Untitled

138 EFFECTS OF EARLY MALTREATMENT AND STRESSchild’s current emotional problems. Early maternal depression plus concurrentinternalizing (sad, withdrawn, fearful, anxious) behavior problems predicted largercortisol responses.Finally, again on the issue of maternal depression and more particularly relevantto issues of adolescence, Halligan and colleagues (Halligan, Herbert,Goodyer, & Murray, 2004) recently reported that in early adolescence, childrenwhose early morning cortisol levels vary a good deal from day to day, often spikingto higher than expected concentrations, had mothers who were clinically depressedduring the child’s infancy. Furthermore, maternal depression during achild’s infancy was a significant factor even after taking into account maternaldepression between infancy and early adolescence. The authors noted that theirmeasure of erratic basal cortisol concentrations had previously been shown to bea risk factor for the onset of depression in studies of adolescents (Goodyer, Herbert,& Tamplin, 2003), thus raising the possibility that maternal depression in infancyimpaired the mother’s ability to provide sensitive, responsive care, shaping vulnerabilitiesin the child’s HPA system that later, in adolescence, might increasethe risk that the child would also experience clinical depression.Evidence From Orphaned ChildrenNotably, none of the studies of maternal depression or maternal stress that haveshown relations with children’s cortisol levels has based their findings on measuresof the caregiver-infant relationship. Thus we can only speculate that motherswho were more stressed or depressed were providing less supportive care andthat it was the care the children received that mediated the association betweenmaternal factors and child HPA axis functioning. This is also true of the next setof studies that have examined the impact of early, severe, maltreatment. However,with the maltreatment literature we can at least be assured that the care thechild received fell into the grossly inadequate range. The HPA axis studies ofmaltreated children can be summarized as follows. If the maltreatment resulted inchronic posttraumatic stress disorder (PTSD), two studies have now shown thatprepubescent children with PTSD pursuant to early, severe, and prolonged abusehave significantly elevated basal cortisol levels (Carrion et al., 2002; De Belliset al., 1999). However, it is possible that this heightened reactivity reflects ongoingadversity in the children’s home lives, possibly contributed to by their ownbehavior problems (Kaufman et al., 1997).In part because of the difficulty of disentangling early versus later psychosocialadversity, my research group has chosen to focus on children adopted frominstitutions (i.e., postinstitutionalized, or PI, children). Conditions in orphanagesvary around the world and even from room to room within the same orphanage(see review, Johnson, 2000). However, few orphanages manage to provide theircharges with consistent, sensitive, and individualized care (Castle et al., 1999).Although family processes undoubtedly vary among adoptive families, care pro-