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

Dirk West (1, 2) , Stephan Claes (2, 3) , Dirk Deboutte (1, 2)

1 University Center of Child and Adolescent Psychiatry Antwerp (UCKJA), ZNA Middelheim
2 The Collaborative Antwerp Psychiatric Research Institute (CAPRI)
3 University Psychiatric Center, Campus Leuven

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.

Mots clés: ADHD; Children; Cortisol; HPA axis; Stress

Dirk West, Stephan Claes, Dirk Deboutte. Differences in hypothalamic–pituitary–adrenal axis functioning among children with ADHD predominantly inattentive and combined types. European Child and Adolescent Psychiatry, 2009, 18 (9), pp.543-553. ⟨10.1007/s00787-009-0011-1⟩. ⟨hal-00535141⟩