Low hair cortisol concentration and emerging attention-deficit/hyperactivity symptoms in preschool age

Previous research demonstrated hypoactivity of the HPA axis in children with attention-deficit/hyperactivity disorder (ADHD) or externalizing symptoms. We analyzed the predictive association between the long-term HPA axis activity and increasing symptoms of ADHD in the preschool period. The sample consisted of n=125 4-year-old children and their families (including n=64 children with elevated ADHD symptoms). ADHD symptoms were assessed by a structured clinical interview with the mother and by parent- and teacher-report questionnaires. The long-term HPA axis activity was assessed by the hair cortisol concentration (HCC) (over a 3-month period). After controlling for potential confounders, low HCC predicted an increase in ADHD symptoms between the age of 4 and 5 years. Exploration of gender effects revealed that cross-sectional and predictive associations were significant in boys but not in girls. Low HCC might thus be regarded as an early marker of a possibly gender-related developmental pathway to ADHD.