Masters Thesis

Comparing Acute and Long-Term Cortisol Measurements and Anxiety in Preschool-Aged Children

Anxiety in children, including excessive fear or worry, trouble sleeping, fatigue, and irritability, can be distressing for children and families and contribute to impairment throughout the lifespan. Up to one in five preschool-aged children meet criteria for anxiety disorders, and these disorders may predict continued anxiety and other symptoms over time. However, the psychobiology associated with early childhood anxiety has received little empirical investigation. Cortisol, the end product of the hypothalamic-pituitary-adrenocortical (HPA) axis, may be associated with risk for anxiety in children. Additionally, stress can impact the HPA axis, and increased stress may sensitize an individual’s stress response system. Identifying associations between different methods of cortisol measurement and anxiety in preschoolers can clarify methodological discrepancies and further understanding of the relation between stress reactivity and anxiety. This study compared methods of assessing cortisol and anxiety by examining acute (salivary) and long-term (hair) HPA axis functioning in association with risk for anxiety in preschool-aged children. Children’s anxiety was assessed via parent-reported questionnaire. In addition, children’s fear and inhibition was observed and coded during a structured laboratory stress task. Parents also reported the frequency of recent stressful events for the child/family. Finally, children’s acute cortisol reactivity was assessed using 4 saliva samples timed around the laboratory stress task; children’s chronic cortisol concentrations was assessed through children’s hair samples. Findings demonstrated that children showing higher levels of fear/inhibition during a laboratory stress task showed a steeper elevated change (slope) in salivary cortisol in response to the task, but was there was no association with total cortisol output (area under the curve). Children’s parent-reported anxiety was not significantly associated with acute cortisol reactivity or hair cortisol concentrations (HCC). Parent-reported separation anxiety was higher among non-white participants and parent-reported social anxiety was higher among families with higher annual income. HCC was also not associated with fear in the laboratory stressor task. However, HCC was higher among males and white participants. In addition, life stress was not significantly related to acute cortisol reactivity or long-term cortisol activity in hair and did not significantly moderate any of the anxiety-cortisol relations. However, life stress was higher for non-white participants and those with more educated parents. Thus, when comparing both cortisol assessments, this study suggests that change in salivary cortisol in response to an acute stressor may best predict behavior relevant to anxiety. If results are replicated in future research, these data could distinguish objective biological assessments that can aide in identifying children at risk for anxiety. Given the other nonsignificant results, replication is needed to confirm the lack of associations or to determine if there are associations between anxiety and cortisol not identified in the present study.

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