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Reduced salivary cortisol in children with comorbid Attention deficit hyperactivity disorder and oppositional defiant
S Himani Kariyawasam1, Frank Zaw, Sheila L Handley
1Diana, Princess of Wales Children's Hospital, Birmingham, UK.
Insights
Children with Attention-deficit hyperactivity disorder (ADHD) and Oppositional-defiant disorder (ODD) show lower salivary cortisol levels. Stimulant medication may normalize these levels, suggesting HPA axis involvement in behaviorally disturbed youth.
Area of Science:
- Neuroendocrinology
- Child Psychiatry
- Behavioral Science
Background:
- The hypothalamic-pituitary-adrenal (HPA) axis plays a role in neuropsychiatric disorders.
- Evidence suggests HPA axis underfunction in behaviorally disturbed children.
- Co-morbidity is frequent in childhood neuropsychiatric disorders, complicating HPA axis assessment.
Purpose of the Study:
- To determine if salivary cortisol is reduced in children with co-morbid Attention-deficit hyperactivity disorder (ADHD) and Oppositional-defiant disorder (ODD).
- To examine the effect of stimulant medication on salivary cortisol levels in this population.
Main Methods:
- Salivary cortisol was measured in 32 children diagnosed with ADHD/ODD (DSM-IV criteria).
- A control group of 25 healthy children was included for comparison.
- Data analysis considered whether patients were prescribed stimulant medication.
Main Results:
- Children with ADHD/ODD exhibited significantly lower salivary cortisol levels compared to healthy controls.
- This reduction in cortisol was specifically observed in the subgroup of ADHD/ODD patients not receiving stimulant medication.
Conclusions:
- Findings support potential HPA axis dysfunction in behaviorally disturbed children.
- Reduced salivary cortisol may indicate underarousal or HPA axis subsensitivity.
- The impact of stimulant medication on cortisol secretion warrants further investigation to understand its therapeutic relevance.
Objectives:
There is growing interest in the role of the hypothalamic-pituitary-adrenal (HPA) axis in neuropsychiatric disorders and there is some evidence that the HPA axis may be underfunctional in behaviorally disturbed children. However, co-morbidity is common in childhood neuropsychiatric disorders. Stimulant medication is widely used in the treatment of Attention-deficit hyperactivity disorder (ADHD) and can increase cortisol secretion when given acutely. We therefore set out to determine the whether salivary cortisol would be reduced in a group of children with ADHD/ODD (Oppositional-defiant disorder) and to examine the effect of stimulant medication on any such relationship.
Design:
Salivary cortisol was determined in thirty-two children with co-morbid ADHD and Oppositional-defiant disorder (ODD) according to DSM-IV criteria, compared to twenty-five healthy controls of similar age and ethnic background. Data were analysed according to prescription of stimulant medication in the patient group.
Results:
Salivary cortisol was significantly lower in the ADHD/ODD group than in the controls. Further analysis revealed that this reduction was restricted to the subgroup of patients not prescribed stimulant medication.
Conclusions:
The results support the possibility of a dysfunction of control of the HPA axis in these behaviorally disturbed children. A reduction in salivary cortisol could reflect underarousal, an elevated threshold for detection of stressors or a subsensitivity of the HPA axis itself. It remains to be determined whether the ability of stimulant medications to negate the apparent deficit in cortisol secretion in these ADHD/ODD patients is an unrelated consequence of increased dopamine release or a reflection of their therapeutic benefit. The use of stimulant medication for co-existing ADHD should be taken into account in future studies of cortisol in behaviorally disturbed children.