Abstract
Reported findings on cortisol reactivity to stress in young people with ADHD are very variable. This inconsistency may be explained by high rates of comorbidity with Conduct Disorder (CD). The present study examined cortisol responses to a psychosocial stressor in a large sample of adolescent males with ADHD (n=202), with or without a comorbid diagnosis of Conduct Disorder (CD). Associations between stress reactivity and callous-unemotional traits and internalizing symptoms were also assessed. The ADHD only (n=95) and ADHD+CD (n=107) groups did not differ in baseline cortisol, but the ADHD+CD group showed significantly reduced cortisol stress reactivity relative to the ADHD only group. Regression analyses indicated that ADHD symptom severity predicted reduced baseline cortisol, whereas CD symptom severity predicted increased baseline cortisol (ADHD β=−0.24, CD β=0.16, R=0.26) and reduced cortisol stress reactivity (β=−0.17, R=0.17). Callous-unemotional traits and internalizing symptoms were not significantly related to baseline or stress-induced cortisol. Impaired cortisol reactivity is hypothesised to reflect fearlessness and is associated with deficient emotion regulation and inhibition of aggressive and antisocial behaviour. Consequently, it may partly explain the greater severity of problems seen in those with comorbid ADHD and CD.
Highlights
Symptom severity predicted increased baseline cortisol (ADHD β 1⁄4 À 0.24, Conduct Disorder (CD) β 1⁄40.16, R1⁄4 0.26) and reduced cortisol stress reactivity (β1⁄4 À 0.17, R 1⁄40.17)
Reduced cortisol reactivity to stress has been found in children with Attention-Deficit/Hyperactivity Disorder (ADHD) and comorbid disruptive behaviour disorders (DBDs) compared to children with ADHD alone (Hastings et al, 2009; Snoek et al, 2004)
We studied cortisol levels in 202 male adolescents with ADHD, of whom 107 met criteria for a diagnosis of CD, under baseline conditions and during a psychosocial stressor that involved frustration and competition
Summary
Symptom severity predicted increased baseline cortisol (ADHD β 1⁄4 À 0.24, CD β 1⁄40.16, R1⁄4 0.26) and reduced cortisol stress reactivity (β1⁄4 À 0.17, R 1⁄40.17). Other studies found positive associations between ADHD symptoms and cortisol in population-based samples (e.g., Palma et al, 2012) or comparable cortisol levels in children with and without ADHD (e.g., Snoek et al, 2004; Cakaloz et al, 2005; Freitag et al, 2009; Palma et al, 2012) These mixed results could be due to variations within ADHD samples, especially in relation to comorbid disorders, sample size and hormone measurement techniques (see Fairchild (2012), for a review). Problems with adherence to a saliva collection protocol might be pronounced in young people with ADHD who have difficulties with concentration, organisation and being forgetful; this could lead to both false positive and false negative findings (Kudielka et al, 2004)
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