Skip to main content

Transforming the understanding
and treatment of mental illnesses.

Celebrating 75 Years! Learn More >>

 Archived Content

The National Institute of Mental Health archives materials that are over 4 years old and no longer being updated. The content on this page is provided for historical reference purposes only and may not reflect current knowledge or information.

Behavioral Program May Stabilize Stress Hormone Patterns in Foster Children

Science Update

An intervention designed to enhance family interaction and improve foster parenting skills may benefit young foster children who had experienced extreme neglect or maltreatment in early life. The intervention stabilizes the children’s daily patterns of cortisol, one of several hormones controlled by the stress management system called the hypothalamic-pituitary-adrenal (HPA) axis. The study was published in the fall 2007 issue of Psychoneuroendocrinology.

Normal cortisol patterns are elevated in the morning and decline throughout the day, reaching very low levels at bedtime. For most people, stress is associated with higher cortisol levels, and chronically high levels are associated with a number of diseases. But for some children exposed to extreme neglect or maltreatment early in life, researchers have found a different pattern. In these children, cortisol levels appear to be dampened or low throughout the day. This may signify a malfunction of the HPA axis, which could lead to increased vulnerability to illness. Even when these children are placed in a relatively stable foster care environment, their cortisol levels do not always stabilize.

Philip Fisher, Ph.D., of the Oregon Social Learning Center in Eugene, Ore., and colleagues designed a supportive intervention for foster parents called Multidimensional Treatment Foster Care for Preschoolers (MTFC-P), which emphasizes consistent and responsive parenting. They randomly assigned 117 preschoolers (3-6 years old) who had a history of severe early-life neglect and maltreatment and their foster parents to either the MTFC-P intervention or to regular foster care, and compared each group’s morning and evening cortisol levels over a one-year period. A third group of community preschoolers not in foster care and with no history of maltreatment also participated in the study for comparison.

Fisher and colleagues found that the foster children in the intervention group showed a more consistent cortisol pattern throughout the day, and less variability in evening cortisol levels, indicating stabilization of HPA axis functioning. Their cortisol patterns were similar to those of the community children in the study. In contrast, the children in the regular foster care group worsened over time. Their morning cortisol levels continued to decline and failed to stabilize.

“These results provide evidence of a distinct biological response to a behavioral intervention,” said Dr. Fisher. “If improved caregiving follows early childhood neglect, disruptions in a child’s HPA axis functioning may be reversed or even prevented, giving the child a better chance at overcoming early-life challenges.”


Fisher PA, Stoolmiller M, Gunnar MR, Burraston BO. Effects of a therapeutic intervention for foster preschoolers on diurnal cortisol activity . Psychoneuroendocrinology. 2007, 32, 892-905.