Time-of-day effects in arousal: disrupted diurnal cortisol profiles in children with ADHD.
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.
Child and Adolescent Psychiatry Research Unit, Department of Psychiatry and Medical Psychology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium. lindita.imeraj@ugent.be
Lindita
L
Imeraj
Inge
I
Antrop
Herbert
H
Roeyers
James
J
Swanson
Ellen
E
Deschepper
Sarah
S
Bal
Dirk
D
Deboutte
D000704:Analysis of Variance; D019540:Area Under Curve; D001143:Arousal / Q000502:physiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000502:physiology; D008297:Male; D012463:Saliva / Q000737:chemistry*
D006854:Hydrocortisone