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

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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.

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Acknowledgments

This work has been supported by the Special Research Fund of the University of Antwerp. Stephan Claes is a Senior Clinical Investigator of the Fund for Scientific Research Flanders. We are grateful to all the children and their parents for their cooperation and participation in this research study. We acknowledge J. Sulon of the Department of Reproduction Physiology of the University of Liège for the analyses of salivary cortisol. We also acknowledge W. Ang, M. Coudeville, H. De Vlieger, I. Jespers, W. Mengde, I. Mussche, P. Nordin, K. Ponnet, S. Sliwinski, A. Steppe, and E. Van den haute for their contributions.

Conflict of interest statement

The authors reported no biomedical financial interest or potential conflicts of interest.

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Authors and Affiliations

  1. University Center of Child and Adolescent Psychiatry Antwerp (UCKJA), ZNA Middelheim, University of Antwerp, Lindendreef 1, 2020, Antwerp, Belgium

    Dirk van West & Dirk Deboutte

  2. University Psychiatric Center, Campus Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Stephan Claes

  3. The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Dirk van West, Stephan Claes & Dirk Deboutte

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van West, D., Claes, S. & Deboutte, D. Differences in hypothalamic–pituitary–adrenal axis functioning among children with ADHD predominantly inattentive and combined types. Eur Child Adolesc Psychiatry 18, 543–553 (2009). https://doi.org/10.1007/s00787-009-0011-1

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