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Time‐of‐day effects in arousal: disrupted diurnal cortisol profiles in children with ADHD
Author(s) -
Imeraj Lindita,
Antrop Inge,
Roeyers Herbert,
Swanson James,
Deschepper Ellen,
Bal Sarah,
Deboutte Dirk
Publication year - 2012
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/j.1469-7610.2012.02526.x
Subject(s) - evening , morning , arousal , psychology , circadian rhythm , cortisol awakening response , attention deficit hyperactivity disorder , hydrocortisone , medicine , glucocorticoid , endocrinology , developmental psychology , clinical psychology , neuroscience , physics , astronomy
Background: Fluctuations in attention‐deficit hyperactivity disorder (ADHD) symptoms related to regulatory deficits in arousal states are themselves characterized by circadian rhythms. Although cortisol is an important circadian arousal‐related marker, studies focusing on across‐the‐day cortisol variations in ADHD are scarce. There is no study with multiple measurements to take into account interday and intraday variability. Methods: Salivary cortisol was sampled five times a day (awakening, 30 min after awakening, noon, 4 p.m., 8 p.m.) across five consecutive days in 33 children with ADHD (22 with and 11 without oppositional defiant disorder; ODD) and 33 class‐ and sex‐matched controls (aged 6–12). The cortisol awakening response (increase from awakening to 30 min after awakening) and the diurnal cortisol profile (across‐the‐day variations) were compared for ADHD with ODD (ADHD + ODD) and without ODD (ADHD) subgroups and the control group. Results: The cortisol awakening response was not significantly different between groups. However, longitudinal analyses to evaluate cortisol profiles across the day revealed a significant Group × Time effect ( p < .001). More specifically, compared to each other, the ADHD subgroup showed a flatter slope with relative morning hypo‐arousal and evening hyperarousal, whereas the ADHD + ODD subgroup showed a steeper slope with relative morning hyperarousal and evening hypo‐arousal ( p < .001). Conclusions: Findings support time‐related arousal disruptions in children with ADHD associated with the presence or absence of ODD comorbidity. We recommend research on cortisol in larger samples for a better understanding of arousal mechanisms involved in ADHD not only with and without ODD but also with other comorbidities which may have implications for timing of arousal‐based treatments.