TABLE 3.

Quasi-Experimental Prevention-Oriented Studies That Assessed Cortisol Activity in Infants, Children, or Adolescents

Study	Sample Description and Child Age at Baseline	Intervention and Follow-up Time	Cortisol Measure	Results	Scorea
Fisher et al, 200059	• Foster children entering new placements	• Intervention: intensive preservice training, and postplacement support and supervision through daily telephone contact, weekly home visits by a consultant, support group meetings, and a 24-hour call line, and children received services from a behavior specialist	• Diurnal: 3 samples (30 minutes after waking, between 10 and 10:30 am, and 30 minutes before bedtime) on 2 consecutive days at baseline and 12 weeks	• For diurnal and single cortisol assessments, trends in data (from baseline to follow-up) suggested cortisol patterns for the intervention group were converging with patterns among the community controls, whereas patterns among the regular foster group were diverging from community controls	2
	• Early intervention foster care (n = 10), regular foster care (n = 10), and a community comparison (n = 10); N = 30	• Follow-up: 12 weeks after intervention began	• Basal: midmorning cortisol, weekly
	• Ages 4.4–5.4 years at baseline
Lindblad et al, 200760	• Sample from Sweden	• Music intervention: 2 (1-hour) music education classes per week for the academic year (9 months)	• Diurnal (at waking, 30 minutes after waking, 1 hour after lunch, before bed)	• Intervention group had lower afternoon cortisol at the end of the school year; however, no difference in change in cortisol by group over the duration of the study	1
	• Music intervention (n = 16), placebo intervention (n = 17), and no intervention (n = 27); N = 60	• Control intervention: 1 hour of data education or usual curriculum	• 3 times during academic year	• For the other times of cortisol assessment (ie, waking, 30 minutes after waking, or before bed), there were no intervention effects at the end of the school year or for change over the duration of the study
	• Entering fifth and sixth grades at baseline	• Follow-up: 3 times over 9 months
Fernald et al, 200961	• Sample from rural Mexico	• Intervention: conditional cash transfer program, where cash payments were distributed if children and family members complied with requirements, such as prenatal care, well-baby care, nutrition monitoring, and educational programs	• Basal	• In repeated-measures analyses that included 3 cortisol assessments, the intervention group had lower cortisol relative to controls; change in cortisol in response to the team visit did not differ between groups	5
	• Low-income households	• Follow-up: after 3.5 years of participation	• Responsivity: before and after interview team’s arrival	• Intervention was associated with lower cortisol only among children whose mothers had high depressive symptoms
	• Poverty-alleviation intervention (n = 491) and a comparison group from similar communities (n = 706); N = 1197
	• Ages 2–6 years at baseline
Bernard et al, 201062	• Children involved with CPS	• Intervention: placement into foster care	• Diurnal cortisol (waking and bedtime)	• CPS-involved children living with birth parents exhibited a more blunted diurnal pattern (according to slope) relative to children in foster care and differed from low-risk children in bedtime cortisol levels (whereas children in foster care did not)	3
	• Children in foster care (n = 184), CPS-involved children living with birth parents (n = 155), and community comparison from low-risk homes (n = 96); N = 435	• Average time in foster care was 3.6 months	• 2 consecutive days
	• Ages 2.9–31.4 months at baseline

N = 4 articles. Samples are from the United States unless otherwise stated. CPS, Child Protective Services.

^aQuality score was calculated on the basis of 6 study characteristics: study design, size, cortisol assessment (diurnal or responsivity), key covariates used as controls or exclusion criteria (if necessary), cortisol inter- and intraassay CVs, and length of follow-up from start of intervention.