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Published in: European Child & Adolescent Psychiatry 2/2015

01-02-2015 | Original Contribution

The Pressure–Activation–Stress scale in relation to ADHD and cortisol

Authors: J. Isaksson, K. W. Nilsson, F. Lindblad

Published in: European Child & Adolescent Psychiatry | Issue 2/2015

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Abstract

The Pressure–Activation–Stress (PAS) scale is a self-report questionnaire for children concerning perceived stress. To explore behavioral and physiological correlates, we investigated if scores discriminate between a group prone to perceive high levels of stress [children with attention-deficit/hyperactivity disorder (ADHD)] and a healthy school sample, and if they are associated with diurnal cortisol levels. The PAS scale was filled in at home by children (11–17 years) with clinically confirmed ADHD (n = 102) and non-affected comparisons (n = 146). Saliva samples were collected four times during a regular school day for radioimmunoassay analysis of cortisol. Subtypes and severity of ADHD symptoms were determined using parental rating scales. Children with ADHD scored higher on the PAS scale than a school sample. The PAS scores were similar over ages in the ADHD group while they increased with age in the healthy group. Female sex was associated with higher stress in both groups but no gender interaction was found. No association was found between PAS scores and cortisol levels in neither group. Children in the ADHD group had a lower ratio of cortisol levels/perceived stress on all sampling occasions, built up both by the higher PAS scores and the lower cortisol levels in children with ADHD. The higher PAS scores in children with ADHD support the validity of the scale. The lack of association between PAS scores and diurnal cortisol levels is intriguing and illustrates the complexity of the stress concept. Stress-related fragility seems to accompany ADHD during childhood.
Literature
1.
go back to reference Lindblad F, Backman L, Akerstedt T (2008) Immigrant girls perceive less stress. Acta Paediatr 97:889–893PubMedCrossRef Lindblad F, Backman L, Akerstedt T (2008) Immigrant girls perceive less stress. Acta Paediatr 97:889–893PubMedCrossRef
2.
go back to reference Ursin H, Eriksen HR (2004) The cognitive activation theory of stress. Psychoneuroendocrinology 29:567–592PubMedCrossRef Ursin H, Eriksen HR (2004) The cognitive activation theory of stress. Psychoneuroendocrinology 29:567–592PubMedCrossRef
3.
go back to reference Eriksen HR, Olff M, Murison R, Ursin H (1999) The time dimension in stress responses: relevance for survival and health. Psychiatry Res 85:39–50PubMedCrossRef Eriksen HR, Olff M, Murison R, Ursin H (1999) The time dimension in stress responses: relevance for survival and health. Psychiatry Res 85:39–50PubMedCrossRef
4.
go back to reference Kristenson M, Garvin P, Lundberg U (2012) The role of saliva cortisol measurement in health and disease. Bentham e books, London Kristenson M, Garvin P, Lundberg U (2012) The role of saliva cortisol measurement in health and disease. Bentham e books, London
5.
go back to reference Juster RP, McEwen BS, Lupien SJ (2010) Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 35:2–16PubMedCrossRef Juster RP, McEwen BS, Lupien SJ (2010) Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 35:2–16PubMedCrossRef
6.
go back to reference Karatsoreos IN, McEwen BS (2011) Psychobiological allostasis: resistance, resilience and vulnerability. Trends Cognit Sci 15:576–584CrossRef Karatsoreos IN, McEwen BS (2011) Psychobiological allostasis: resistance, resilience and vulnerability. Trends Cognit Sci 15:576–584CrossRef
7.
go back to reference Lackschewitz H, Huther G, Kroner-Herwig B (2008) Physiological and psychological stress responses in adults with attention-deficit/hyperactivity disorder (ADHD). Psychoneuroendocrinology 33:612–624PubMedCrossRef Lackschewitz H, Huther G, Kroner-Herwig B (2008) Physiological and psychological stress responses in adults with attention-deficit/hyperactivity disorder (ADHD). Psychoneuroendocrinology 33:612–624PubMedCrossRef
8.
go back to reference Hirvikoski T, Lindholm T, Nordenstrom A, Nordstrom AL, Lajic S (2009) High self-perceived stress and many stressors, but normal diurnal cortisol rhythm, in adults with ADHD (attention-deficit/hyperactivity disorder). Horm Behav 55:418–424PubMedCrossRef Hirvikoski T, Lindholm T, Nordenstrom A, Nordstrom AL, Lajic S (2009) High self-perceived stress and many stressors, but normal diurnal cortisol rhythm, in adults with ADHD (attention-deficit/hyperactivity disorder). Horm Behav 55:418–424PubMedCrossRef
9.
go back to reference Bernardi S, Faraone SV, Cortese S, Kerrige BT, Pallanti S, Wang S, Blanco C (2012) The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med 42:875–887PubMedCentralPubMedCrossRef Bernardi S, Faraone SV, Cortese S, Kerrige BT, Pallanti S, Wang S, Blanco C (2012) The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med 42:875–887PubMedCentralPubMedCrossRef
10.
go back to reference Combs MA, Canu WH, Broman-Fulks JJ, Rocheleau CA, Nieman DC (2012) Perceived stress and ADHD symptoms in adults. J Atten Disord (Epub ahead of print) Combs MA, Canu WH, Broman-Fulks JJ, Rocheleau CA, Nieman DC (2012) Perceived stress and ADHD symptoms in adults. J Atten Disord (Epub ahead of print)
11.
go back to reference Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. An overview. Ann N Y Acad Sci 931:1–16PubMedCrossRef Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. An overview. Ann N Y Acad Sci 931:1–16PubMedCrossRef
12.
go back to reference Riley AW, Spiel G, Coghill D, Döpfmer M, Falissard B, Lorenzo MJ, Preuss U, Ralston SJ, Group AS (2006) Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. Eur Child Adolesc Psychiatry 15(Suppl 1):138–145 Riley AW, Spiel G, Coghill D, Döpfmer M, Falissard B, Lorenzo MJ, Preuss U, Ralston SJ, Group AS (2006) Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. Eur Child Adolesc Psychiatry 15(Suppl 1):138–145
13.
go back to reference Gaub M, Carlson CL (1997) Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. J Abnorm Child Psychol 25:103–111PubMedCrossRef Gaub M, Carlson CL (1997) Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. J Abnorm Child Psychol 25:103–111PubMedCrossRef
14.
go back to reference Kaiser NM, McBurnett K, Pfiffner LJ (2011) Child ADHD severity and positive and negative parenting as predictors of child social functioning: evaluation of three theoretical models. J Atten Disord 15:193–203PubMedCrossRef Kaiser NM, McBurnett K, Pfiffner LJ (2011) Child ADHD severity and positive and negative parenting as predictors of child social functioning: evaluation of three theoretical models. J Atten Disord 15:193–203PubMedCrossRef
15.
go back to reference Hoza B, Mrug S, Gerdes AC, Hinshaw SP, Bukowski WM, Gold JA, Kraemer HC, Pelham WE Jr, Wigal T, Arnold LE (2005) What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol 73:411–423PubMedCrossRef Hoza B, Mrug S, Gerdes AC, Hinshaw SP, Bukowski WM, Gold JA, Kraemer HC, Pelham WE Jr, Wigal T, Arnold LE (2005) What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? J Consult Clin Psychol 73:411–423PubMedCrossRef
16.
go back to reference Nijmeijer JS, Minderaa RB, Buitelaar JK, Mulligan A, Hartman CA, Hoekstra PJ (2008) Attention-deficit/hyperactivity disorder and social dysfunctioning. Clin Psychol Rev 28:692–708PubMedCrossRef Nijmeijer JS, Minderaa RB, Buitelaar JK, Mulligan A, Hartman CA, Hoekstra PJ (2008) Attention-deficit/hyperactivity disorder and social dysfunctioning. Clin Psychol Rev 28:692–708PubMedCrossRef
17.
go back to reference Loe IM, Feldman HM (2007) Academic and educational outcomes of children with ADHD. J Pediatr Psychol 32:643–654PubMedCrossRef Loe IM, Feldman HM (2007) Academic and educational outcomes of children with ADHD. J Pediatr Psychol 32:643–654PubMedCrossRef
18.
go back to reference Ek U, Westerlund J, Holmberg K, Fernell E (2011) Academic performance of adolescents with ADHD and other behavioural and learning problems––a population-based longitudinal study. Acta Paediatr 100:402–406PubMedCrossRef Ek U, Westerlund J, Holmberg K, Fernell E (2011) Academic performance of adolescents with ADHD and other behavioural and learning problems––a population-based longitudinal study. Acta Paediatr 100:402–406PubMedCrossRef
19.
go back to reference King JA, Barkley RA, Barrett S (1998) Attention-deficit hyperactivity disorder and the stress response. Biol Psychiatry 44:72–74PubMedCrossRef King JA, Barkley RA, Barrett S (1998) Attention-deficit hyperactivity disorder and the stress response. Biol Psychiatry 44:72–74PubMedCrossRef
20.
go back to reference Blomqvist M, Holmberg K, Lindblad F, Fernell E, Ek U, Dahllof G (2007) Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder. Eur J Oral Sci 115:1–6PubMedCrossRef Blomqvist M, Holmberg K, Lindblad F, Fernell E, Ek U, Dahllof G (2007) Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder. Eur J Oral Sci 115:1–6PubMedCrossRef
21.
go back to reference Ma L, Chen YH, Chen H, Liu YY, Wang YX (2011) The function of hypothalamus-pituitary-adrenal axis in children with ADHD. Brain Res 1368:159–162PubMedCrossRef Ma L, Chen YH, Chen H, Liu YY, Wang YX (2011) The function of hypothalamus-pituitary-adrenal axis in children with ADHD. Brain Res 1368:159–162PubMedCrossRef
22.
go back to reference Isaksson J, Nilsson KW, Nyberg F, Hogmark A, Lindblad F (2012) Cortisol levels in children with attention-deficit/hyperactivity disorder. J Psychiatr Res 46:1398–1405PubMedCrossRef Isaksson J, Nilsson KW, Nyberg F, Hogmark A, Lindblad F (2012) Cortisol levels in children with attention-deficit/hyperactivity disorder. J Psychiatr Res 46:1398–1405PubMedCrossRef
23.
go back to reference Wiklund M, Malmgren-Olsson EB, Ohman A, Bergstrom E, Fjellman-Wiklund A (2012) Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender––a cross-sectional school study in Northern Sweden. BMC Public Health 12:993PubMedCentralPubMedCrossRef Wiklund M, Malmgren-Olsson EB, Ohman A, Bergstrom E, Fjellman-Wiklund A (2012) Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender––a cross-sectional school study in Northern Sweden. BMC Public Health 12:993PubMedCentralPubMedCrossRef
24.
go back to reference Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB, Clevenger W, Davies M, Elliott GR, Greenhill LL, Hechtman L, Hoza B, Jensen PS, March JS, Newcorn JH, Owens EB, Pelham WE, Schiller E, Severe JB, Simpson S, Vitiello B, Wells K, Wigal T, Wu M (2001) Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 40:168–179PubMedCrossRef Swanson JM, Kraemer HC, Hinshaw SP, Arnold LE, Conners CK, Abikoff HB, Clevenger W, Davies M, Elliott GR, Greenhill LL, Hechtman L, Hoza B, Jensen PS, March JS, Newcorn JH, Owens EB, Pelham WE, Schiller E, Severe JB, Simpson S, Vitiello B, Wells K, Wigal T, Wu M (2001) Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry 40:168–179PubMedCrossRef
25.
go back to reference Bussing R, Fernandez M, Harwood M, Wei H, Garwan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15:317–328PubMedCentralPubMedCrossRef Bussing R, Fernandez M, Harwood M, Wei H, Garwan CW, Eyberg SM, Swanson JM (2008) Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment 15:317–328PubMedCentralPubMedCrossRef
26.
go back to reference Hansen AM, Garde AH, Christensen JM, Eller NH, Netterstrom B (2003) Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark. Scand J Clin Lab Invest 63:303–310PubMedCrossRef Hansen AM, Garde AH, Christensen JM, Eller NH, Netterstrom B (2003) Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark. Scand J Clin Lab Invest 63:303–310PubMedCrossRef
27.
go back to reference Clow A, Hucklebridge F, Thorn L (2010) The cortisol awakening response in context. International Review of Neurobiology, Elsevier Inc, United States, pp 153–75 Clow A, Hucklebridge F, Thorn L (2010) The cortisol awakening response in context. International Review of Neurobiology, Elsevier Inc, United States, pp 153–75
28.
go back to reference Schraml K, Perski A, Grossi G, Simonsson-Sarnecki M (2011) Stress symptoms among adolescents: the role of subjective psychosocial conditions, lifestyle, and self-esteem. J Adolesc 34:987–996PubMedCrossRef Schraml K, Perski A, Grossi G, Simonsson-Sarnecki M (2011) Stress symptoms among adolescents: the role of subjective psychosocial conditions, lifestyle, and self-esteem. J Adolesc 34:987–996PubMedCrossRef
29.
go back to reference Friberg P, Hagquist C, Osika W (2012) Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time. BMJ open 2:e000681PubMedCrossRef Friberg P, Hagquist C, Osika W (2012) Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time. BMJ open 2:e000681PubMedCrossRef
30.
go back to reference Rucklidge JJ, Tannock R (2001) Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J Am Acad Child Adolesc Psychiatry 40:530–540PubMedCrossRef Rucklidge JJ, Tannock R (2001) Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J Am Acad Child Adolesc Psychiatry 40:530–540PubMedCrossRef
31.
go back to reference Rucklidge JJ (2008) Gender differences in ADHD: implications for psychosocial treatments. Expert Rev Neurother 8:643–655PubMedCrossRef Rucklidge JJ (2008) Gender differences in ADHD: implications for psychosocial treatments. Expert Rev Neurother 8:643–655PubMedCrossRef
32.
go back to reference Johnson JH, Reader SK (2002) Assessing stress in families of children with ADHD: preliminary development of the disruptive behavior stress inventory. J Clin Psychol Med Sett 9:51–62CrossRef Johnson JH, Reader SK (2002) Assessing stress in families of children with ADHD: preliminary development of the disruptive behavior stress inventory. J Clin Psychol Med Sett 9:51–62CrossRef
33.
go back to reference Osika W, Friberg P, Wahrborg P (2007) A new short self-rating questionnaire to assess stress in children. Int J Behav Med 14:108–117PubMedCrossRef Osika W, Friberg P, Wahrborg P (2007) A new short self-rating questionnaire to assess stress in children. Int J Behav Med 14:108–117PubMedCrossRef
34.
go back to reference Halford C, Jonsdottir IH, Eek F (2012) Perceived stress, psychological resources and salivary cortisol. In: Kristenson M, Garvin P, Lundberg U (eds) The role of saliva cortisol measurement in health and disease. Bentham e books, London Halford C, Jonsdottir IH, Eek F (2012) Perceived stress, psychological resources and salivary cortisol. In: Kristenson M, Garvin P, Lundberg U (eds) The role of saliva cortisol measurement in health and disease. Bentham e books, London
35.
go back to reference Heim C, Ehlert U, Hellhammer DH (2000) The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 25:1–35PubMedCrossRef Heim C, Ehlert U, Hellhammer DH (2000) The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 25:1–35PubMedCrossRef
36.
go back to reference Hellhammer DH, Wust S, Kudielka BM (2009) Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 34:163–171PubMedCrossRef Hellhammer DH, Wust S, Kudielka BM (2009) Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 34:163–171PubMedCrossRef
37.
go back to reference Quas JA, Hong M, Alkon A, Boyce WT (2000) Dissociations between psychobiologic reactivity and emotional expression in children. Dev Psychobiol 37:153–175PubMedCrossRef Quas JA, Hong M, Alkon A, Boyce WT (2000) Dissociations between psychobiologic reactivity and emotional expression in children. Dev Psychobiol 37:153–175PubMedCrossRef
38.
go back to reference Lindblad F, Lindahl M, Theorell T, von Scheele B (2006) Physiological stress reactions in 6th and 9th graders during test performance. Stress Health 22:189–195CrossRef Lindblad F, Lindahl M, Theorell T, von Scheele B (2006) Physiological stress reactions in 6th and 9th graders during test performance. Stress Health 22:189–195CrossRef
39.
go back to reference Pervanidou P, Chrousos GP (2010) Neuroendocrinology of post-traumatic stress disorder. Prog Brain Res 182:149–160PubMedCrossRef Pervanidou P, Chrousos GP (2010) Neuroendocrinology of post-traumatic stress disorder. Prog Brain Res 182:149–160PubMedCrossRef
40.
go back to reference Badanes LS, Watamura SE, Hankin BL (2011) Hypocortisolism as a potential marker of allostatic load in children: associations with family risk and internalizing disorders. Dev Psychopathol 23:881–896PubMedCentralPubMedCrossRef Badanes LS, Watamura SE, Hankin BL (2011) Hypocortisolism as a potential marker of allostatic load in children: associations with family risk and internalizing disorders. Dev Psychopathol 23:881–896PubMedCentralPubMedCrossRef
41.
go back to reference Het S, Schoofs D, Rohleder N, Wolf OT (2012) Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect. Psychosom Med 74:23–32PubMedCrossRef Het S, Schoofs D, Rohleder N, Wolf OT (2012) Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect. Psychosom Med 74:23–32PubMedCrossRef
42.
go back to reference Donev R, Thome J (2010) Inflammation: good or bad for ADHD? Atten Deficit Hyperact Disord 2:257–266CrossRef Donev R, Thome J (2010) Inflammation: good or bad for ADHD? Atten Deficit Hyperact Disord 2:257–266CrossRef
43.
go back to reference Benarroch EE (1993) The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc Mayo Clin 68:988–1001CrossRef Benarroch EE (1993) The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc Mayo Clin 68:988–1001CrossRef
44.
go back to reference Thayer JF, Ahs F, Fredrikson M, Sollers JJ 3rd, Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 36:747–756PubMedCrossRef Thayer JF, Ahs F, Fredrikson M, Sollers JJ 3rd, Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 36:747–756PubMedCrossRef
45.
go back to reference Beauchaine T (2001) Vagal tone, development, and Gray’s motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Dev Psychopathol 13:183–214PubMedCrossRef Beauchaine T (2001) Vagal tone, development, and Gray’s motivational theory: toward an integrated model of autonomic nervous system functioning in psychopathology. Dev Psychopathol 13:183–214PubMedCrossRef
46.
go back to reference Musser ED, Galloway-Long HS, Frick PJ, Nigg JT (2013) Emotion regulation and heterogeneity in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 52(163–71):e2PubMed Musser ED, Galloway-Long HS, Frick PJ, Nigg JT (2013) Emotion regulation and heterogeneity in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 52(163–71):e2PubMed
47.
go back to reference Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396PubMedCrossRef Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396PubMedCrossRef
48.
go back to reference Schlotz W, Hellhammer J, Schulz P, Stone AA (2004) Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response. Psychosom Med 66:207–214PubMedCrossRef Schlotz W, Hellhammer J, Schulz P, Stone AA (2004) Perceived work overload and chronic worrying predict weekend-weekday differences in the cortisol awakening response. Psychosom Med 66:207–214PubMedCrossRef
Metadata
Title
The Pressure–Activation–Stress scale in relation to ADHD and cortisol
Authors
J. Isaksson
K. W. Nilsson
F. Lindblad
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry / Issue 2/2015
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-014-0544-9

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