Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?
BACKGROUND
Expressed Emotions (EE) are associated with oppositional behavior (OPB) in children with Attention Deficit/Hyperactivity Disorder (ADHD). EE has been linked to altered stress responses in some disorders, but ADHD has not been studied. We test the hypothesis that OPB in ADHD is mediated by altered stress-related cortisol reactivity to EE.


METHODS
Two groups of children (with/without ADHD) and their respective parents were randomly assigned to two different conditions with/without negative emotion and participated in an emotion provocation task. Parents' EE, their ratings of their children's OPB and their children's salivary cortisol levels were measured.


RESULTS
Low parental warmth was associated with OPB in ADHD. High levels of parental EE elicited a larger cortisol response. Stress-related cortisol reactivity mediated the EE-OPB link for all children. This highlights the general importance of parent-child interactions on externalizing behavior problems.


CONCLUSIONS
High EE is a salient stressor for ADHD children that leads to increased levels of cortisol and OPB. The development of OPB might be mediated by the stress-response to high EE.
Christiansen
Hanna
H
Clinic for Child & Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany.
Oades
Robert D
RD
Psychogiou
Lamprini
L
Hauffa
Berthold P
BP
Sonuga-Barke
Edmund J
EJ
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000378:metabolism* / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D004644:Emotions / Q000502:physiology; D019260:Expressed Emotion / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D008960:Models, Psychological; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D011581:Psychological Tests; D012463:Saliva / Q000378:metabolism; D012919:Social Behavior; D013315:Stress, Psychological / Q000378:metabolism*; D013997:Time Factors
D006854:Hydrocortisone