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Erbas Unverdi G, Ozgur B, Gungor HC, Casamassimo PS. Comparison of dmft and behavior rating scores between children with systemic disease and healthy children at the first dental visit. BMC Oral Health 2024; 24:548. [PMID: 38730438 PMCID: PMC11088136 DOI: 10.1186/s12903-024-04285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To evaluate and compare oral health and behavior scores at the first dental visit and dental treatment need using general anesthesia/sedation (GA/S) of children with systemic diseases (SD) and healthy children. METHODS Data were obtained from healthy children (n = 87) and children with SD (n = 79), aged 4 to 6 years, presenting to a hospital dental clinic for a first dental examination. The total number of decayed, missing and filled teeth (dmft), dental behavior score using Frankl Scale, and dental treatment need using GA/S were recorded. Chi-square / Fisher's exact test and Mann-Whitney U tests were used for statistical analyses. RESULTS The patients with SD were diagnosed with cardiac disease (61%), renal disease (9%), and pediatric cancers (30%). The median dmft values of the SD group (3.00) were significantly lower than those of healthy children (5.00) (p = 0.02) and healthy children exhibited significantly more positive behavior (90.8%) than children with SD (73.4%) (p = 0.002). The number of patients needing GA/S for dental treatment did not differ significantly between the two groups (p = 0.185). There was no relationship between dental treatment need with GA/S and dental behavior scores of the patients (p = 0.05). A statistically significant relationship was found between the patients' dmft scores and the need for dental treatment using GA/S; and the cut-off value was found to be dmft > 4 for the overall comparisons. CONCLUSION The presence of chronic disease in children appeared to affect the cooperation negatively at the first dental visit compared to healthy controls, however, it did not affect the oral health negatively. Having a negative behavior score or SD did not necessitate the use of GA/S for dental treatment.
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Affiliation(s)
- Gizem Erbas Unverdi
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - Beste Ozgur
- Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Hamdi Cem Gungor
- Division of Pediatric Dentistry, Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Paul S Casamassimo
- Division of Pediatric Dentistry, Ohio State University (Research Center), Columbus, OH, USA
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Garre-Morata L, de Haro T, Villén RG, Fernández-López ML, Escames G, Molina-Carballo A, Acuña-Castroviejo D. Changes in Cortisol and in Oxidative/Nitrosative Stress Indicators after ADHD Treatment. Antioxidants (Basel) 2024; 13:92. [PMID: 38247516 PMCID: PMC10812591 DOI: 10.3390/antiox13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Although ADHD is one of the most prevalent diseases during childhood, we still do not know its precise origin; oxidative/nitrosative stress and the hypothalamic-pituitary-adrenal axis are suggested contributors. Methylphenidate, among others, is the main drug used in ADHD patients, but its effects on relevant markers and structures remain unclear. This study, involving 59 patients diagnosed with ADHD according to DSM-5 criteria, aimed to assess changes in cortisol levels (using cortisol awakening response, CAR) and oxidative/nitrosative status with the treatment. Blood samples before and 3 months after treatment with methylphenidate were used to measure oxidative and inflammatory markers, as well as the endogenous antioxidant activity, while saliva samples tracked cortisol awakening response (CAR). The results showed a treatment-related improvement in the redox profile, with the reduction in advanced oxidation protein products (AOPP), lipid peroxidation (LPO), and nitrite plus nitrate (NOx) levels, and the increase in the enzymatic activities of glutathione reductase (GRd) and catalase (CAT). Moreover, the area under the curve (AUC) of CAR increased significantly, indicating increased reactivity of the HPA axis. These results support, for the first time, the involvement of the endogenous antioxidant system in the pathophysiology of ADHD.
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Affiliation(s)
- Laura Garre-Morata
- UGC of Laboratorios Clínicos, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; (L.G.-M.); (T.d.H.)
| | - Tomás de Haro
- UGC of Laboratorios Clínicos, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; (L.G.-M.); (T.d.H.)
- Ibs.Granada, 18016 Granada, Spain; (M.L.F.-L.); (G.E.)
| | | | - María Luisa Fernández-López
- Ibs.Granada, 18016 Granada, Spain; (M.L.F.-L.); (G.E.)
- UGC of Pediatrics, San Cecilio University Hospital, 18016 Granada, Spain;
| | - Germaine Escames
- Ibs.Granada, 18016 Granada, Spain; (M.L.F.-L.); (G.E.)
- Ibs.CIBERfes, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, 18016 Granada, Spain
- Centro de Investigación Biomédica, Departamento de Fisiología, Facultad de Medicina, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, 18016 Granada, Spain
| | - Antonio Molina-Carballo
- Ibs.Granada, 18016 Granada, Spain; (M.L.F.-L.); (G.E.)
- UGC of Pediatrics, San Cecilio University Hospital, 18016 Granada, Spain;
- Department of Pediatrics, Medicine Faculty, University of Granada, 18071 Granada, Spain
| | - Darío Acuña-Castroviejo
- UGC of Laboratorios Clínicos, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; (L.G.-M.); (T.d.H.)
- Ibs.Granada, 18016 Granada, Spain; (M.L.F.-L.); (G.E.)
- Ibs.CIBERfes, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, 18016 Granada, Spain
- Centro de Investigación Biomédica, Departamento de Fisiología, Facultad de Medicina, Parque Tecnológico de Ciencias de la Salud, Universidad de Granada, 18016 Granada, Spain
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The Effect of Dental Treatments in Caries Management on Stress and Salivary Protein Levels. J Clin Med 2022; 11:jcm11154350. [PMID: 35893440 PMCID: PMC9332813 DOI: 10.3390/jcm11154350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
A great burden is put on healthcare systems by dental caries and understanding patients’ treatment needs is of utmost importance. The aim of this pre−post study was to assess dental anxiety and the psychological stress induced by two different types of dental treatment (prophylaxis and cavity preparation), by combining psychometric evaluations with salivary biomarkers, in a group of 28 schoolchildren presenting in a university clinic. Pre- and post-treatment unstimulated whole saliva was collected and levels of cortisol, alpha-amylase (sAA) and total protein content were measured. The State−Trait Anxiety Inventory for Children and the Frankl Behaviour Rating Scale (FBRS) were applied. Statistical analysis was performed using the Stata/IC 16 (StataCorp) programme. All salivary parameters showed strong positive correlations between pre- and post-treatment levels. Post-treatment, salivary cortisol decreased (p = 0.008, paired t-test), sAA did not change significantly (p = 0.572, sign test), while the sAA/cortisol ratio (AOC) increased (p = 0.036, sign test). There were no correlations between state and trait anxiety levels. State anxiety scores registered significantly higher values for children with an FBRS score of 3 compared with a score of 4 (p < 0.001, unpaired t-test). The post-treatment decrease in the salivary cortisol level was higher for prophylaxis compared with the cavity preparation group (p = 0.024, t-test). These results demonstrate that sAA and cortisol levels are altered differently by psychological stress induced by two different types of dental treatment.
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Management for Caries Prevention in ADHD Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127455. [PMID: 35742701 PMCID: PMC9223500 DOI: 10.3390/ijerph19127455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
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Gomes HDS, Anabuki AA, Viana KA, Abreu LG, Batista AC, Hosey MT, Costa LR. Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE. Braz Oral Res 2022; 36:e067. [PMID: 36507754 DOI: 10.1590/1807-3107bor-2022.vol36.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
Abstract
There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.
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Affiliation(s)
- Heloisa de Sousa Gomes
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Anna Alice Anabuki
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Karoline Alves Viana
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte, MG, Brasil
| | - Aline Carvalho Batista
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Marie Therese Hosey
- King's College London, Centre for Oral Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial, London, United Kingdom
| | - Luciane Rezende Costa
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
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Carpena MX, Sánchez-Luquez KY, Martins-Silva T, Santos TM, Farias CP, Leventhal DGP, Berruti B, Zeni CP, Schmitz M, Chazan R, Hutz MH, Salatino-Oliveira A, Genro JP, Rohde LA, Tovo-Rodrigues L. Stress-related genetic components in attention-deficit/hyperactivity disorder (ADHD): Effects of the SERPINA6 and SERPINA1 genetic markers in a family-based brazilian sample. J Psychiatr Res 2022; 149:1-9. [PMID: 35217314 DOI: 10.1016/j.jpsychires.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022]
Abstract
SERPINA6 and SERPINA1 were recently identified as the main genes associated with plasma cortisol concentration in humans. Although dysregulation in the Hypothalamus-Pituitary-Adrenal (HPA) axis has been observed in Attention Deficit/Hyperactivity Disorder (ADHD), the molecular mechanisms underlying this relationship are still unclear. Evaluation of the SERPINA6/SERPINA1 gene cluster in ADHD may provide relevant information to uncover them. We tested the association between the SERPINA6/SERPINA1 locus, including 95 single nucleotide polymorphisms (SNPs), and ADHD, using data from a Brazilian clinical sample of 259 ADHD probands and their parents. The single SNP association was tested using binary logistic regression, and we performed Classification and Regression Tree (CART) analysis to evaluate genotype combinations' effects on ADHD susceptibility. We assessed SNPs' regulatory effects through the Genotype-Tissue Expression (GTEx) v8 tool, and performed a complementary look-up analysis in the largest ADHD GWAS to date. There was a suggestive association between ADHD and eight variants located in the SERPINA6 region and one in the intergenic region between SERPINA6 and SERPINA1 after correction for multiple tests (p < 0.032). CART analysis showed that the combined effects of genotype GG in rs2144833 and CC in rs10129500 were associated with ADHD (OR = 1.78; CI95% = 1.24-2.55). The GTEx assigned the SNPs as eQTLs for genes in different tissues, including SERPINA6, and the look-up analysis revealed two SNPs associated with ADHD. These results suggest a shared genetic component between cortisol levels and ADHD. HPA dysregulation/altered stress response in ADHD might be mediated by upregulation of corticosteroid binding globulin (CBG, encoded by SERPINA6) expression.
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Affiliation(s)
- Marina Xavier Carpena
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil; Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Consolação Street, 896 - Building 28, 1st Floor - Consolação, São Paulo, SP, 01302-907, Brazil
| | - Karen Yumaira Sánchez-Luquez
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil
| | - Thais Martins-Silva
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil; Human Development and Violence Research Centre (DOVE), Mal. Deodoro Street, 1160 - 3rd Floor, Pelotas, 96020-220, Brazil
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil
| | - Cid Pinheiro Farias
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil
| | - Daniel Gray Paschoal Leventhal
- International Center for Equity in Health, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil
| | - Barbara Berruti
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil
| | - Cristian Patrick Zeni
- McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Road, Suite 2100, Houston, TX, 77054, USA
| | - Marcelo Schmitz
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Ramiro Barcelos Street, 400N - Room 2201(a), 2nd Floor - Santana, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
| | - Rodrigo Chazan
- Federal University of Rio Grande Do Sul, Post-graduate Program in Psychiatry and Behavioral Sciences, Ramiro Barcelos Street, 2400 - 2nd Floor - Floresta, Porto Alegre, Rio Grande do Sul, 90035-007, Brazil
| | - Mara H Hutz
- Post-graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande Do Sul, Vale Campus, 9500 Bento Gonçalves Ave. - Building 43312M, Porto Alegre, RS, Brazil
| | - Angélica Salatino-Oliveira
- Post-graduate Program in Genetics and Molecular Biology, Federal University of Rio Grande Do Sul, Vale Campus, 9500 Bento Gonçalves Ave. - Building 43312M, Porto Alegre, RS, Brazil
| | - Julia P Genro
- Post-graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Sarmento Leite Street, 245 - Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande Do Sul, Ramiro Barcelos Street, 400N - Room 2201(a), 2nd Floor - Santana, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, 785 Dr. Ovídio Pires de Campos Street, 1(st)floor, Room 6, South Wing - Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Luciana Tovo-Rodrigues
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Mal. Deodoro Street 1160, 3rd Floor, Pelotas, RS, Brazil.
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Llorens M, Barba M, Torralbas J, Nadal R, Armario A, Gagliano H, Betriu M, Urraca L, Pujol S, Montalvo I, Gracia R, Giménez-Palop O, Palao D, Pàmias M, Labad J. Stress-related biomarkers and cognitive functioning in adolescents with ADHD: Effect of childhood maltreatment. J Psychiatr Res 2022; 149:217-225. [PMID: 35287052 DOI: 10.1016/j.jpsychires.2022.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/15/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Our study aimed to explore whether stress-related hormones (hypothalamic-pituitary-adrenal [HPA] axis hormones and prolactin) are associated with poorer cognitive functioning in adolescents with attention deficit and hyperactivity disorder (ADHD) and to test the potential moderating effect of childhood maltreatment. Seventy-six adolescents with ADHD were studied. The ADHD rating scale (ADHD-RS) and Childhood Trauma Questionnaire (CTQ) were administered. Seven cognitive tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered, and two cognitive factors (attention and memory as well as executive functioning) were identified by confirmatory factor analysis. Stress-related hormone levels were assessed at the clinic (plasma prolactin and cortisol levels and salivary cortisol levels) before cognitive testing and at home for two consecutive days (cortisol awakening response [CAR] and diurnal cortisol slope). Multiple linear regression analyses were used to explore the association between hormone levels and ADHD severity or cognitive functioning while adjusting for sex and childhood maltreatment. Regarding hormonal measurements obtained at the clinic, female sex moderated the relationship between salivary cortisol levels and executive functioning, whereas childhood maltreatment moderated the relationship between salivary cortisol levels and inattention symptoms of patients with ADHD. Prolactin levels were not associated with cognitive functioning or the severity of ADHD. Regarding HPA axis measurements performed at home, lower cortisol levels at awakening were associated with poorer executive functioning. Neither CAR nor the cortisol diurnal slope were associated with cognitive functioning or ADHD severity. Our study suggests that HPA axis hormone levels are associated with the severity of cognitive and inattention symptoms of patients with ADHD and that childhood maltreatment and sex exert distinct moderating effects depending on the symptom type.
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Affiliation(s)
- Marta Llorens
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain
| | - Maria Barba
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Jordi Torralbas
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Roser Nadal
- Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Psicobiology Unit, Faculty of Psychology, Universitat Autònoma de Barcelona Spain, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain
| | - Antonio Armario
- Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Psicobiology Unit, Faculty of Psychology, Universitat Autònoma de Barcelona Spain, Spain; Animal Physiology Unit (Department of Cellular Biology, Physiology and Immunology), Faculty of Biosciences, Universitat Autònoma de Barcelona, Spain
| | - Humberto Gagliano
- Animal Physiology Unit (Department of Cellular Biology, Physiology and Immunology), Faculty of Biosciences, Universitat Autònoma de Barcelona, Spain
| | - Maria Betriu
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Lara Urraca
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Susana Pujol
- Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Itziar Montalvo
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Rebeca Gracia
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Olga Giménez-Palop
- Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain; Department of Endocrinology, Parc Taulí Hospital Universitari, I3PT, Sabadell, Spain
| | - Diego Palao
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Montserrat Pàmias
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Sabadell, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Javier Labad
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona. Cerdanyola Del Vallès, Spain; Institut de Neurociències, Translational Neuroscience Research Unit I3PT-INc-UAB, Spain; Centro de Investigación Biomédica en Red (CIBERSAM), Spain; Institut D'Investigació I Innovació Parc Taulí (I3PT), Sabadell, Spain; Department of Mental Health, Consorci Sanitari Del Maresme, Mataró, Spain.
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Ji D, Flouri E, Papachristou E, Francesconi M. Childhood Trajectories of Hyperactivity/Inattention Symptoms and Diurnal Cortisol in Middle Adolescence: Results from a UK Birth Cohort. J Atten Disord 2022; 26:809-821. [PMID: 34378439 PMCID: PMC8859655 DOI: 10.1177/10870547211036755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Children with attention-deficit/hyperactivity disorder (ADHD) show hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Whether the association between hyperactivity/inattention symptoms with HPA axis dysfunction holds in the general child population too is not clear. METHOD We assessed associations between longitudinal trajectories of hyperactivity/inattention symptoms during ages 4 to 13 years and basal cortisol profiles at age 15 in a British general population cohort. RESULTS Adolescents with persistently high levels of hyperactivity/inattention symptoms since childhood showed lower total morning cortisol and a smaller diurnal decline, even after adjusting for confounders. No associations were found between any of the symptom trajectories and cortisol awakening response, diurnal slope or daily output of cortisol. CONCLUSION This study provides evidence for hypocortisolism among adolescents with chronic hyperactivity/inattention symptoms in the general population.
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Affiliation(s)
- Dongying Ji
- UCL Institute of Education, London, UK,Dongying Ji, Department of Psychology and Human Development, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK.
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Babu NSV, Roy A. Comparative Analysis of the Status of Dental Caries and Selected Salivary Electrolytes in Children with Autism. Int J Clin Pediatr Dent 2022; 15:S242-S246. [PMID: 35645511 PMCID: PMC9108855 DOI: 10.5005/jp-journals-10005-2153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Materials and methods Results Conclusion Clinical significance How to cite this article
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Affiliation(s)
- NS Venkatesh Babu
- Department of Pediatrics and Preventive Dentistry, VS Dental College and Hospital, Bengaluru, Karnataka, India
- NS Venkatesh Babu, Department of Pediatrics and Preventive Dentistry, VS Dental College and Hospital, Bengaluru, Karnataka, India, Phone: +91 9448710392, e-mail:
| | - Abhipsa Roy
- Department of Pediatrics and Preventive Dentistry, VS Dental College and Hospital, Bengaluru, Karnataka, India
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Payen A, Chen MJ, Carter TG, Kilmer RP, Bennett JM. Childhood ADHD, Going Beyond the Brain: A Meta-Analysis on Peripheral Physiological Markers of the Heart and the Gut. Front Endocrinol (Lausanne) 2022; 13:738065. [PMID: 35299964 PMCID: PMC8921263 DOI: 10.3389/fendo.2022.738065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in children. Questions regarding its increased diagnostic rates and pharmacological treatments in developing children have led to a more holistic review of the multi-system pathophysiology observed in ADHD. The dopaminergic neurotransmitter system, known for its influence on reward-motivated behaviors and motor control, and the frontostriatal systems, that mediate motor, cognition, and behavior, are associated with ADHD's development. However, studies have shown that these neural systems do not wholly account for ADHD's multilayered and heterogeneous symptom presentation. For instance, the literature suggests that emotional dysregulation, the inability to regulate one's emotional responses to provoking stimuli, is associated with increased risk for social impairment in ADHD. A broader examination of physiological systems in children with ADHD has found potential markers in the heart-brain and gut-brain axes that correspond with certain behaviors associated with emotional dysregulation in recent studies. Hence, the purpose of this meta-analysis is to aggregate ten applicable published case studies and analyze task-related heart rate reactivity (HRR; n = 5 studies) and gut microbiota (n = 5 studies) data in children with and without ADHD. Data from a total of 531 youth with ADHD and 603 youth without ADHD revealed significant small and medium effect sizes for higher Chao1 levels and Actinobacteria levels in the ADHD group, respectively, but no evidence of altered task-related HRR. Thus, further research into multi-system psychophysiological measures of emotional dysregulation and ADHD is warranted. The clinical, empirical, and educational implications of these findings are discussed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021236819).
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Affiliation(s)
- Ameanté Payen
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Michelle J. Chen
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - T. Grace Carter
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Ryan P. Kilmer
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Jeanette M. Bennett
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
- *Correspondence: Jeanette M. Bennett,
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Tomasin MDFM, de Sant'Anna GR, Hoshi AT, Duarte DA. Dental procedures cause stress in children with cerebral palsy? J Clin Exp Dent 2021; 13:e1112-e1117. [PMID: 34824697 PMCID: PMC8601703 DOI: 10.4317/jced.58392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/11/2021] [Indexed: 11/05/2022] Open
Abstract
Background To evaluate the level of stress during dental care in children and preadolescents with cerebral palsy through biological and psychological parameters. Material and Methods A total of 38 children aged 7 to 12 years were divided into two groups: one with 18 children with cerebral palsy and the other with 20 healthy children (control group). Saliva was noninvasively collected before and after dental care to analyze salivary biomarkers. The Frankl Behavior Scale and the Facial Image Scale were applied. Results After the dental procedure, cortisol levels were significantly higher (p = 0.02) in the cerebral palsy group than in the control group. Salivary alpha-amylase was not significantly different between groups. Regarding psychological parameters, anxiety was significantly higher (p = 0.00012) in the cerebral palsy group than in the control group. Conclusions There was a change in physiological parameters (salivary cortisol and salivary alpha-amylase) and in psychological parameters (Frankl Behavioral Scale and Facial Image Scale) in patients with cerebral palsy, who exhibited higher stress and anxiety levels than did children without cerebral palsy. Key words:Ortisol, physiological stress, dental care, cerebral palsy, dental treatment anxiety.
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Affiliation(s)
| | | | - Adriano-Tomio Hoshi
- Department of Pediatric Dentistry, School of Dentistry, Western Paraná State University, Brazil
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12
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Cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD): evidence from a systematic review with meta-analysis. Transl Psychiatry 2021; 11:430. [PMID: 34413283 PMCID: PMC8377148 DOI: 10.1038/s41398-021-01550-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
Several studies reported abnormal cortisol and inflammatory biomarker levels in youths with attention deficit hyperactivity disorder (ADHD), but the results have not been conclusive. We conducted a systematic review followed by a meta-analysis of case-control studies assessing blood or saliva cortisol levels and blood levels of inflammatory biomarkers in youth with ADHD. The effect sizes (ES) were synthesized by using a random-effects model. In the 19 studies on cortisol levels (totaling n = 916 youth with ADHD and n = 947 typically developing (TD), healthy youth), youth with ADHD have lower basal cortisol levels at any time-points during the day (effect size: .68; p = 0.004) and lower cumulative levels of cortisol (ES: .39, p = .008) throughout the day than TD youth. Moreover, morning cortisol levels were lower in ADHD youth when compared with TD youth (14 studies, n = 1679, ES: .84, p = 0.003), while there is no difference for the afternoon cortisol levels (p = 0.48). The meta-analysis on inflammation biomarker was conducted on 4 studies (totaling n = 404 youth) showed that Tumour Necrosis Factor-alpha (TNF-α) was lower in ADHD when compared with TD (3 studies, n = 257 youth, p = 0.004), while no differences for Interleukin-1β(IL-1β) (p = 0.21), IL-6 (p = 0.09) and IL-10 (p = 0.77). The lower cortisol in the context of low TNF-α levels may indicate a specific pattern of biomarkers in ADHD, and further investigation is warranted.
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13
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El Ghamry RH, Mohamed MM, Azzam HM, Elhabiby MM, Hasan HM, Hashish AF, Elhamshary MM, Barakat DMH. Aggression in ADHD: relation to salivary cortisol. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Study of cortisol levels in patients with ADHD in correlation with aggressive behaviors associated with ADHD has received limited research attention. This factor is essential for comprehending the psychopathophysiology of ADHD and its comorbidities. The present study aimed to investigate the cortisol level in ADHD children and its relation to severity of symptoms and associated aggressive behavior in those children. The sample consisted of 129 patients and 80 healthy controls evaluated by administering the Mini International Neuropsychiatric Interview for Children, The Wechsler Intelligence Scale for Children, Conners’ parent rating scale, problem scale of C.B.C.L., and Socioeconomic Status Scale. Salivary cortisol was measured using radio-immune assay.
Results
Salivary cortisol level in our ADHD subjects was significantly lower (11.826 ng/ml) than in the control group (19.619 ng/ml with P-value 0.001). Our results failed to find any correlation between ADHD symptoms severity and salivary cortisol levels. Severity of delinquent, aggressive, and externalizing behaviors of ADHD children positively correlated with cortisol salivary levels.
Conclusion
Salivary cortisol levels are lower in children with ADHD relative to age- and sex-matched healthy controls. In addition, there is no obvious correlation between severity of ADHD symptoms and basal salivary cortisol levels. We also concluded that there is positive correlation between delinquent, aggressive, and externalizing behaviors in children with ADHD and their basal salivary cortisol levels.
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Baakdah RA, Turkistani JM, Al-Qarni AM, Al-Abdali AN, Alharbi HA, Bafaqih JA, Alshehri ZS. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health 2021; 21:186. [PMID: 33845835 PMCID: PMC8040197 DOI: 10.1186/s12903-021-01555-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Behaviour management strategies involving pharmacological or non-pharmacological interventions during dental procedures should be considered to attain safe and successful treatment outcomes. This study compared the frequencies of use and the completeness of treatment with these interventions. Methods A total of 1725 dental records of patients up to 18 years old, who were treated in the King Abdulaziz Medical City in Jeddah City from October 2018 to June 2019, were used in this retrospective, cross-sectional study. Inferential analysis, Chi-square test, Kruskal–Wallis test, and regression model were used in the data analysis. Results About two-thirds of the patients were treated with attendant non-pharmacological interventions, while one-third, with pharmacological interventions. The application of General Anesthesia (GA) was the most frequently used intervention. Restorative procedures and extractions were done in higher frequencies with pharmacological interventions. Treatments with space maintainers and orthodontic appliances were carried out in higher frequencies with non-pharmacological strategies. The choice of intervention was significantly influenced by the systemic conditions of the patients. Patients treated with non-pharmacological intervention comprised the dominant type of patients, because they required treatments with less pain. Those treated with GA needed restorative treatments and extractions, or treatments that involve pain, but these treatments had higher frequencies of being completed. Conclusions The treatments with pharmacological intervention through GA have higher frequencies of being completed, compared to those with non-pharmacological interventions. Factors, such as age, potential to complete the treatment, and the type of dental treatment applied, influence the choice of treatment intervention.
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Affiliation(s)
- Rania A Baakdah
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Jihan M Turkistani
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia.
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15
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Abedizadeh H, Faramarzi M, Khafri S, Qujeq Q, Ahangary M, Ghasempour M. The association between the salivary cortisol level of mothers, children's temperament, and early childhood caries. J Indian Soc Pedod Prev Dent 2021; 39:196-201. [PMID: 34341241 DOI: 10.4103/jisppd.jisppd_247_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Multiple factors can affect early childhood caries (ECC). Maternal stress and child's temperament, as predictors of child behavior, are among factors that may be associated with ECC. OBJECTIVES The aim of this study was to evaluate the association between the salivary cortisol level of mothers as an indicator of maternal stress, child's temperament, and ECC. METHODS Ninety preschool children, who were divided into three groups of ECC, severe ECC (S-ECC), and caries-free (CF), were included in this study, as well as their mothers with no history of anxiety disorders. The salivary cortisol levels of mothers were analyzed using ELISA assay. Children were examined for the evidence of caries, using the decayed-missing-filled teeth index, based on the World Health Organization standard criteria. Child temperament was also assessed, using Cloninger's Preschool Temperament and Character Inventory, consisting of seven significant factors (cooperativeness, harm avoidance, novelty seeking, reward dependence, persistence, self-directing, and self-transcendence). RESULTS The association between the salivary cortisol level of mothers and temperament of children with S-ECC was positive although it was not statistically significant (P > 0.05). Of seven temperament factors, only harm avoidance was significantly different between the CF and S-ECC groups (P = 0.016). CONCLUSION Maternal stress and child's temperament were not associated with ECC. Based on the present findings, children with less harm avoidance may be more prone to S-ECC.
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Affiliation(s)
- Hossein Abedizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Mahbobeh Faramarzi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Soraya Khafri
- Social Determination of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Qurdi Qujeq
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Majid Ahangary
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Maryam Ghasempour
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
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Effect of one-month treatment with methylphenidate on salivary cortisol level of attention deficit hyperactivity disorder children. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychological disorders that affects children, adolescents, and adults. Dysfunction of the hypothalamic-pituitary-adrenal axis (HPA) has been implicated in its pathophysiology. So, this study aimed to compare the salivary cortisol level between ADHD children and healthy children. It also compared the salivary cortisol level of ADHD children before treatment and 1 month after treatment with methylphenidate.
Results
This study showed that there was a statistically significant decrease in salivary cortisol level of the ADHD group, specifically hyperactive/impulsive subtype compared to the control group. Furthermore, it showed a statistically significant increase of salivary cortisol level after treatment compared to before treatment in the ADHD group.
Conclusions
HPA axis dysfunction may be related to the pathophysiology of ADHD, specifically hyperactive/impulsive subtype. Methylphenidate positively affects the HPA axis of ADHD children.
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17
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Krahel A, Paszynska E, Slopien A, Gawriolek M, Otulakowska-Skrzynska J, Rzatowski S, Hernik A, Hanć T, Bryl E, Szczesniewska P, Bilska K, Duda J, Tyszkiewicz-Nwafor M, Dmitrzak-Weglarz M. Stress/Immune Biomarkers in Saliva among Children with ADHD Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020769. [PMID: 33477503 PMCID: PMC7831062 DOI: 10.3390/ijerph18020769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 11/16/2022]
Abstract
Background. This cross-sectional study aimed to evaluate stress and immune biomarkers in saliva samples of attention-deficit/hyperactivity disorder ADHD compared to healthy non-ADHD children. Material and methods. A total of 132 children under 11 years old (8.5 ± 1.1) enrolled in a cross-sectional study: with confirmed ADHD (n = 60) and healthy controls (n = 72). The clinical evaluation included physical measurements (height, waist, hip circumference, body weight, body mass index BMI, BMI z-score) and unstimulated saliva collection and measurements of free cortisol, salivary alpha-amylase (sAA), and secreted immunoglobulins (sIgA, IgG, and IgM) with quantitative assay (ELISA) analysis. Unpaired t-test, Welch test, or Mann-Whitney U test were applied for group comparisons when appropriate, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05. Results. In the ADHD group, body weight (p ≤ 0.01), BMI (p ≤ 0.009), and hip circumference (p ≤ 0.001) significantly differed, while waist size and BMI z-score did not (p > 0.05). Significant elevation of the salivary sAA (p = 0.03), sIgA (p = 0.02), and IgM (p ≤ 0.001) biomarkers were detected, without differences in the morning cortisol (p > 0.05). Significant correlations between cortisol and BMI, hip size, and IgA, as well as between IgG and sAA and IgA were obtained. Conclusions. Saliva can be used to monitor ADHD status with regard to biomarkers indicating the hypothalamus-pituitary-adrenal axis, as HPA axis, and sympathetic activity. The results indicate that morning collection of saliva in contrast to unchanged salivary cortisol, may evaluate mentioned above system dysregulations by measurements of sAA and immunoglobulins among ADHD children.
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Affiliation(s)
- Anna Krahel
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
| | - Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
- Correspondence:
| | - Agnieszka Slopien
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (A.S.); (M.T.-N.)
| | - Maria Gawriolek
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
| | - Justyna Otulakowska-Skrzynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
| | - Szymon Rzatowski
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
| | - Amadeusz Hernik
- Department of Integrated Dentistry, Poznan University of Medical Sciences, 60-812 Poznan, Poland; (A.K.); (M.G.); (J.O.-S.); (S.R.); (A.H.)
| | - Tomasz Hanć
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, 61-614 Poznan, Poland; (T.H.); (E.B.); (P.S.)
| | - Ewa Bryl
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, 61-614 Poznan, Poland; (T.H.); (E.B.); (P.S.)
| | - Paula Szczesniewska
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, 61-614 Poznan, Poland; (T.H.); (E.B.); (P.S.)
| | - Karolina Bilska
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (K.B.); (J.D.); (M.D.-W.)
| | - Joanna Duda
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (K.B.); (J.D.); (M.D.-W.)
| | - Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (A.S.); (M.T.-N.)
| | - Monika Dmitrzak-Weglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (K.B.); (J.D.); (M.D.-W.)
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The Role of the Circadian System in Attention Deficit Hyperactivity Disorder. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1344:113-127. [PMID: 34773229 DOI: 10.1007/978-3-030-81147-1_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by the core symptoms of inattention, impulsivity and hyperactivity. Similar to many other neuropsychiatric conditions, ADHD is associated with very high levels of sleep disturbance. However, it is not clear whether such sleep disturbances are precursors to, or symptoms of, ADHD. Neither is it clear through which mechanisms sleep and ADHD are linked. One possible link is via modulation of circadian rhythms. In this chapter we overview the evidence that ADHD is associated with alterations in circadian processes, manifesting as later chronotype and delayed sleep phase in ADHD, and examine some mechanisms that may lead to such changes. We also interrogate how the circadian clock may be a substrate for therapeutic intervention in ADHD (chronotherapy) and highlight important new questions to be addressed to move the field forward.
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Vlad R, Pop AM, Olah P, Monea M. The Evaluation of Dental Anxiety in Primary School Children: A Cross-Sectional Study from Romania. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E158. [PMID: 33023083 PMCID: PMC7599995 DOI: 10.3390/children7100158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Current data report that high levels of dental anxiety in children have a negative impact on oral health. The aim of this study was to measure dental anxiety, based on the Abeer Children Dental Anxiety Scale (ACDAS) used as a self-reported measure and to correlate its values with the salivary cortisol levels. The study was conducted in 2019 and included 389 children aged 6-9 years old; evaluation of dental anxiety and saliva sampling were performed. The influence of gender on the presence of dental anxiety was analyzed using Fisher's exact test, the salivary cortisol level was compared between anxious and non-anxious children and was further correlated with the ACDAS score (p < 0.05). Girls had higher odds of experiencing dental anxiety (odds ratio: 1.533, p = 0.041). Salivary cortisol levels were higher in anxious compared to non-anxious children (median 1.251 vs. 1.091 ng/mL, p < 0.001) and showed a positive moderate correlation with the ACDAS score (r = 0.411, p < 0.001). Children aged 6-9 years have a high prevalence of dental anxiety, with girls being more susceptible to this condition. Salivary cortisol levels are higher in anxious children and correlate positively with the ACDAS score, proving that ACDAS can be used for the detection of dental anxiety.
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Affiliation(s)
- Ramona Vlad
- Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Tirgu Mures, Romania; (R.V.); (M.M.)
| | - Anca Maria Pop
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Tirgu Mures, Romania
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Tirgu Mures, Romania;
| | - Monica Monea
- Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, 540139 Tirgu Mures, Romania; (R.V.); (M.M.)
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20
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Paszynska E, Dmitrzak-Węglarz M, Perczak A, Gawriolek M, Hanć T, Bryl E, Mamrot P, Dutkiewicz A, Roszak M, Tyszkiewicz-Nwafor M, Slopien A. Excessive Weight Gain and Dental Caries Experience among Children Affected by ADHD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165870. [PMID: 32823570 PMCID: PMC7460135 DOI: 10.3390/ijerph17165870] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
In recent years, attention has been paid to the co-occurrence of attention deficit hyperactivity disorder (ADHD) and obesity, but results in relation to dental caries outcomes differ. The study was conducted to determine obesity/overweight and dental caries in children suffering from ADHD and to draw comparisons with non-ADHD children. A total of 119 children under 11 years old (8.2 ± 1.2) were enrolled into a cross-sectional study: those with confirmed ADHD (n = 39), and healthy controls (n = 80). The behavioral evaluation included a parent interview directed at sweetened food/drink habits. The clinical evaluation included physical measurements (height, waist, hip circumference, body weight, body mass index (BMI), and dental examination (International Caries Detection and Assessment System—ICDAS). Results showed a higher prevalence of abnormal body weight, hip circumference, and BMI, and a higher frequency of caries (84.6%) in the ADHD group. Significant caries differences for primary (ICDAS 0, 1, 2, 5, 6 scores) and permanent teeth (ICDAS 1, 3 scores) were recorded. The questionnaire pinpointed interplays between sugar consumption and tooth decay, especially for primary dentition. It can be concluded that the consumption of sweetened foods/drinks among ADHD children may lead to an increased rate of overweight, but may also affect oral health. Limiting sugar consumption might be one of the important elements in prevention programmes against dental caries and overweight/obesity.
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan 60-812, Poland; (A.P.); (M.G.)
- Correspondence:
| | - Monika Dmitrzak-Węglarz
- Psychiatric Genetics Unit, Department of Psychiatry, Poznan University of Medical Sciences, Poznan 60-806, Poland;
| | - Aleksandra Perczak
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan 60-812, Poland; (A.P.); (M.G.)
| | - Maria Gawriolek
- Department of Integrated Dentistry, Poznan University of Medical Sciences, Poznan 60-812, Poland; (A.P.); (M.G.)
| | - Tomasz Hanć
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan 61-614, Poland; (T.H.); (E.B.); (P.M.)
| | - Ewa Bryl
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan 61-614, Poland; (T.H.); (E.B.); (P.M.)
| | - Paula Mamrot
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, Poznan 61-614, Poland; (T.H.); (E.B.); (P.M.)
| | - Agata Dutkiewicz
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan 60-572, Poland; (A.D.); (M.T.-N.); (A.S.)
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan 60-806, Poland;
| | - Marta Tyszkiewicz-Nwafor
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan 60-572, Poland; (A.D.); (M.T.-N.); (A.S.)
| | - Agnieszka Slopien
- Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences, Poznan 60-572, Poland; (A.D.); (M.T.-N.); (A.S.)
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Attention-Deficit/Hyperactivity Disorder, Its Pharmacotherapy, and Adrenal Gland Dysfunction: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103709. [PMID: 32466107 PMCID: PMC7277140 DOI: 10.3390/ijerph17103709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/25/2022]
Abstract
This study aims to examine the co-occurrence rate of attention deficit hyperactivity disorder (ADHD) and adrenal gland disorders, as well as whether pharmacotherapy may affect ADHD patients’ risk of developing adrenal gland disorder. One group of patients newly diagnosed with ADHD (n = 75,247) and one group of age- and gender-matching controls (n = 75,247) were chosen from Taiwan′s National Health Insurance database during the period of January 1999 to December 2011. Both patients and controls were monitored through December 31, 2011, in order to identify the occurrence of adrenal gland disorders (ICD-9-CM code 255.X). We also explored the potential effect of methylphenidate (MPH) and atomoxetine (ATX) treatments on the risk of developing adrenal gland disorders. We found that ADHD patients showed a significantly increased probability of developing an adrenal gland disorder compared to the control group (0.2% of ADHD vs. 0.1% of controls). However, neither MPH nor ATX treatment significantly influenced the patients’ risk of developing adrenal gland dysfunction. We propose that patients with ADHD had greater comorbid rates with adrenal gland dysfunction than the control subjects. Nevertheless, undergoing treatment with MPH or ATX did not significantly influence the risk of developing adrenal gland dysfunction among ADHD patients.
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The Potential Influence of the Bacterial Microbiome on the Development and Progression of ADHD. Nutrients 2019; 11:nu11112805. [PMID: 31744191 PMCID: PMC6893446 DOI: 10.3390/nu11112805] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 02/06/2023] Open
Abstract
The latest research cumulates staggering information about the correlation between the microbiota-gut-brain axis and neurodevelopmental disorders. This review aims to shed light on the potential influence of the microbiome on the development of the most prevalent neurodevelopmental disease, attention-deficit-hyperactive disorder (ADHD). As the etiology and pathophysiology of ADHD are still unclear, finding viable biomarkers and effective treatment still represent a challenge. Therefore, we focused on factors that have been associated with a higher risk of developing ADHD, while simultaneously influencing the microbial composition. We reviewed the effect of a differing microbial makeup on neurotransmitter concentrations important in the pathophysiology of ADHD. Additionally, we deduced factors that correlate with a high prevalence of ADHD, while simultaneously affecting the gut microbiome, such as emergency c-sections, and premature birth as the former leads to a decrease of the gut microbial diversity and the latter causes neuroprotective Lactobacillus levels to be reduced. Also, we assessed nutritional influences, such as breastfeeding, ingestion of short-chain fatty acids (SCFAs) and polyunsaturated fatty acids (PUFAs) on the host′s microbiome and development of ADHD. Finally, we discussed the potential significance of Bifidobacterium as a biomarker for ADHD, the importance of preventing premature birth as prophylaxis and nutrition as a prospective therapeutic measurement against ADHD.
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AlMaummar M, AlThabit HO, Pani S. The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety. BMC Oral Health 2019; 19:211. [PMID: 31492133 PMCID: PMC6731601 DOI: 10.1186/s12903-019-0901-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background The purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years, 3 months and 1 year after the successful completion of dental treatment through either pharmacological or non-pharmacological behavior management techniques. Methods A total of 1567 patients aged between 6 and 9 years who had completed dental treatment were screened. A total of 703 patients who were caries free at the end of 3 months were classified based on Frankl behavior score and administered the Arabic version of the Children’s Fear Survey Schedule- Dental Subscale (CFSS-DS) and accordingly allocated to one of three groups; (Phobic Patients, Anxious Patients, Control Group). A total of 183 patients met the inclusion criteria and were followed up for 1 year. A total of 151 patients completed the study. Patients’ heart rate on recall, salivary cortisol and salivary amylase were compared between the groups. Results The results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate or extent of dental treatment. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. These findings were replicated on 1-year recall. Conclusions Within the limitations of this study we can conclude that salivary amylase is an indicator of of acute stress that can differentiate between anxiety and dental fear; while salivary cortisol appears to be a marker of long-term stress that lacks the sensitivity to differentiate between the two.
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Affiliation(s)
| | - Huda Othman AlThabit
- Resident in Pediatric Dentistry, Saudi Board in Pediatric Dentistry, Riyadh, Saudi Arabia
| | - Sharat Pani
- Room No 1012, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Knight FLC, Dimitriou D. Poor Sleep Has Negative Implications for Children With and Without ADHD, but in Different Ways. Behav Sleep Med 2019; 17:423-436. [PMID: 29072500 DOI: 10.1080/15402002.2017.1395335] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Sleep problems are commonly reported in attention deficit hyperactivity disorder (ADHD), and are also a familiar characteristic of typical development (TD). We sought to elucidate the relationship between sleep, ADHD trait behaviors, and cognitive inattention, and how it manifests between ADHD and TD children. Participants: Eighteen children diagnosed with ADHD and 20 age-matched TD controls aged 5 to 11 years old participated in the study. Methods: Sleep profiles were assessed using Children's Sleep Habits Questionnaire and actigraphy measures. Behavioral functioning was examined using Conners' Parent Report Scale and attention using the computerized Conners' Continuous Performance Task. Results: We found evidence of (a) poorer sleep quality in the ADHD group, despite no difference in actual sleep time, (b) poor sleep quality in TD children predicting increased ADHD-trait behaviors, despite no association with attention, and (c) a consistent trend for poor sleep quality predicting reduced attentional control in ADHD children, despite no association with behavior. Conclusions: Poor sleep quality affects developmental subgroups in different ways. For ADHD children, poor sleep worsens their predisposed attentional deficit, while for TD children it mimics ADHD behaviors. These findings have important implications for the debate on overdiagnosis of childhood ADHD, and the use of sleep-based interventions. Above all, they highlight the importance of promoting good sleep hygiene in all children.
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Affiliation(s)
- Frances Le Cornu Knight
- a Lifespan Learning and Sleep Laboratory (LiLAS) , UCL, Institute of Education , London, England
| | - Dagmara Dimitriou
- a Lifespan Learning and Sleep Laboratory (LiLAS) , UCL, Institute of Education , London, England
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Altered hypothalamus-pituitary-adrenal axis function: A relevant factor in the comorbidity of atopic eczema and attention deficit/hyperactivity disorder? Psychoneuroendocrinology 2019; 105:178-186. [PMID: 30583940 DOI: 10.1016/j.psyneuen.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/20/2022]
Abstract
Epidemiological data show a significant association between childhood atopic eczema (AE) and an increased risk to develop attention deficit/hyperactivity disorder (ADHD). However, the underlying mechanisms of the comorbidity of AE and ADHD are mostly unknown. We investigated whether alterations of hypothalamus-pituitary-adrenal (HPA) axis function represent a shared feature of AE and ADHD potentiating AE-ADHD comorbidity. Children aged 6-12 years with AE, ADHD, or comorbid AE + ADHD and healthy control (HC) children were examined cross-sectionally (N = 145). To evaluate HPA axis function, salivary cortisol in response to psychosocial stress (Trier Social Stress Test for Children, TSST-C), after awakening (cortisol awakening response, CAR), and throughout the day (short diurnal profile) and hair cortisol capturing long-term HPA axis activity were assessed. Quantile regression analyses showed an attenuated cortisol response (% maximum change) to the TSST-C in children with ADHD compared to HC. A diminished cortisol response to acute stress was also observed in the comorbid AE + ADHD group, in which the reduction was numerically even more pronounced. Contrary to our previous findings, no alteration of the cortisol response to the TSST-C was observed in children with AE. However, in children with AE, increased ADHD-like behavior (i.e., inattention, impulsivity, and overall ADHD symptom severity) was associated with a reduced HPA axis response to acute stress. No such associations were observed in children without AE. Groups did not differ in CAR, short diurnal profile, and hair cortisol. These findings underscore the potential relevance of HPA axis function in the pathophysiology of AE and ADHD with emphasis on stress reactivity. Additional studies are required to further explore the separate and joint role of the HPA axis in the pathophysiology of AE and ADHD.
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Zhu Y, Chen X, Zhao H, Chen M, Tian Y, Liu C, Han ZR, Lin X, Qiu J, Xue G, Shu H, Qin S. Socioeconomic status disparities affect children's anxiety and stress-sensitive cortisol awakening response through parental anxiety. Psychoneuroendocrinology 2019; 103:96-103. [PMID: 30665044 DOI: 10.1016/j.psyneuen.2019.01.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/08/2018] [Accepted: 01/09/2019] [Indexed: 01/07/2023]
Abstract
Socioeconomic status (SES) disparities have profound impacts on child development and health, which are linked to negative emotions and alterations in the integrity of stress-sensitive hypothalamus-pituitary-adrenal (HPA)-axis system. However, its underlying psychophysiological mechanisms remain poorly understood. Here we investigate how family SES, in concert with parental anxiety, affects children's anxiety and their integrity of HPA-axis system in two studies involving a total of 1318 children and their parents. In Study 1 with a cohort of 1088 children and their parents, we found that low-SES children relative to high-SES ones experienced a higher level of anxiety mediated by increasing parental anxiety. In Study 2 with an independent cohort of 230 children and their parents, we found that low-SES children exhibited an increase in pre-bedtime basal cortisol but a decrease in cortisol awakening response (CAR). Structural equation modeling (SEM) further revealed that the association between low SES and children's reduced CAR was mediated by increased parental and child anxiety. Our findings suggest that low-SES children are more vulnerable to anxiety and altered HPA-axis integrity, most likely mediated through increased parental anxiety.
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Affiliation(s)
- Yannan Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Xu Chen
- Faculty of Psychology at Southwest University, Chongqing, China
| | - Hui Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Menglu Chen
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Yanqiu Tian
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Chao Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Zhuo Rachel Han
- Faculty of Psychology at Beijing Normal University, Beijing, China
| | - Xiuyun Lin
- Faculty of Psychology at Beijing Normal University, Beijing, China
| | - Jiang Qiu
- Faculty of Psychology at Southwest University, Chongqing, China
| | - Gui Xue
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Hua Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China
| | - Shaozheng Qin
- State Key Laboratory of Cognitive Neuroscience and Learning & McGovern Institute for Brain Research at Beijing Normal University, Beijing, China.
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Aksoy A, Cesur MG, Dağdeviren BH, Özkaynak YA, Karacin G, Gültekin F. Assessment of Pain, Anxiety, and Cortisol Levels During the Initial Aligning Phase of Fixed Orthodontic Treatment. Turk J Orthod 2019; 32:34-40. [PMID: 30944898 DOI: 10.5152/turkjorthod.2019.18043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022]
Abstract
Objective We assessed pain and anxiety using psychological testing instruments (State-Trait Anxiety Inventory for Children, visual analog scale) and a physiological testing instrument (salivary cortisol hormone level) after the insertion of orthodontic appliances and during the initial alignment phase of orthodontic treatment. Methods The study group involved two groups matched according to age and gender. Group 1 used 0.016-, 0.016×0.016-, and 0.16×0.22-inch and Group 2 used 0.014-, 0.016-, and 0.016×0.016-inch superelastic nickel-titanium archwires in the initial alignment phase of treatment. Pain and anxiety instruments were applied, and saliva samples were collected from the patients before and after molar band insertions, and bracket and initial archwire placement, and 7 days after the initial bonding and archwire replacements. Results Cortisol levels and state anxiety scores revealed statistically significant differences within groups (p<0.01, p<0.05). No significant differences were found between Group 1 and Group 2 in cortisol hormone levels, anxiety scores, or pain measurements (p>0.05). Although not statistically significant, the most severe pain was measured in the posterior teeth after band insertion and in the anterior teeth after the first archwire insertion (p>0.05). Conclusion Orthodontic appliances and the initial alignment phase of orthodontic treatment affect patients' anxiety and cortisol hormone levels. Both archwires were equally effective with regard to perceived pain, anxiety, and stress hormone levels.
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Affiliation(s)
- Alev Aksoy
- Department of Orthodontics, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Mine Geçgelen Cesur
- Department of Orthodontics, Adnan Menderes University School of Dentistry, Aydın, Turkey
| | | | | | - Gizem Karacin
- Department of Orthodontics, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Fatih Gültekin
- Department of Medical Biochemisrtry, Health Sciences University School of Medicine, İstanbul, Turkey
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Pani S, AlMaummar M, Althabit H. The impact of dental anxiety on the salivary cortisol and alpha-amylase levels of children undergoing dental treatment. SAUDI JOURNAL OF ORAL SCIENCES 2019. [DOI: 10.4103/sjos.sjoralsci_54_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kamradt JM, Momany AM, Nikolas MA. A meta-analytic review of the association between cortisol reactivity in response to a stressor and attention-deficit hyperactivity disorder. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2018; 10:99-111. [PMID: 28875432 PMCID: PMC5837926 DOI: 10.1007/s12402-017-0238-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
Abstract
A substantial literature suggests that abnormal cortisol reactivity may be a vulnerability for deleterious mental health outcomes, including ADHD. ADHD has been linked with difficulty in emotion regulation and increased risk of experiencing stressors, both of which may be related to psychobiological abnormalities (e.g., abnormal cortisol reactivity). Research has been mixed regarding the association between cortisol reactivity and ADHD. Therefore, the present meta-analytic review (k = 12) sought to quantify this association and review the relevant methodological issues and theoretical implications of this area of research. Overall, no effect was found between cortisol reactivity and ADHD (r = 0), although significant heterogeneity in the analyses suggested that there might be moderators of this association, if one does exist. Results highlight the importance of addressing limitations of the current literature on cortisol reactivity and ADHD and exploring additional indices of emotion regulation that may be associated with ADHD. Implications for future research efforts are discussed.
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Affiliation(s)
- Jaclyn M Kamradt
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA.
| | - Allison M Momany
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, 11 Seashore Hall E, University of Iowa, Iowa City, IA, 52242, USA
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30
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Herbert J. Testosterone, Cortisol and Financial Risk-Taking. Front Behav Neurosci 2018; 12:101. [PMID: 29867399 PMCID: PMC5964298 DOI: 10.3389/fnbeh.2018.00101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/27/2018] [Indexed: 11/13/2022] Open
Abstract
Both testosterone and cortisol have major actions on financial decision-making closely related to their primary biological functions, reproductive success and response to stress, respectively. Financial risk-taking represents a particular example of strategic decisions made in the context of choice under conditions of uncertainty. Such decisions have multiple components, and this article considers how much we know of how either hormone affects risk-appetite, reward value, information processing and estimation of the costs and benefits of potential success or failure, both personal and social. It also considers how far we can map these actions on neural mechanisms underlying risk appetite and decision-making, with particular reference to areas of the brain concerned in either cognitive or emotional functions.
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Affiliation(s)
- Joe Herbert
- John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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31
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Salivary cortisol and alpha-amylase diurnal profiles and stress reactivity in children with Attention Deficit Hyperactivity Disorder. Psychoneuroendocrinology 2018; 90:174-181. [PMID: 29501948 DOI: 10.1016/j.psyneuen.2018.02.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022]
Abstract
There is growing evidence for dysregulation of the stress system in individuals with Attention Deficit Hyperactivity Disorder (ADHD). The stress system includes neuroanatomical and functional components that function in concert to maintain homeostasis and its main effectors are the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic/adrenomedullary nervous system (SNS). As stress system activity demonstrates a distinct circadian variation, we aimed to describe simultaneously, diurnal rhythms of both the HPA axis and the SNS in children with ADHD and a comparison group. Moreover, we attempted to investigate stress responses to a physical stressor, venipuncture, in both groups. Sixty-two prepubertal children with ADHD combined (ADHD-C) or inattentive (ADHD-I) type and 40 typically developing children provided saliva samples at six specific time points during a day, as well as before and 10 min after a scheduled morning venipuncture. Salivary cortisol and α- amylase were selected as reliable noninvasive biomarkers for HPA axis and SNS function and were measured in the samples obtained. Results revealed that children with ADHD-C had lower mean cortisol values both 30 min after awakening and at 18:00 h than controls (p = 0.002 and p = 0.018 respectively), as well as lower mean Cortisol Awakening Response (CAR) and Area Under the Curve for "wake to bed" period (AUCi) values of cortisol (p = 0.004 and p = 0.001, respectively). Also, mean CAR and cortisol AUCi were lower in children with ADHD-I than the control group (p = 0.034 and p = 0.038 respectively). Alpha-amylase measurements showed an increase over time (p < 0.001), which was similar in all three groups. Interestingly, α-amylase changes over time were correlated with the corresponding cortisol changes (p < 0.001). Venipuncture, elicited a significant increase only in α-amylase levels and more so in the control group (p = 0.003). These findings suggest a partial hypofunction of the stress system in children with ADHD.
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Merwin SM, Barrios C, Smith VC, Lemay EP, Dougherty LR. Outcomes of early parent-child adrenocortical attunement in the high-risk offspring of depressed parents. Dev Psychobiol 2018. [DOI: 10.1002/dev.21623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Chelsey Barrios
- Department of Psychology; University of Maryland; College Park Maryland
| | - Victoria C. Smith
- Department of Psychology; University of Maryland; College Park Maryland
| | - Edward P. Lemay
- Department of Psychology; University of Maryland; College Park Maryland
| | - Lea R. Dougherty
- Department of Psychology; University of Maryland; College Park Maryland
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Işık Ü, Bilgiç A, Toker A, Kılınç I. Serum levels of cortisol, dehydroepiandrosterone, and oxytocin in children with attention-deficit/hyperactivity disorder combined presentation with and without comorbid conduct disorder. Psychiatry Res 2018; 261:212-219. [PMID: 29324397 DOI: 10.1016/j.psychres.2017.12.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/10/2017] [Accepted: 12/31/2017] [Indexed: 01/02/2023]
Abstract
The present study aimed to investigate serum cortisol, dehydroepiandrosterone (DHEA), and oxytocin levels of children with attention-deficit/hyperactivity disorder (ADHD) combined presentation and those diagnosed with ADHD combined presentation and coexisting conduct disorder. A total of 74 drug-naive children with ADHD combined presentation alone, 32 children with ADHD combined presentation + conduct disorder, and 42 healthy controls were included. The severities of ADHD and conduct disorder symptoms were assessed via parent- and teacher-rated questionnaires. The severity of aggression, anxiety, and depression symptoms of the children were assessed by the self-report inventories. Independent of potential confounders, including age, sex, pubertal stage, and severity of depression and anxiety, serum oxytocin levels of the ADHD combined presentation + conduct disorder group were significantly lower than those of both the ADHD combined presentation alone and control groups. There was also a trend for the ADHD combined presentation + conduct disorder group to show lower serum DHEA levels than that of the ADHD combined presentation alone group. However, serum cortisol levels did not show significant alterations among the groups. These findings suggest that oxytocin and DHEA may play a role in the pathophysiology of conduct disorder, at least in the presence of ADHD combined presentation.
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Affiliation(s)
- Ümit Işık
- Department of Child and Adolescent Psychiatry, Yozgat City Hospital, Yozgat, Turkey.
| | - Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Ibrahim Kılınç
- Department of Biochemistry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Dušková M, Vašáková J, Dušková J, Kaiferová J, Broukal Z, Stárka L. The role of stress hormones in dental management behavior problems. Physiol Res 2017; 66:S317-S322. [PMID: 28948815 DOI: 10.33549/physiolres.933718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dental management behavior problems are thought to be both multifactorial and multidimensional, consisting of physiological, behavioral and cognitive components. The stress response to pain or even the anticipation of distress initiates activation of the hypothalamic-pituitary-adrenal axis and causes an increase of cortisol and catecholamines. The literature on the role of hormones in dental management behavior problems comprises about one hundred papers, which have mainly been focused on this activation of the HPA axis in various situations in dental care. They have generally used salivary cortisol as a marker of the activity of the HPA axis, sometimes combined with salivary alpha amylase. Here we summarize the literature data on the role of stress hormones in dental management behavior problems.
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Affiliation(s)
- M Dušková
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic.
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Baribeau DA, Dupuis A, Paton TA, Scherer SW, Schachar RJ, Arnold PD, Szatmari P, Nicolson R, Georgiades S, Crosbie J, Brian J, Iaboni A, Lerch J, Anagnostou E. Oxytocin Receptor Polymorphisms are Differentially Associated with Social Abilities across Neurodevelopmental Disorders. Sci Rep 2017; 7:11618. [PMID: 28912494 PMCID: PMC5599599 DOI: 10.1038/s41598-017-10821-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/15/2017] [Indexed: 12/17/2022] Open
Abstract
Oxytocin is a pituitary neuropeptide that affects social behaviour. Single nucleotide polymorphisms (SNPs) in the oxytocin receptor gene (OXTR) have been shown to explain some variability in social abilities in control populations. Whether these variants similarly contribute to the severity of social deficits experienced by children with neurodevelopmental disorders is unclear. Social abilities were assessed in a group of children with autism spectrum disorder (ASD, n = 341) or attention deficit hyperactivity disorder (ADHD, n = 276) using two established social measures. Scores were compared by OXTR genotype (rs53576, rs237887, rs13316193, rs2254298). Unexpectedly, the two most frequently studied OXTR SNPs in the general population (rs53576 and rs2254298) were associated with an increased severity of social deficits in ASD (p < 0.0001 and p = 0.0005), yet fewer social deficits in ADHD (p = 0.007 and p < 0.0001). We conclude that these genetic modifier alleles are not inherently risk-conferring with respect to their impact on social abilities; molecular investigations are greatly needed.
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Affiliation(s)
| | - Annie Dupuis
- Department of Biostatistics Design and Analysis, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tara A Paton
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada.,The McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Russell J Schachar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul D Arnold
- Hotchkiss Brain Institute, Departments of Psychiatry & Medical Genetics, University of Calgary, Calgary, Alberta, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rob Nicolson
- The Children's Health Research Institute and Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Chedoke Hospital, Hamilton, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Brian
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alana Iaboni
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jason Lerch
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Evdokia Anagnostou
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada. .,Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
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Okabe R, Okamura H, Egami C, Tada Y, Anai C, Mukasa A, Iemura A, Nagamitsu S, Furusho J, Matsuishi T, Yamashita Y. Increased cortisol awakening response after completing the summer treatment program in children with ADHD. Brain Dev 2017; 39:583-592. [PMID: 28347595 DOI: 10.1016/j.braindev.2017.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/01/2017] [Accepted: 03/03/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Little is known about the cortisol awakening response (CAR) in children with attention deficit hyperactivity disorder (ADHD). Here, we examined the CAR in children with ADHD and their mothers before, immediately after, and 4months after an intensive summer treatment program (STP). METHODS Participants were 37 children aged 7-12years who completed the STP in 2009 and 2010, and their mothers. Daily saliva samples for cortisol measurement were collected twice daily at awakening and 30min afterwards at pre-STP, post-STP, and during a follow-up measurement period. ADHD symptom scores were evaluated by parents, and participants completed the Kid-KINDLR QOL questionnaire. RESULTS CAR was low in children with ADHD before the STP, and increased to the control range 4months after STP. Maternal CAR also tended to increase after STP. Changes in the CAR in children tended to correlate with an improved ADHD inattention scores (p=0.091), physical health (p=0.070), and school life subscales scores in the Kid-KINDLR (p=0.079). CONCLUSION We demonstrated that STP improved the behavior and QOL of children with ADHD. Our results indicate that STP could lead to improvements in HPA axis function, as reflected by increased CAR after STP.
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Affiliation(s)
- Rumiko Okabe
- Department of Pediatrics & Child Health Kurume University School of Medicine, Kurume, Japan
| | - Hisayoshi Okamura
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University School of Medicine, Kurume, Japan
| | - Chiyomi Egami
- Faculty of Nursing, Fukuoka Prefectural University, Fukuoka, Japan
| | | | | | - Akiko Mukasa
- NPO Kurume STP, Kurume, Japan; Graduate School of Psychological Sciences, Hiroshima International University, Japan
| | - Akiko Iemura
- Department of Pediatrics & Child Health Kurume University School of Medicine, Kurume, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics & Child Health Kurume University School of Medicine, Kurume, Japan
| | - Junichi Furusho
- College of Education, Psychology, and Human Studies, Aoyamagakuin University, Tokyo, Japan
| | - Toyojiro Matsuishi
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University School of Medicine, Kurume, Japan; Research Center for Children, Research Center for Rett Syndrome, St Mary's Hospital, Kurume, Japan
| | - Yushiro Yamashita
- Department of Pediatrics & Child Health Kurume University School of Medicine, Kurume, Japan; Cognitive and Molecular Research Institute of Brain Diseases, Kurume University School of Medicine, Kurume, Japan.
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Corominas-Roso M, Armario A, Palomar G, Corrales M, Carrasco J, Richarte V, Ferrer R, Casas M, Ramos-Quiroga JA. IL-6 and TNF-α in unmedicated adults with ADHD: Relationship to cortisol awakening response. Psychoneuroendocrinology 2017; 79:67-73. [PMID: 28262601 DOI: 10.1016/j.psyneuen.2017.02.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/10/2017] [Accepted: 02/16/2017] [Indexed: 01/23/2023]
Abstract
There is preliminary evidence that the immune system's cytokines may have impact on ADHD in children. Nevertheless, studies exploring the possible role of pro-inflammatory cytokines in adults with ADHD are lacking. This study aimed to assess differences in serum IL-6 and TNF-α between patients and controls and their possible relationship to resting cortisol. 108 adults with ADHD (DSM-IV), 44 inattentive and 64 combined, age ranging between 18 and 55 years, and 27 healthy controls were included. Major psychiatric disorders and organic comorbidities were excluded. Serum samples for IL-6 and TNF-α and salivary samples to assess cortisol awakening response were collected on the same day. Analysis of variance was applied to study differences in IL-6 and TNF-α between groups. Pearson correlations were used to study associations between IL-6, TNF-α, and CAR. There were no significant differences in serum IL-6 or TNF-α levels between patients and controls or between combined and inattentive patients. Negative associations between IL-6 (r=-0.386, p=0.020), TNF-α (r=-0.372, p=0.023) and cortisol awakening response were found in the inattentive subtype, whereas no association was seen in the combined subtype. A negative correlation between IL-6 and cortisol was also present in the control group (r=-0.44, 0.030). The peripheral pro-inflammatory markers, IL-6 and TNF-α, do not appear to be primarily involved in ADHD in adults, although the role of other inflammatory markers cannot be ruled out. The differences regarding the association between IL-6 and TNF-α and morning cortisol response suggest possible underlying neurobiological differences between the inattentive or combined patients that merit further studies.
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Affiliation(s)
- M Corominas-Roso
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain.
| | - A Armario
- Institut de Neurociéncies, Red de Trastornos Adictivos (RTA) and CIBERSAM, Unitat de Fisiologia Animal, Department de Biologia Cel·lular, Fisiologia I Immunologia, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - G Palomar
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - J Carrasco
- Institut de Neurociéncies, Red de Trastornos Adictivos (RTA) and CIBERSAM, Unitat de Fisiologia Animal, Department de Biologia Cel·lular, Fisiologia I Immunologia, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - V Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - R Ferrer
- Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - M Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - J A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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Korpa T, Pervanidou P, Angeli E, Apostolakou F, Papanikolaou K, Papassotiriou I, Chrousos GP, Kolaitis G. Mothers' parenting stress is associated with salivary cortisol profiles in children with attention deficit hyperactivity disorder. Stress 2017; 20:149-158. [PMID: 28264636 DOI: 10.1080/10253890.2017.1303472] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The aim of this study was to explore the relation between mothers' parenting stress and the functioning of the hypothalamic-pituitary-adrenal axis (HPAA), as expressed by daily salivary cortisol concentrations, in their children diagnosed with attention deficit hyperactivity disorder (ADHD). Seventy-five children aged 6-11 years diagnosed with ADHD predominant hyperactive-impulsive/combined (ADHD-HI/C, N = 49) and inattentive symptoms (ADHD-I, N = 26) and 45 healthy peers and their mothers participated in the study. Μothers completed measures assessing their children's ADHD status, perceived parenting stress (Parenting Stress Index - Short Form, PSI-SF), mothers' symptoms of psychopathology, social support and socioeconomic status. Children's salivary cortisol samples were collected at six different time points on a single day. Mothers of children with ADHD-HI/C reported higher levels of parenting stress than mothers of children with ADHD-I and controls. All PSI-SF subscales showed significant associations with children's cortisol awakening response (CAR) in both ADHD groups, with the exception of the parental distress subscale in the ADHD-I group. In both ADHD groups, the parent-child dysfunctional interaction subscale, the difficult child subscale and the PSI total score were significantly associated with children's CAR. An interrelation is revealed between mothers' high levels of parenting stress and HPAA functioning in children with ADHD. In this population, CAR has been identified as a sensitive peripheral measure of HPAA functioning in children. Lay summaryThis study showed that in families of children diagnosed with ADHD, there is a complex relation between the mothers' high levels of parenting stress and children's atypical hypothalamic-pituitary-adrenal axis functioning.
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Affiliation(s)
- Terpsichori Korpa
- a Department of Child and Adolescent Psychiatry , Athens University Medical School, "Aghia Sophia" Children's Hospital: Thivon and Papadiamantopoulou , Athens , Greece
| | - Panagiota Pervanidou
- b Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics , National and Kapodistrian University of Athens, School of Medicine, "Aghia Sophia' Children's Hospital", Thivon and Papadiamantopoulou , Athens , Greece
| | - Eleni Angeli
- b Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics , National and Kapodistrian University of Athens, School of Medicine, "Aghia Sophia' Children's Hospital", Thivon and Papadiamantopoulou , Athens , Greece
| | - Filia Apostolakou
- c Department of Clinical Biochemistry , " Aghia Sophia" Children's Hospital: Thivon and Papadiamantopoulou , Athens , Greece
| | - Katerina Papanikolaou
- a Department of Child and Adolescent Psychiatry , Athens University Medical School, "Aghia Sophia" Children's Hospital: Thivon and Papadiamantopoulou , Athens , Greece
| | - Ioannis Papassotiriou
- c Department of Clinical Biochemistry , " Aghia Sophia" Children's Hospital: Thivon and Papadiamantopoulou , Athens , Greece
| | - George P Chrousos
- b Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics , National and Kapodistrian University of Athens, School of Medicine, "Aghia Sophia' Children's Hospital", Thivon and Papadiamantopoulou , Athens , Greece
| | - Gerasimos Kolaitis
- a Department of Child and Adolescent Psychiatry , Athens University Medical School, "Aghia Sophia" Children's Hospital: Thivon and Papadiamantopoulou , Athens , Greece
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Wang LJ, Huang YS, Hsiao CC, Chen CK. The Trend in Morning Levels of Salivary Cortisol in Children With ADHD During 6 Months of Methylphenidate Treatment. J Atten Disord 2017; 21:254-261. [PMID: 23223012 DOI: 10.1177/1087054712466139] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the trend in cortisol levels in children with ADHD treated with methylphenidate (MPH) and nontreated healthy controls over a 6-month period. METHOD The morning salivary cortisol levels of 50 patients with ADHD (40 boys and 10 girls, mean age = 7.6 years) and 50 age- and gender-matched healthy controls were measured at baseline and at 1, 3, and 6 months from baseline. The neuropsychological performance of the ADHD patients was measured via administration of the Continuous Performance Test. RESULTS The cortisol levels of ADHD patients increased significantly after 1 month of MPH treatment before decreasing to an intermediate level, but were significantly positively correlated with neuropsychological performance throughout the 6-month treatment period. The cortisol levels of the controls did not change significantly over the 6-month period. CONCLUSION MPH administration appears to positively influence the functioning of the hypothalamic-pituitary-adrenal axis in ADHD patients.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Shu Huang
- 2 Department of Child Psychiatry and Sleep center, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan.,3 Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Cheng-Cheng Hsiao
- 4 Department of Psychiatry, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chih-Ken Chen
- 3 Chang Gung University School of Medicine, Taoyuan, Taiwan.,5 Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Taiwan
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Schote AB, Bonenberger M, Pálmason H, Seitz C, Meyer J, Freitag CM. Glucocorticoid receptor variants in childhood attention-deficit/hyperactivity disorder and comorbid psychiatric disorders. Psychiatry Res 2016; 246:275-283. [PMID: 27741480 DOI: 10.1016/j.psychres.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 08/10/2016] [Accepted: 10/02/2016] [Indexed: 01/06/2023]
Abstract
Stress results in a variety of neuroendocrine, immune and behavioral responses and represents a risk factor for many disorders. Following exposure to stress, glucocorticoids are secreted from the adrenal cortex and act via the ligand-activated glucocorticoid receptor (GR). Several polymorphisms of the GR-encoding gene NR3C1 have been described and functionally investigated. However, the impact of these variants on complex diseases such as Attention-Deficit/Hyperactivity Disorder (ADHD) is still unclear. In this study, 251 children with ADHD, 19 affected and 35 unaffected siblings, and their parents were included in a family-based association study assessing seven common variants of NR3C1 (TthIIII_rs10052957; NR3C1-I_rs10482605; ER22/23EK_rs6189/rs6190; N363S_rs56149945; BclI_rs41423247; GR-9beta_rs6198). A four-marker haplotype (TthIIII-NR3C1-I-ER22/23EK) was nominally associated with ADHD. In addition, in index children with ADHD, associations with comorbid disorders, inattentive and hyperactive-impulsive symptoms were explored. N363S minor allele carriers were more likely to show comorbid conduct disorder (CD). In our study, NR3C1 variants moderately affected ADHD and had a significant effect on comorbid CD. Therefore, NR3C1 as an important gene of the hypothalamic-pituitary-adrenal axis seems to be particularly relevant for the pathophysiology of ADHD combined with comorbid CD. For a deeper understanding, investigations in larger samples of healthy, ADHD and CD individuals are warranted.
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Affiliation(s)
- Andrea B Schote
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany.
| | - Martina Bonenberger
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany
| | - Haukur Pálmason
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany
| | - Christiane Seitz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Saarland University Hospital, Homburg, Germany
| | - Jobst Meyer
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JW Goethe University, Frankfurt am Main, Germany
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Chau YCY, Lai KYC, McGrath CPJ, Yiu CKY. Oral health of children with attention deficit hyperactivity disorder. Eur J Oral Sci 2016; 125:49-54. [PMID: 28035689 DOI: 10.1111/eos.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
Abstract
This study assessed and compared oral health and oral-health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12-18 yr of age, with ADHD and 31 age- and gender-matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann-Whitney U-tests and chi-square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent-reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral-health attitudes and behaviours than do children without ADHD.
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Affiliation(s)
- Yvonne C Y Chau
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kelly Y C Lai
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colman P J McGrath
- Dental Public Health, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Cynthia K Y Yiu
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong SAR, China
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Cortisol levels at baseline and under stress in adolescent males with attention-deficit hyperactivity disorder, with or without comorbid conduct disorder. Psychiatry Res 2016; 242:130-136. [PMID: 27280522 PMCID: PMC4986851 DOI: 10.1016/j.psychres.2016.05.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 01/29/2023]
Abstract
Reported findings on cortisol reactivity to stress in young people with ADHD are very variable. This inconsistency may be explained by high rates of comorbidity with Conduct Disorder (CD). The present study examined cortisol responses to a psychosocial stressor in a large sample of adolescent males with ADHD (n=202), with or without a comorbid diagnosis of Conduct Disorder (CD). Associations between stress reactivity and callous-unemotional traits and internalizing symptoms were also assessed. The ADHD only (n=95) and ADHD+CD (n=107) groups did not differ in baseline cortisol, but the ADHD+CD group showed significantly reduced cortisol stress reactivity relative to the ADHD only group. Regression analyses indicated that ADHD symptom severity predicted reduced baseline cortisol, whereas CD symptom severity predicted increased baseline cortisol (ADHD β=-0.24, CD β=0.16, R=0.26) and reduced cortisol stress reactivity (β=-0.17, R=0.17). Callous-unemotional traits and internalizing symptoms were not significantly related to baseline or stress-induced cortisol. Impaired cortisol reactivity is hypothesised to reflect fearlessness and is associated with deficient emotion regulation and inhibition of aggressive and antisocial behaviour. Consequently, it may partly explain the greater severity of problems seen in those with comorbid ADHD and CD.
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43
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Gomes HS, Vieira LAC, Costa PS, Batista AC, Costa LR. Professional dental prophylaxis increases salivary cortisol in children with dental behavioural management problems: a longitudinal study. BMC Oral Health 2016; 16:74. [PMID: 27539128 PMCID: PMC4989520 DOI: 10.1186/s12903-016-0273-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/11/2016] [Indexed: 12/24/2022] Open
Abstract
Background Dental procedures may cause stress and increase the salivary cortisol levels. It is important to known if apparently simple procedures such as professional dental prophylaxis at low speed (DP) are stressful for children with dental behaviour management problems (DBMP) to help with behaviour guidance strategies. This longitudinal study aimed to evaluate if DP changes a physiological marker of stress (salivary cortisol) in children with DBMP who were referred to dental treatment under sedation. Methods One paediatric dentist carried out a DP with rubber cup and pumice followed by dental examination in 39 children aged 2–5 years, prior to the dental sedation appointment. Children’s saliva was collected at three different moments: upon waking (UW), on arrival at the dental office reception area (RA) and 25 min after the dental prophylaxis (DP). The saliva samples were analysed using an enzyme immunoassay kit. The Wilcoxon test was used in paired comparison (P < 0.05). Results Salivary cortisol levels decreased from UW (0.34; 0.15–0.54) to RA (0.14; 0.08–0.56) (P = 0.019) and increased from RA to DP (0.25; 0.06–1.48) (P = 0.008). Higher salivary cortisol levels were observed at DP when compared to RA in children who did not have previous dental treatment (P = 0.007), had toothache (P = 0.006), presented some protest behaviour during DP (P = 0.008), or needed protective stabilisation by parents for the dental examination (P = 0.005). Conclusions Paediatric dentists should be aware that even simple procedures such as professional dental prophylaxis are related to stress in young children.
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Affiliation(s)
- Heloisa Sousa Gomes
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Goiás (UFG), Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil
| | - Liliani Aires Candido Vieira
- Departamento de Saúde Oral, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil
| | - Paulo Sucasas Costa
- Departamento de Pediatria, Faculdade de Medicina/UFG, Rua 235 c/ 1a. s/n - S. Universitário, CEP 74605-020, Goiânia, GO, Brazil
| | - Aline Carvalho Batista
- Departamento de Ciências Estomatológicas, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil
| | - Luciane Rezende Costa
- Departamento de Saúde Oral, Faculdade de Odontologia/UFG, Av. Universitária Esquina com 1ª Avenida s/n, Setor Universitário, CEP: 74605-220, Goiânia, GO, Brazil. .,Faculdade de Odontologia, Universidade Federal de Goiás, Primeira Avenida, Setor Universitário, CEP: 74605-220, Goiânia, Goiás, Brazil.
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Ramos-Quiroga JA, Corominas-Roso M, Palomar G, Ferrer R, Valero S, Corrales M, Richarte V, Casas M. Cortisol awakening response in adults with attention deficit hyperactivity disorder: Subtype differences and association with the emotional lability. Eur Neuropsychopharmacol 2016; 26:1140-9. [PMID: 27084305 DOI: 10.1016/j.euroneuro.2016.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 02/12/2016] [Accepted: 03/24/2016] [Indexed: 01/08/2023]
Abstract
Cortisol awakening response (CAR) has been studied in children with ADHD, and some authors have reported morning cortisol differences among ADHD subtypes. Despite, only half of the children with ADHD continue to exhibit the disorder into adulthood, CAR has not been studied in adults so far. One hundred and nine adults with ADHD according to the DSM-IV criteria (46 inattentive and 63 combined) ranging in age from 18 to 55 years, and 27 healthy controls were included. Psychiatric and organic comorbidities were excluded. Salivary cortisol samples were obtained at 0, 30, 45 and 60 minutes after awakening. CAR was present in 84% of the healthy controls but in only 64% of the adults with ADHD (68% of the inattentive and 61% of the combined were CAR-positive). There were no significant differences in any of the morning cortisol measures between patients and controls or between the combined and inattentive subtypes of ADHD. Among the inattentive subtype but not in the combined patients, significant positive correlations were observed between the CAR and emotional lability (p=0.05), or self-concept (p=0.014) CAARS subscales, as well as with the cognitive impulsivity subscale of the Barratt impulsiveness scale (p=0.028). These results suggest that adults with ADHD exhibit normal cortisol responses upon awakening and thus cannot be defined in terms of hypo-arousal. Neurobiological differences between the combined and inattentive subtypes involving cortisol, are discussed.
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Affiliation(s)
- J A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - M Corominas-Roso
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain.
| | - G Palomar
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - R Ferrer
- Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - S Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - V Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain
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Circadian rhythms and attention deficit hyperactivity disorder: The what, the when and the why. Prog Neuropsychopharmacol Biol Psychiatry 2016; 67:74-81. [PMID: 26776072 DOI: 10.1016/j.pnpbp.2016.01.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 01/17/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterised by impulsivity, inattention and hyperactivity. Aside from these core psychopathologies, sleep disturbances are found to be highly comorbid with ADHD, and indeed dysregulated sleep may contribute to some of the symptoms of the disorder. It is not clear how sleep disturbances come to be so common in ADHD, but one putative mechanism is through the circadian timekeeping system. This system underpins the generation of near 24-hour rhythms in a host of physiological, behavioural and psychological parameters, and is a key determinant of the sleep/wake cycle. In this paper we review the evidence for sleep and circadian rhythm disturbance in ADHD, examine the possible mechanistic links between these factors and the disorder and discuss future directions through which the circadian clock can be targetted for ADHD symptom relief.
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46
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The aetiological association between the dynamics of cortisol productivity and ADHD. J Neural Transm (Vienna) 2016; 123:991-1000. [PMID: 27106905 PMCID: PMC5005391 DOI: 10.1007/s00702-016-1534-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/23/2016] [Indexed: 11/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been linked to dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, indexed by salivary cortisol. The phenotypic and aetiological association of cortisol productivity with ADHD was investigated. A selected twin design using 68 male twin-pairs aged 12–15, concordant or discordant for high ADHD symptom scores, or control twin-pairs with low ADHD symptoms, based on developmentally stable parental ADHD ratings. A genetic growth curve model was applied to cortisol samples obtained across three points during a cognitive-electroencephalography assessment, to examine the aetiological overlap of ADHD affection status (high versus low ADHD symptom scores) with latent intercept and slope factors. A significant phenotypic correlation emerged between ADHD and the slope factor, with cortisol levels dropping faster for the group with high ADHD symptom scores. The analyses further suggested this overlap was mostly driven by correlated genetic effects. We identified change in cortisol activity over time as significantly associated with ADHD affection status, primarily explained by shared genetic effects, suggesting that blunted cortisol productivity can be a marker of genetic risk in ADHD.
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Tanaka S, Uehara N, Tsuchihashi N, Sugimoto K. Emotional relationships between child patients and their mothers during dental treatments. J Dent Sci 2016; 11:287-292. [PMID: 30894986 PMCID: PMC6395250 DOI: 10.1016/j.jds.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/09/2016] [Indexed: 12/04/2022] Open
Abstract
Background/purpose The behavioral control of child patients is an important issue in pediatric dentistry. The emotional states of the mothers of patients may influence the attitudes of their children. The aim of this study was to investigate the emotional states estimated from physiological responses of child patients and the subjective anxieties of their mothers during dental treatments and discuss the emotional relationships between children and their mothers. Materials and methods To assess physiological responses associated with emotional changes induced by dental treatments in child patients aged 3–6 years, activity in the autonomic nervous were analyzed from variations in inter-beat intervals in electrocardiogram. Anxiety levels of accompanying mothers were examined using the State Trait Anxiety Inventory, which was filled out during the treatment of their child. Results Regarding the stress of child patients from the aspect of autonomic nervous activities during dental treatments, comparison between the cooperative and uncooperative patient groups showed that the uncooperative group demonstrated significantly higher sympathetic nervous activity and significantly lower parasympathetic nervous activity relative to the cooperative group, and their accompanying mothers showed significantly higher state anxiety scores relative to the mothers of cooperative children. Moreover, positive correlation between state anxiety scores of mothers and sympathetic nervous activities of their children was observed. Conclusion These results indicated that uncooperative child patients undergo more stress and their mothers feel more anxiety from dental treatments, resulting in an emotional relationship between children and their mothers, which requires dental professionals to make special considerations to calm the anxiety of the mother, as well as the stress of the child patient.
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Affiliation(s)
- Shizuka Tanaka
- Department of Behavioral Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoko Uehara
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Natsumi Tsuchihashi
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kumiko Sugimoto
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Zenglein Y, Schwenck C, Westerwald E, Schmidt C, Beuth S, Meyer J, Palmason H, Seitz C, Hänig S, Freitag CM. Empirically Determined, Psychopathological Subtypes in Children With ADHD. J Atten Disord 2016; 20:96-107. [PMID: 24149942 DOI: 10.1177/1087054713508312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to empirically determine subgroups of ADHD defined by specific patterns of psychopathology. METHOD A clinical sample of 223 children with ADHD, aged 5 to 14 years, was examined with the Child Behavior Checklist (CBCL). In addition, comorbid psychiatric disorders, psychosocial risk factors, and socioeconomic status were assessed. RESULTS Cluster analysis of CBCL subscales yielded a solution with four distinct subgroups. While "externalizers" showed a high rate of comorbid oppositional defiant disorder (ODD) and conduct disorder (CD), "obsessive-compulsives" exhibited thought problems, low rates of comorbid CD, and high symptoms of inattention. "High psychiatric symptom carriers" had high rates of familial risk factors, acute life events, comorbid ODD, and CD. "Low psychiatric symptom carriers" also scored low in all other variables studied. CONCLUSION Children with ADHD can be divided into four subgroups according to their CBCL-based psychopathology, and these subgroups differ in their risk factor profiles.
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Affiliation(s)
| | | | | | | | - Sonja Beuth
- Goethe-University, Frankfurt am Main, Germany
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Palma SMM, Natale ACMP, Calil HM. A four-year follow-up controlled study of stress response and symptom persistence in Brazilian children and adolescents with attention deficit disorder and hyperactivity (ADHD). Psychiatry Res 2015; 230:227-32. [PMID: 26365689 DOI: 10.1016/j.psychres.2015.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/31/2015] [Accepted: 08/30/2015] [Indexed: 02/01/2023]
Abstract
This study evaluated children and adolescents with Attention Deficit Disorder andHyperactivity Disorder (ADHD), reassessing them at a four-year follow-up. Their cortisol response to a stress stimulus was measured twice. ADHD symptom persistence, development of comorbidities, and psychostimulant usage were also reassessed. The initial sample consisted of 38 ADHD patients and 38 healthy controls, age ranging 6-14. At the follow-up, there were 37 ADHD patients and 22 healthy controls, age ranging 10-18. ADHD was classified as persistent if the patients fulfilled all DSM IV criteria for syndromic or subthreshold or had functional impairment. Salivary cortisol samples were collected prior to the application of a cognitive stressor (Continuous Performance Test - CPT), and at three time intervals afterwards at baseline and at the follow-up. Their reassessment showed that 75% had persistent symptoms, psychiatric comorbidities (oppositional defiant and behavioral disorders), functional and academic impairement. Only seven patients were on medication. The ADHD group's cortisol levels were lower than those measured four years earlier, but cortisol concentrations were similar for both ADHD and control groups at the four-year follow-up. The cortisol results suggest that HPA axis reactivity could be a marker differentiating ADHD from ADHD with comorbidities.
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Affiliation(s)
- Sonia Maria Motta Palma
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Brazil
| | | | - Helena Maria Calil
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Brazil.
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Corominas-Roso M, Palomar G, Ferrer R, Real A, Nogueira M, Corrales M, Casas M, Ramos-Quiroga JA. Cortisol Response to Stress in Adults with Attention Deficit Hyperactivity Disorder. Int J Neuropsychopharmacol 2015; 18:pyv027. [PMID: 25782526 PMCID: PMC4576517 DOI: 10.1093/ijnp/pyv027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Differences in the cortisol response have been reported between children exhibiting the inattentive and hyperactive/impulsive subtypes of attention deficit hyperactivity disorder. However, there is no such information about adults. The aim of the present study was to determine the possible differences between the combined and inattentive subtypes in the cortisol response to stress. METHODS Ninety-six adults with attention deficit hyperactivity disorder, 38 inattentive and 58 combined, without any medical or psychiatric comorbidities and 25 healthy controls were included. The Trier Social Stress Test was used to assess physiological stress responses. Clinical data and subjective stress levels, including the Perceived Stress Scale, were also recorded. RESULTS No significant differences in the cortisol response to the Trier Social Stress Test were found between patients and controls. However, albeit there were no basal differences, lower cortisol levels at 15 (P=.015), 30 (P=.015), and 45 minutes (P=.045) were observed in the combined compared with the inattentive subtype after the stress induction; these differences disappeared 60 minutes after the stress. In contrast, the subjective stress responses showed significant differences between attention deficit hyperactivity disorder patients and controls (P<.001), but no differences were seen between attention deficit hyperactivity disorder subtypes. In turn, subjective stress measures, such as the Perceived Stress Scale, positively correlated with the whole cortisol stress response (P<.027). CONCLUSIONS Both the combined and inattentive attention deficit hyperactivity disorder adults exhibited a normal cortisol response to stress when challenged. Nevertheless, the inattentive patients displayed a higher level of cortisol after stress compared with the combined patients. Despite the differences in the cortisol response, adults with attention deficit hyperactivity disorder reported high levels of subjective stress in their every-day life.
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Affiliation(s)
- Margarida Corominas-Roso
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain (Drs Corominas-Roso M, Palomar G, Real A, Nogueira M, Corrales M, Casas M, and Ramos-Quiroga JA); Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain (Drs Corominas-Roso Casas M and Ramos-Quiroga JA); Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Catalonia, Spain (Drs Casas M and Ramos-Quiroga JA); Department of Biochemistry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain (Dr Ferrer R).
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