Stress Response in ADHD Predominantly Inattentive and ADHD Combined Type

Individuals with the Combined type of ADHD and people with Inattentive ADD have a very different salivary cortisol response to stress. Cortisol is a hormone that is produced by the adrenal glands. Its main job is to mobilize sugar and move the sugar, in the form of glucose, into the blood stream so that it can be quickly used as energy in times of stress. Cortisol recruits glucose by causing a breakdown of muscle and a release of amino acids that are then converted to glucose. The brain, under stress, requires a great deal of energy and cortisol’s main goal is to provide that energy.

Cortisol along with other neurotransmitters help you make a small memory imprint of dangers to avoid in the future but an over exposure to blood cortisol levels causes brain cell damage. This cell damage, in turn, leads to both memory loss and learning impairments.

Chronic stress is known to produce high cortisol levels. Hyperthyroidism and certain pituitary and adrenal abnormalities can also produce elevated cortisol levels. Pregnancy also produces elevated cortisol levels. Cortisol is one of the 'fight or flight' hormones that are necessary to get us out of life threatening situations but our cortisol levels are not meant to stay elevated.

Scientist do not know what is happening in the brain of individuals with ADHD that is causing abnormalities in the cortisol response but both the Inattentive types and the ADHD Combined type with Oppositional Defiance Disorder have been found to have abnormal cortisol responses. In ADHD-PI the cortisol level is high and in ADHD-C/ODD the cortisol levels can be unusually low.

Some scientists have proposed using cortisol levels as a diagnostic tool to identify people with ADHD and conduct disorders or to identify people with ADHD-PI. The science, at this point, is not definitive enough for ADHD with conduct disorder to propose the use of cortisol as a diagnostic tool but there is a growing body of evidence linking high cortisol levels to ADHD-PI.

It is possible that treatment strategies that would normalize cortisol levels in people with Inattentive ADHD might reduce executive function problems such as attention deficits, memory impairments, and other cognitive problems.

Cortisol levels can be normalized and in my next post I will speak about some of the treatment strategies that have proved successful in improving blood cortisol levels.


  1. I am so glad I found this! I have ADHD...or some form of it or all... I hate the thought but I have passed it on to one of my boys...I just registered him for kindergarten and am dreading it...because of the nightmare school was for me... I am hoping I can find a natural something or other to help him so he doesn't have to suffer the way I did and still do!! Thank you for your site!

  2. My 7 year old son, ADHD-combined and highly inattentive, is responding partly to psychostimulants and clonidine (works on hyperactivity and impulsivity but little on attention). EEC and Thyroïd are fine but we found he has low cortisol. Would this explain his attention problem and med non-responsivness ?


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