ADHD Inattentive and Stress Response

The stress response of people with Inattentive ADHD  'ain't right'.
I will soon be back from all our various trips this summer and will start posting regularly.  I know that I have been very slack and I am sorry about this.  We are in town for a few days while my eldest son takes a Middle School, study skills course and I thought that I would post a quick report.  I wanted to let you know about a brand new study on the Inattentive ADHD HPA axis and on stress, cortisol, and how all of these factors influence people with ADHD Inattentive type.

We have all been in the situation where we are stressed out and as a result of this stress become totally inattentive and distracted. How we deal with our stress has to do with how well our HPA axis is working and as it turns out, the HPA axis of kids with Inattentive ADHD does not work so well.  It may turn out that the inattentiveness of people with ADHD-PI has as much to do with how well their HPA axis works as with anything else.

The new study, published last month in the Journal of Psychiatric Research found that both boys and girls with ADHD Inattentive symptoms had abnormal cortisol, stress and HPA responses and that this abnormal stress response was unique to the study participants that had inattentive ADHD symptoms.

These findings are especially important when you take into account the affect that the stimulant treatments can have on Inattentive symptoms and on the HPA axis. Stimulants in general can cause symptoms of anxiety or increase the 'fight and flight' response because they work on dopamine receptors that have an effect on these brain functions. Ritalin works on these receptors more strongly than the Adderall family but all stimulants can affect our stress response.

From reading this study it appears that boys have a blunted stress response whereas girls have a heightened response that then bottoms out. What I take from this study is that the cortisol response of people with ADHD Inattentive 'just ain't right'.  Treating ADHD-PI may involve medications and non-medical ADHD interventions that improve the HPA axis functioning because these improvements may result in dramatic improvements of Inattentive ADHD symptoms.

 Journal of Psychiatric Research 2011 Jul 27.
Symptoms of attention deficit hyperactivity disorder in children are associated with cortisol responses to psychosocial stress but not with daily cortisol levels.
Anu-Katriina P, Kajantie E, Alexander J, Pyhälä R, Lahti J, Heinonen K, Eriksson JG, Strandberg TE, Räikkönen K.


University of Helsinki, PO BOX 9, Institute of Behavioral Sciences, 00014 Helsinki, Finland; Children's Hospital, Helsinki University Central Hospital and University of Helsinki, PO BOX 280, 00029 Helsinki, Finland.


We tested associations of diurnal hypothalamic-pituitary adrenal axis (HPAA) activity and its response to stress with behavioral symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among 272 eight-year-old children.We measured their diurnal salivary cortisol and salivary cortisol responses to the Trier Social Stress Test for Children (TSST-C). Mothers rated their child's behavior with the ADHD-IV Rating Scale and the Child Behavior Checklist (CBCL). There were no significant associations between ADHD symptoms and diurnal cortisol concentrations. The boys with predominantly inattentive symptoms of ADHD (ADHD-I; scores at or above the 90th percentile) had 26% lower mean salivary cortisol levels during the TSST-C than the boys with scores below this cutoff. In the girls with symptoms of ADHD-I, initial salivary cortisol levels prior to the TSST-C were higher and fell more rapidly during and after the TSST-C, which was not seen in the remaining girls (P = 0.007 for interaction 'ADHD-I × sampling time'). Controlling for Oppositional Defiant Disorder/Conduct Disorder and Anxiety Disorder or excluding children with these comorbid problems did not substantially affect these findings. We conclude that the boys and the girls with behavioral symptoms of ADHD-I had reduced HPAA responsiveness to stress, which is also seen in people after traumatic events or with chronic stress. Their diurnal cortisol rhythm was not affected. Thus, ADHD-I may be associated with dysregulation of the HPAA or reduced engagement with stressful stimuli.

1 comment:

  1. I was at a loss at what to do with my son's behavioral issues but this helped almost immediately and the results have been consistent. I really appreciate these techniques so much


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