title: Self- or parent report of (co-occurring) internalizing and externalizing problems, and basal or reactivity measures of HPA-axis functioning: a systematic evaluation of the internalizing-hyperresponsivity versus externalizing-hyporesponsivity HPA-axis hypothesis.
abstract: BACKGROUND
  Previous research findings on the link between adolescents' psychopathology and hypothalamic-pituitary-adrenal (HPA) axis activity have been heterogeneous.
  
  
  METHODS
  Adolescents (n=211) with a preadolescent DSM-IV diagnosis participated in a lab-based social stress task. Saliva cortisol was assessed at awakening and during social stress. It was investigated if continuous measures of internalizing and externalizing problems and their interaction, using both self- and parent report, were associated with basal or reactivity measures of HPA-axis functioning.
  
  
  RESULTS
  During social stress, an enhanced total release of cortisol was associated with self-reported internalizing problems and a blunted total release of cortisol with self-reported externalizing problems. Post hoc analyses revealed that the association between enhanced cortisol output and internalizing problems held for boys but not for girls. Associations with morning cortisol measures were overall weak.
  
  
  CONCLUSIONS
  Only in the context of stress, and particularly when based on self-report, blunted cortisol output was associated with externalizing and enhanced cortisol output with internalizing problems. Our broad approach demonstrates the importance of who reports on psychopathology, the use of dimensional measures of psychopathology, simultaneous analysis of internalizing and externalizing problems, and the use of awakening and social stress related measures of cortisol.
authors.affiliation: Interdisciplinary Center for Psychiatric Epidemiology, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. c.hartman@accare.nl
authors.forename: Catharina A
authors.initials: CA
authors.lastname: Hartman
authors.forename: Vera W
authors.initials: VW
authors.lastname: Hermanns
authors.forename: Peter J
authors.initials: PJ
authors.lastname: de Jong
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System; D007389:Internal-External Control; D008297:Male; D010290:Parents / Q000523:psychology*; D010913:Pituitary-Adrenal System; D012463:Saliva; D057566:Self Report; D013315:Stress, Psychological / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology*
chemical_list: D006854:Hydrocortisone
keywords: AUC; Adolescents; CAR; CBCL; CD; Child Behavior Checklist; Cortisol; EXT; Externalizing problems; GSST; Groningen Social Stress Test; INT; Internalizing problems; OCC; ODD; Psychopathology; YSR; Youth Self Report; area under the curve; conduct disorder; cortisol awakening response; externalizing problems; internalizing problems; oppositional defiant disorder; oral contraceptives