title: Adrenomedullary function during cognitive testing in attention-deficit/hyperactivity disorder.
abstract: OBJECTIVE
  Reported correlations between epinephrine (EPI) excretion and classroom performance, the cognition-enhancing effects of EPI infusion, increased EPI excretion with stimulants, and reports of decreased EPI excretion in attention-deficit/hyperactivity disorder (ADHD) suggest that sympathoadrenomedullary function might be altered in ADHD. This hypothesis was tested by examining sympathetic and adrenomedullary functioning during cognitive testing in boys with diagnosed ADHD.
  
  
  METHODS
  Urinary excretion of EPI and norepinephrine during a 3-hour cognitive test battery was assessed in 7- to 13-year-old boys. Excretion rates (nanograms per hour per square meter of body surface area) were determined in 200 individuals with ADHD (diagnosed according to DSM-IV criteria), with or without co-occurring oppositional defiant/conduct disorder or learning disorder. A non-ADHD contrast group (n = 51) with similar comorbidity was also studied.
  
  
  RESULTS
  Substantially lower (mean +/- SE) urinary EPI excretion was observed in the ADHD-inattentive subtype (n = 71) compared with the control group (200 +/- 22 versus 278 +/- 24 ng/hr/m2; F = 5.99, p = .015, critical alpha = .017). No diagnostic group differences were seen for norepinephrine excretion. Correlational analysis of both parent- and teacher-rated behaviors revealed that inattention factors consistently negatively predicted urinary EPI excretion.
  
  
  CONCLUSIONS
  The data extend findings of lower adrenomedullary activity during cognitive challenge in individuals with ADHD and suggest that the alteration is associated with inattentive behavior.
authors.affiliation: Child Study Center, Yale University School of Medicine, New Haven, CT 06510, USA. george.anderson@yale.edu
authors.forename: G M
authors.initials: GM
authors.lastname: Anderson
authors.forename: M A
authors.initials: MA
authors.lastname: Dover
authors.forename: B P
authors.initials: BP
authors.lastname: Yang
authors.forename: J M
authors.initials: JM
authors.lastname: Holahan
authors.forename: S E
authors.initials: SE
authors.lastname: Shaywitz
authors.forename: K E
authors.initials: KE
authors.lastname: Marchione
authors.forename: L M
authors.initials: LM
authors.lastname: Hall
authors.forename: J M
authors.initials: JM
authors.lastname: Fletcher
authors.forename: B A
authors.initials: BA
authors.lastname: Shaywitz
mesh_terms: D000293:Adolescent; D000313:Adrenal Medulla / Q000378:metabolism* / Q000503:physiopathology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000652:urine*; D002395:Catecholamines / Q000652:urine; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis*; D004837:Epinephrine / Q000652:urine*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009638:Norepinephrine / Q000652:urine; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales
chemical_list: D002395:Catecholamines; D009638:Norepinephrine; D004837:Epinephrine