Cortisol levels at baseline and under stress in adolescent males with attention-deficit hyperactivity disorder, with or without comorbid conduct disorder
Open accessAbstract
Reported findings on cortisol reactivity to stress in young people with ADHD are very variable. This inconsistency may be explained by high rates of comorbidity with Conduct Disorder (CD). The present study examined cortisol responses to a psychosocial stressor in a large sample of adolescent males with ADHD (n=202), with or without a comorbid diagnosis of Conduct Disorder (CD). Associations between stress reactivity and callous-unemotional traits and internalizing symptoms were also assessed. The ADHD only (n=95) and ADHD+CD (n=107) groups did not differ in baseline cortisol, but the ADHD+CD group showed significantly reduced cortisol stress reactivity relative to the ADHD only group. Regression analyses indicated that ADHD symptom severity predicted reduced baseline cortisol, whereas CD symptom severity predicted increased baseline cortisol (ADHD β=-0.24, CD β=0.16, R=0.26) and reduced cortisol stress reactivity (β=-0.17, R=0.17). Callous-unemotional traits and internalizing symptoms were not significantly related to baseline or stress-induced cortisol. Impaired cortisol reactivity is hypothesised to reflect fearlessness and is associated with deficient emotion regulation and inhibition of aggressive and antisocial behaviour. Consequently, it may partly explain the greater severity of problems seen in those with comorbid ADHD and CD.
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A particularly severe subgroup of children with antisocial behavior show hypoactivity of the hypothalamus-pituitary-adrenal axis.
“However, our findings align well with evidence that a particularly severe subgroup of children with antisocial behavior show hypoactivity of the hypothalamus-pituitary-adrenal axis50,51.”
From Peripubertal stress increases play fighting at adolescence and modulates nucleus accumbens CB1 receptor expression and mitochondrial function in the amygdala (2018) · cites this paper as [50]
The Discussion (page not provided) reports that low HPA-axis activity under stress was more apparent in adolescent boys with ADHD who had more severe conduct problems. The claim omits that population and stress-specific qualification: the paper explicitly says conduct disorder was not associated with HPA-axis hypoactivity at baseline. (LLM, conf=0.88)
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Salivary Bioscience in Clinical Psychology and Psychiatry
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- Authors
- Northover, C., Thapar, A., Langley, K., Fairchild, G., & van Goozen, S. H. M.
- Affiliations
- Cardiff University (GB)
- University of Southampton (GB)
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2016-08
- Volume
- 242
- Pages
- 130-136
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC4986851
- OpenAlex
- W2415790851
- Cited by
- 46
- References
- 54
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 8 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 2 · 2016: 1
- FWCI
- 5.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychiatry Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Funders
- UK Medical Research Council (G1000632)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- cortisol, stress reactivity, attention deficit hyperactivity disorder, conduct disorder, comorbidities, adolescents, callous-unemotional traits, internalizing problems, fearlessness, emotion regulation, antisocial behavior, symptom severity
- MeSH terms
- Adolescent, Aggression, Attention Deficit Disorder with Hyperactivity, Child, Emotions, Humans, Hydrocortisone, Male, Saliva, Stress, Physiological, Comorbidity, Conduct Disorder
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