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Adrenocortical Functioning in Boys with Attention-Deficit/Hyperactivity Disorder: Examining Subtypes of ADHD and Associated Comorbid Conditions

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Abstract

Disruptions to hypothalamic-pituitary-adrenal (HPA) axis function have been associated with varying forms of psychopathology in children. Studies suggesting children with ADHD have blunted HPA function have been complicated by the prevalence of comorbid diagnoses and heterogeneity of ADHD. The goals of this research were to assess the relations between waking and stress–response salivary cortisol levels and comorbid disruptive behavior (DBD) and anxiety (AnxD) disorders and problems in boys with ADHD, and to examine whether cortisol levels varied across ADHD subtypes. One hundred seventy elementary school-age boys with ADHD provided salivary cortisol at waking and in reaction to venipuncture. Parent reports were used to assess boys’ psychiatric diagnoses and severity of behavioral problems. Boys’ comorbid AnxD and anxiety problems were associated with greater cortisol reactivity, whereas boys’ comorbid DBD and oppositional problems predicted diminished adrenocortical activity. Reactive cortisol increases were greatest in boys with ADHD and comorbid AnxD, but without DBD. ADHD subtypes were not differentially associated with waking, pre-stress baseline, or reactive cortisol levels. However, comorbid DBD predicted decreased cortisol reactivity in boys with inattentive and hyperactive subtypes of ADHD, but not in boys with combined subtype of ADHD. The results clarify previous patterns of distinct and divergent dysregulations of HPA function associated with boys’ varying kinds of psychopathology.

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Notes

  1. It could be argued that dimensional scores for severity of problems, rather than categorical scores for presence of diagnoses, might be a stronger way to examine whether inattention or hyperactivity problems are differentially associated with HPA axis activity depending on the presence of comorbid difficulties. This was addressed using the scores from the Conners’ PRS-R. Regression and correlation analyses using these dimensional scores supported the categorical analyses. Specifically, the Conners’ score for Oppositional problems was negatively correlated with the magnitude of cortisol stress response for boys with ADHD-PI, r = -0.35, p = 0.012, and boys with ADHD-HI, r = -0.42, p = 0.069, but not for boys with ADHD-C, r = 0.02, ns. Considered another way, in boys without DBD, the correlation between Inattention problems and magnitude of cortisol stress response was not significant, r = 0.08, ns, but for boys with DBD, there was a significant negative correlation, r = -0.21, p = 0.046. The correlation for Hyperactive problems on the Conners’ was not significant for either group of boys, r = -0.09 and -0.12, respectively.

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Acknowledgements

Fonds de Recherche en Santé du Quebec (FRSQ), Galileo Genomics, and Genizon financially supported this research, l’Hôpital Sainte-Justine provided infrastructure support, and Francois L’Heureux and Aracely Contreras assisted with data management. The participating boys and their families have our sincere gratitude.

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  1. Department of Psychology, Centre for Research in Human Development, Concordia University, Montreal, H4B 1R6, QC, Canada

    Paul D. Hastings & William T. Utendale

  2. l’Hôpital Sainte-Justine, l’Université de Montréal, Montréal, QC, Canada

    Isabel Fortier & Philippe Robaey

  3. Biochemistry & Medical Genetics, University of Manitoba, Winnipeg, MA, Canada

    Louise R. Simard

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Hastings, P.D., Fortier, I., Utendale, W.T. et al. Adrenocortical Functioning in Boys with Attention-Deficit/Hyperactivity Disorder: Examining Subtypes of ADHD and Associated Comorbid Conditions. J Abnorm Child Psychol 37, 565–578 (2009). https://doi.org/10.1007/s10802-008-9292-y

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