The Stress Response in Adolescents with Inattentive Type ADHD Symptoms



To investigate the hypothalamic pituitary adrenal (HPA) axis response to a stressor in adolescents with inattentive type attention-deficit hyperactivity disorder symptoms (ADHD-I).


Salivary cortisol was measured in threshold inattentive (TI, n = 7), moderately inattentive (MI, n = 13) and no symptom (comparison) (n = 19) groups of healthy, young adolescents, based on symptom counts, prior to and after an induced social/cognitive stressor.


The TI group displayed a significant decrease in cortisol post stressor whereas both the MI and comparison groups showed an increase in cortisol.


The diagnostic threshold of inattentive type ADHD shows HPA axis dysregulation whereas the more mild form does not show dysfunction.

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  1. 1.

    American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders 4th edn, text revision. American Psychiatric Press, Washington DC

  2. 2.

    Henry JP (1992) Biological basis of the stress response. Integrative Physiol Behav Science 27:66–83

    Article  Google Scholar 

  3. 3.

    Linden W, Earle TL, Gerin W, Christenfeld N (1997) Physiological stress reactivity and recovery: conceptual siblings separated at birth? J Psychosom Res 42:117–135

    PubMed  Article  Google Scholar 

  4. 4.

    Peters ML, Godaert GLR, Ballieux RE, van Vliet M, Willemsen JJ, Sweep FC, Heijnen CJ (1998) Cardiovascular and endocrine responses to experimental stress: effects of mental effort and controllability. Psychoneuroendocrinology 23:1–17

    PubMed  Article  Google Scholar 

  5. 5.

    Sonia L (2003), “Stress-function-morphology correlations in the brain”. Available at Access Science@ McGraw-Hill,, DOI 10.1036/1097–8542.YB031345. Accessed August 20, 2004

  6. 6.

    Chrousos GP, Gold PW (1992) The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267:1244–1252

    PubMed  Article  Google Scholar 

  7. 7.

    Barkley RA (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of attention deficit hyperactivity disorder. Psychol Bull 121:54–94

    Article  Google Scholar 

  8. 8.

    Gray JA (1982) The neuropsychology of anxiety. Oxford University Press, New York

    Google Scholar 

  9. 9.

    Quay HC (1997) Inhibition and attention deficit hyperactivity disorder. J Abnorm Psychol 25:7–13

    Google Scholar 

  10. 10.

    Schachar RJ, Tannock R, Logan G (1993), Inhibitory control, impulsiveness and attention deficit hyperactivity disorder. Clin Psychol Rev 13:721–739

    Article  Google Scholar 

  11. 11.

    Milich R, Hartung CM, Martin CA, Haigler ED (1994) Behavioral disinhibition and underlying processes in adolescents with disruptive behavior disorders. In: D. K. Routh Disruptive behavior disorders in childhood. Plenum press, New york, pp 109–138

  12. 12.

    King JA, Barkley RA, Barrett S (1998) Attention-deficit hyperactivity disorder and the stress response. Biol Psychiatry 44:72–74

    PubMed  Article  Google Scholar 

  13. 13.

    Kaneko M, Hoshino Y, Hashimoto S, Okano T, Kumashiro H (1993) Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder. J Autism Dev Disord 23:59–65

    PubMed  Article  Google Scholar 

  14. 14.

    Scerbo AS, Kolko DJ (1994) Salivary testosterone and cortisol in disruptive children: relationship to aggressive, hyperactive, and internalizing behaviors. J Am Acad Child Adolesc Psychiatry 33:1174–1184

    PubMed  Article  Google Scholar 

  15. 15.

    Snoek H, Van Goozen SH, Matthys W, Buitelaar JK, van Engeland H (2004) Stress responsivity in children with externalizing behavior disorders. Dev Psychopathol 16:389–406

    PubMed  Google Scholar 

  16. 16.

    Hong HJ, Shin DW, Lee EH, Oh YH, Noh KS (2003) Hypothalamic-pituitary-adrenal reactivity in boys with attention deficit hyperactivity disorder. Yonsei Med J 44:608–614

    PubMed  Google Scholar 

  17. 17.

    Barkley RA (1990) Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment. The Guildford Press, New York

    Google Scholar 

  18. 18.

    Doyle S, Wallen M, Whitmont S (1995) Motor skills in Australian children with attention deficit hyperactivity disorder. Occup Ther Int 2:229–240

    Google Scholar 

  19. 19.

    Hartsough CS, Lambert MN (1985) Medical factors in hyperactive and normal children: prenatal, development, and health history findings. Am J Orthopsychiatry 55:190–210

    PubMed  Article  Google Scholar 

  20. 20.

    Parry T (1996) Multiple stimuli disorganization syndrome: Treatment and management of children with attentional disorders. Aust Educ Develop Psychol 13:56–58

    Google Scholar 

  21. 21.

    Piek JP, Pitcher TM, Hay DA (1999) Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder. Dev Med Child Neuro 41:159–165

    Article  Google Scholar 

  22. 22.

    Dorn LD, Lucke JF, Loucks TL, Berga SL (2007) Salivary cortisol reflects serum cortisol: analysis of circadian profiles. Ann Clin Biochem 44:281–284

    PubMed  Article  Google Scholar 

  23. 23.

    Kirschbaum C, Hellhammer DH (1989) Salivary cortisol in psychobiological research: and overview. Neuropsychobiology 22:150–169

    PubMed  Article  Google Scholar 

  24. 24.

    Gallagher P, Leitch MM, Massey AE, McAllister Williams RH, Young AH (2006), Assessing cortisol and dehydroepiandrosterone (DHEA) in saliva: effects on collection method. J Psychopharmacol, ISSN 0269-8811

  25. 25.

    Kertes DA, Gunnar MR (2004) Evening activities as a potential confound in research on the adrenocortical system in children. Child Dev 75:193–204

    PubMed  Article  Google Scholar 

  26. 26.

    Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39:28–38

    PubMed  Article  Google Scholar 

  27. 27.

    Angold A, Fisher PW (1999) Interviewer-based interviews. In: Shaffer D, Lucas CP, Richters JE (eds) Diagnostic assessment in child and adolescent psychopathology. Guilford Press, New York, NY, pp 34–64

    Google Scholar 

  28. 28.

    Prudence Fisher, personal communication, September, 2002

  29. 29.

    Reiter EO, Lee PA (2001) Have the onset and temp of puberty changed? Arch Pediatr AdolescMed 155:988–989

    Google Scholar 

  30. 30.

    Tung YC, Lee JS, Tsai WY, Hsiao PH (2004) Physiological changes of adrenal androgens in childhood. J Formos Med Assoc 103:921–924

    PubMed  Google Scholar 

  31. 31.

    Hollingshead A (1975) Four factors index of social status. Manual. Yale University, New Haven CT

  32. 32.

    Kariyawasam SH, Zaw F, Handley SL (2002) Reduced salivary cortisol in children with comorbid Attention deficit hyperactivity disorder and oppositional defiant disorder. Neuro Endocrinol Lett 23:45–48

    PubMed  Google Scholar 

  33. 33.

    Van Goozen SHM, Matthys W, Cohen-Kettenis PT, Gispen-de Wied C, Weigant VM, Van Engeland H (1998) Salivary cortisol and cardiovascular activity during stress in oppositional defiant disorder boys and normal controls. Biol Psychiatry 43:531–539

    PubMed  Article  Google Scholar 

  34. 34.

    Van Goozen SHM, Matthys W, Cohen-Kettenis PT, Buitelaar JK, Van Engeland H (2000) Hypothalamic-pituitary-adrenal axis and autonomic nervous system activity in disruptive children and matched controls. J Am Acad Child Adolesc Psychiatry 39:1438–1445

    PubMed  Article  Google Scholar 

  35. 35.

    McBurnett K, Lahey BB, Rathouz PJ, Loeber R (2000) Low salivary cortisol and persistent aggression in boys referred for disruptive behavior. Arch Gen Psychiatry 57:38–43

    PubMed  Article  Google Scholar 

  36. 36.

    Oosterlaan J, Geurts HM, Knol DL, Sergeant JA (2005) Low basal salivary cortisol is associated with teacher-reported symptoms of conduct disorder. Psychiatry Res 134:1–10

    PubMed  Article  Google Scholar 

  37. 37.

    Pajer K, Gardner W, Rubin RT, Perel J, Neal S (2001) Decreased cortisol levels in adolescent girls with conduct disorder. Arch Gen Psychiatry 58:297–302

    PubMed  Article  Google Scholar 

  38. 38.

    Shoal GD, Giancola PR, Kirillova GP (2003) Salivary cortisol, personality, and aggressive behavior in adolescent boys: a 5-year longitudinal study. J Am Acad Child Adolesc Psychiatry 42:1101–1107

    PubMed  Article  Google Scholar 

  39. 39.

    Gerra G, Zaimovic A, Avanzini P, Chittolini B, Giucastro G, Caccavari R, Palladino M, Maestri D, Monica C, Delsignore R, Brambilla F (1997) Neurotransmitter-neuroendocrine responses to experimentally induced aggression in humans: influence of personality variable. Psychiatry Res 66:33–43

    PubMed  Article  Google Scholar 

  40. 40.

    Tennes K, Kreye M (1985) Children’s adrenocortical responses to classroom activities and tests in elementary school. Psychosom Med 47:451–460

    PubMed  Google Scholar 

  41. 41.

    van Bokhoven I, Van Goozen SHM, van Engeland H, Schaal B, Arseneault L, Séguin JR, Nagin DS, Vitaro F, Tremblay RE (2005), Salivary cortisol and aggression in a population-based longitudinal study of adolescent males J Neural Transm 112:1083–1096

    PubMed  Article  Google Scholar 

  42. 42.

    Marshall WA, Tanner JM (1969) Variations in the pattern of pubertal changes in girls. Arch Dis Child 44:291–303

    PubMed  Google Scholar 

  43. 43.

    Marshall WA, Tanner JM (1970) Variations in the pattern of pubertal changes in boys. Arch Dis Child 45:13–23

    PubMed  Article  Google Scholar 

  44. 44.

    Greenhouse SW, Geisser S (1959) On methods in the analysis of profile data. Psychometrika 32:95–112

    Article  Google Scholar 

  45. 45.

    Thompson KN, Phillips LJ, Komesaroff P, Yuen HP, Wood SJ, Pantelis C, Velakoulis D, Yung AR, McGorry PD (2006), Stress and HPA-axis functioning in young people at ultra high risk for psychosis. J Psychiatr Res (Epub ahead of print)

  46. 46.

    Klein LC, Corwin EJ (2002) Seeing the unexpected: how sex differences in stress responses may provide a new perspective on the manifestation of psychiatric disorders. Curr Psychiatry Rep 4:441–448

    PubMed  Article  Google Scholar 

  47. 47.

    Weizman R, Dick J, Gil-Ad I, Weitz R, Tyano S, Laron Z (1987) Effects of acute and chronic methylphenidate administration on beta-endorphin, growth hormone, prolactin and cortisol in children with attention deficit disorder and hyperactivity. Life Sci 40:2247–2252

    PubMed  Article  Google Scholar 

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Thank you is extended to Jodi Heaton who coordinated multiple aspects of the study and to the adolescents and their parents who spent many hours helping to complete the research.

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Corresponding author

Correspondence to William T. Randazzo.

Additional information

Support for the research was provided by the National Institute of Mental Health, RO1 58393-03, the National Institutes of Health, General Clinical Research Center (M01 RR 10732), and the Shibley Endowment, The Pennsylvania State University.

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Randazzo, W.T., Dockray, S. & Susman, E.J. The Stress Response in Adolescents with Inattentive Type ADHD Symptoms. Child Psychiatry Hum Dev 39, 27–38 (2008).

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  • Attention-deficit hyperactivity
  • Inattention
  • HPA
  • Stress
  • Cortisol