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Saliva Cortisol and Heart Rate Variability as Biomarkers in Understanding Emotional Reaction and Regulation of Young Children—A Review

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DOI: 10.4236/psych.2013.46A2004    3,744 Downloads   6,601 Views   Citations


Cortisol and heart rate variability (HRV) are good indicators for the non-invasive assessment of the hypothalamic-pituitary-adrenal (HPA) and autonomic nervous system (ANS) activity in response to psychophysiological stress respectively. Emerging evidence from previous studies suggests a link between cortisol and HRV response to stress and social experiences during early development. However, research in this area has been constrained by a number of conceptual and methodological challenges. Time is a crucial variable that needs to be taken into account in study designs since stress-sensitive physiological systems change over time in response to changing intrinsic and extrinsic states. In this review, our focus is on the HPA axis and HRV responses as an allostatic system with young children’s individual differences in temperament, social regulation, and environmental sources of influence taken into account. The conclusions include: 1) cortisol levels are related to various time courses, ranging from moment-to-moment changes to changes occurring over the course of days, months, and years in consideration of individual differences in state and trait emotions; 2) it is necessary to take individual characteristics, multi-faceted constructs related to early development, and developmental changes into account in studies of reactivity and regulation patterns of the cortisol and HRV in young children; and 3) prospective examination is needed on the long-term outcomes of various individual characteristics and environmental influences (e.g., attachment quality, family and daycare environment, and environmental control of the child) in early experience that are related to reactivity differences in HRV and atypical cortisol patterns.

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Li, I. , Chwo, S. & Pawan, C. (2013). Saliva Cortisol and Heart Rate Variability as Biomarkers in Understanding Emotional Reaction and Regulation of Young Children—A Review. Psychology, 4, 19-26. doi: 10.4236/psych.2013.46A2004.


[1] Adam, E. (2012). Emotion-cortisol transactions occur over multiple time scales in development: Implications for research on emotion and the development of emotional disorders. Monographs of the Society for Research in Child Development, 77, 17-27. doi:10.1111/j.1540-5834.2012.00657.x
[2] Bayart, F., Hayashi, K. T., Faull, K. F., Barchas, J. D., & Levine, S. (1990). Influence of maternal proximity on behavioral and physiological responses to separation in infant rhesus monkeys (Macaca mulatta). Behavioral Neuroscience, 104, 108-115. doi:10.1037/0735-7044.104.1.98
[3] Beauchaine, T. (2001). Vagal tone, development, and Gray’s motivational theory: Toward an integrated model of autonomic nervous system functioning in psychopathology. Development and Psychopathology, 13, 183-214. doi:10.1017/S0954579401002012
[4] Binder, E. B., Bradley, R. G., Liu, W., Epstein, M. P., Deveau, T. C., Mercer, K. B., Tang, Y., Gillespie, C. F., Heim, C. M., Nemeroff, C. B., Cubells, J. F., & Ressler, K. J. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. Journal of the American Medical Association, 299, 1-5. doi:10.1001/jama.299.11.1291
[5] Calkins, S. D. (1997). Cardiac vagal tone indices of temperamental reactivity and behavioral regulation in young children. Developmental Psychobiology, 31, 125-135. doi:10.1002/(SICI)1098-2302(199709)31:2<125::AID-DEV5>3.0.CO;2-M
[6] Calkins, S. D., & Dedmon, S. A. (2000). Physiological and behavioral regulation in two-year-old children with aggressive/destructive behavior problems. Journal of Abnormal Child Psychology, 28, 103-118. doi:10.1023/A:1005112912906
[7] Calkins, S. D., & Fox, N. A. (2002). Self-regulatory processes in early personality development: A multilevel approach to the study of childhood social withdrawal and aggression. Development & Psychopathology, 14, 477-498. doi:10.1017/S095457940200305X
[8] Calkins, S. D., & Swingler, M. M. (2012). Psychobiological measures of temperament in childhood. In M. Zentner, & R. L. Shiner (Eds.), Handbook of temperament (pp. 229-247). New York, NY: Guilford Press.
[9] Clarke-Stewart, K. A. (1973). Interactions between mothers and their young children: Characteristics and consequences. Monographs of the Society for Research in Child Development, 38, 6-7. doi:10.2307/1165928
[10] Coplan, R. J., Rubin, K. H., Fox, N. A., Calkins, S. D., & Stewart, S. (1994). Being alone, playing alone and acting alone: Distinguishing among reticence, and passive- and active-solitude in young children. Child Development, 65, 129-137. doi:10.2307/1131370
[11] Crockenberg, S. (2003). Rescuing the baby from the bath water: How temperament and gender (may) moderate effects of child care on child development. Child Development, 74, 968-972. doi:10.1111/1467-8624.00585
[12] Crockenberg, S. C., & Leerkes, E. M. (2004). Infant and maternal behaviors regulate infant reactivity to novelty at 6 months. Developmental Psychology, 40, 1123-1132. doi:10.1037/0012-1649.40.6.1123
[13] Davis, E. P., Donzella, B., Krueger, W. K., & Gunnar, M. R. (1999). The start of a new school year: Individual differences in salivary cortisol response in relation to child temperament. Developmental Psychobiology, 35, 188-196. doi:10.1002/(SICI)1098-2302(199911)35:3<188::AID-DEV3>3.0.CO;2-K
[14] De Kloet, E. R., Sibug, R. M., Helmerhorst, F. M., & Schmidt, M. (2005). Stress, genes and the mechanism of programming the brain for later life. Neuroscience & Biobehavioral Reviews, 29, 271-281. doi:10.1016/j.neubiorev.2004.10.008
[15] Dettling, A. C., Gunnar, M. R., & Donzella, B. (1999). Cortisol levels of young children in full-day childcare centers: Relations with age and temperament. Psychoneuroendocrinology, 24, 505-518. doi:10.1016/S0306-4530(99)00009-8
[16] Dettling, A. C., Parker, S. W., Lane, S., Sebanc, A., & Gunnar, M. R. (2000). Quality of care and temperament determine whether cortisol levels rise over the day for children in full-day childcare. Psychoneuroendocrinology, 25, 819-836. doi:10.1016/S0306-4530(00)00028-7
[17] Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355-391. doi:10.1037/0033-2909.130.3.355
[18] Dozier, M., Peloso, E., Lewis, E., Laurenceau, J., & Levin, S. (2008). Effects of an attachment-based intervention on the cortisol production of infants and toddlers in foster care. Development and Psychopathology, 20, 845-859. doi:10.1017/S0954579408000400
[19] Eisenberg, N., Fabes, R. A., Murphy, B., Maszk, P., Smith, M., & Karbon, M. (1995). The role of emotionality and regulation in children’s social functioning: A longitudinal study. Child Development, 66, 1360-1384. doi:10.2307/1131652
[20] Fabes, R. A., Eisenberg, N., & Eisenbud, L. (1993). Behavioral and physiological correlates of children’s reactions to others in distress. Developmental Psychology, 29, 655-663. doi:10.1037/0012-1649.29.4.655
[21] Fabes, R. A., Eisenberg, N., Karbon, M., Troyer, D., & Switzer, G. (1994). The relations of children’s emotion regulation to their vicarious emotional responses and comforting behaviors. Child Development, 65, 1678-1693. doi:10.2307/1131287
[22] Gillespie, C. F., Phifer, J., Bradley, B., & Ressler, K. J. (2009). Risk and resilience: Genetic and environmental influences on development of the stress response. Depress Anxiety, 26, 984-992. doi:10.1002/da.20605
[23] Goeders, N. E. (2003). The impact of stress on addiction. European Neuropsychopharmacology, 13, 435-441. doi:10.1016/j.euroneuro.2003.08.004
[24] Gold, P. W., & Chrousos, G. P. (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: High vs low CRH/NE states. Molecular psychiatry, 7, 254-275. doi:10.1038/
[25] Graham, Y. P., Heim, C., Goodman, S. H., Miller, A. H., & Nemeroff, C. B. (1999). The effects of neonatal stress on brain development: Implications for psychopathology. Development and Psychopathology, 11, 545-565. doi:10.1017/S0954579499002205
[26] Greenspan, S. I. (2003). Child care research: A clinical perspective. Child Development, 74, 1064-1068. doi:10.1111/1467-8624.00591
[27] Gunnar, M. R. (1980a). Contingent stimulation: A review of its role in early development. In S. Vevine, & H. Ursin (Eds.), Coping and health (pp. 101-119). New York: Plenum. doi:10.1007/978-1-4684-1042-6_6
[28] Gunnar, M. R. (1980b). Control, warning signals, and distress in infancy. Developmental Psychology, 16, 281-289. doi:10.1037/0012-1649.16.4.281
[29] Gunnar, M. R. (2001). The role of glucocorticoids in anxiety disorders: A critical analysis. In M. W. Vasey, & M. R. Dadds (Eds.), The developmental psychopathology of anxiety (pp. 143-159). New York: Oxford Press.
[30] Gunnar, M. R., & Donzella, B. (2002). Social regulation of the cortisol levels in early human development. Psychoneuroendocrinology, 27, 199-220. doi:10.1016/S0306-4530(01)00045-2
[31] Gunnar, M. R., Kryzer, E., Van Ryzin, M. J., & Phillips, D. A. (2010). The rise in cortisol in family day care: Associations with aspects of care quality, child behavior, and child sex. Child Development, 81, 851-869. doi:10.1111/j.1467-8624.2010.01438.x
[32] Gunnar, M. R., Larson, M., Hertsgaard, L., Harris, M., & Brodersen, L. (1992). The stressfulness of separation among 9-month-old infants: Effects of social context variables and infant temperament. Child Development, 63, 290-303. doi:10.2307/1131479
[33] Gunnar, M. R., Morison, S. J., Chisholm, K., & Schuder, M. (2001). Salivary cortisol in children adopted from Romanian orphanages. Development and Psychopathology, 13, 611-628. doi:10.1017/S095457940100311X
[34] Gunnar, M. R., Tout, K., deHaan, M., Pierce, S., & Stansbury, K., (1997). Temperament, social competence, and adrenocortical activity in preschoolers. Developmental Psychobiology, 31, 65-85. doi:10.1002/(SICI)1098-2302(199707)31:1<65::AID-DEV6>3.0.CO;2-S
[35] Gunnar, M. R., & White, B. P. (2001). Salivary cortisol measures in infant and child assessment. In L. T. Singer, & P. S. Zeskind (Eds.), Biobehavioral assessment of the infant (pp. 167-189). New York: Guilford Press.
[36] Heim, C., Owen, M. J., Plotsky, P. M., & Nemeroff, C. B. (1997). The role of early adverse life events in the etiology of depression and posttraumatic stress disorder: Focus on corticotropin-releasing factor. Annals of the New York Academy of Sciences, 821, 194-207. doi:10.1111/j.1749-6632.1997.tb48279.x
[37] Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 1389-1398. doi:10.1016/S0006-3223(03)00465-7
[38] Hertsgaard, L., Gunnar, M. R., Larson, M., Brodersen, L., & Lehman, H. (1992). First time experiences in infancy: When they appear to be pleasant, do they activate the adrenocortical stress response? Developmental Psychobiology, 25, 319-334. doi:10.1002/dev.420250503
[39] Jarvis, P. A., & Creasey, G. L. (1991). Parental stress, coping and attachment in families with an eighteen-month-old infant. Infant Behavior and Development, 14, 383-395. doi:10.1016/0163-6383(91)90029-R
[40] Joffe, J., Rawson, R., & Mulick, J. (1973). Control of their environment reduces emotionality in rats. Science, 180, 1383-1384. doi:10.1126/science.180.4093.1383
[41] Kirschbaum, C., & Hellhammer, D. H. (1989). Salivary cortisol in psychobiological research: An overview. Neuropsychobiology, 22, 150-169. doi:10.1159/000118611
[42] Lamb, M. E. (1998). Nonparental child care: Context, quality, correlates, and consequences. In W. Damon, I. E. Sigel, & K. A. Renninger (Eds.), Handbook of child psychology (Vol. 4) Child psychology in practice (5th ed., pp. 73-133). New York: Wiley.
[43] Larson, M., Gunnar, M. R., & Hertsgaard, L. (1991). The effects of morning naps, car trips, and maternal separation on adrenocortical activity in human infants. Child Development, 62, 362-372. doi:10.2307/1131009
[44] Legendre, A., & Trudel, M. (1996). Cortisol and behavioural responses of young children in a group of unfamiliar peers. Merrill-Palmer Quarterly, 42, 554-577.
[45] Li, I., & Shen, P. S. (2008). Internalizing disposition and preschool children’s cortisol fluctuations. Child: Care, Health, & Development, 34, 626-630. doi:10.1111/j.1365-2214.2008.00847.x
[46] Li, I., Chiou, H. H., & Shen, P. S. (2007). Correlations between cortisol level and internalizing disposition of young children are increased by selecting optimal sampling times and aggregating data. Developmental Psychobiology, 49, 633-639. doi:10.1002/dev.20239
[47] Luby, J. L., Heffelfinger, A. K., Mrakotsky, C., Hessler, M. J., Brown, K. M., & Hildebrand, T. (2002). Preschool major depressive disorder: Preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 928-937. doi:10.1097/00004583-200208000-00011
[48] Mathew, S. J., Coplan, J. D., Goetz, R. R., Feder, A., Greenwald, S., Dahl, R. E., Ryan, N. D., Mann, J. J., & Weissman, M. M. (2003). Differentiating depressed adolescent twenty-four hour cortisol secretion in light of their adult clinical outcome. Neuropsychopharmacology, 28, 1336-1343. doi:10.1038/sj.npp.1300184
[49] McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171-179.
[50] Mineka, S., Gunnar, M. R., & Champoux, M. (1986). Control and early socio-emotional development: Infant rhesus monkeys reared in controllable versus uncontrollable environments. Child Development, 57, 1241-1256. doi:10.2307/1130447
[51] Ouellet-Morin, I., Boivin, M., Dionne, G., Lupien, S. J., Arseneault, L., Barr, R. G., Pérusse, D., & Tremblay, R. E. (2008). Variations in heritability of cortisol reactivity to stress as a function of early familial adversity among 19-month-old twins. Archives of General Psychiatry, 65, 211-218. doi:10.1001/archgenpsychiatry.2007.27
[52] Pettit, G. S., & Bates, J. E., (1984). Continuity of individual-differences in the mother-infant relationship from 6 to 13 months. Child Development, 55, 729-739. doi:10.2307/1130125
[53] Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology, 32, 301-318. doi:10.1111/j.1469-8986.1995.tb01213.x
[54] Porges, S. W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123-146. doi:10.1016/S0167-8760(01)00162-3
[55] Porges, S. W., Doussard-Roosevelt, J. A., Portales, A. L., & Suess, P. E. (1994). Cardiac vagal tone: Stability and relation to difficultness in infants and three-year-old children. Developmental Psychobiology, 27, 289-300. doi:10.1002/dev.420270504
[56] Propper, C., & Moore, G. A. (2006). The influence of parenting on infant emotionality: A multi-level psychobiological perspective. Developmental Review, 26, 427-460. doi:10.1016/j.dr.2006.06.003
[57] Raine, A. (2002). Biosocial studies of antisocial and violent behavior in children and adults: A review. Journal of Abnormal Child Psychology, 30, 311-326. doi:10.1023/A:1015754122318
[58] Roma, P. G., Champoux, M., & Suomi, S. J. (2006). Environmental control, social context, and individual differences in behavioral and cortisol responses to novelty in infant rhesus monkeys. Child Development, 77, 118-131. doi:10.1111/j.1467-8624.2006.00860.x
[59] Rosenblum, K. R., McDonough, S. C., Muzik, M., Miller, A. L., & Sameroff, A. J. (2002). Maternal representations of the infant: Effects on infant response to the still-face. Child Development, 73, 999-1015. doi:10.1111/1467-8624.00453
[60] Rothbart, M. K., & Bates, J. E. (1998). Temperament. In W. Damon (Series Ed.), & N. Eisenberg (Vol. Ed.) (Eds.), Handbook of CHILD Psychology: Vol. 3. Social, emotional and personality development (5th ed., pp. 105-176). New York: Wiley.
[61] Santucci, A., Silk, J. S., Shaw, D. S., Gentzler, A., Fox, N., & Cohn, J. (2008). Vagal tone and temperament as predictors of emotion regulation strategies in young children. Developmental Psychobiology, 50, 205-216. doi:10.1002/dev.20283
[62] Schulkin, J. (2003). Rethinking homeostasis. Cambridge: MIT Press.
[63] Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 104, 601-630. doi:10.1037/0033-2909.130.4.601
[64] Sims, M., Guilfoyle, A., & Parry, T. (2006). Children’s cortisol levels and quality of child care provision. Child: Care, Health & Development, 32, 452-466. doi:10.1111/j.1365-2214.2006.00632.x
[65] Sterling, P., & Eyer, J. (1988). Allostasis: A new paradigm to explain arousal pathology. In S. Fisher, & J. Reason (Eds.), Handbook of life stress, cognition and health (pp. 629-649). New York: John Wiley & Sons.
[66] Stifter, C. A., & Jain, A. (1996). Psychophysiological correlates of infant temperament: Stability of behavior and autonomic patterning from 5 to 18 months. Developmental Psychobiology, 29, 379-391. doi:10.1002/(SICI)1098-2302(199605)29:4<379::AID-DEV5>3.0.CO;2-N
[67] Stifter, G. A., & Fox, N. A. (1990). Infant reactivity: Physiological correlates of newbom and 5-month temperament. Developmental Psychology, 26, 582-588. doi:10.1037/0012-1649.26.4.582
[68] Suchecki, D., Rosenfeld, P., & Levine, S. (1993). Maternal regulation of the hypothalamic-pituitary-adrenal axis in the infant rat: The roles of feeding and stroking. Developmental Brain Research, 75, 185-192. doi:10.1016/0165-3806(93)90022-3
[69] Susman, E. J., & Pajer, K. (2004). Biology behavior integration and antisocial behaavior in girls. In M. Putallaz, & K. L. Bierman (Eds.), Aggression, antisocial behaavior, and violence among girls (pp. 23-47). New York: Guilford Press.
[70] Susman, E. J. (2006). Psychobiology of persistent antisocial behavior: Stress, early vulnerabilities and the attenuation hypothesis. Neuroscience and Biobehavioral Reviews, 30, 376-389. doi:10.1016/j.neubiorev.2005.08.002
[71] Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61, 201-216. doi:10.1016/S0165-0327(00)00338-4
[72] Thayer, J. F., & Lane, R. D. (2009). Claude bernard and the heart-brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews, 33, 81-88. doi:10.1016/j.neubiorev.2008.08.004
[73] Thayer, J. F., Ahs, F., Fredrikson, M., Sollers III, J. J., & Wager, T. D. (2012). A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neuroscience & Biobehavioral Reviews, 36, 747-756. doi:10.1016/j.neubiorev.2011.11.009
[74] Thompson, L. A., & Trevathan, W. R. (2008). Cortisol reactivity, maternal sensitivity, and learning in three-month-old infants. Infant Behavior and Development, 31, 92-105. doi:10.1016/j.infbeh.2007.07.007
[75] Tiller, W. A., McCraty, R., & Atkinson, M. (1996). Cardiac coherence: A new, noninvasive measure of autonomic nervous system order. Alternative Therapies in Health and Medicine, 2, 52-65.
[76] Tyrka, A. R., Price, L. H., Marsit, C., Walters, O. C., & Carpenter, L. L. (2012). Childhood adversity and epigenetic modulation of the leukocyte glucocorticoid receptor: Preliminary findings in healthy adults. PLoS One, 7, e30148. doi:10.1371/journal.pone.0030148
[77] Tyrka, A. R., Wier, L., Price, L. H., Ross, N., Anderson, G. M., Wilkinson, C. W., & Carpenter, L. L. (2008). Childhood parental loss and adult hypothalamic-pituitary-adrenal function. Biological Psychiatry, 63, 1247-1254. doi:10.1016/j.biopsych.2009.08.014
[78] Vanitallie, T. B. (2002). Stress: A risk factor for serious illness. Metabolism, 51, 40-45. doi:10.1053/meta.2002.33191
[79] Von Borell, E., Langbein, J., Després, G., Hansen, S., Leterrier, C., Marchant-Forde, J., Marchant-Forde, R., Minero, M., Mohr, E., & Prunier, A. (2007). Heart rate variability as a measure of autonomic regulation of cardiac activity for assessing stress and welfare in farm animals—A review. Physiology & Behavior, 92, 293-316. doi:10.1016/j.physbeh.2007.01.007
[80] Watamura, S. E., Donzella, B., Alwin, J., & Gunnar, M. R. (2003). Morning to afternoon increases in cortisol concentrations for infants and toddlers at child care: Age differences and behavioral correlates. Child Development, 74, 1006-1020. doi:10.1111/1467-8624.00583
[81] White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 279-333. doi:10.1037/h0040934
[82] Wilson, R. S., & Matheny Jr., A. P. (1986). Behavior genetics research in infant temperament: The Louisville twin study. In R. Plomin, & J. Dunn (Eds.), The study of temperament: Changes, continuities and challenges (pp. 81-97). Hillsdale, NJ: Erlbaum.

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