KU researchers seek to combat 'stress hormone' in children in adverse family situations

LAWRENCE — Excess stress is hazardous to everyone. But for infants and toddlers facing toxic stress due to traumatic and adverse events or living situations, it can mean stunted growth, behavioral challenges, struggles in school and troubled adulthood. University of Kansas researchers are part of a grant project that is implementing an intervention throughout the state to help families in adverse situations nurture their children to prevent such problems, all of which can help children be healthier, save communities money and keep children in their homes.

Project NeuroNurture is a $2.4 million intervention program that will serve 1,500 families at five sites covering 34 counties in Kansas. KU researchers will provide an evaluation of the intervention’s effectiveness and measure cortisol, or the “stress hormone,” in children taking part in the program.

Research has proven that a 10-week early intervention called the Attachment and Bio-behavioral Catch-up, or ABC, can help regulate cortisol levels in infants and toddlers. The hormone occurs naturally in humans, urging them to wake up, respond to threats and take action in adverse situations. The levels are higher in the morning and decrease during the course of the day. However, for children in consistently stressful situations, cortisol levels can stay elevated throughout the day and lead to long-term negative effects on the child’s development.

“It’s like their bodies are constantly activated for something adverse to happen, and that long-term activation can have a devastating impact on their long-term development. Research has shown that toxic stress, if not addressed early on, can lead to increased risk of serious problems later in life,” said Amy Mendenhall, associate professor of social welfare at KU and principal investigator for the project’s evaluation. “These problems may include difficulty with memory and learning, depression, anxiety, lower immune function and heart disease.”

Kaela Byers, a former researcher at KU and current researcher at Chapin Hall at the University of Chicago, led a project in 2015 to bring ABC to Kansas and facilitated training in the intervention for providers at Early Head Start locations in Kansas.

“The ABC intervention had a positive impact on children during the smaller pilot here in Kansas. Now we are excited to be able to expand the intervention and hopefully the impact to even more Kansas families,” Mendenhall said.

The United Methodist Health Ministry Fund, Kansas Health Foundation, Wyandotte Health Foundation, REACH Healthcare Foundation and Hutchinson Community Foundation are underwriting the $2.4 million investment in Project NeuroNurture. The project has trained providers to implement the ABC intervention through in-home visits over 10 weeks, teaching parents play-based strategies to nurture, engage with and build attachment with their children, which can regulate cortisol and prevent toxic stress. The sessions are videotaped and provided to the parents to highlight strengths, weaknesses and document progress made.

The grant provides funds to five sites to incorporate the ABC method into their existing infant/toddler home visit programs:

• Horizons Mental Health Center: Reno County
• Rainbows United: Sedgwick and Butler counties
• Russell Child Development Center: Greeley, Wichita, Scott, Lane, Ness, Hamilton, Kearny, Finney, Hodgeman, Stanton, Haskell, Gray, Ford, Morton, Stevens, Seward, Meade and Clark counties
• Project Eagle — University of Kansas Medical Center: Wyandotte County
• Northwest Kansas Council on Substance Abuse: Cheyenne, Rawlins, Decatur, Norton, Sherman, Thomas, Sheridan, Graham, Wallace, Logan, Gove and Trego counties.

Providers use a screening tool, developed by Byers, to identify those who could benefit from the intervention. The screening identifies adverse events and situations in families such as extreme poverty, domestic violence, mental health issues in parents, substance abuse in the home and others. KU researchers will evaluate the effectiveness of the intervention at the five different sites, how it is administered by differing agencies and report their findings to funders, partner sites and policymakers.

Whitney Grube, graduate research assistant at KU and project director, leads the collection of outcome data, including the saliva samples to monitor cortisol levels in the children taking part in the intervention. Samples are taken for two consecutive days in the morning and evening at the beginning of the intervention, at its completion and six months later to determine if cortisol levels have become more regulated. The evaluation will also track parent outcomes such as parents’ beliefs about their parenting skills and child outcomes such as age-appropriate social and emotional development.

Mendenhall said the evaluation will help determine how best to implement the program in varied geographic areas across the state and how different types of agencies, such as mental health centers and child development centers, can most effectively employ the intervention with the resources they have.

Identifying and addressing toxic stress in children early has numerous benefits. Helping children and families is “the best investment,” Mendenhall said, as it is more cost-effective to prevent future health and mental health problems than to treat them later in life. Not only does it save communities money, it can help improve the long-term well-being and success of children.

Image: This graphic illustrates normal to dangerous levels of cortisol, known as the stress hormone, in infants. KU researchers are taking part in a project to help families lower cortisol levels and improve health in infants in toxic stress environments. Credit: NeuroNurtureKs.org