Elizabeth J. Susman

Identifying Risk for Obesity in Early Childhood

OBJECTIVES. Our aim with this study was to assist clinicians by estimating the predictive value of earlier levels of BMI status on later risk of overweight and obesity during the middle childhood and early adolescent years. METHODS. We present growth data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal sample of 1042 healthy US children in 10 locations. Born in 1991, their growth reflects the secular trend of increasing overweight/obesity in the population. Height and weight of participating children in the study were measured at 7 time points. We examined odds ratios for overweight and obesity at age 12 years comparing the frequency with which children did versus did not reach specific BMI percentiles in the preschool- and elementary-age periods. To explore the question of whether and when earlier BMI was predictive of weight status at age 12 years, we used logistic regression to obtain the predicted probabilities of being overweight or obese (BMI ≥85%) at 12 years old on the basis of earlier BMI. RESULTS. Persistence of obesity is apparent for both the preschool and elementary school period. Children who were ever overweight (>85th percentile), that is, ≥1 time at ages 24, 36, or 54 months during the preschool period were >5 times as likely to be overweight at age 12 years than those who were below the 85th percentile for BMI at all 3 of the preschool ages. During the elementary school period, ages 7, 9, and 11 years, the more times a child was overweight, the greater the odds of being overweight at age 12 years relative to a child who was never overweight. Sixty percent of children who were overweight at any time during the preschool period and 80% of children who were overweight at any time during the elementary period were overweight at age 12 years. Follow-up calculations showed that 2 in 5 children whose BMIs were ≥50th percentile by age 3 years were overweight at age 12 years. No children who were <50th percentile for BMI at all points during elementary school were overweight at age 12 years. Children who have higher range BMIs earlier, but not at the 85th percentile, are also more likely to be overweight at age 12 years. Even at time points before and including age 9 years, children whose BMIs are between the 75th and 85th percentile have an ∼40% to 50% chance of being overweight at age 12 years. Children at 54 months old whose BMIs are between the 50th and 75th percentile are 4 times more likely to be overweight at age 12 years than their contemporaries who are <50th percentile, and those whose BMIs are between the 75th and 85th percentile are >6 times more likely to be overweight at age 12 years than those <50th percentile. CONCLUSIONS. The data from this study indicate that children with BMIs >85th percentile, as well as with BMIs in the high reference range are more likely than children whose BMI is <50th percentile to continue to gain weight and reach overweight status by adolescence. Pediatricians can be confident in counseling parents to begin to address the at-risk childs eating and activity patterns rather than delaying in hopes that overweight and the patterns that support it will resolve themselves in due course. Identifying children at risk for adolescent obesity provides physicians with an opportunity for earlier intervention with the goal of limiting the progression of abnormal weight gain that results in the development of obesity-related morbidity.

Psychobiology of persistent antisocial behavior: Stress, early vulnerabilities and the attenuation hypothesis

Stress experienced during the sensitive prenatal, postnatal and early childhood periods of brain development can have damaging consequences for developing biological systems. Stressors imposed by early physical vulnerabilities and an adverse care giving environment is proposed to set in motion early precursors of later persistent antisocial behavior. The purpose of this report is to present an integrated theoretical perspective of potential mechanisms involved in the development of persistent antisocial behavior with an emphasis on early stressors and the neuroendocrinology of stress. The attenuation of endocrine physiology of the stress system is considered a key mechanism involved in persistent antisocial behavior. The amygdala is considered a structure/process linking subjective experiences, emotional learning, brain development and stress physiology. Attenuated cortisol level subsequent to early vulnerabilities is considered a risk marker for persistent antisocial behavior.

Self-regulation and Rapid Weight Gain in Children From Age 3 to 12 Years

OBJECTIVE To examine the extent to which self-regulatory capacities, measured behaviorally at ages 3 and 5 years, were linked to rapid weight gain in children from age 3 to 12 years. Self-regulation failure, or the inability to control an impulse or behavior, has been implicated as a mechanism in the development of overweight. DESIGN Prospective longitudinal cohort study. SETTING Home and laboratory-based settings in 10 sites across the United States. PARTICIPANTS Data were drawn from 1061 children as part of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Self-regulatory capacity was measured in 2 behavioral protocols; children participated in a self-control procedure at age 3 years and a delay of gratification procedure at age 5 years. MAIN OUTCOME MEASURES Age- and sex-specific body mass index (BMI) z scores were calculated based on measured BMI at 6 points. RESULTS Mixed-modeling analyses were used to examine differences in the rate of weight gain over time based on the extent to which children exhibited the ability to self-regulate in the behavioral procedures. Compared with children who showed high self-regulation in both behavioral protocols at ages 3 and 5 years, children who exhibited a compromised ability to self-regulate had the highest BMI z scores at each point and the most rapid gains in BMI z scores over the 9-year period. Effects of pubertal status were also noted for girls. CONCLUSION Self-regulation failure in early childhood may predispose children to excessive weight gain through early adolescence.

Attenuation of cortisol across development for victims of sexual abuse

Inconsistencies exist in literature examining hypothalamic-pituitary-adrenal (HPA) axis activity in children and adults who have experienced childhood abuse. Hence, the extent and manner to which childhood abuse may disrupt HPA axis development is largely unknown. To address these inconsistencies, the developmental course of nonstress cortisol in a long-term longitudinal study was assessed at six time points from childhood through adolescence and into young adulthood to determine whether childhood abuse results in disrupted cortisol activity. Nonstress, morning cortisol was measured in 84 females with confirmed familial sexual abuse and 89 nonabused, comparison females. Although dynamically controlling for co-occurring depression and anxiety, hierarchical linear modeling (HLM) showed that relative to comparison females, the linear trend for abused females was significantly less steep when cortisol was examined across development from age 6 to age 30, t (1, 180) = -2.55, p < .01, indicating attenuation in cortisol activity starting in adolescence with significantly lower levels of cortisol by early adulthood, F (1, 162) = 4.78, p < .01. As a more direct test of the attenuation hypothesis, supplemental HLM analyses of data arrayed by time since the disclosure of abuse indicated that cortisol activity was initially significantly higher, t (1, 425) = 2.18, p < .05, and slopes were significantly less steep t (1, 205) = -2.66, p < .01, for abused females. These findings demonstrate how the experience of childhood abuse might disrupt the neurobiology of stress, providing some support for the attenuation hypothesis that victims of abuse may experience cortisol hyposecretion subsequent to a period of heightened secretion.

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.

Sex Difference in Testosterone Response to a Video Game Contest

Abstract Testosterone (T) and cortisol (C) were assayed from saliva samples given by young men ( n = 28) and women ( n = 32) before, during, and after competing with a same-sex partner in a video game. The T response to the competition is different in each sex; the C response is the same. Male results confirm prior reports of a precontest rise in testosterone. Male results did not confirm previous findings that, after a contest, the testosterone of winners is higher than that of losers, perhaps because the video game contest produced little mood difference between male winners and losers. Unlike male testosterone, female testosterone generally decreased throughout the experiment. Trends in T and C are parallel in women but not in men. Apparently T works differently in competition between men than between women.

Male testosterone linked to high social dominance but low physical aggression in early adolescence

BACKGROUND The association of male pubertal testosterone with social dominance and physical aggression was studied in a population sample of boys followed from age 6 to 13 years to understand the origin of the links between violent behavior and gonadal hormones. METHOD Physical aggression was assessed from the end of kindergarten to the end of elementary school by teachers and peers (aged 6 to 12 years). Social dominance and testosterone levels were assessed at 13 years of age during a 1-day visit to a laboratory with four unfamiliar peers. RESULTS Boys perceived as socially dominant by unfamiliar peers were found to have concurrently higher levels of testosterone than boys perceived as less socially dominant. In contrast, boys who had a history of high physical aggression, from age 6 to 12, were found to have lower testosterone levels at age 13 compared with boys with no history of high physical aggression. The former were also failing in school and were unpopular with their peers. CONCLUSIONS Both concurrent and longitudinal analyses indicated that testosterone levels were positively associated with social success rather than with physical aggression. High testosterone levels in adolescent boys may thus be regarded as a marker of social success in a given context, rather than of social maladjustment as suggested in previous studies.

Participation in biomedical research : the consent process as viewed by children, adolescents, young adults, and physicians

We examined the capacity of children, adolescents, and young adults to assent and consent to participation in biomedical research, and what physician-investigators believe is important for patients in these age groups to know about such participation. The sample included 44 male and female subjects, ranging in age from 7 to 20 years, who were hospitalized to treat either pediatric cancer or obesity. The participants completed a structured interview that assessed knowledge of research participation using the elements outlined in the federal guidelines for informed consent. The study subjects were most knowledgeable about those elements of consent that assessed concrete information (e.g., freedom to ask questions, time elements involved, and the benefits of participation). They were less knowledgeable about those elements of informed consent that assessed abstract information (e.g., scientific vs therapeutic purpose of the study, and alternative treatments). Chronologic age was not related to knowledge of the elements of informed consent. The strategies that the study subjects used to reason about participation in research appeared to parallel their reasoning about other physical phenomena.

Negative affect and hormone levels in young adolescents: Concurrent and predictive perspectives.

The purpose of this study was to test hypotheses regarding (1) relations among negative affect and hormones of gonadal and adrenal origin in young adolescents, at three times of measurement, over a one-year period; and (2) stability of negative affect. The sample consisted of 10- to 14-year-old boys (N=56) and 9- to 14-year-old girls (N=52). The adolescents were assessed three times at 6-month intervals over one year. Serum levels of gonadotropins, gonadal steroids, adrenal androgens, and cortisol were assessed, as well as stage of pubertal development (Tanner criteria). The negative affect assessments consisted of self-report questionnaire and interview measures of anxiety and depressive affect, as well as mother reports of internalizing behavior problems. In the concurrent (cross-sectional) analyses, boys reporting higher levels of negative affect tended to be those at higher genital stage or older age, with lower testosterone and cortisol levels and lower dehydroepian-drosterone sulphate levels. In the longitudinal analyses, negative affect, and to a lesser extent hormone levels at the first time of measurement predicted negative affect 12 months later. The findings suggest that puberty-related hormone levels should be considered along with psychological characteristics in examining the processes involved in the development of negative affect during the pubertal years.

Effect of corticosteroids for fetal maturation on perinatal outcomes, February 28-March 2, 1994

The National Institutes of Health Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes brought together specialists in obstetrics, neonatology, pharmacology, epidemiology, and nursing; basic scientists in physiology and cellular biology; and the public to address the following questions: (1) For what conditions and purposes are antenatal corticosteroids used, and what is the scientific basis for that use? (2) What are the short-term and long-term benefits of antenatal corticosteroid treatment? (3) What are the short-term and long-term adverse effects for the infant and mother? (4) What is the influence of the type of corticosteroid, dosage, timing and circumstances of administration, and associated therapy on treatment outcome? (5) What are the economic consequences of this treatment? (6) What are the recommendations for use of antenatal corticosteroids? and (7) What research is needed to guide clinical care? Following 1 1/2 days of presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. The consensus panel concluded that antenatal corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome, and intraventricular hemorrhage in preterm infants. These benefits extend to a broad range of gestational ages (24-34 weeks) and are not limited by gender or race. Although the beneficial effects of corticosteroids are greatest more than 24 hours after beginning treatment, treatment less than 24 hours in duration may also improve outcomes. The benefits of antenatal corticosteroids are additive to those derived from surfactant therapy. In the presence of preterm premature rupture of the membranes, antenatal corticosteroid therapy reduces the frequency of respiratory distress syndrome, intraventricular hemorrhage, and neonatal death, although to a lesser extent than with intact membranes. Whether this therapy increases either neonatal or maternal infection is unclear. However, the risk of intraventricular hemorrhage and death from prematurity is greater than the risk from infection. Data from trials with followup of children up to 12 years indicate that antenatal corticosteroid therapy does not adversely affect physical growth or psychomotor development. Antenatal corticosteroid therapy is indicated for women at risk of premature delivery with few exceptions and will result in a substantial decrease in neonatal morbidity and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare example of a technology that yields substantial cost savings in addition to improving health.