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

• DOI: 10.1007/s00787-009-0011-1
• Publication Date: 2009-03-17T03:52:26Z
• Authors: Dirk van West; Stephan Claes; Dirk Deboutte
• Keywords: Male; Parents; Hypothalamo-Hypophyseal System; Hydrocortisone; Personality Inventory; Psychometrics; speech; Pituitary-Adrenal System; Stress; Cortisol; Diagnosis, Differential; 03 medical and health sciences; 0302 clinical medicine; ddc:150; ADHD; Psychology; Humans; Speech; hydrocortisone; Child; Saliva; Children; Psychiatric Status Rating Scales; Psychological Disorders, Mental Health Treatment and Prevention; HPA axis; biomarkers; parents; ADHD; Children; Cortisol; HPA axis; psychophysical stress; Psychologie; Phobic Disorders; psychische Störungen, Behandlung und Prävention; Attention Deficit Disorder with Hyperactivity; Female; Human medicine; stress, psychological; Biomarkers; Stress, Psychological

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.