Sex and Cortisol Reactivity Moderate the Association Between Irritability and ADHD Symptoms in Early Childhood

• In Event: Poster Session 05
  In Poster Session: PS 05 Topic - Sex, Gender

Abstract

Background: Irritability is a transdiagnostic symptom of psychopathology and mood dysregulation (American Psychological Association, 2013; Brotman et al., 2017), as well as a sign of acute and chronic stress (Repetti & Wood, 1997; Yang et al., 2015), in children, adolescents, and adults. Furthermore, irritability in early childhood is predictive of later psychopathology (Dougherty et al., 2013, 2015; Stringaris et al., 2009). Numerous studies have shown a bidirectional association between psychopathology and stress responsivity in the hypothalamic-pituitary-adrenal (HPA) axis, which culminates in cortisol reactivity (CR; Doom & Gunnar, 2013; Grimm et al., 2017). Previous research also indicates an association between atypical CR in early childhood and mental health issues (Barrios et al., 2017; Hankin, 2015; Shonkoff et al., 2009; Zakreski et al., 2018). Research addressing the relation between irritability and CR, however, is limited (Mikita et al., 2015; Morris et al., 2017). As early childhood irritability and CR both predict psychological impairment, understanding how these variables interact in early childhood may contribute to a better understanding of the development of psychopathology.
Methods: Participants were 156 children enrolled in a longitudinal study of temperament and later risk for mood disorders. At age three, saliva samples were collected from participants at four timepoints in relation to a stressor task (Barrios et al., 2017; Klein & Finsaas, 2017). CR was derived from area under the curve with respect to increase (AUCi). Parent-reported irritability and psychopathology symptoms were assessed at ages three and six using the Preschool Age Psychiatric Assessment (PAPA). For statistical analyses, irritability was the IV, psychopathology symptom scores for anxiety, depression, ADHD, and ODD were the DVs, and CR and sex were the moderating variables. Covariates included symptom scores at each corresponding age, symptom scores of the outcome variable from earlier ages, and variables that correlated with the outcome variable.
Results: The association between age three irritability and ADHD scores was moderated by CR levels and sex (Table 1), with results suggesting that high irritability was associated with lower ADHD symptoms for males with mean CR levels and females with blunted CR levels. Age three irritability predicted age six ADHD symptoms when moderated by CR and sex in females, indicating high previous irritability was associated with higher ADHD symptoms when CR levels were elevated and lower ADHD symptoms when CR levels were blunted (Figure 1). At age six, higher irritability was associated with more ADHD symptoms in males with mean or elevated CR levels, whereas higher irritability was associated with fewer ADHD symptoms in females with blunted CR levels.
Conclusions: CR levels demonstrated largely opposite effects on the relationship between irritability and ADHD symptoms in young males versus females. These findings underscore the importance of considering both biological and psychological variables, as well as sex differences, in understanding future risk for psychopathology. Future research should include sex and CR as possible contributors to the association between irritability and ADHD.

Authors

• Rachel M Kaplan, University of New Orleans
  Presenting Author

• Sarah Black, University of New Orleans
  Non-Presenting Author

• Lea Rose Dougherty, University of Maryland, College Park
  Non-Presenting Author

• Daniel N Klein, Stony Brook University
  Non-Presenting Author