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Bürger I, Erlandsson K, Borneskog C. Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100975. [PMID: 38678676 DOI: 10.1016/j.srhc.2024.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The research gap regarding Attention Deficit Hyperactivity Disorder (ADHD) in people who were assigned female at birth has led to a lack of knowledge and adequate approaches in clinical practice, as well as diagnosis processes. Recent studies report potential associations between reproductive hormones and ADHD, but existing research remains scarce. AIM This study aims to explore the experiences of people who perceive an association between their menstrual cycle and their ADHD symptoms. METHODOLOGY Design and Method. A qualitative research design with an inductive approach was used. Ten participants were interviewed, using semi-structured, in-depth interviews. The data was transcribed, coded, and analyzed using reflexive thematic analysis according to Braun and Clarke. RESULTS Findings show participant's perceived associations between their ADHD and their menstrual cycle: participants reported experiencing ADHD symptom mor severe during the mid-luteal phase of the menstrual cycle. Other results showed uncertainty around ADHD medication in relation to the cycle and varied experiences with health care encounters as well as heightened challenged around menstrual health management. CONCLUSIONS This study provides insights to how perceived associations between ADHD and the menstrual cycle might be experienced. This report highlights the need for further research and theory about the potential associations between ADHD and reproductive hormones. The researchers strongly suggested that forthcoming ADHD studies consider times of key hormonal changes, such as puberty and menarche, menopause, hormonal birth control, pregnancy, hormone treatment, and more.
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Affiliation(s)
- Isabel Bürger
- Dalarna University, School of Health and Welfare, Sweden
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Ocañas SR, Ansere VA, Kellogg CM, Isola JVV, Chucair-Elliott AJ, Freeman WM. Chromosomal and gonadal factors regulate microglial sex effects in the aging brain. Brain Res Bull 2023; 195:157-171. [PMID: 36804773 PMCID: PMC10810555 DOI: 10.1016/j.brainresbull.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
Biological sex contributes to phenotypic sex effects through genetic (sex chromosomal) and hormonal (gonadal) mechanisms. There are profound sex differences in the prevalence and progression of age-related brain diseases, including neurodegenerative diseases. Inflammation of neural tissue is one of the most consistent age-related phenotypes seen with healthy aging and disease. The pro-inflammatory environment of the aging brain has primarily been attributed to microglial reactivity and adoption of heterogeneous reactive states dependent upon intrinsic (i.e., sex) and extrinsic (i.e., age, disease state) factors. Here, we review sex effects in microglia across the lifespan, explore potential genetic and hormonal molecular mechanisms of microglial sex effects, and discuss currently available models and methods to study sex effects in the aging brain. Despite recent attention to this area, significant further research is needed to mechanistically understand the regulation of microglial sex effects across the lifespan, which may open new avenues for sex informed prevention and treatment strategies.
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Affiliation(s)
- Sarah R Ocañas
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Victor A Ansere
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Collyn M Kellogg
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose V V Isola
- Aging & Metabolism Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Ana J Chucair-Elliott
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Willard M Freeman
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA; Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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3
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Ocañas SR, Ansere VA, Tooley KB, Hadad N, Chucair-Elliott AJ, Stanford DR, Rice S, Wronowski B, Pham KD, Hoffman JM, Austad SN, Stout MB, Freeman WM. Differential Regulation of Mouse Hippocampal Gene Expression Sex Differences by Chromosomal Content and Gonadal Sex. Mol Neurobiol 2022; 59:4669-4702. [PMID: 35589920 PMCID: PMC9119800 DOI: 10.1007/s12035-022-02860-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/25/2022] [Indexed: 01/23/2023]
Abstract
Common neurological disorders, like Alzheimer's disease (AD), multiple sclerosis (MS), and autism, display profound sex differences in prevalence and clinical presentation. However, sex differences in the brain with health and disease are often overlooked in experimental models. Sex effects originate, directly or indirectly, from hormonal or sex chromosomal mechanisms. To delineate the contributions of genetic sex (XX v. XY) versus gonadal sex (ovaries v. testes) to the epigenomic regulation of hippocampal sex differences, we used the Four Core Genotypes (FCG) mouse model which uncouples chromosomal and gonadal sex. Transcriptomic and epigenomic analyses of ~ 12-month-old FCG mouse hippocampus, revealed genomic context-specific regulatory effects of genotypic and gonadal sex on X- and autosome-encoded gene expression and DNA modification patterns. X-chromosomal epigenomic patterns, classically associated with X-inactivation, were established almost entirely by genotypic sex, independent of gonadal sex. Differences in X-chromosome methylation were primarily localized to gene regulatory regions including promoters, CpG islands, CTCF binding sites, and active/poised chromatin, with an inverse relationship between methylation and gene expression. Autosomal gene expression demonstrated regulation by both genotypic and gonadal sex, particularly in immune processes. These data demonstrate an important regulatory role of sex chromosomes, independent of gonadal sex, on sex-biased hippocampal transcriptomic and epigenomic profiles. Future studies will need to further interrogate specific CNS cell types, identify the mechanisms by which sex chromosomes regulate autosomes, and differentiate organizational from activational hormonal effects.
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Affiliation(s)
- Sarah R Ocañas
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Victor A Ansere
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kyla B Tooley
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Ana J Chucair-Elliott
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
| | - David R Stanford
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
| | - Shannon Rice
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
| | - Benjamin Wronowski
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kevin D Pham
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA
| | - Jessica M Hoffman
- Department of Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven N Austad
- Department of Biology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael B Stout
- Aging & Metabolism Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Willard M Freeman
- Genes & Human Disease Program, Oklahoma Medical Research Foundation, 825 NE 13thStreet, Oklahoma City, OK, 73104, USA.
- Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK, USA.
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Itoh S, Yamazaki K, Suyama S, Ikeda-Araki A, Miyashita C, Ait Bamai Y, Kobayashi S, Masuda H, Yamaguchi T, Goudarzi H, Okada E, Kashino I, Saito T, Kishi R. The association between prenatal perfluoroalkyl substance exposure and symptoms of attention-deficit/hyperactivity disorder in 8-year-old children and the mediating role of thyroid hormones in the Hokkaido study. ENVIRONMENT INTERNATIONAL 2022; 159:107026. [PMID: 34890903 DOI: 10.1016/j.envint.2021.107026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Disruption of thyroid hormone (TH) levels during pregnancy contributes to attention deficit hyperactivity disorder (ADHD). Exposure to perfluoroalkyl substances (PFAS) during gestation may affect levels of maternal and neonatal TH; however, little is known about the effect of PFAS on ADHD mediated by TH. OBJECTIVES We investigated the impact of maternal PFAS exposure on children's ADHD symptoms with the mediating effect of TH. METHODS In a prospective birth cohort (the Hokkaido study), we included 770 mother-child pairs recruited between 2002 and 2005 for whom both prenatal maternal and cord blood samples were available. Eleven PFAS were measured in maternal serum obtained at 28-32 weeks of gestation using ultra-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. TH and thyroid antibody, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured in maternal blood during early pregnancy (median 11 gestational weeks) and in cord blood at birth. ADHD symptoms in the children at 8 years of age were rated by their parents using the ADHD-Rating Scale (ADHD-RS). The cut-off value was set at the 80th percentile for each sex. RESULTS Significant inverse associations were found between some PFAS in maternal serum and ADHD symptoms among first-born children. Assuming causality, we found only one significant association: maternal FT4 mediated 17.6% of the estimated effect of perfluoroundecanoic acid exposure on hyperactivity-impulsivity among first-born children. DISCUSSION Higher PFAS levels in maternal serum during pregnancy were associated with lower risks of ADHD symptoms at 8 years of age. The association was stronger among first-born children in relation to hyperactivity-impulsivity than with regard to inattention. There was little mediating role of TH during pregnancy in the association between maternal exposure to PFAS and reduced ADHD symptoms at 8 years of age.
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Affiliation(s)
- Sachiko Itoh
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Keiko Yamazaki
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Satoshi Suyama
- Funded Research Division of Child and Adolescent Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuko Ikeda-Araki
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan; Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Yu Ait Bamai
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Sumitaka Kobayashi
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Hideyuki Masuda
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Takeshi Yamaguchi
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Houman Goudarzi
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan; Center for Medical Education and International Relations, Hokkaido University, Sapporo, Japan
| | - Emiko Okada
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Ikuko Kashino
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan
| | - Takuya Saito
- Funded Research Division of Child and Adolescent Psychiatry, Hokkaido University Hospital, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental Health and Sciences, Hokkaido University, Sapporo, Japan.
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Skogheim TS, Weyde KVF, Aase H, Engel SM, Surén P, Øie MG, Biele G, Reichborn-Kjennerud T, Brantsæter AL, Haug LS, Sabaredzovic A, Auyeung B, Villanger GD. Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and associations with attention-deficit/hyperactivity disorder and autism spectrum disorder in children. ENVIRONMENTAL RESEARCH 2021; 202:111692. [PMID: 34293314 DOI: 10.1016/j.envres.2021.111692] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may be a risk factor for neurodevelopmental deficits and disorders, but evidence is inconsistent. OBJECTIVES We investigated whether prenatal exposure to PFAS were associated with childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). METHODS This study was based on the Norwegian Mother, Father and Child Cohort Study and included n = 821 ADHD cases, n = 400 ASD cases and n = 980 controls. Diagnostic cases were identified by linkage with the Norwegian Patient Registry. In addition, we used data from the Medical Birth Registry of Norway. The study included the following PFAS measured in maternal plasma sampled mid-pregnancy: Perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorohexane sulfonate (PFHxS), perfluoroheptanesulfonic acid (PFHpS), and perfluorooctane sulfonate (PFOS). Relationships between individual PFAS and ADHD or ASD diagnoses were examined using multivariable adjusted logistic regression models. We also tested for possible non-linear exposure-outcome associations. Further, we investigated the PFAS mixture associations with ASD and ADHD diagnoses using a quantile-based g-computation approach. RESULTS Odds of ASD was significantly elevated in PFOA quartile 2 [OR = 1.71 (95% CI: 1.20, 2.45)] compared to quartile 1, and PFOA appeared to have a non-linear, inverted U-shaped dose-response relationship with ASD. PFOA was also associated with increased odds of ADHD, mainly in quartile 2 [OR = 1.54 (95% CI: 1.16, 2.04)] compared to quartile 1, and displayed a non-linear relationship in the restricted cubic spline model. Several PFAS (PFUnDA, PFDA, and PFOS) were inversely associated with odds of ADHD and/or ASD. Some of the associations were modified by child sex and maternal education. The overall PFAS mixture was inversely associated with ASD [OR = 0.76 (95% CI: 0.64, 0.90)] as well as the carboxylate mixture [OR = 0.79 (95% CI: 0.68, 0.93)] and the sulfonate mixture [OR = 0.84 (95% CI: 0.73, 0.96)]. CONCLUSION Prenatal exposure to PFOA was associated with increased risk of ASD and ADHD in children. For some PFAS, as well as their mixtures, there were inverse associations with ASD and/or ADHD. However, the inverse associations reported herein should not be interpreted as protective effects, but rather that there could be some unresolved confounding for these relationships. The epidemiologic literature linking PFAS exposures with neurodevelopmental outcomes is still inconclusive, suggesting the need for more research to elucidate the neurotoxicological potential of PFAS during early development.
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Affiliation(s)
- Thea S Skogheim
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Kjell Vegard F Weyde
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Heidi Aase
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Stephanie M Engel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7435, Chapel Hill, NC, 27599-7435, USA
| | - Pål Surén
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Merete G Øie
- Department of Psychology, University of Oslo, PO Box 1094, Blindern, N-0317, Oslo, Norway
| | - Guido Biele
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171, Blindern, N-0318, Oslo, Norway
| | - Anne Lise Brantsæter
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Line S Haug
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Azemira Sabaredzovic
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Bonnie Auyeung
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK; Department of Psychiatry, Autism Research Centre, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK
| | - Gro D Villanger
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213, Oslo, Norway
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Lasmono A, Ismail RI, Kaligis F, Minayati K, Wiguna T. Empathy Quotient and Systemizing Quotient in Elementary School Children with and without Attention-Deficit/Hyperactivity Disorder: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9231. [PMID: 34501828 PMCID: PMC8431277 DOI: 10.3390/ijerph18179231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/14/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
This study compares the Empathy Quotient (EQ) and Systemizing Quotient (SQ) scores of elementary school children with and without ADHD. The study also examined their brain types and, because sex plays a big role in empathy and systemizing ability, compared the results of the boys and girls. This cross-sectional study involved 122 participants, including 61 parents of children with ADHD and 61 parents of children without ADHD. The EQ, SQ and brain types were obtained using the Empathy and Systemizing Quotient in children (EQ-/SQ-C), validated in the Indonesian language. Data was analyzed using the SPSS program version 20 for Windows, with a p-value < 0.05 for statistical significance. There was a significant difference in EQ between children with and without ADHD, the score being lower in children with ADHD. There was also a significant difference in SQ among girls with and without ADHD, but not in boys. The brain types in both groups were not significantly different. The results indicate that children with ADHD have a lower ability to empathize compared to children without ADHD. Systemizing abilities were significantly lower in girls with ADHD than in girls without. Therefore, an intervention program focusing on improving empathy and systemizing ability needs to be developed in the community.
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Affiliation(s)
- Agnes Lasmono
- Department of Psychiatry, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia;
| | - Raden Irawati Ismail
- Child and Adolescent Psychiatry Division, Department of Psychiatry, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia; (R.I.I.); (F.K.); (K.M.)
| | - Fransiska Kaligis
- Child and Adolescent Psychiatry Division, Department of Psychiatry, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia; (R.I.I.); (F.K.); (K.M.)
| | - Kusuma Minayati
- Child and Adolescent Psychiatry Division, Department of Psychiatry, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia; (R.I.I.); (F.K.); (K.M.)
| | - Tjhin Wiguna
- Child and Adolescent Psychiatry Division, Department of Psychiatry, Faculty of Medicine, Dr. Cipto Mangunkusumo General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia; (R.I.I.); (F.K.); (K.M.)
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Watkins DJ, Meeker JD, Tamayo-Ortiz M, Sánchez BN, Schnaas L, Peterson KE, Téllez-Rojo MM. Gestational and peripubertal phthalate exposure in relation to attention performance in childhood and adolescence. ENVIRONMENTAL RESEARCH 2021; 196:110911. [PMID: 33640497 PMCID: PMC8119354 DOI: 10.1016/j.envres.2021.110911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
The prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) has been increasing. Research suggests that exposure to endocrine disrupting chemicals such as phthalates may play a role, but studies of in utero phthalate exposure and ADHD-related symptoms beyond early childhood are limited. We investigated associations between measures of in utero phthalate exposure and ADHD symptoms, such as inattention and impulsivity, in childhood (age 6-11 years, n = 221) and in adolescence (age 9-18 years, n = 200), as well as cross-sectional relationships between phthalate exposure and ADHD symptoms in adolescence (n = 491) among participants in the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) cohort. Women provided urine samples up to three times during pregnancy and adolescents provided a urine sample at 9-18 years of age for phthalate metabolite measurement. We administered the Conners' Continuous Performance Test (CPT) when children were age 6-11 years and again at 9-18 years of age. We used multivariable linear regression to examine associations between the geometric mean of phthalate metabolite levels across pregnancy and CPT scores in childhood or adolescence separately, adjusting for age, years schooling (at 9-18 only), maternal education, and specific gravity. Although average in utero phthalate concentrations were not associated with CPT scores in childhood, interquartile range (IQR) increases of in utero MBzP, MCPP, and MBP were associated with 4.2%, 4.7%, and 4.5% (p < 0.05) higher Omissions scores in adolescence, respectively, indicating higher inattention. In utero MiBP levels were also associated with higher Inter-Stimulus Interval (ISI) and Variability scores (5.4% and 5.5% per IQR, p < 0.05) in adolescence. In addition, urinary DEHP metabolite levels during adolescence were cross-sectionally associated with poorer scores on several CPT indices indicating greater inattention. These findings suggest that in utero phthalate exposure may have adverse effects on attention, but these effects may not appear until adolescence, a period of extensive neurodevelopment. Future research investigating the long-term effects of in utero phthalate exposure on attention and ADHD in adolescence, as well as identification of potential mechanisms involved, is needed.
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Affiliation(s)
- Deborah J Watkins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - John D Meeker
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Marcela Tamayo-Ortiz
- National Council of Science and Technology, National Institute of Public Health, Mexico City, Mexico
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Lourdes Schnaas
- National Institute of Perinatology, ABC Hospital, Mexico City, Mexico
| | - Karen E Peterson
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Martha María Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Işık Ü, Kılıç F, Aktepe E, Tanrıtanır B. The Relationship between Second-to-Fourth Digit Ratios, Attention-Deficit/Hyperactivity Disorder Symptoms, Aggression, and Intelligence Levels in Boys with Attention-Deficit/Hyperactivity Disorder. Psychiatry Investig 2020; 17:596-602. [PMID: 32517417 PMCID: PMC7324736 DOI: 10.30773/pi.2020.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/15/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Observations of sex differences have led some scientists to doubt whether the neuroendocrine system is involved in attentiondeficit/hyperactivity disorder (ADHD) etiology. One of the interesting study subjects in this context is prenatal steroid hormone exposure. The aim of the present study was to replicate and extend previous work by addressing two research questions: 1) Are second-tofourth digit (2D:4D) ratios lower in ADHD than in controls? 2) Is there a correlation between 2D:4D ratios and symptoms of ADHD, aggression and intelligence scores in boys with ADHD? METHODS The study included 100 treatment-naive male children diagnosed with ADHD and 55 healthy male children. We measured the ratios of 2D:4D and administered a Wechsler Intelligence Scale for Children-Revised to assess IQ scores, as well as behavioral rating scales, in children with ADHD and comparison individuals. RESULTS We observed lower 2D:4D ratios in the right hand in ADHD in comparison to the control group. The left-hand ratios of 2D:4D, however, did not differ between ADHD and control groups. There were negative correlations between the left-hand 2D:4D ratios and the hyperactivity scores. However, no significant correlation was detected between right-hand 2D:4D ratios and the psychological questionnaire scores. CONCLUSION These results provide further evidence that fetal androgen exposure may contribute to the pathophysiology of ADHD, at least in boys.
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Affiliation(s)
- Ümit Işık
- Department of Child and Adolescent Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Faruk Kılıç
- Department of Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Evrim Aktepe
- Department of Child and Adolescent Psychiatry, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
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9
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Wernicke J, Zabel JT, Zhang Y, Becker B, Montag C. Association between tendencies for attention-deficit/hyperactivity disorder (ADHD) and the 2D:4D digit ratio: a cross-cultural replication in Germany and China. Early Hum Dev 2020; 143:104943. [PMID: 32126477 DOI: 10.1016/j.earlhumdev.2019.104943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
Prenatal testosterone is considered to be a possible factor contributing to the development of attention-deficit/hyperactivity disorder (ADHD) symptomatology, but findings regarding the connection between individual variations in prenatal testosterone exposure as (indirectly) indexed by the second-to-fourth digit (2D:4D) ratio and ADHD remain inconsistent. To clarify the inconsistent findings and to facilitate generalization on the association between subclinical variations in ADHD tendencies and lower 2D:4D ratios the current study applied a cross-cultural replication approach employing independent healthy adult cohorts from Germany and China. Samples from Germany and China were matched for gender and age (in each sample nmales = 96, nfemales = 96; ageGermany: M = 21.47, SD = 2.55; ageChina: M = 21.36, SD = 2.28). All participants filled in the Adult ADHD Self-Report Scale Symptom Checklist (ASRS) and provided hand scans to measure 2D:4D ratios. The German sample had significantly higher 2D:4D ratios than the Chinese sample but in both samples males had significantly lower 2D:4D ratios than females. The hypothesised negative association between 2D:4D ratios and ADHD tendencies was observed on a descriptive level in German and Chinese males and with one exception in Chinese females. But only in German males correlations gained significance (range: r = -0.198 to r = -0.177). The observed effect sizes are in line with former research that was conducted in samples from different cultures. In future research on the connection between testosterone and ADHD not only prenatal but also postnatal testosterone as well as possible moderators like childhood maltreatment should be taken into account.
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Affiliation(s)
- Jennifer Wernicke
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany.
| | - Julia Tamara Zabel
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Yingying Zhang
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany; The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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10
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Cesta CE, Öberg AS, Ibrahimson A, Yusuf I, Larsson H, Almqvist C, D'Onofrio BM, Bulik CM, Fernández de la Cruz L, Mataix-Cols D, Landén M, Rosenqvist MA. Maternal polycystic ovary syndrome and risk of neuropsychiatric disorders in offspring: prenatal androgen exposure or genetic confounding? Psychol Med 2020; 50:616-624. [PMID: 30857571 PMCID: PMC7093321 DOI: 10.1017/s0033291719000424] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/09/2019] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Maternal polycystic ovary syndrome (PCOS) has been proposed as a model for investigating the role of prenatal androgen exposure in the development of neuropsychiatric disorders. However, women with PCOS are at higher risk of developing psychiatric conditions and previous studies are likely confounded by genetic influences. METHODS A Swedish nationwide register-based cohort study was conducted to disentangle the influence of prenatal androgen exposure from familial confounding in the association between maternal PCOS and offspring attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and Tourette's disorder and chronic tic disorders (TD/CTD). PCOS-exposed offspring (n = 21 280) were compared with unrelated PCOS-unexposed offspring (n = 200 816) and PCOS-unexposed cousins (n = 17 295). Associations were estimated with stratified Cox regression models. RESULTS PCOS-exposed offspring had increased risk of being diagnosed with ADHD, ASD, and TD/CTD compared with unrelated PCOS-unexposed offspring. Associations were stronger in girls for ADHD and ASD but not TD/CTD [ADHD: adjusted hazard ratio (aHR) = 1.61 (95% confidence interval (CI) 1.31-1.99), ASD: aHR = 2.02 (95% CI 1.45-2.82)] than boys [ADHD: aHR = 1.37 (95% CI 1.19-1.57), ASD: aHR = 1.46 (95% CI 1.21-1.76)]. For ADHD and ASD, aHRs for girls were stronger when compared with PCOS-unexposed cousins, but slightly attenuated for boys. CONCLUSIONS Estimates were similar when accounting for familial confounding (i.e. genetics and environmental factors shared by cousins) and stronger in girls for ADHD and ASD, potentially indicating a differential influence of prenatal androgen exposure v. genetic factors. These results strengthen evidence for a potential causal influence of prenatal androgen exposure on the development of male-predominant neuropsychiatric disorders in female offspring of women with PCOS.
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Affiliation(s)
- Carolyn E. Cesta
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna S. Öberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abraham Ibrahimson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ikram Yusuf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Brian M. D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mina A. Rosenqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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11
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Wilson HA, Martin ER, Howes C, Wasson CS, Newman AE, Choleris E, MacLusky NJ. Low dose prenatal testosterone exposure decreases the corticosterone response to stress in adult male, but not female, mice. Brain Res 2020; 1729:146613. [DOI: 10.1016/j.brainres.2019.146613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
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12
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Mitochondrial-associated protein biomarkers in patients with attention-deficit/hyperactivity disorder. Mitochondrion 2019; 49:83-88. [DOI: 10.1016/j.mito.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/01/2019] [Accepted: 07/22/2019] [Indexed: 12/27/2022]
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13
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Origins and Impact of Psychological Traits in Polycystic Ovary Syndrome. Med Sci (Basel) 2019; 7:medsci7080086. [PMID: 31387252 PMCID: PMC6723772 DOI: 10.3390/medsci7080086] [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: 06/03/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
Women with polycystic ovary syndrome (PCOS) exhibit compromised psychiatric health. Independent of obesity, women with PCOS are more susceptible to have anxiety and depression diagnoses and other neuropsychiatric disorders. During pregnancy women with PCOS display high circulating androgen levels that may cause prenatal androgen exposure affecting the growing fetus and increasing the risk of mood disorders in offspring. Increasing evidence supports a non-genetic, maternal contribution to the development of PCOS and anxiety disorders in the next generation. Prenatal androgenized rodent models reflecting the anxiety-like phenotype of PCOS in the offspring, found evidence for the altered placenta and androgen receptor function in the amygdala, together with changes in the expression of genes associated with emotional regulation and steroid receptors in the amygdala and hippocampus. These findings defined a previously unknown mechanism that may be critical in understanding how maternal androgen excess can increase the risk of developing anxiety disorders in daughters and partly in sons of PCOS mothers. Maternal obesity is another common feature of PCOS causing an unfavorable intrauterine environment which may contribute to psychiatric problems in the offspring. Whether environmental factors such as prenatal androgen exposure and obesity increase the offspring's susceptibility to develop psychiatric ill-health will be discussed.
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14
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Yuksel T, Sizer E, Durak H. 2D:4D ratios as an indicator of intrauterine androgen exposure in children who stutter. Early Hum Dev 2019; 135:27-31. [PMID: 31228858 DOI: 10.1016/j.earlhumdev.2019.06.003] [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] [Received: 02/13/2019] [Revised: 06/01/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
Abstract
AIM We aimed to explore whether there is a relationship between stuttering and digit ratio (2D:4D), which is thought to be a marker of prenatal testosterone exposure. METHODS We evaluated a total of 90 children who stutter (CWS; n = 40 mild-to-moderate and n = 50 severe stutters) and 40 healthy peers (CWNS) as controls. We used the Clinical Global Impression-Severity (CGIS) scale to measure the severity of stuttering. We measured the lengths of index finger (2D) and ring finger (4D) of both hands directly and divided to calculate 2D:4D ratio. The difference between the right and the left hand 2D:4D ratio (DR-L) was also calculated. RESULT Significant difference was found in right 2D:4D and the mean DR-L between the CWS and CWNS groups. Right 2D:4D was significantly lower in stuttering boys than in control boys, and in stuttering girls than control girls. Also, DR-L was significantly lower in stuttering boys than control boys. In ANOVA, there were significant differences between the mild-to-moderate, severe stuttering and control groups in terms of right 2D:4D and DR-L. Right hand 2D:4D and DR-L decreased from controls to severe stutterers. CONCLUSION Our results suggest that lower right 2D:4D and DR-L were related to the presence and severity of stuttering in children, i.e. CWS had lower 2D:4D and DR-L than CWNS. Further large-scale prospective studies are needed to clarify the reliability of 2D:4D ratio as an indicator of fetal sex hormone exposure level and its relation with the presence and severity of stuttering in children.
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Affiliation(s)
- Tugba Yuksel
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey.
| | - Esra Sizer
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey
| | - Hasan Durak
- Dicle University School of Medicine, Department of Child and Adolescent Psychiatry, Diyarbakir, Turkey
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15
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Nguyen TV, Jutras B, Monnier P, Muckle G, Velez M, Arbuckle TE, Saint-Amour D. Prenatal masculinization of the auditory system in infants: The MIREC-ID study. Psychoneuroendocrinology 2019; 104:33-41. [PMID: 30784903 DOI: 10.1016/j.psyneuen.2019.02.015] [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] [Received: 11/12/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 11/30/2022]
Abstract
Sex differences in inner-ear function are detectable in infants, notably through the measurement of otoacoustic emissions (OAEs). Prevailing theories posit that prenatal exposure to high levels of androgens in boys may weaken OAEs, and that this phenomenon may predominantly affect the right ear/left hemisphere (Geschwind-Galaburda (GG) hypothesis). Yet, actual tests of these models have been difficult to implement in humans. Here we examined the relationship between markers of fetal androgen exposure collected at birth (anogenital distances (AGD); penile length/width, areolar/scrotal/vulvar pigmentation) and at 6 months of age (2nd to 4th digit ratio (2D:4D)) with two types of OAEs, click-evoked OAEs (CEOAEs) and distortion-product OAEs (DPOAEs) (n = 49; 25 boys; 24 girls). We found that, in boys, scrotal pigmentation was inversely associated with the amplitude and reproducibility of CEOAEs in the right ear at 4 kHz, with trends also present in the same ear for mean CEOAE amplitude and CEOAE amplitude at 2 kHz. Penile length was inversely associated with the mean amplitude of DPOAEs in both the right and left ears, as well as with DPOAE amplitude in the right ear at 2 kHz and the reproducibility of CEOAEs in the left ear at 2.8 kHz. Finally, AGD-scrotum in boys was positively associated in boys with the amplitude of DPOAEs in the left ear at 2.8 kHz. Unexpectedly, there were no sex differences in the amplitude or reproducibility of OAEs, nor, in girls, any associations between androgenic markers and auditory function. Nonetheless, these findings, reported for the first time in a sample of human infants, support both the prenatal-androgen-exposure and GG models as explanations for the masculinization of auditory function in male infants.
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Affiliation(s)
- Tuong-Vi Nguyen
- Department of Psychiatry, McGill University, Royal Victoria Hospital, Montreal, Canada; Department of Obstetrics & Gynecology McGill University, Royal Victoria Hospital, Montreal, Canada; Research Institute of the McGill University Health Centre [RI-MUHC), Royal Victoria Hospital, Montreal, Canada.
| | - Benoît Jutras
- Research Center, CHU Sainte-Justine, Montreal, Canada; School of Speech Language Pathology and Audiology, Université de Montréal, Montréal, Canada
| | - Patricia Monnier
- Department of Obstetrics & Gynecology McGill University, Royal Victoria Hospital, Montreal, Canada; Research Institute of the McGill University Health Centre [RI-MUHC), Royal Victoria Hospital, Montreal, Canada
| | - Gina Muckle
- School of Psychology, Laval University, Quebec CHU Research Centre, Quebec City, Canada
| | - Maria Velez
- Department of Obstetrics & Gynecology, Queen's University, Kingston, Ontario, Canada
| | - Tye E Arbuckle
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa Canada
| | - Dave Saint-Amour
- Research Center, CHU Sainte-Justine, Montreal, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Canada
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16
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Wang LJ, Lee SY, Chou MC, Lee MJ, Chou WJ. Dehydroepiandrosterone sulfate, free testosterone, and sex hormone-binding globulin on susceptibility to attention-deficit/hyperactivity disorder. Psychoneuroendocrinology 2019; 103:212-218. [PMID: 30711898 DOI: 10.1016/j.psyneuen.2019.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/03/2019] [Accepted: 01/21/2019] [Indexed: 02/07/2023]
Abstract
The neuroendocrine system may affect the pathophysiology of gender differences in attention deficit/hyperactivity disorder (ADHD). This study examines whether the relationships among dehydroepiandrosterone sulfate (DHEA-S), free testosterone, or sex hormone-binding globulin (SHBG) and ADHD presentations exhibit gender differences. A total of 113 boys and 35 girls with ADHD (all drug naïve) and 46 and 26 healthy control boys and girls, respectively, were recruited. Blood samples were obtained to measure the serum levels of DHEA-S, free testosterone, and SHBG in each child. The Swanson, Nolan, and Pelham Scale for ADHD Version IV (SNAP-IV) was used to evaluate behavioral symptoms and the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and the Conners' Continuous Performance Test (CPT) were utilized to assess neurocognitive functions. Patients with ADHD had lower DHEA-S levels than male and female healthy control subjects, and no significant differences were observed in free testosterone and SHBG levels between the patients and the controls. DHEA-S levels were negatively correlated with children's impulsivity performance in the CPT. SHBG levels were negatively correlated with ADHD behavior symptoms among boys. Free testosterone levels were not significantly correlated with either ADHD clinical symptoms or neuropsychological functions. We propose that DHEA-S serves as a potential biomarker of ADHD and is consistently involved in the pathogenesis of ADHD in both boys and girls. SHBG may be involved in behaviors associated with ADHD in boys. Additional studies with basic scientific measures are warranted to elucidate the relationship between androgen hormones and clinical presentations of ADHD.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Miao-Chun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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17
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Roberts B, Eisenlohr-Moul T, Martel MM. Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology 2018; 88:105-114. [PMID: 29197795 PMCID: PMC5803442 DOI: 10.1016/j.psyneuen.2017.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
Abstract
Although Attention-Deficit/Hyperactivity Disorder shows (ADHD) male predominance, females are significantly impaired and exhibit additional comorbid disorders during adolescence. However, no empirical work has examined the influence of cyclical fluctuating steroids on ADHD symptoms in women. The present study examined estradiol (E2), progesterone (P4), and testosterone (T) associations with ADHD symptoms across the menstrual cycle in regularly-cycling young women (N=32), examining trait impulsivity as a moderator. Women completed a baseline measure of trait impulsivity, provided saliva samples each morning, and completed an ADHD symptom checklist every evening for 35days. Results indicated decreased levels of E2 in the context of increased levels of either P4 or T was associated with higher ADHD symptoms on the following day, particularly for those with high trait impulsivity. Phase analyses suggested both an early follicular and early luteal, or post-ovulatory, increase in ADHD symptoms. Therefore, ADHD symptoms may change across the menstrual cycle in response to endogenous steroid changes.
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Affiliation(s)
- Bethan Roberts
- Department of Psychology, University of Kentucky, Lexington, KY 40506, United States.
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of North Carolina at Chapel Hill, 2218 Nelson Highway, Suite 3, Chapel Hill, NC 27517, United States.
| | - Michelle M Martel
- Department of Psychology, University of Kentucky, 207C Kastle Hall, Lexington, KY 40506, United States.
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