Cortisol awakening response in healthy children and children with ADHD: Impact of comorbid disorders and psychosocial risk factors

Cortisol secretion in children with symptoms of reactive attachment disorder

“…Our review has demonstrated that studies of adults who have been maltreated show conflicting results regarding the impact of maltreatment on diurnal secretion of cortisol and that there is a gap in the literature as regards cortisol production in maltreated schoolage children (Hunter et al, 2011). Altered function of the HPA axis has been described in depression (Holsboer, 2001), post-traumatic stress disorder (Yehuda, 2009), ADHD (Freitag et al, 2009;Stadler et al, 2011), conduct disorder and antisocial personality disorder (Vanyukov et al, 1993). Studies of children reared in institutions have shown that lack of caregiver sensitivity and positive regard is associated with a general suppression of the hypothalamic-pituitary axis and that this can recover if the environment improves.…”

Time‐of‐day effects in arousal: disrupted diurnal cortisol profiles in children with ADHD

“…For example, cortisol levels were lower than normal in children with comorbid ADHD and ODD/conduct disorder (CD) (King, Barkley, & Barrett, 1998) and in clinic-referred disruptive boys (McBurnett, Lahey, Rathouz, & Loeber, 2000), but this deficit may be normalized by treatment with stimulant medication (Kariyawasam, Zaw, & Handley, 2002). In some studies of ADHD children, lowered awakening response (Freitag, et al, 2009) or lower basal values (Kariyawasam, et al, 2002) were associated with comorbid ODD, but this pattern was not confirmed by others (Hastings, et al, 2009). Such discrepancies suggest that ADHD with comorbid ODD/CD may differ from ODD and CD and other aggressive behaviour without ADHD.…”

Endocrine Dysfunction and Growth in Attention Deficit Hyperactivity Disorder

“…found these decreased wakening cortisol levels in ADHD children only when ADHD was also associated with comorbid oppositional defiant disorder (ODD). Diminished wakening cortisol was not observed in children with ADHD only or in children with ADHD plus conduct disorder or anxiety disorder (Freitag et al, 2009). In other studies, in this case 170 elementary school-age ADHD males, no differences in baseline, waking cortisol levels between ADHD subtypes could be demonstrated (Hastings et al, 2009).…”

“…In some studies, ADHD subtypes are found to have both decreased baseline, wakening cortisol levels and a decreased response to stressful stimuli (Freitag et al, 2009). Freitag et.…”

“…In summary, studies of hypothalamic -pituitary -adrenocortical axis activity in ADHD children have yielded conflicting results, likely due to the confounding variables of comorbidities, subtypes and heterogeneity of ADHD (Hastings et al, 2009); the variety of methods used to assess stress hormone activity; and current psychosocial conflicts such as parenting issues, family conflicts and stressful, acute life events, all of which can increase cortisol levels (Freitag et al, 2009) and affect the outcome of studies of hormonal levels and behavior. If further research is able to better clarify this complex interaction, measurements of hormonal levels may become a useful diagnostic adjunct to help select the most appropriate treatment modalities for pediatric behavioral disorders and aggression (Barzman et al, 2010 Abbreviations: ADHD = attention deficit hyperactivity disorder; ADHD-CU = ADHD with callous unemotional traits; ADHD-HI = ADHD with hyperactive impulsive traits; ADHD-I = ADHDpredominantly inattention type; ADHD-C = ADHD-combined type Table 1.…”