Salivary cortisol levels in children adopted from Romanian orphanages

Six and a half years after adoption. 6- to 12-year-old children reared in R omanian orphanages for more than 8 months in their first years of life (RO, n = 18) had higher cortisol levels over the daytime hours than did early a dopted (EA, less than or equal to 4 months of age, n = 15) and Canadian bor n (CB, n = 27) children, The effect was marked, with 22% of the RO children exhibiting cortisol levels averaged over the day that exceeded the mean pl us 2 SD of the EA and CB levels. Furthermore. the longer beyond 8 months th at the RO children remained institutionalized the higher their cortisol lev els. Cortisol levels for EA children did not differ in any respect from tho se of CB comparison children. This latter finding reduces but does not elim inate concerns that the results could be due to prenatal effects or birth f amily characteristics associated with orphanage placement. Neither age at c ortisol sampling nor low IQ measured earlier appeared to explain the findin gs, Because the conditions in Romanian orphanages at the time these childre n were adopted were characterized by multiple risk factors. including gross privation of basic needs and exposure to infectious agents. the factor(s) that produced the increase in cortisol production cannot be determined. Nor could we determine whether these results reflected effects on the limbic-h ypothalamic-pituitary-adrenal axis directly or were mediated by differences in parent-child interactions or family stress occasion by behavioral probl ems associated with prolonged orphanage care in this sample.