Differences in hypothalamic-pituitary-adrenal axis functioning among children with ADHD predominantly inattentive and combined types

Eur Child Adolesc Psychiatry. 2009 Sep;18(9):543-53. doi: 10.1007/s00787-009-0011-1. Epub 2009 Mar 18.

Abstract

Some evidence suggests that the HPA axis may be dysfunctional in children with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to investigate whether a different pattern of HPA axis activity is found between the inattentive (I) and combined (C) subtypes of ADHD, in comparison with healthy control children. A total of 100 prepubertal subjects [52 children with ADHD combined type (ADHD-C), 23 children with ADHD predominantly inattentive type (ADHD-I), and 25 healthy control subjects] were studied. The effects of stress were studied by comparing cortisol responses to a psychosocial stressor, consisting of a public speaking task. Children with ADHD-I showed an elevated cortisol response to the psychosocial stressor, in contrast to children with ADHD-C who showed a blunted cortisol response to the psychosocial stressor. When a distinction was made between responders and non-responders (a subject was classified as a responder when there was an increase in cortisol reactivity), hyperactivity symptoms were clearly related to a lower cortisol reactivity to stress. The results indicate that a low-cortisol responsivity to stress may be a neurobiological marker for children with ADHD-C, but not for those with ADHD-I. Directions for future research and clinical implications are discussed.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / classification
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / physiopathology*
  • Biomarkers
  • Child
  • Diagnosis, Differential
  • Female
  • Humans
  • Hydrocortisone / analysis
  • Hydrocortisone / physiology
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Male
  • Parents / psychology
  • Personality Inventory
  • Phobic Disorders / metabolism
  • Phobic Disorders / psychology
  • Pituitary-Adrenal System / physiopathology*
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Saliva / chemistry
  • Speech / physiology
  • Stress, Psychological / physiopathology
  • Stress, Psychological / psychology

Substances

  • Biomarkers
  • Hydrocortisone