Of Hugs and Hormones

Lack of Touch Puts Kids Out of Touch

By William J. Cromie

Gazette Staff

Hugs are as vital to the health and development of infants as food and water, according to decades of research by a Harvard scientist.

Mary Carlson, a neurobiologist at Harvard Medical School, measured stress in Romanian children raised in orphanages or attending poor-quality day-care centers. She concludes that the lack of touching and attention stunted their growth and adversely affected their behavior.

Carlson hopes to use these results to assess the quality of child-care for young inner-city children in the United States. She also believes that her findings argue against recent changes in welfare policies in this country.

"This is the first demonstration that institutional settings that deprive infants and children of the type of attention and stimulation they receive in typical family life have a serious and lasting impact," Carlson says. "Political and economic conditions that led many families to put their children in orphanages and inferior day-care centers in Romania are paralleled in this country by regulations that force single mothers to work without having adequate daycare for their young children."

Many people were appalled at the sight of young children crowded into dreary, meagerly staffed orphanages, without hugs, toys, or activities. Under the pressures of welfare reform, Carlson fears that similar conditions could occur in the United States, already lacking in adequate day-care facilities.

In an effort to improve Romania's industrial output, Nicolae Ceausescu, president from 1974 until 1989, required that both parents should work and should raise large families. Many families could not care for their children during weekdays and others abandoned their youngest or least able children to orphanages.

"In Romania, social policy was based solely on economics rather than what was best for families," Carlson maintains. "In this country, welfare reforms threaten to force single women into the workplace without providing them with high-quality care for their young children.

"Congressional leaders and some influential journalists have even endorsed re-establishment of orphanages. Of course, we would spend the money to make them 'good' facilities. But money's not the point -- young kids need social interaction, and a most important part of that interaction is touch. They need to be cuddled."

Bizarre Behavior

Why study neglected kids in Romania when there are so many deprived kids in the United States? "In this country, neglect is usually combined with abuse of various kinds," Carlson answers. "This was not the case in Romania, and we wanted to examine the consequences of neglect separately from those of abuse."

Carlson believed that if she could employ scientific techniques to show the critical role of touch in human development, her findings would support efforts to reform child-care policies in Romania and other nations.

She and others have done research on monkeys and rats which demonstrates crucial links among touch, the secretion of the stress hormone cortisol, and social development. Newborn monkeys deprived of physical contact with their mothers, or social contact with others, develop abnormal stress profiles and exhibit bizarre behaviors.

"In the past, everyone thought survival depended on satisfying basic drives such as hunger and thirst," Carlson points out. "The animal studies, however, show that touch is the key to bonding between infants and their mothers."

Institutionalized children in Romania resemble these socially deprived monkeys. They do not form normal relationships with other kids, are unresponsive and fearful, and exhibit behavior such as self-clasping, rocking, and swaying. Similarly, untouched and ignored rats show a disregulation of their daily cycle of cortisol secretion, brain degeneration, and memory loss.

In times of stress, the body prepares itself for fight or flight by secreting adrenaline, then cortisol. The latter hormone mobilizes energy stored in fat, the liver, and other locations. It also shuts down energy-expensive systems for growth, digestion, reproduction, and immunity against disease.

For millions of years, this response has enabled humans and their predecessors to adapt to acute stress, attacks by large, hungry animals, or a horrific traffic jam. But this adaptation can be damaging in conditions of chronic stress -- poverty, uncertainty, violence, living unhappily in an orphanage or a grim day-care facility.

Carslon and her colleagues studied 60 Romanian children a few months to 3 years of age. The researchers measured their cortisol levels by analyzing samples of saliva. They found their daily cycle of cortisol secretion and stress response to be poorly regulated.

In the morning, levels of the hormone were lower than in normal infants. The hormone peaked at noon in the most deprived children; normally it should peak just before waking. In afternoon hours, cortisol secretion stayed high when it should drop low. Following a stressful event, such as a brief physical examination, cortisol levels rose higher and remained elevated longer in children who were worst off.

"This disregulation seems to interfere with growth and mental and motor activities," Carlson says. Children with the lowest morning levels did the poorest on tests of picture recognition, saying words, waving hello and goodbye, socializing, standing on one foot, and walking upstairs without holding on -- all things normal 2- to 3-year- olds do.

"Two-year-olds in orphanages performed at mental and motor levels we normally see in one-year-olds," Carlson declares. "The more abnormal the cortisol levels, the poorer the outcome."

Children in day-care centers went home to their families in the evenings and on weekends. They showed the same abnormal hormone levels as their abandoned peers during the week, but not on the weekends when they rejoined their families.

To determine how hugs and other forms of physical contact might change a child's life, 30 children participated in an enrichment program. One caretaker was assigned to every four kids, instead of attending 12 to 20 children, as was usual. This adult played with all the children, showed them toys, picked them up, held them, straightened their clothes and hair. The enrichment did help the children before a shortage of funds brought the program to a close after 13 months.

"When the enriched kids returned to the typical conditions that involved little touching, the physical and behavioral advantage they had obtained faded," Carlson reports. "Although the enriched group showed a better response to stress as long as 18 months later, they still were socially withdrawn and failed to respond normally to other children and adults."

Carlson notes that victims of the Holocaust, severely depressed people, and those with post-traumatic stress disorder (PTSD) exhibit abnormalities in their daily cortisol cycle. Brain images of people with long-term depression and PTSD show shrinkage in an area known as the hippocampus, which plays a role in both memory and in the regulation of cortisol secretion.

Chicago Violence

Besides championing high-quality, touching care for all children, Carlson and husband, Felton Earls, are applying lessons they learned in Romania to children in poor neighborhoods in the United States, who suffer stress as a consequence of poor-quality care and violence. Earls, a professor of human behavior and development at the Harvard School of Public Health, directs the Project on Human Development in Chicago, an effort to study all factors contributing to behavior and quality of life in 343 Chicago neighborhoods.

Carlson and Earls are discussing with parents and care providers a plan to measure cortisol levels in inner-city communities. In one Mexican-American neighborhood, for example, both kids and adults are stressed by gang violence, unemployment, poverty, and uncertainty about changes in immigration laws.

By doing hormone-testing in such communities, Carlson and Earls want to gain a better understanding of the connection between stress and behavior. "We also want to explore the advantages of Head Start and other types of early education programs compared to a lack of such enrichment. We hope this knowledge will help convince federal and state governments to increase funding for high-quality early education programs and anti-violence legislation in this country."

Carlson points to the fact that testing results in Romania have helped change some policies and practices there. Assisted by the United Nations Children's Fund (UNICEF), the Romanian government has established a new Department of Child Protection. Last week, Mary Robinson, U.N. high commissioner for human rights, told a press conference at Harvard that UNICEF has a program to address the rights, health care, and education of children in Romania.

In the United States, Carlson believes, abnormal cortisol levels can serve as an early warning of vulnerability to stress in many situations. Even with the best of daycare, some children don't do well in certain groups. "It would be better to determine this early than to wait one to two years and then conclude that there is something wrong with the child," Carlson notes. "Some kids cry much of the time; others are stoic. Some may be suffering from physical or verbal abuse at home. A stress profile could provide the earliest warning that something is wrong and needs to be corrected."