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HPA axis dysregulation in adult adoptees twenty years after severe institutional deprivation in childhood

Research output: Contribution to journalArticle

Robert Kumsta, Wolff Schlotz, Dennis Golm, Dirk Moser, Mark Kennedy, Nicky Knights, Jana Kreppner, Barbara Maughan, Michael Rutter, Edmund Sonuga-Barke

Original languageEnglish
Pages (from-to)196-202
Early online date28 Sep 2017
Publication statusPublished - Dec 2017


King's Authors


Hypothalamic–pituitary–adrenal (HPA) axis function is disrupted in institutionally-deprived children – reduced morning cortisol, flattened diurnal slope and blunted reactivity persist even after successful adoption into positive family environments. Here we test whether such effects persist into adulthood. Cortisol release across the day (sampled at awakening, 30 and 45 minutes later, and at four points across the day) was investigated in young adult adoptees who had lived in severe deprivation for up to 43 months in early childhood in Ceaușescu’s Romanian orphanages and a comparison group of non-deprived UK adoptees (Total N = 57; mean age = 24 ± 0.9 years). The mediating role of cortisol levels on adult mental health was examined using data from standardized clinical assessments. Cortisol profiles were disrupted in the Romanian adoptees who experienced more than 6 months deprivation marked by a striking absence of the cortisol awakening response (CAR) and a significantly flatter cortisol curve until 1 hour 15 minutes after awakening. Whereas institutional deprivation was associated with both cortisol secretion and emergence of emotional problems in young adulthood, path analysis revealed no evidence for a mediating role of CAR disruption in the sub-sample studied here. The results are in line with findings of HPA axis hypo-functionality following early adverse experience and provide strong evidence for long-term programming effects of HPA axis function through experience of institutional deprivation.

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