Anxiety symptom severity differentiates HPA acute stress reactivity in children

Abstract

Rationale/statement of the problem : Considerable research has focused on the relationship of anxiety with alterations in the hypothalamic-pituitary-adrenal (HPA) acute stress response. Findings, however, differ among studies on adults and children, and among different types of anxiety. This study investigates the relationship of anxiety symptom severity with HPA reactivity to the cold pressor task (CPT) in preadolescent children. We hypothesize that children with increased symptoms of anxiety will have increased cortisol (HPA) reactivity to the CPT. Methods : A social-evaluative adaptation of the CPT was used to elicit HPA acute stress reactivity among 42 children (26 female, 16 male) aged 8–12 years (mean age, 10 years) recruited from a child anxiety disorders clinic (n=20) and from the community at large (n=22). Repeated saliva samples were assayed for cortisol to determine maximum task response (TR) and area under the curve with respect to the increase from baseline (AUCi). Multi-dimensional anxiety measures included the Screen for Anxiety and Related Disorders (SCARED: parent and child report); State Trait Anxiety Inventory-Trait (STAI-T), and Children's Anxiety Sensitivity Index (CASI). Subjects were grouped according to recruitment source and high/low symptom measures (all subjects by anxiety measure median split); groups were compared via independent samples t-tests. Results : Maximum cortisol TR and AUCi did not differ between children recruited from the anxiety disorders clinic and the community. Among all subjects, maximum TR was significantly greater for those with high anxiety symptoms on the STAI-T (p=0.006), SCARED-C (p=0.012), and SCARED-P (p=0.031), and approached significance on the CASI (p=0.056), compared to those with low symptoms on these measures. AUCi was greater among those with high symptoms on the SCARED-C (p=0.01) and SCARED-P (p=0.011), but not on the STAI-T (p=0.113) or CASI (p=0.072). Conclusion : Results suggest that increased anxiety symptom severity is associated with greater cortisol reactivity to acute stress in preadolescent children. Moreover, findings were similar among youth recruited from the clinic and the community, thus providing additional evidence of the high prevalence of anxiety in children and the potential associated risk of alterations in physiological stress reactivity among those with more severe symptoms.

Keywords

• anxiety
• children
• stress
• cortisol
• cold pressor task