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Llorens M, Barba M, Torralbas J, Nadal R, Armario A, Gagliano H, Betriu M, Urraca L, Pujol S, Montalvo I, Gracia R, Giménez-Palop O, Palao D, Pàmias M, Labad J. Stress-related biomarkers and cognitive functioning in adolescents with ADHD: Effect of childhood maltreatment. J Psychiatr Res 2022; 149:217-225. [PMID: 35287052 DOI: 10.1016/j.jpsychires.2022.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/15/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Our study aimed to explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment. Seventy-six adolescents with ADHD were studied. The ADHD rating scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory as well as executive functioning) were identified by confirmatory factor analysis. Stress-related hormone levels were assessed at the clinic (plasma prolactin and cortisol levels and salivary cortisol levels) before cognitive testing and at home for two consecutive days (cortisol awakening response [CAR] and diurnal cortisol slope). Multiple linear regression analyses were used to explore the association between hormone levels and ADHD severity or cognitive functioning while adjusting for sex and childhood maltreatment. Regarding hormonal measurements obtained at the clinic, female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. Prolactin levels were not associated with cognitive functioning or the severity of ADHD. Regarding HPA axis measurements performed at home, lower cortisol levels at awakening were associated with poorer executive functioning. Neither CAR nor the cortisol diurnal slope were associated with cognitive functioning or ADHD severity. Our study suggests that HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending on the symptom type.
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Affiliation(s)
- Marta Llorens
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain
| | - Maria Barba
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Jordi Torralbas
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Roser Nadal
- Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Psicobiology Unit, Faculty of Psychology, Universitat Autònoma de Barcelona Spain, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain
| | - Antonio Armario
- Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Psicobiology Unit, Faculty of Psychology, Universitat Autònoma de Barcelona Spain, Spain; Animal Physiology Unit (Department of Cellular Biology, Physiology and Immunology), Faculty of Biosciences, Universitat Autònoma de Barcelona, Spain
| | - Humberto Gagliano
- Animal Physiology Unit (Department of Cellular Biology, Physiology and Immunology), Faculty of Biosciences, Universitat Autònoma de Barcelona, Spain
| | - Maria Betriu
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Lara Urraca
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Susana Pujol
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Itziar Montalvo
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Rebeca Gracia
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Olga Giménez-Palop
- Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain; Department of Endocrinology, Parc Taulí Hospital Universitari, I3PT, Sabadell, Spain
| | - Diego Palao
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Montserrat Pàmias
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Javier Labad
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain; Department of Mental Health, Consorci Sanitari Del Maresme, Mataró, Spain.
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Salivary cortisol and alpha-amylase diurnal profiles and stress reactivity in children with Attention Deficit Hyperactivity Disorder. Psychoneuroendocrinology 2018; 90:174-181. [PMID: 29501948 DOI: 10.1016/j.psyneuen.2018.02.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022]
Abstract
There is growing evidence for dysregulation of the stress system in individuals with Attention Deficit Hyperactivity Disorder (ADHD). The stress system includes neuroanatomical and functional components that function in concert to maintain homeostasis and its main effectors are the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic/adrenomedullary nervous system (SNS). As stress system activity demonstrates a distinct circadian variation, we aimed to describe simultaneously, diurnal rhythms of both the HPA axis and the SNS in children with ADHD and a comparison group. Moreover, we attempted to investigate stress responses to a physical stressor, venipuncture, in both groups. Sixty-two prepubertal children with ADHD combined (ADHD-C) or inattentive (ADHD-I) type and 40 typically developing children provided saliva samples at six specific time points during a day, as well as before and 10 min after a scheduled morning venipuncture. Salivary cortisol and α- amylase were selected as reliable noninvasive biomarkers for HPA axis and SNS function and were measured in the samples obtained. Results revealed that children with ADHD-C had lower mean cortisol values both 30 min after awakening and at 18:00 h than controls (p = 0.002 and p = 0.018 respectively), as well as lower mean Cortisol Awakening Response (CAR) and Area Under the Curve for "wake to bed" period (AUCi) values of cortisol (p = 0.004 and p = 0.001, respectively). Also, mean CAR and cortisol AUCi were lower in children with ADHD-I than the control group (p = 0.034 and p = 0.038 respectively). Alpha-amylase measurements showed an increase over time (p < 0.001), which was similar in all three groups. Interestingly, α-amylase changes over time were correlated with the corresponding cortisol changes (p < 0.001). Venipuncture, elicited a significant increase only in α-amylase levels and more so in the control group (p = 0.003). These findings suggest a partial hypofunction of the stress system in children with ADHD.
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