Classroom Emotional Support predicts differences in preschool children's cortisol and alpha-amylase levels

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Abstract

Accumulating evidence suggests children enrolled in full-time child care often display afternoon elevations of the hormone cortisol, which is an indicator of stress. Recent advances in immunoassays allow for measurement of activity in the hypothalamic–pituitary–adrenal axis and the autonomic sympathetic nervous system from saliva, and measurement of both systems provides a more complete understanding of activity in the stress response system. This study is the first to examine both cortisol and alpha-amylase in children attending child care and focuses on the influences of specific indicators of classroom process quality. A diverse sample of 63 preschool children nested in 14 classrooms of varying quality participated in this study; child salivary cortisol and alpha-amylase were collected at six times over 2 days. Results indicate that children in classrooms with higher Emotional Support displayed a greater decline in cortisol from morning to afternoon. Further, children in classrooms with higher Emotional Support exhibited lower total alpha-amylase output while attending child care. Implications for professional development for early childhood teachers and measurement of classroom quality are discussed.

Highlights

► Classroom Emotional Support predicts differences in salivary cortisol and alpha-amylase. ► Gender and age of entry into child care was not related to cortisol or alpha-amylase. ► Classroom Emotional Support is essential to understanding differences in stress response system.

Introduction

Children's responses to their environments encompass a wide variety of developmental domains including social, emotional, and cognitive development. Researchers of child care environments and teacher–child interactions have often measured these various responses through observation, survey, and interviews (Early et al., 2005, NICHDECCRN, 2002). Recently, researchers in early care and education have begun to investigate children's physiological responses to interactions within their early care settings, most often in an effort to provide information that cannot be measured through observation (Vermeer & van Ijzendoorn, 2006). Children's stress responses have been of particular interest in conjunction with the quality of child care environments. Such information on children's physiological responses to the environment provides an additional way of understanding how child care quality impacts children's development.

It is well documented that cortisol levels, a biomarker for activity in the hypothalamic–pituitary–adrenal (HPA) axis, vary as a function of context. Specifically, children often display elevated levels of cortisol at child care but not at home (Groeneveld et al., 2010, Watamura et al., 2009). Given that cortisol is expected to decline across the day (Gunnar & Donzella, 2002), interest in differentiating the experiences of children in child care settings often leads researchers to explore indices of classroom quality. Preliminary evidence suggests that classroom process quality, namely the interactions within the classroom, may be central to identifying characteristics of the classroom that lead to elevations in cortisol as increased teacher sensitivity in the classroom is linked to a decrease in cortisol throughout the day when compared to children in classrooms with lower sensitivity (Watamura et al., 2009). Essentially, individual patterns of cortisol activity for children in classrooms that foster community, cohesion, and autonomy closely resemble activity displayed in the home environment. Further, in family child care homes characterized by teachers who provided high levels of verbal and behavioral attention, children's cortisol patterns showed the expected decline throughout the day. Children in those family child care settings showed no difference between cortisol patterns at home and patterns at child care (Dettling, Parker, Lane, Sebanc, & Gunnar, 2000).

Although the current body of literature has identified relationships between child and classroom characteristics that influence activity in the HPA axis, little emphasis has been placed on the functioning of the remaining components of the stress response system. The stress response system is comprised of three integral but unique components: the HPA axis, the parasympathetic nervous system, and the sympathetic nervous system (Del Giudice, Ellis, & Shirtcliff, 2011). In early childhood, the stress response system is immature and is largely influenced by experiences, relationships, and interactions during this period (Levine, 1994, Meaney et al., 1996). Given that 36% of preschool children experience center-based care (U.S. Department of Education, 2006), the purpose of the current study is to identify indicators of classroom quality that impact preschool children's activity in the stress response system.

Activity throughout the stress response system is essential for human functioning as it allows an individual to cope with positive (e.g., excitement about an upcoming vacation) and negative (e.g., experiencing a car accident) events. Individuals vary slightly in how their stress response system calibrates to the environment due to his or her ability to adapt and modify to the “local conditions of the social and physical environment,” (p. 1563, Del Giudice et al., 2011). The three components of the stress response system (i.e., parasympathetic, sympathetic, and HPA axis) have unique purposes, but the timing of activation for each component is somewhat dependent. Simply, the parasympathetic branch of the stress response system serves as a ‘first responder’ in the event of a challenge, triggering increased attention and vigilance. If the parasympathetic response is not sufficient, the sympathetic system is activated, secreting norepinephrine and epinephrine. Finally, the HPA axis is signaled and provides a more sustained response and helps the sympathetic system recover (for detailed review see Del Giudice et al., 2011, Gunnar and Quevedo, 2007). These systems converge at the hypothalamus where a behavioral response within the individual is signaled (Palkovits, 1987). Activity in the stress response system is uncorrelated (e.g., Davis and Granger, 2009, El-Sheikh et al., 2009, Fortunato et al., 2008, Wolf et al., 2008) suggesting that activity in the three components are separate entities. The current study focuses only on how classroom quality relates to activity in two of the components, the HPA axis and the sympathetic nervous system (SNS). Thus, more detail regarding the HPA axis and SNS is provided below.

The HPA axis produces cortisol, a steroid hormone that impacts brain functioning and behavior (Bohus, de Kloet, & Veldhuis, 1982), as well as regulates important bodily functions such as the immune system (Palacios & Sugawara, 1982) and emotional expression (Oberlander, Weinberg, Papsdorf, Grunau, Misri, & Devlin, 2008). Salivary cortisol is a well-established measure of activity in the HPA axis (Granger, Schwartz, Booth, Curran, & Zakaria, 1999) and is strongly correlated with serum cortisol levels (Charmandari, Tsigos, & Chrousos, 2005). Cortisol levels in individuals vary diurnally with levels highest in the morning and gradually declining throughout the day (Gunnar & Donzella, 2002). Deviation in the diurnal patterns of cortisol is linked to internalizing and externalizing behaviors (Shirtcliff, Granger, Booth, & Johnson, 2005), anxiety (Feder et al., 2004), and immune deficiencies (Greenspan, 2003). Until recently, the specific associations of elevated cortisol on child outcomes for children in child care were unclear. There is new evidence that children who display elevations in cortisol at child care are more likely to display lower levels of sIgA antibodies and experience increased illness (Watamura, Coe, Laundenslager, & Robertson, 2010). Lower levels of sIgA are linked to a variety of poor health outcomes such as an increased risk of respiratory illness (Winzer et al., 1999).

Salivary alpha-amylase (sAA) is predictive of norepinephrine levels in humans (Chatterton, Vogelsong, Lu, Ellman, & Hudgens, 1996), and it is considered to be a surrogate biomarker for the SNS (Granger et al., 2006, van Stegeren et al., 2006). sAA is an enzyme in the mouth that aids in digestion, and the appearance of sAA is associated with the introduction of solid foods into an infant's diet (Davis & Granger, 2009). The salivary glands that produce and secrete sAA are stimulated by the sympathetic (and parasympathetic) nerves, and thus activity in the SNS is related to increases in sAA (Nater & Rohleder, 2009). Further, sAA is also correlated with other measures of activity in the SNS such as skin conductance (El-Sheikh, Erath, Buckhalt, Granger, & Mize, 2008) as well as two cardiac indices of SNS, vagal suppression (El-Sheikh, Mize, & Granger, 2005) and preejection period (i.e., the elapsed time between a heartbeat and the ejection of blood into the aorta; Granger, Kivlighan, El-Sheikh, Gordis, & Stroud, 2007), identifying sAA as a reliable and non-invasive measurement of activity in the SNS. Generally, sAA also follows a diurnal pattern, decreasing 60 min after wake, increasing over the day peaking around 4:30 pm, and then declining (Nater, Rohleder, Schlotz, Ehlert, & Kirschbaum, 2007). This diurnal pattern for sAA is also apparent in children, although overall levels are smaller in magnitude compared to adults (Wolf et al., 2008). Activity in the SNS is related to overall arousal (i.e., negative or positive arousal) in response to environmental stressors (Beauchaine, 2001), as well as behaviors specific to positive affect and surgency. Specifically, during a laboratory task, higher positive affect (e.g., smiling, laughing) and higher frequency of approach behaviors (e.g., boldness/surgency, exuberance) were related to higher baseline sAA in toddlers (Fortunato et al., 2008). Thus, research suggests that sAA is related more to the expression of emotions, both negative and positive, and this may influence relationships that children experience in the classroom, complying with Nigg's (2006) theory that activity in the SNS relates to overall emotional arousal whereas the HPA axis responds to more intense triggers and/or helps the SNS recover. Thus, the measurement of sAA and cortisol provide unique indicators to aid in understanding activity in the HPA axis and SNS.

The patterns of activity described above for cortisol (declining across the day) and sAA (increasing throughout the day) promote homeostasis within the HPA axis and SNS (McEwen & Seeman, 1999). To date, only the associations between activity in the HPA axis and child care quality have been investigated; this study is the first to understand activity of the SNS in the context of child care.

Children consistently demonstrate higher cortisol levels at child care than at home (Dettling et al., 1999, Watamura et al., 2003). However, a meta-analysis (Vermeer & van Ijzendoorn, 2006) indicates that only 18% of the variability in cortisol is attributable to the context (home vs. classroom). Investigations into global quality of the child care context reveal that children in classrooms rated as good or excellent by the Early Childhood Environmental Rating Scale-Revised (ECERS-R; Harms, Clifford, & Cryer, 1998) continue to demonstrate a rise in cortisol throughout the day (Rappolt-Schlichtmann et al., 2009, Watamura et al., 2003, Watamura et al., 2010, Watamura et al., 2002). Given the complex nature of the classroom, a global measurement of quality may not be distinctive enough to specifically relate to children's activity in the HPA axis or identify relations with activity in the sympathetic nervous system. Instead, particular components of classroom quality may differentially impact children's activity in the HPA axis or SNS.

In the field of early care and education, global quality is often categorized into two separate but related components: structure and process. Structural quality refers to elements of the classroom that are constant, materialistic in nature, exist without interactions, and form the foundation for potential learning experiences (Layzer & Goodson, 2006). Research investigating correlates between cortisol and structural quality have identified group size, square feet/individual, parent involvement, and health and safety as salient influences on cortisol levels in young children (Legendre, 2003, Lisonbee et al., 2008, Martimportugués-Goyenechea and Gómez-Jacinto, 2005, Rappolt-Schlichtmann et al., 2009, Sims et al., 2006). The HPA axis generally interprets crowding or large groups as stressors and responds with elevated cortisol levels (Lisonbee et al., 2008, Martimportugués-Goyenechea and Gómez-Jacinto, 2005, Rappolt-Schlichtmann et al., 2009). In child care, cortisol levels are lower in classrooms with more than 16.5 ft2 of useable play space per child and those with less than 15 people (Legendre, 2003). Cortisol levels are also lower for children in classrooms with a parent orientation and teachers who are invested in protecting the health and safety of each child (Sims et al., 2006). Yet, in the other studies focused on understanding links between classroom quality and children's social and academic outcomes, structural quality often demonstrates an indirect effect, whereas process quality has a direct effect (Mashburn et al., 2008, NICHDECCRN, 2002). Thus, in line with this research, the current study focuses on how specific components of process quality, after accounting for structural quality, may influence child activity in the HPA axis and SNS.

Process quality encompasses interactions and experiences that occur in the classroom that require active human interaction and intent (Cassidy et al., 2005a, Cryer, 1999, Phillipsen et al., 1997). The mechanisms by which specific components of process quality impact cortisol levels have not been explored in depth; relations between classroom quality and children's sAA levels have not been pursued. Given these preliminary findings and improved measurement techniques for classroom process quality and activity in the SNS, it is important to investigate further the relations between specific dimensions of process quality and the activity the HPA axis and SNS. Classrooms high in process quality are likely to have a teacher who (a) has sensitive, warm, and secure interactions, (b) organizes the classroom in such a way that is not rigid or regimented, and (c) engages their students in intentional, instructional discussions, activities, and conversations (Burchinal et al., 2000, Hamre and Pianta, 2007).

There are associations among these constructs of process quality (i.e., Emotional Support, organization and behavior management, intentional instruction) and activity in the SNS and HPA axis reflected in the parenting and early education literature. Children of parents who are emotionally supportive and responsive are more likely to demonstrate cortisol activity that declines throughout the day (Francis et al., 1999, Gunnar et al., 1992). Results are similar for child care as children exposed to teachers who are warm and nurturing are more likely to display cortisol levels that resemble levels demonstrated at home (Groeneveld et al., 2010). Further, research examining mother–child interactions and activity in the SNS indicate that children whose mothers are more “in tune’ with their child's emotional needs have better regulation within the SNS” (Moore & Calkins, 2004). This association is also evident in the child care setting; lower sAA was positively associated with a close teacher–child relationship for preschool children (Mize, Lisonbee, & Granger, 2005), implying that children with lower baseline sAA may have fewer moments in the classroom that demand high emotional arousal, possibly due to the close relationship with the teacher. Thus, emotional support, whether provided by the parent or a teacher, seems to influence activity in the HPA axis and SNS.

Teachers within classrooms high in process quality also organize the classroom in such a way that is not rigid or regimented, and this structured organization is likely to help support activity in the HPA axis and SNS. Cortisol levels increase in unorganized, chaotic, or noisy environments (Martimportugués-Goyenechea & Gómez-Jacinto, 2005), and maternal negative management of child behavior is associated with poor regulation of SNS (Calkins, Smith, Gill, & Johnson, 1998). Further, children's activity in the SNS increased after hearing an argument between two adults (El-Sheikh et al., 2009), suggesting that conflict is associated with abnormalities in the SNS. Thus, classrooms in which students have engaging activities, are efficiently managed, and where little misbehavior occurs may not elicit increased activity in the HPA axis or the SNS.

Finally, child cortisol is more likely to decline across the day when children are exposed to child care that affords more opportunities for stimulation (Dettling et al., 2000). However, Dettling et al. aggregated instructional stimulation and conversational exchanges with caregiver sensitivity, thus limiting the ability to illustrate specific links between intentional, instructional discussions, activities, and conversations to activity in the HPA axis. This study aims to understand the specific relation between instructional discussion and activity in the HPA axis. Regarding activity in the SNS, higher levels of baseline sAA are tentatively related to poorer scores on standardized tests of achievement in middle childhood (Granger et al., 2007), but this is not a direct association between teacher's instructional skills and facilitation. A major strength of this study is the ability to examine the unique contribution of instructional discussions and facilitation in early childhood classrooms and relations to activity in the HPA axis and SNS via salivary cortisol and sAA, respectively.

Although characteristics of the classroom environment influence children's cortisol levels, research suggests individual child characteristics, such as gender and experience in the child care environment, also influence associations with cortisol, but not sAA. Regarding gender, new evidence suggests that adolescent males exhibit higher awakening cortisol levels than females (Roisman et al., 2009). Further, in the child care environment, boys demonstrated significantly higher total cortisol activity (Groeneveld et al., 2010, Ouellet-Morin et al., 2010). Ouellet-Morin et al. contend that children with less child care experience (enrolled in child care after 16 months of age) demonstrated higher cortisol levels at 3 years of age than children who started child care earlier in life. This study acknowledges that these child characteristics along with indicators of classroom quality (i.e., structure and process) are needed to understand better the differences in activity of the HPA axis and SNS.

Classroom indicators of process quality such as warm, sensitive relationships, effective questioning and promotion of thinking skills, as well as predictable routines and well-managed activities and behaviors are influential for child emotional and academic development (Hamre & Pianta, 2007). Further, caregiver sensitivity is related to activity and development of the SNS and HPA axis in early childhood (Groeneveld et al., 2010, Mize et al., 2005), but specific associations with intentional classroom instruction and classroom management and behavior have not been explored. The primary aim of this study is to understand how three aspects of classroom process quality (i.e., sensitive and warm interactions, classroom management and behavior, intentional and instructional discussions) impact activity in the HPA axis and SNS after accounting for relations with structural quality and child characteristics. Note that the hypotheses for sAA are largely exploratory, but specific hypotheses are provided and were formulated from knowledge garnered from studies that examined sAA outside of the classroom context.

With regard to the emotional climate and support in the classroom, it is expected that children in classrooms with higher levels of respectful and warm interactions, support for autonomy, and sensitive teachers will demonstrate lower activity in the HPA axis and SNS. This would support previous research claiming associations with sensitive caregivers and the HPA axis and SNS. Second, based on research with adults indicating that chaotic environments influence cortisol activity and that conflict influences activity in the SNS, we hypothesize that this association will also hold for children such that children in classrooms that follow a predictable routine and manage child behavior in an effective, calm manner will have lower activity in the HPA axis and SNS. Given Granger et al.’s (2007) finding suggesting that in middle childhood, there is a positive association between lower sAA and test scores, we expect that activity in the SNS may be lower for children in classrooms with a high frequency of intentional, instructional discussions aimed to further children's learning and understanding. Given the absence of theory or research to suggest a distinct association between instructional dialog and cortisol levels, a null relation is expected.

Section snippets

Participants

The classrooms in this study were drawn from a random sample of child care centers in one metropolitan county that participated in North Carolina's Division of Child Development (DCD) Star Rated License. Under the Star Rated License, child care centers in North Carolina are awarded 1–5 stars based upon program standards and staff education levels. One hundred centers were randomly selected and divided into two groups (high quality, 4 or 5 stars; low quality, 1–3 stars). Then, in a strategic

Results

First, descriptive results examining the levels and patterns of cortisol and sAA are presented. Then, the models predicting cortisol AUCg and RDC for cortisol are presented. Models are presented separately for each indicator of classroom process quality (Emotional Support, Classroom Organization, and Instructional Support) to explore relations to cortisol AUCg and RDC. Finally, parallel models are repeated predicting sAA.

Discussion

This study was the first to explore sAA activity within the child care context and the first to measure the relation between classroom interactions, measured by the CLASS, and activity in the SNS and HPA axis. Overall, children in this sample showed an increase in cortisol from morning arrival to early afternoon; this increase in cortisol during the child care day has been replicated in numerous other studies for children in child care (e.g., Sims et al., 2006, Watamura et al., 2003). This

Role of the funding source

This research was mostly funded by an internal faculty grant to Linda Hestenes and Marion O’Brien grant from the school of Human Environmental Sciences at The University of North Carolina at Greensboro. Additionally, Bridget Hatfield was supported by dissertation fellowships from the Society of Research in Child Development and Kappa Omicron Nu; these funds primarily paid for the alpha-amylase assays.

Acknowledgements

The authors would like to thank Doug Granger for his continued support and guidance on this research project. Further, we are indebted to the children, families, teachers and child care centers who participated in this project. Finally, we would like to thank Crystal Sexton and Nicole Brown for their assistance with data collection, management, and organization.

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