Stress reactivity in war-exposed young children with and without posttraumatic stress disorder: Relations to maternal stress hormones, parenting, and child emotionality and regulation

The current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children’s stress response. Participants were 232 Israeli children aged 1.5–5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic–pituitary–adrenal and sympathetic–adrenal–medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma. It is estimated that millions of the world’s children are growing up amid political violence, continuous war, tribal and racial terrorism, genocide, militaryattacks on civilian locations, orguerrillawarfare (Belsky,2008;Masten & Narayan,2012). Others, such as children of combat soldiers in the United States, experience the aftermath of war-related trauma through a parent (McFarlane, 2009), while still others are exposed to a single act of terrorism, for instance, the September 11 attack (Chemtob, Nomura, & Abramovitz, 2008 )o r the Oklahoma City bombing (Pfefferbaum et al., 1999). Although systematic research is often difficult in zones of war, several studies have described children’s response to war and terrorism across the globe, including Lebanon (Bryce, Walker, Ghorayeb, & Kanj, 1989), Gaza (Qouta, Punamaki, & El Sarraj, 2003), Israel (Laor, Wolmer, & Cohen, 2001), Kosovo (Lopes Cardozo, Kaiser, Gotway, & Agani, 2003), Bosnia–Hercegovina (Smith, Perrin, Yule, & RabeHesketh, 2001), and Rwanda (Schaal, Jacob, Dusingizemungu, & Elbert, 2010). Studies indicate that political violence compromises children’s mental health, leading to anxiety, depression, posttraumatic symptoms, and conduct problems; that such problems tend to persist after the war has subsided; and that maternal factors, particularly the mother’s well-being and support networks, function as resilience factors (Allwood, Bell-Dolan, & Husain, 2002; Feldman & Vengrober, 2011). However, very little research has focused on infants and young children exposed to political violence, and we are aware of no study that tested hormones, observed parenting, and temperamental dispositions in warexposed young children. In this study, we recruited a large cohort of infants and young children aged 1.5 to 5 years living in a zone of continuous war. Our goal was to examine children’s physiological stress response and assess maternal and child factors that may correlate with variability in young children’s stress response in the context of war exposure. Two neuroendocrine markers of stress were tested, cortisol (CT) and salivary alpha amylase (sAA), which are considered as biomarkers of the two arms of the stress response: the hypothalamic–pituitary–adrenal (HPA) and the sympathetic–adrenal–medullary