Editors' ChoicePsychiatry

Reversing the effects of early life stress during puberty

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Science Translational Medicine  20 Nov 2019:
Vol. 11, Issue 519, eaaz9754
DOI: 10.1126/scitranslmed.aaz9754


Post-institutionalized youth show evidence of pubertal recalibration of stress reactivity.

Experiences of profound social deprivation during infancy shape the development of the hypothalamic-pituitary-adrenocortical (HPA) axis, an important stress response system. Specifically, children who were exposed to institutionalized care as infants show blunted cortisol reactivity to psychosocial stressors even years after being adopted into stable, supportive families. However, new evidence suggests that these effects could be reversed later in development under certain conditions.

Gunnar and colleagues tested whether post-institutionalized youth showed evidence of stress recalibration with puberty. Participants were post-institutionalized youth and comparison (never adopted) youth ages 7 to 15 at baseline. Each of three consecutive annual sessions assessed pubertal stage via physical examination and salivary cortisol reactivity to the Trier social stress test, a task designed to measure response to social evaluation, which was adapted for children. Findings revealed that post-institutionalized youth, but not nonadopted youth, showed increasing cortisol stress reactivity with pubertal development. That is, stress response among post-institutionalized youth more closely resembled that of nonadopted youth with increasing pubertal stage.

These findings highlight a powerful developmental effect and suggest that puberty marks a sensitive period for recalibration of the HPA axis. Importantly, adopting children from institutionalized care into stable families does not appear sufficient to recalibrate the HPA axis. Instead, pubertal development may be necessary to reopen a window of opportunity during which marked shifts in the caregiving environment can have an outsize effect.

The discovery of pubertal stress recalibration in post-institutionalized children leads to several important directions for future research. The mechanism underlying recalibration of the HPA axis and the extent to which findings generalize to other forms of early life stress, such as maltreatment, remain unknown. Future studies are needed to better understand whether pubertal stress recalibration is associated with improvements in mental and physical health. This study has critical implications for the timing of interventions, suggesting that the peripubertal period is an important time for interventions to promote resilience following early life stress.

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