Stress, Cortisol Response and Predominantly Inattentive ADHD

People with Predominantly Inattentive ADHD have been shown to have an increased salivary cortisol level when placed in a stressful situation. The other types of ADHD have a normal stress response. Interestingly, people with ADHD and Oppositional Defiance Disorder have a blunted or low salivary cortisol response to stress.

The problem with a having a heightened cortisol response is that you cannot think properly and it is ultimately damaging to your brain. Cortisol is meant to be used by your brain in emergencies. Its role is to provide your brain energy in the form of glucose. I will get that glucose by any means necessary including breaking down protein. Increased cortisol levels lead to very poor cognitive outcomes and to memory loss.

Rats who had previously mastered how to navigate a maze could not remember how to get through it after being injected with cortisol. Long term exposure to increased cortisol levels leads to damage in the portion of the brain that regulates cortisol. Cortisol also changes neurotransmitter action in the prefrontal cortex (PFC). Problematic neurotransmission action in the PFC is thought to be the heart of the problem in ADHD.

There are many interventions that have shown to improve cortisol response. Regular exercise, EEG Neurobiofeedback, meditation, yoga and massage have been found helpful in improving cortisol levels and cognitive function.

Several schools are involved in studies where the effects of meditation and yoga performed bi-weekly in the classroom are being measured. Teachers are reporting that kids are more focused and relaxed after the exercises and that kids that you would never imagine doing yoga are participating willingly.

According to the Franklin Institute, a study on the results of meditation on cortisol level found that meditation twice weekly for 6 weeks decreased cortisol levels and improved cognitive function. The effects of the meditation lasted even 6 weeks after the program was finished.

In one study kids who received a 15 minute massage scored higher on cognitive performance test than did kids who were just read to for 15 minutes. Regular exercise also increases our ability to regulate our cortisol levels as dose Neurobiofeedback.

There are many ways for individuals with ADHD-PI to gain control of the increased cortisol levels that may be decreasing their cognitive function. EEG Neurobiofeedback may be unavailable or unaffordable for many but exercise, meditation, yoga, and massage are just as helpful and are readily available. These cortisol lowering practices should become a part of the lives and habits of individuals with Predominantly Inattentive ADHD.


  1. Search pubmed and cortisol and china and ADHD and it says the rervse

  2. The function of hypothalamus-pituitary-adrenal axis in children with ADHD.

    AuthorsMa L, et al. Show all Journal
    Brain Res. 2011 Jan 12;1368:159-62. Epub 2010 Nov 12.

    Department of Pediatric, Union Hospital, Fujian Medical University, Fujian Fuzhou 350001, China.

    OBJECTIVE: To explore the relationship between hypothalamus-pituitary-adrenal (HPA) axis and Attention Deficit Hyperactivity Disorder (ADHD) in non-stress states.

    METHOD: 128 male children with ADHD aged between 6 and 14 years old were recruited, while 30 healthy male children were chosen as a control group. The diagnostic material was based on DSM-IV. The included ADHD children were further classified into the three sub-groups: ADHD-predominantly inattention type (ADHD-I) (n=44), ADHD-predominantly hyperactive impulsive type (ADHD-HI) (n=32), and ADHD-combined type (ADHD-C) (n=52). The levels of cortisol and adrenocorticotropin hormone (ACTH) were evaluated by the automatic particle enzyme immunoassay and electrochemiluminescence respectively per morning (8:00 am). Intelligence test was assessed by the Raven's Standard Progressive Matrices.

    RESULTS: The children with ADHD had significantly lower intelligence quotient (IQ) (84.5±11.3) in contrast to the control group (98.6±12.4, P<0.01), although the lower level of IQ in ADHD-C group (79.2±10.7) was also found when compared with other two sub-groups [ADHD-I (85.6±10.4) and ADHD-HI (91.3±12.6)]. In addition, no significant difference between the ADHD-HI group and the control group regarding the level of IQ were revealed. The level of cortisol in the ADHD group (226.47±129.12 nmol/L) was significantly lower than that of the control group (384.53±141.43 nmol/L, P<0.001). The level of cortisol of the ADHD-HI group (154.36±71.62 nmol/L) was significantly lower than that of other two groups [ADHD-I group (219.42±117.66 nmol/L) (P<0.01) and ADHD-C group (258.30±136.39 nmol/L) (P<0.01)]. There were no significant differences in the ACTH level either between the ADHD and the control group (P>0.05), or between sub-groups in ADHD (P>0.05).

    CONCLUSION: In the non-stress states, the existence of dysfunction of the HPA axis (lower plasma cortisol) in children with ADHD might be due to the under-reactivity of the HPA axis ; the low plasma cortisol level might contribute less to the outcomes of cognitive behavior of ADHD children and instead more closely relate to the core domains of attention deficit, hyperactivity and impulsive behavior of ADHD patients.

    Copyright © 2010 Elsevier B.V. All rights reserved.
    PMID 20971091 [PubMed - indexed for MEDLINE]
    Full text: Elsevier Science
     Citation 10 of 93 
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    You are absolutely right but the mystery is the under response in the non stress conditions and the over response by some people with Inattentive ADHD under stressful conditions. I think that most researchers agree that the HPA axis is working inefficiently somehow in people with ADHD and that cortisol levels are either too high or to low and that both of these states contribute possibly to less than optimal attention. Thanks for this keen insight!!

  3. mt son is supposidly ADHD and is cortisol deficient he does not have problems focusing but can get out of hand on most days. he is very hyper active. i just want to know if it is necessary to medicate for both problems.

  4. Low cortisol levels are common in the hyperactive type of ADHD. My
    rule of thumb is that you medicate if he is a danger to himself or
    others. If he is so impulsive that he may do something to himself or
    someone else then he needs to be medicated. If not you can try some
    of the non-drug treatments. My most recent post labeled Inattentive ADHD Limbo (search the side search bar with those words to find it) outlines what those
    are .


  5. An alternative option to meditation is using binaural "healing beats" that you can download from internet sites. A number of short recordings are available for free.

    All you have to do is relax and listen to the beats with a pair of headphones, so this is any easy way to get kids interested in meditation.

    In the book ADD Practical Coping Methods, ADD expert Barbara Fisher recommends that inattentive ADDers should take calcium with stimulants to help reduce anxiety. However, I haven't come across any studies supporting this idea.

  6. Thanks Mike, If you have links that you have found really useful I would love to visit them. I will check out the book by Barbara Fisher. It sounds informative.


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