Elana B. Gordis

Salivary α‐Amylase in Biobehavioral Research

Abstract:  In the history of science, technical advances often precede periods of rapid accumulation of knowledge. Within the past three decades, discoveries that enabled the noninvasive measurement of the psychobiology of stress (in saliva) have added new dimensions to the study of health and human development. This widespread enthusiasm has led to somewhat of a renaissance in behavioral science. At the cutting edge, the focus is on testing innovative theoretical models of individual differences in behavior as a function of multilevel biosocial processes in the context of everyday life. Several new studies have generated renewed interest in salivary α‐amylase (sAA) as a surrogate marker of the autonomic/sympathetic nervous system component of the psychobiology of stress. This article reviews sAAs properties and functions; presents illustrative findings relating sAA to stress and the physiology of stress, behavior, cognitive function, and health; and provides practical information regarding specimen collection and assay. The overarching intent is to accelerate the learning curve such that investigators avoid potential pitfalls associated with integrating this unique salivary analyte into the next generation of biobehavioral research.

Salivary Alpha Amylase-Cortisol Asymmetry in Maltreated Youth

BACKGROUND Maltreatment represents a major stressor in the lives of many youth. Given the known effects of stress exposure on subsequent functioning of biological stress response systems, researchers have been interested in the effects of maltreatment on the functioning of these systems. Experimental studies reveal that previous exposure to stress affects the symmetry between components of the physiological stress response to subsequent stress. The present study examined asymmetry between salivary alpha amylase (sAA), a sympathetic indicator, and cortisol reactivity to a social stressor among maltreated and comparison youth age 9 to 14 years. Consistent with earlier studies suggesting that stress leads to asymmetry between hypothalamic-pituitary-adrenal axis and sympathetic nervous system activity, we expected that maltreated youth would exhibit greater sAA-cortisol asymmetry than would comparison youth. METHODS Forty-seven maltreated and 37 comparison youth visited the laboratory and engaged in a social stress protocol. We collected 2 saliva samples before the stressor and 4 after, at 0 min post-stress and every 10 min for 30 min. RESULTS Maltreatment status moderated the relation between sAA and cortisol activity in response to the stressor. Comparison youth showed significant links between the sAA and cortisol responses; maltreated youth had no significant associations between responses in the two biomarkers. CONCLUSION The data were consistent with sAA-cortisol asymmetry among maltreated youth. Further research should seek to replicate this finding and investigate its implication for developmental trajectories.

Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement--a hypothesis that warrants testing in future research.

Children's Exposure to Violence in the Family and Community

Exposure to family and community violence is linked with aggression, depression, posttraumatic stress symptoms, and academic and cognitive difficulties. It has the potential to permeate many dimensions of childrens day-to-day lives and to erode possible sources of social support. Although the literature focuses on deleterious outcomes, many children fare well in the face of exposure to violence. Research attending to developmental processes, the co-occurrence of multiple forms of violence, and psychobiological mechanisms will clarify why outcomes are better for some children than for others. Greater understanding of childrens risk and resilience in the face of such exposure will inform intervention efforts.

Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test.

OBJECTIVE Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics. METHOD A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. RESULTS At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths (χ(2)(1) = 8.82, p = .006). CONCLUSIONS CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care. CLINICAL TRIAL REGISTRY INFORMATION: Community Clinic Test of Youth Anxiety and Depression Study, URL: http://clinicaltrials.gov, unique identifier: NCT01005836.

The Co-Occurrence of Husband-to-Wife Aggression, Family-of-Origin Aggression, and Child Abuse Potential in a Community Sample Implications for Parenting

Despite considerable research on the effects of husband-to-wife aggression, family-of-origin aggression, and child abuse potential, information is limited regarding the co-occurrence of these three family aggression factors and their impact on specific positive and negative dimensions of parenting. This article examines the separate and additive influences of these family aggression variables on mothers’ and fathers’ parenting in two samples of community families. Co-occurrence rates for husband-to-wife aggression and family-of-origin aggression range from 9% to 12%. Co-occurrence rates for husband-to-wife aggression and child abuse potential range from 6% to 14%, with correlations ranging from .25 to .48. Husband-to-wife aggression is associated with several categories of disrupted parenting. Comparisons of parents with zero, one, or two to three of the family aggression risk variables reveal significant group differences, particularly in parents’ discipline control strategies. The discussion addresses the importance of assessing multiple family aggression factors and the implications for intervention and prevention.

The nuts and bolts of behavioral observation of marital and family interaction.

Despite considerable discussion in the literature about the advantages of observational research and the relative benefits of different coding systems and strategies, little is written about the actual implementation of this assessment strategy. This paper presents an overall framework as well as the essential components involved in collecting (selection of task, setting, unit of analysis, and coding system) and coding (transcribing, selecting and training coders, transforming data, and analyzing reliability) of observational data. To achieve success with observational methods, we emphasize several issues, including (a) the research question as the motivator for all decisions, (b) the interrelatedness of tasks, and (c) the implications of decisions early in the process for later stages of analysis and interpretation. Investigators are encouraged to communicate the details of their observational and coding procedures so that these methods are readily accessible for purposes of replication and comparison.

Co-occurrence between marital aggression and parents' child abuse potential: the impact of cumulative stress.

Evidence suggests that marital aggression and parent-to-child aggression sometimes occur within the same family, but little is known about why certain families are vulnerable to multiple forms of family aggression. According to family systems theory, negative affect in one family relationship can spread to other family relationships. According to family stress theory, aversive circumstances increase families’ vulnerability to disruption and conflict. Based on these theories, the present study tests the hypothesis that cumulative family stresses potentiate the association between marital aggression and parents’ child abuse potential. In a series of additive interactional models, husband-to-wife aggression was linked to husbands’ and wives’ child abuse potential in a context of both high financial stress and high parenting stress but was not linked in a context of low stress. Wife-to-husband aggression was linked to wives’, but not husbands’, child abuse potential in a context of high stress. These results highlight the potential role of contextual factors in the pervasiveness of aggressive exchanges across multiple family subsystems.

Skin Conductance Reactivity and Respiratory Sinus Arrhythmia Among Maltreated and Comparison Youth: Relations with Aggressive Behavior

OBJECTIVE The goal of this study was to examine respiratory sinus arrhythmia (RSA), an indicator of parasympathetic nervous system-linked cardiac activity, and skin conductance level (SCL), a sympathetic indicator, as moderators of the link between child maltreatment and adolescent aggression. METHOD Participants were 234 maltreated (48.3% male) and 128 (57.8% male) comparison youth aged 9-16 years participating in wave 2 of a longitudinal study. RESULTS Regression analyses suggest that among boys, high RSA may be protective against the effects of maltreatment on aggressive behavior. Among girls, the moderating effect of RSA was further moderated by SCL reactivity such that low levels of both baseline RSA and SCL reactivity, or conversely high levels of both baseline RSA and SCL reactivity, exacerbated the link between maltreatment and aggression. CONCLUSIONS High RSA may protect against the effects of maltreatment on aggressive behavior, though this effect may be moderated by SCL reactivity among girls.

Sex differences in salivary cortisol in response to acute stressors among healthy participants, in recreational or pathological gamblers, and in those with posttraumatic stress disorder

Sex differences in incidence and severity of some stress-related, neuropsychiatric disorders are often reported to favor men, suggesting that women may be more vulnerable to aberrant hypothalamic-pituitary-adrenal (HPA) axis responses to stress. In this review, we discuss several investigations that we, and others, have conducted assessing salivary cortisol as a measure of HPA function. We have examined basal cortisol among healthy men and women and also following acute exposure to stressors. Among healthy participants, men had higher basal cortisol levels than did women. In response to acute stressors, such as carbon dioxide or noise, respectively, cortisol levels were comparable between men and women or higher among women. We have also examined cortisol levels among those with problem eating, gambling, or posttraumatic stress disorder (PTSD). Women with restrained eating habits have higher basal cortisol levels than do women without restrained eating habits. Pathological gamblers have more aberrant stress response to gambling stimuli than do recreational gamblers, and these effects are more prominent among men than women. Men who have motor vehicle accident related PTSD, demonstrate more aberrant cortisol function, than do their female counterparts. Although these sex differences in cortisol seem to vary with type of stress exposure and/or pathophysiological status of the individual, other hormones may influence cortisol response. To address this, cortisol levels among boys and girls with different stress-related experiences, will be the subject of future investigation.