Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University of Marburg, Schützenstrasse 45, 35039, Marburg, Germany.
Clinical Psychology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria.
Eur Child Adolesc Psychiatry. 2024 Feb;33(2):569-579. doi: 10.1007/s00787-023-02180-1. Epub 2023 Mar 14.
Low activity of the hypothalamic-pituitary-adrenal axis (HPAA) has been found in children with attention deficit hyperactivity disorder (ADHD). The condition may be related to the reduced attention regulation capacity and/or to comorbid oppositional defiant or conduct disorder (ODD/CD). Sex differences are probable but not sufficiently studied. We analyzed the HPAA activity and sympathetic nervous system reactivity (SR) in children with ADHD while accounting for ADHD symptom presentation, comorbidity, and sex differences. The sample comprised 205 children, 98 (61 boys, 37 girls) with ADHD and 107 (48 boys, 59 girls) healthy controls. DSM-5 phenotypic symptom presentation and comorbid ODD/CD were assessed using clinical interviews. Hair cortisol concentration (HCC) was used to assess the long-term, cumulative activity of the HPAA. SR was assessed via skin conductance response (SCR). For control purposes, comorbid internalizing symptoms and indicators of adverse childhood experiences (ACE) were assessed. Children were medication naive. Boys presenting with predominantly inattentive symptoms (ADHD-I) showed lower HCC than healthy boys. Girls presenting with combined symptoms (ADHD-C) showed higher HCC than did healthy girls (p's < 0.05, sex-by-group interaction, F (2,194) = 4.09, p = 0.018). Boys with ADHD plus ODD/CD showed a blunted SR (p < 0.001, sex-by-group interaction, F (2,172) = 3.08, p = 0.048). Adjustment for ACE indicators led to non-significant differences in HCC but did not affect differences in SR. HCC constitutes an easily assessable, reliable, and valid marker of phenotypic ADHD-related features (i.e. symptom presentation and comorbidity). It indicates more homogenous subgroups of ADHD and might point to specifically involved pathophysiological processes.
下丘脑-垂体-肾上腺轴（HPAA）活性低下已在注意缺陷多动障碍（ADHD）儿童中发现。这种情况可能与注意力调节能力降低有关，或者与共患对立违抗性障碍或品行障碍（ODD/CD）有关。性别差异可能存在，但研究不足。我们分析了 ADHD 儿童的 HPAA 活性和交感神经系统反应性（SR），同时考虑了 ADHD 症状表现、共病和性别差异。样本包括 205 名儿童，98 名（61 名男孩，37 名女孩）患有 ADHD，107 名（48 名男孩，59 名女孩）健康对照。使用临床访谈评估 DSM-5 表型症状表现和共患 ODD/CD。头发皮质醇浓度（HCC）用于评估 HPAA 的长期、累积活性。SR 通过皮肤电反应（SCR）进行评估。为了控制目的，还评估了共患的内化症状和不良童年经历（ACE）的指标。儿童均未接受药物治疗。表现为单纯注意力不集中症状的男孩（ADHD-I）的 HCC 低于健康男孩。表现为混合症状的女孩（ADHD-C）的 HCC 高于健康女孩（p 值均<0.05，性别-组间交互作用，F（2,194）=4.09，p=0.018）。伴有 ODD/CD 的 ADHD 男孩的 SR 减弱（p<0.001，性别-组间交互作用，F（2,172）=3.08，p=0.048）。调整 ACE 指标后，HCC 的差异不再显著，但 SR 的差异没有改变。HCC 是一种易于评估、可靠且有效的与 ADHD 相关表型特征（即症状表现和共病）的标志物。它表明 ADHD 存在更为同质的亚组，并且可能指向特定涉及的病理生理过程。
