Salivary Cortisol Levels in Abused Children with Attention Deficit Hyperactivity Disorder

Abstract

The role of psychosocial factors in perpetuating and predisposing towards the development of attention deficit hyperactivity disorder (ADHD) symptoms has been neglected within the field of child mental health. Clinicians, when told that a child had a diagnosis of ADHD, have been found to underestimate the presence of psychosocial factors, and are less likely to ask about the possibility of neglect or abuse. Recent neuro-biological findings showed the impact of early abuse on brain development and HPA. The implications of these findings underlie the need for a more integrated bio-psycho-social approach to ADHD. This work was undertaken to compare salivary cortisol levels and executive functions using Wisconsin card sorting test (WCST) between ADHD and controls and to elucidate the impact of exposure to abuse on salivary cortisol levels and executive functions in ADHD children. To achieve this goal, a total number of fifty Egyptian children diagnosed to have ADHD and thirty healthy age, sex, IQ, socioeconomic and educational matched were included in the study as controls. All participants were subjected to full clinical examination, clinical psychiatric interview, cognitive and psychosocial assessment including intellectual assessment by WISC-R, assessing ADHD symptoms by CPRS-R-L, exposure to abuse by Child abuse and neglect scale and evaluating the executive performance by WSCT. Salivette test tubes were given to participants for collecting saliva to measure cortisol at morning and bedtime. Patients received written instructions on sampling time and procedure. Summary 103 ADHD cases were then grouped into 2 groups according the severity of abuse scale scores into 28 abused ADHD patients and 22 non-abused ADHD patients. Occurrence of abuse was operationally defined in the studied sample as children scoring more than 66 on the child abuse and neglect scale for children. From 0 to 66 was deemed no abuse due to minimal occurrence of the abuse. On analyzing the results statistically, ADHD cases were found to be more exposed to different types of abuse from both parents than controls with high statistical difference (p<0.001). Fathers were more abusing than mothers in abused ADHD group regarding different types of abuse.