Emotion Dysregulation and Sluggish Cognitive Tempo as Moderators of Cortisol Responsivity in Children with ADHD

Objectives Despite substantial theoretical and empirical work examining the relation between attention-deficit/hyperactivity disorder (ADHD) and cortisol response, mixed results across studies suggest there are potential moderators in this link that have been previously unexplored. Emotion dysregulation (ED) and sluggish cognitive tempo (SCT) commonly co-occur with ADHD, with one another, and have yet to be included together in investigations exploring this relation. Methods The current study examined the moderating effects of ED and SCT on the relation between symptoms of ADHD and cortisol response. Salivary cortisol response after participation in a novel social group was examined in 102 children (M-age = 8.75 years, 69.6% male), approximately half with ADHD. Results A significant three-way interaction of ADHD, ED, and SCT on cortisol response (p = .014) indicated the strongest association between ADHD and cortisol response when ED and SCT were low (p = .047), with children low in ADHD showing greater cortisol response in the presence of elevated ED (p = .033) or SCT (p = .021). Conclusions These findings point to a pattern of cortisol responding that is specific to ADHD symptomatology, possibly indicating attenuated hypothalamic-pituitary-adrenal axis activity, and demonstrate the effect of ED and SCT on social functioning. Other clinical implications based on the findings across different levels of ADHD, ED, and SCT symptoms are discussed. Future research should seek to explore the mechanisms underlying the different patterns of responding.