Intervention Effects on Diurnal Cortisol Rhythms of Child Protective Services-Referred Infants in Early Childhood: Preschool Follow-up Results of a Randomized Clinical Trial




Kristin Bernard, Camelia E. Hostinar, and Mary Dozier

Brief Type

Journal Publication


  • Attachment and Biobehavioral Catch-Up (ABC)


Importance: A number of interventions for at-risk children have shown benefits immediately after treatment. However, the present study shows persistent long-term effects of a parenting intervention on children's hypothalamic-pituitary-adrenal (HPA) activity, a physiological stress system that is implicated in numerous psychological and physical health problems across the lifespan.

Objective: To examine whether differences in diurnal cortisol production between children receiving the active parenting intervention and children in the control group persisted at a preschool follow-up (approximately 3 years post-intervention).

Design: Between-subject comparison of cortisol patterns among 2 groups of children (experimental and control groups).

Setting: Children involved with Child Protective Services following allegations of neglect.

Participants: A sample of 115 children (43.5% female) between 46.5 and 69.6 months of age (M = 50.73, SD = 4.98), who had been previously randomly assigned to either the ABC intervention (n = 54) or the control intervention (n = 61).

Intervention: The Attachment and Biobehavioral Catch-up Intervention (ABC) was the experimental intervention and it focused on three aims: increasing parental nurturance to child distress, increasing synchronous interactions, and decreasing frightening parental behavior. The control intervention provided educational information about child development to parents. Both interventions were manualized and involved 10 sessions implemented by a trained parent coach in the families' homes or other places of residence.

Main Outcome Measure: Salivary cortisol samples collected at waking and bedtime for children on 3 separate days.

Results: Analyses revealed significant differences in cortisol production at the preschool follow-up, such that children in the ABC intervention group exhibited a typical pattern with higher morning levels and a steep decline across the day, whereas the control group showed a flatter cortisol rhythm with blunted morning levels.

Conclusions and Relevance: Differences in cortisol production between the experimental and control group persisted at the preschool follow-up and resembled differences initially observed 3 months post-intervention. This is encouraging evidence that the ABC intervention for CPS-referred children may have long-lasting effects on a physiological stress system critical for health and adjustment. (author abstract)

Data Collection Methods

  • Standardized assessment tools


For More Information

Bernard, K., Hostinar, C.E., & Dozier, M. (2015) Intervention effects on diurnal cortisol rhythms of CPS-referred infants persist into early childhood: Preschool follow-up results of a randomized clinical trial. JAMA Pediatrics, 169(2), 112-9.
Author contact information:
Kristin Bernard


  • Participant, Family, and Program Outcomes