychopathology, vol. 35, no. 5, pp. 2168-2185, 2023.
[CrossRef] [Google Scholar] [Publisher Link]
[12] Laura H. Goetz, and Nicholas J. Schork, “Personalized Medicine: Motivation, Challenges, and Progress,” Fertility and Sterility, vol. 109, no. 6, pp. 952-963, 2018.
[CrossRef] [Google Scholar] [Publisher Link]
[13] Erin P. Hambrick et al., “Mental Health Interventions for Children in Foster Care: A Systematic Review,” Child & Youth Services Review, vol. 70, pp. 65–77, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[14] James P. Herman et al., “Regulation of the Hypothalamic‑pituitary‑adrenocortical Stress Response,” Comprehensive Physiology, vol. 6, no. 2, pp. 603–621, 2016.
[CrossRef] [Google Scholar] [Publisher Link]
[15] Institute of Medicine, “The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies,” Washington, DC, The National Academies Press, 2013.
[CrossRef] [Publisher Link]
[16] Emilija Knezevic et al., “The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders,” Cells, vol. 12, no. 23, 2023.
[CrossRef] [Google Scholar] [Publisher Link]
[17] Katie A. McLaughlin et al., “Causal Effects of the Early Caregiving Environment on Development of Stress Response Systems in Children,” Proceedings of the National Academy of Sciences, vol. 112, no. 18, pp. 5637–5642, 2015.
[CrossRef] [Google Scholar] [Publisher Link]
[18] Felim Murphy et al., “Childhood Trauma, The HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis,” Frontiers in Psychiatry, vol. 13, 2022.
[CrossRef] [Google Scholar] [Publisher Link]
[19] Y. Negussie, A. Geller, and J.E. DeVoe, “Fostering Caregiver Well-being Toward Healthy Child Development,” Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity, 2019.
[Google Scholar] [Publisher Link]
[20] Elena I. Nikolaeva et al., “The Impact of Daily Affective Touch on Cortisol Levels in Institutionalized & Fostered Children,” Physiology & Behavior, vol. 277, 2024.
[CrossRef] [Google Scholar] [Publisher Link]
[21] Jennifer R. Piazza et al., “Frontiers in the use of Biomarkers of Health in Research on Stress and Aging,” The Journals of Gerontology: Series B, vol. 65B, no. 5, pp. 513–523, 2010.
[CrossRef] [Google Scholar] [Publisher Link]
[22] Emily B. Reilly, and Megan R. Gunnar, “Neglect, HPA Axis Reactivity, and Development,” International Journal of Developmental Neuroscience, vol. 78, pp. 100–108, 2019.
[CrossRef] [Google Scholar] [Publisher Link]
[23] Vanessa Reindl et al., “Caregiving Quality Modulates Neuroendocrine and Immunological Markers in Young Children in Foster Care who have Experienced Early Adversity,” The Journal of Child Psychology and Psychiatry, vol. 63, no. 5, pp. 535-543, 2022.
[CrossRef] [Google Scholar] [Publisher Link]
[24] Aline K. Szenczy et al., “Foster Parent Responsiveness and Young Children’s Diurnal Cortisol Production,” Developmental Psychobiology, vol. 63, no. 5, pp. 1626-1634, 2021.
[CrossRef] [Google Scholar] [Publisher Link]
[25] Flavia Teculeasa, Florinda Golu, and Andrian Gorbănescu, “What Mediates the Link Between Foster Parents’ Sensitivity Towards Child Posttraumatic Stress Symptoms and Job Satisfaction? The Role of Compassion Fatigue and Foster parent-child Relationship,” Journal of Child & Adolescent Trauma, vol. 16, pp. 309-320, 2023.
[CrossRef] [Google Scholar] [Publisher Link]
[26] Ross A. Thompson, “Emotion Dysregulation: A Theme in Search of Definition,” Development and Psychopathology, vol. 31, no. 3, pp. 805–815, 2019.
[CrossRef] [Google Scholar] [Publisher Link]
[27] Esther J.M. van der Vegt et al., “Early Neglect and Abuse Predict Diurnal Cortisol Patterns in Adults: A Study of International Adoptees,” Psychoneuroendocrinology, vol. 34, no. 5, pp. 660–669, 2009.
[CrossRef] [Google Scholar] [Publisher Link]
[28] Judith A. Whitworth et al., “Cardiovascular Consequences of Cortisol Excess,” Vascular Health and Risk Management, vol. 1, no. 4, pp. 291–299, 2005.
[CrossRef] [Google Scholar] [Publisher Link]