title: Child abuse, disruptive behavior disorders, depression, and salivary cortisol levels among institutionalized and community-residing boys in Mongolia.
abstract: BACKGROUND
  Hypothalamic-pituitary-adrenal (HPA) axis activity is related to childhood disruptive behavior disorders and to exposure to abuse and neglect. This study explores the relationship of diurnal salivary cortisol levels with oppositional defiant disorder (ODD) and caregiver attitudes toward physical punishment among boys in Mongolia.
  
  
  METHODS
  Salivary cortisol was collected in the home or institution 4 times daily for 4 days from 46 boys, aged 4-10 years, in Ulaanbaatar, Mongolia. Caregivers rated child disruptive behavior symptoms, attitudes toward physical punishment, and community violence exposures. Mixed effects models were used to estimate the association of psychopathology and caregiver attitudes with salivary cortisol levels.
  
  
  RESULTS
  Boys meeting criteria for ODD displayed consistently lower diurnal salivary cortisol levels compared to boys without ODD diagnoses. Controlling for ODD diagnosis, boys with depression showed higher cortisol levels throughout the day. No other diagnosis was associated with cortisol levels. Psychiatric diagnosis accounted for 17% of between individual variations in cortisol levels unexplained by the covariates. In a separate model, caregivers' beliefs regarding physical punishment accounted for 11% of between individual differences: boys with caregivers who stated physical punishment was necessary for discipline displayed hypocortisolism. Institutionalization did not associate with cortisol levels.
  
  
  CONCLUSIONS
  Salivary cortisol data from a non-Western naturalistic setting support an association of reduced basal HPA activity with disruptive behavior disorders and caregiver attitudes toward discipline. These findings suggest HPA functioning may be a reflection of or mediate disruptive behavior disorders in children across ethnic and cultural settings.
authors.affiliation: Department of Anthropology, Emory University, Atlanta, GA, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Kohrt
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Hruschka
authors.forename: Holbrook E
authors.initials: HE
authors.lastname: Kohrt
authors.forename: Victor G
authors.initials: VG
authors.lastname: Carrion
authors.forename: Irwin D
authors.initials: ID
authors.lastname: Waldman
authors.forename: Carol M
authors.initials: CM
authors.lastname: Worthman
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D002648:Child; D002674:Child, Institutionalized / Q000523:psychology*; D002675:Child, Preschool; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008986:Mongolia; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology
chemical_list: D006854:Hydrocortisone
keywords: attention deficit and disruptive behavior disorder; biological marker; child abuse; culture; parent-child relations