uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Early psychosocial adversity and cortisol levels in children with attention-deficit/hyperactivity disorder
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2013 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 22, no 7, 425-432 p.Article in journal (Refereed) Published
Abstract [en]

Previous studies suggest a different regulation of the hypothalamus-pituitary-adrenal axis (HPA-axis) with lower diurnal cortisol levels, especially in the morning, in children with attention-deficit/hyperactivity disorder (ADHD) compared with controls. Since exposure to foetal and childhood psychosocial adversity has been associated with both ADHD and HPA-axis functioning, such exposures may explain these low cortisol levels in ADHD via early programming of the HPA-axis. Thus, our main aim was to retrospectively study foetal and early childhood exposures to psychosocial adversity in children with ADHD and to relate these exposures to cortisol levels. Saliva samples were collected during a regular weekday in children, 6-17 years old, with clinically confirmed ADHD (n = 197) and non-affected comparisons (n = 221) for radioimmunoassay analysis of cortisol. Parental rating scales were used for categorising subtypes of ADHD and degree of exposure to adversity. Children with ADHD had more reports of at least one rated foetal adversity (p = 0.041) and childhood adversity (p < 0.001) than comparisons. The association between low morning cortisol levels and ADHD-symptoms remained when analyses were adjusted for adversities, age, sex, sampling time and symptoms of oppositional defiant disorder. No relation was found between exposures to foetal/childhood adversity and cortisol levels except for a positive relation between childhood adversity and cortisol morning increase in children with ADHD. The hypothesis that early adversity may influence the HPA-axis, leading to lower cortisol levels in children with ADHD, was not supported by our findings.

Place, publisher, year, edition, pages
2013. Vol. 22, no 7, 425-432 p.
Keyword [en]
ADHD, Trauma, Adversity, HPA-axis, Cortisol, Endocrinology
National Category
Endocrinology and Diabetes Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-204982DOI: 10.1007/s00787-013-0383-0ISI: 000321634800006OAI: oai:DiVA.org:uu-204982DiVA: diva2:641347
Available from: 2013-08-16 Created: 2013-08-13 Last updated: 2017-12-06Bibliographically approved
In thesis
1. ADHD and stress: Diurnal cortisol levels, early psychosocial adversity and perceived stress
Open this publication in new window or tab >>ADHD and stress: Diurnal cortisol levels, early psychosocial adversity and perceived stress
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Hypothalamus-Pituitary-Adrenal axis (HPA-axis) with its end product cortisol mediates the physiological response to stress thereby promoting mobilization of energy. The cortisol levels follow a diurnal rhythm with a distinct awakening response. Regulation of the HPA-axis differs among persons with certain psychiatric disorders when compared with controls. Some reports concern Attention-Deficit/Hyperactivity Disorder (ADHD) but findings are inconclusive. The main aim of the present thesis was to investigate diurnal levels of saliva cortisol in school aged children with ADHD and age matched non-affected comparisons, also taking early adversity, perceived stress and ADHD-medication into consideration.

Children with ADHD had lower cortisol levels at awakening, 30 minutes later and before going to bed than comparisons. When the study group was split into three different age groups similar results were found only for children above 10 years of age. Within the ADHD group, subtype of ADHD or co-occurring symptoms did not affect the cortisol levels. Furthermore, children in the ADHD group had to a higher degree been exposed to foetal and childhood psychosocial adversity than comparisons.

Since exposure to early adversity has been associated with both ADHD and HPA-axis functioning, such exposures could theoretically explain the low cortisol levels in ADHD via early programming of the HPA-axis. However, no relation was found between exposures to psychosocial adversity and diurnal cortisol levels. Neither did continuous medication with stimulants or atomoxetine explain the low cortisol levels. Possibly, medication may rather increase the levels.

Finally, children with ADHD scored higher on perceived stress, measured by the Pressure-Activation-Stress (PAS) scale, than the comparison group. Female sex was also associated with higher stress in both groups, as well as increasing age in the comparison group. As with psychosocial adversity, no association was found between the higher PAS-scores and the lower cortisol levels, indicating the complexity of the stress regulating system.

The results indicate a down-regulated or displaced HPA-axis with lower cortisol levels in children with ADHD. Stress related fragility – with more exposure to early stressors, higher perceived stress and lower diurnal cortisol levels – seem to accompany ADHD during childhood.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 957
Keyword
ADHD, HPA-axis, cortisol, hypocortisolism, diurnal rhythm, trauma, adversity, medication, perceived stress, gender differences
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-211808 (URN)978-91-554-8822-2 (ISBN)
Public defence
2014-01-31, Universitetshuset, sal IX, S:t Olofsgatan, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-01-09 Created: 2013-12-02 Last updated: 2014-01-24

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Isaksson, JohanNilsson, Kent W.Lindblad, Frank

Search in DiVA

By author/editor
Isaksson, JohanNilsson, Kent W.Lindblad, Frank
By organisation
Child and Adolescent PsychiatryCentre for Clinical Research, County of Västmanland
In the same journal
European Child and Adolescent Psychiatry
Endocrinology and DiabetesPsychiatry

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 715 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf