Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain.
Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain.
J Psychiatr Res. 2022 May;149:217-225. doi: 10.1016/j.jpsychires.2022.02.041. Epub 2022 Mar 2.
Our study aimed to explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment. Seventy-six adolescents with ADHD were studied. The ADHD rating scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory as well as executive functioning) were identified by confirmatory factor analysis. Stress-related hormone levels were assessed at the clinic (plasma prolactin and cortisol levels and salivary cortisol levels) before cognitive testing and at home for two consecutive days (cortisol awakening response [CAR] and diurnal cortisol slope). Multiple linear regression analyses were used to explore the association between hormone levels and ADHD severity or cognitive functioning while adjusting for sex and childhood maltreatment. Regarding hormonal measurements obtained at the clinic, female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. Prolactin levels were not associated with cognitive functioning or the severity of ADHD. Regarding HPA axis measurements performed at home, lower cortisol levels at awakening were associated with poorer executive functioning. Neither CAR nor the cortisol diurnal slope were associated with cognitive functioning or ADHD severity. Our study suggests that HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending on the symptom type.
我们的研究旨在探讨应激相关激素（下丘脑-垂体-肾上腺[HPA]轴激素和催乳素）是否与注意缺陷多动障碍（ADHD）青少年的认知功能较差有关，并检验儿童期虐待的潜在调节作用。研究了 76 名患有 ADHD 的青少年。进行了 ADHD 评定量表（ADHD-RS）和儿童期创伤问卷（CTQ）。进行了剑桥神经心理学测试自动化电池（CANTAB）的七个认知任务，并通过验证性因子分析确定了两个认知因素（注意力和记忆以及执行功能）。在认知测试前和在家中连续两天（皮质醇觉醒反应[CAR]和日间皮质醇斜率）评估应激相关激素水平（血浆催乳素和皮质醇水平以及唾液皮质醇水平）。使用多元线性回归分析来探讨激素水平与 ADHD 严重程度或认知功能之间的关系，同时调整性别和儿童期虐待。关于在诊所获得的激素测量值，女性性别调节了唾液皮质醇水平与执行功能之间的关系，而儿童期虐待调节了唾液皮质醇水平与 ADHD 患者注意力不集中症状之间的关系。催乳素水平与认知功能或 ADHD 严重程度无关。关于在家中进行的 HPA 轴测量，唤醒时皮质醇水平较低与执行功能较差有关。CAR 或皮质醇昼夜斜率均与认知功能或 ADHD 严重程度无关。我们的研究表明，HPA 轴激素水平与 ADHD 患者认知和注意力不集中症状的严重程度有关，而儿童期虐待和性别会根据症状类型产生不同的调节作用。
