Open Access Highly Accessed Research

Does the cortisol response to stress mediate the link between expressed emotion and oppositional behavior in Attention-Deficit/Hyperactivity-Disorder (ADHD)?

Hanna Christiansen12, Robert D Oades1*, Lamprini Psychogiou3, Berthold P Hauffa4 and Edmund J Sonuga-Barke567

Author Affiliations

1 Clinic for Child & Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany

2 Department of Clinical Psychology, Philipps-University Marburg, Germany

3 Department of Psychiatry, University of Oxford, Oxford, UK

4 University Children's Hospital, Dept. of Pediatric Endocrinology and Diabetes, Essen, Germany

5 Developmental Brain-Behavior Unit, University of Southampton, Southampton, UK

6 Ghent University, Dunantlaan, Ghent, Belgium

7 MRC Social Genetic Developmental and Psychiatry Centre, Institute of Psychiatry, London, UK

For all author emails, please log on.

Behavioral and Brain Functions 2010, 6:45  doi:10.1186/1744-9081-6-45

Published: 15 July 2010



Expressed Emotions (EE) are associated with oppositional behavior (OPB) in children with Attention Deficit/Hyperactivity Disorder (ADHD). EE has been linked to altered stress responses in some disorders, but ADHD has not been studied. We test the hypothesis that OPB in ADHD is mediated by altered stress-related cortisol reactivity to EE.


Two groups of children (with/without ADHD) and their respective parents were randomly assigned to two different conditions with/without negative emotion and participated in an emotion provocation task. Parents' EE, their ratings of their children's OPB and their children's salivary cortisol levels were measured.


Low parental warmth was associated with OPB in ADHD. High levels of parental EE elicited a larger cortisol response. Stress-related cortisol reactivity mediated the EE-OPB link for all children. This highlights the general importance of parent-child interactions on externalizing behavior problems.


High EE is a salient stressor for ADHD children that leads to increased levels of cortisol and OPB. The development of OPB might be mediated by the stress-response to high EE.