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Stress Effects on the Developing Brain 139vided in these families certainly is an improvement over what the children receivedin their orphanages, and this conclusion is supported by the remarkable catch-upobserved in behavioral, cognitive, and physical development (e.g., Rutter, 1998).Although many children seem to make a total recovery, a significant minoritycontinue to exhibit ongoing problems in attention, impulse control, emotion regulation,and both family (attachment) and peer relationships (see, for example,Rutter, Kreppner, O’Connor, & English and Romanian Adoptees (ERA) StudyTeam, 2001). In several studies, my students and I have examined home baselinecortisol levels several years postadoption in these children (Gunnar, Morison,Chisholm, & Schuder, 2001; Kertes, Gunnar, Madsen & Long, 2006). Similar tothe children who experienced abuse early in life, some of the PI children exhibitan increased set point in the HPA axis, meaning that they appeared to be maintaininga higher basal level of HPA activity than other children. These are thechildren who came from the most deprived preadoption circumstances accordingto parent report and/or who exhibited severe growth failure at adoption that wasreversed by adoption.Do these early adversity effects on the HPA axis have any implications forchildren’s health and well-being? Theoretically they should, but we are far fromhaving clear demonstrations of this in the human literature. Again, the work byEssex and colleagues (Essex et al., 2002; Smider et al., 2002) is suggestive. Recallthat they found that maternal stress during the child’s infancy, particularly asreflected in maternal depressive symptoms, predicted higher child cortisol levelsat age 4.5 yrs if the mother was still highly stressed during the child’s preschoolyears. These researchers have also reported that cortisol levels at 4.5 years predictedchild behavior problems as rated by parent and teacher in kindergarten andfirst grade. Notably, they did not predict whether the child would exhibit anxious,internalizing problems or aggressive, externalizing problems. Rather they predictthe severity or number of behavior problems.Turning to PI children, so far, my students and I have not found that cortisol levelsamong PI children are associated with broad-band measures of internalizing orexternalizing behavior problems. However, in a reanalysis of a study of 100 childrenwho experienced at least 1 month of institutional care prior to adoption, we(Kertes & Gunnar, unpublished data) noted that wakeup but not bedtime cortisollevels at ages 7 to 9 years were correlated with higher scores on the Child BehaviorChecklist scale of anxiety and depressive symptoms. In another as-yet-unpublishedstudy (Bruce, Tarullo, & Gunnar, unpublished data), we have found that 6-year-oldPI children scoring high on a combined observation and interview measure of indiscriminatefriendliness exhibited higher cortisol levels in the late afternoon andevening. Indiscriminate friendliness is defined as overly intimate behavior withstrangers (i.e., immediately sitting on a stranger’s lap, hugging and cuddling with astranger, being willing to go home with a stranger). Thus there are beginning to besome tantalizing suggestions that early adverse conditions that impact activity of