title: Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?
abstract: 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.
authors.affiliation: Clinic for Child & Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Christiansen
authors.forename: Robert D
authors.initials: RD
authors.lastname: Oades
authors.forename: Lamprini
authors.initials: L
authors.lastname: Psychogiou
authors.forename: Berthold P
authors.initials: BP
authors.lastname: Hauffa
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Sonuga-Barke
mesh_terms: 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
chemical_list: D006854:Hydrocortisone