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Pauli-Pott U, Skoluda N, Nater UM, Becker K, Derz F, Kaspar E, Kasperzack D, Kehm K, Kött M, Mann C, Schurek P, Pott W, Schloß S. Long-term cortisol secretion in attention deficit hyperactivity disorder: roles of sex, comorbidity, and symptom presentation. Eur Child Adolesc Psychiatry 2024; 33:569-579. [PMID: 36917355 PMCID: PMC10869441 DOI: 10.1007/s00787-023-02180-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Low activity of the hypothalamic-pituitary-adrenal axis (HPAA) has been found in children with attention deficit hyperactivity disorder (ADHD). The condition may be related to the reduced attention regulation capacity and/or to comorbid oppositional defiant or conduct disorder (ODD/CD). Sex differences are probable but not sufficiently studied. We analyzed the HPAA activity and sympathetic nervous system reactivity (SR) in children with ADHD while accounting for ADHD symptom presentation, comorbidity, and sex differences. The sample comprised 205 children, 98 (61 boys, 37 girls) with ADHD and 107 (48 boys, 59 girls) healthy controls. DSM-5 phenotypic symptom presentation and comorbid ODD/CD were assessed using clinical interviews. Hair cortisol concentration (HCC) was used to assess the long-term, cumulative activity of the HPAA. SR was assessed via skin conductance response (SCR). For control purposes, comorbid internalizing symptoms and indicators of adverse childhood experiences (ACE) were assessed. Children were medication naive. Boys presenting with predominantly inattentive symptoms (ADHD-I) showed lower HCC than healthy boys. Girls presenting with combined symptoms (ADHD-C) showed higher HCC than did healthy girls (p's < 0.05, sex-by-group interaction, F (2,194) = 4.09, p = 0.018). Boys with ADHD plus ODD/CD showed a blunted SR (p < 0.001, sex-by-group interaction, F (2,172) = 3.08, p = 0.048). Adjustment for ACE indicators led to non-significant differences in HCC but did not affect differences in SR. HCC constitutes an easily assessable, reliable, and valid marker of phenotypic ADHD-related features (i.e. symptom presentation and comorbidity). It indicates more homogenous subgroups of ADHD and might point to specifically involved pathophysiological processes.
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Affiliation(s)
- Ursula Pauli-Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany.
| | - Nadine Skoluda
- Clinical Psychology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
- Research Platform The Stress of Life (SOLE)-Processes and Mechanisms underlying Everyday Life Stress, Vienna, Austria
| | - Urs M Nater
- Clinical Psychology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
- Research Platform The Stress of Life (SOLE)-Processes and Mechanisms underlying Everyday Life Stress, Vienna, Austria
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg Justus Liebig University Giessen, Hans-Meerwein-Straße 6, 35032, Marburg, Germany
| | - Friederike Derz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Elena Kaspar
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Daria Kasperzack
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Kira Kehm
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Marie Kött
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Christopher Mann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Pia Schurek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Wilfried Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
| | - Susan Schloß
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany
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