van West Dirk, Claes Stephan, Deboutte Dirk
University Center of Child and Adolescent Psychiatry Antwerp (UCKJA), ZNA Middelheim, University of Antwerp, Antwerp, Belgium.
Eur Child Adolesc Psychiatry. 2009 Sep;18(9):543-53. doi: 10.1007/s00787-009-0011-1. Epub 2009 Mar 18.
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.
一些证据表明，注意力缺陷多动障碍（ADHD）儿童的下丘脑-垂体-肾上腺（HPA）轴可能存在功能失调。本研究的目的是调查与健康对照儿童相比，ADHD注意力不集中型（I）和混合型（C）亚型之间是否存在不同的HPA轴活动模式。共研究了100名青春期前受试者[52名ADHD混合型（ADHD-C）儿童、23名ADHD主要为注意力不集中型（ADHD-I）儿童和25名健康对照受试者]。通过比较皮质醇对由公开演讲任务组成的心理社会应激源的反应来研究应激的影响。与ADHD-C儿童对心理社会应激源的皮质醇反应迟钝相比，ADHD-I儿童对应激源的皮质醇反应升高。当区分反应者和无反应者时（当皮质醇反应性增加时，受试者被归类为反应者），多动症状与对应激的较低皮质醇反应性明显相关。结果表明，对应激的低皮质醇反应性可能是ADHD-C儿童的神经生物学标志物，但不是ADHD-I儿童的。讨论了未来研究的方向和临床意义。
