Childhood Adversity, Cortisol Awakening Response, and Multisystemic Therapy Outcomes Open Access

Abstract

Multisystemic Therapy (MST) is a treatment program for externalizing behavior problems (e.g., aggression and substance use) that has demonstrated efficacy in several studies. There is evidence, however, of effect heterogeneity, and there appear to be moderators of treatment success. Few studies have explored how adverse childhood experiences (ACEs) might affect responsiveness to MST, although ACEs have been linked to risk for externalizing problems.  Emerging research suggests that ACEs may have differential associations with externalizing problems and implicates physiological responsiveness (e.g., cortisol levels) as a mediator and moderator of these associations. Few studies, however, have examined the complex relationship between ACEs, cortisol levels, and problem behaviors in a treatment context. This study aimed to examine 1) the differential effects of types of adversity (i.e., threat versus deprivation), and 2) the role of the cortisol awakening response in the association between ACEs and changes in problem behavior over the course of MST. The study used data from youth ages 12 to 17 years (N=118) who were enrolled in a longitudinal study of youth undergoing MST treatment in Denver, CO. Results from growth curve analyses indicated that response to treatment may vary, depending on the type of adversity exposure and on the level of the awakening cortisol response. Implications for theory and potential treatment modifications are discussed.

Table of Contents

I. INTRODUCTION......1

MST: THEORETICAL UNDERPINNINGS AND ITS UTILITY......1

CHILDHOOD ADVERSITY AS A POTENTIAL EFFECT MODIFIER......2

CHILDHOOD ADVERSITY AND EXTERNALIZING BEHAVIOR: NEUROPHYSIOLOGICAL PERSPECTIVES......4

CORTISOL AND PROBLEM BEHAVIORS......6

THE PRESENT STUDY......9

II. METHOD......10

PARTICIPANTS......10

STUDY DESIGN AND PROCEDURE......11

MEASURES......12

DATA ANALYSES......15

III. RESULTS......16

PRELIMINARY ANALYSES......16

HYPOTHESIS TESTING......17

IV. DISCUSSION......19

HPA AXIS ACTIVITY MODERATES THE ASSOCIATION BETWEEN CHILDHOOD ADVERSITY AND RESPONSE TO MST......20

THREAT, DEPRIVATION, AND HPA AXIS ACTIVITY......23

CLINICAL IMPLICATIONS......24

STRENGTHS AND LIMITATIONS......25

TABLE 1. INTERCORRELATIONS AMONG STUDY VARIABLES......40

TABLE 2. SAMPLE DESCRIPTIVE STATISTICS......41

TABLE 3. SUMMARY OF RESULTS FROM HLM ANALYSES......42

About this Master's Thesis

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School	Laney Graduate School
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	M.A.
Submission	Master's Thesis
Language	English
Research Field	Psychology, Clinical
Keyword	cortisol awakening response childhood adversity Multi-systemic therapy Problem behaviors Externalizing behaviors
Committee Chair / Thesis Advisor	Brennan, Patricia, Emory University
Committee Members	Craighead, Linda, Emory University Fivush, Robyn, Emory University

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