Related Experiment Video
Updated: Aug 11, 2026
The Trier Social Stress Test Protocol for Inducing Psychological Stress
Published on: October 19, 2011
Depression, anxiety and the dexamethasone suppression test in hospitalized prepubertal children
R Livingston1, C Martin-Cannici
1Division of Child Psychiatry, University of Arkansas for Medical Sciences, Little Rock.
Insights
The dexamethasone suppression test (DST) shows high sensitivity in identifying depression or anxiety in children. However, its specificity is limited, making it difficult to distinguish these conditions from pure behavior disorders in pediatric patients.
Area of Science:
- Pediatric endocrinology
- Child and adolescent psychiatry
- Clinical diagnostics
Background:
- The dexamethasone suppression test (DST) is a diagnostic tool for assessing hypothalamic-pituitary-adrenal (HPA) axis function.
- Previous studies have yielded inconsistent results regarding the sensitivity and specificity of the DST in pediatric populations.
- Methodologic variations and limited data necessitate further investigation into the DST's utility in children.
Purpose of the Study:
- To evaluate the sensitivity and specificity of the DST in a cohort of hospitalized prepubertal children.
- To assess the association between DST results and specific psychiatric diagnoses in children.
- To determine the diagnostic accuracy of the DST for major depressive episode (MDE) and separation anxiety disorder (SAD) versus behavior disorders (BD).
Main Methods:
- The DST was administered to 32 hospitalized prepubertal children using 0.5 mg of dexamethasone with a 4 p.m. cortisol sample.
- Children were diagnosed using the Diagnostic Interview for Children and Adolescents (DICA) and DSM-III criteria.
- Analysis of variance (ANOVA) was used to compare cortisol levels among diagnostic groups, and a cutoff value of 5.0 micrograms/dl was used for positive DST results.
Main Results:
- Cortisol levels varied significantly across principal diagnoses (p < 0.001), with the highest levels observed in children with MDE or SAD and the lowest in those with BD.
- A positive DST result was positively associated with MDE and SAD and negatively associated with BD.
- No significant correlation was found between cortisol levels and anxiety or depression rating scales.
Conclusions:
- The DST demonstrated excellent sensitivity in this pediatric sample.
- The DST's specificity was limited in distinguishing between children with MDE/SAD and those with pure BD.
- Further research may refine the DST's application in pediatric psychiatric diagnostics.
Abstract:
Because of the methodologic differences and limited data, the sensitivity and specificity of the dexamethasone suppression test in children are in question. In our study we used 0.5 mg of dexamethasone and a 4 p.m. cortisol sample to perform the DST on 32 hospitalized prepubertal children diagnosed by a structured interview (DICA) and DSM-III criteria. Cortisols differed significantly by ANOVA among principal diagnoses, with highest values in children with major depression (MDE) or separation anxiety (SAD) and lowest in those with behavior disorders (BD). Using 5.0 micrograms/dl as a cutoff value for positive DST, MDE and SAD are positively and BD negatively associated with positive DST results. Rating scales for anxiety and depression showed no significant association with cortisol level. We conclude that the DST in this sample shows excellent sensitivity but its specificity is limited to distinguishing depressed or anxious children from those with pure behavior disorder.
