ESPE Abstracts (2018) 89 P-P2-024

The Effectiveness of a Stress-Management Intervention Program in Behavioral Parameters and Hair Cortisol Concentrations in Children with Attention Deficit Hyperactivity Disorder

August Kapogiannisa,b, Gerasimos Makrisb, Aimilia Mantzouc, Theodora Bachouroud, Christina Darviria, George Chrousosa,c & Panagiota Pervanidoub


aPostgraduate Course, Science of Stress Management and Health Promotion, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; bDevelopmental & Behavioral Pediatrics Unit, First Department of Pediatrics, “Aghia Sophia” Children’s University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; cChoremeion Research Laboratory, First Department of Pediatrics, “Aghia Sophia” Children’s University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; dCenter for Differential Diagnosis, Diagnosis and Support (KE.D.D.Y.), Pyrgos, Greece


Background: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental condition in school-aged children, with a prevalence of 5–8%. In individuals with ADHD, there is an attenuated biologic stress response to challenging situations.

Objective: This study aimed at evaluating the effectiveness of an 8-week stress management program, comprising self-applied cognitive exercises, on stress perception and anxiety symptoms, sleep quality and hair cortisol concentrations in children with ADHD.

Method: Sixty children (65% males) with ADHD, aged between 7 and 12 years old, and their parents took part in the study. All children were under usual behavioral therapy care, but no pharmacotherapy. The intervention was an 8-week, two-armed, non-blinded, randomized, controlled trial with a 1:1 allocation ratio, intervention vs. wait-list, control groups. The Achenbach system (CBCL questionnaires), the ADHD scales the Personal Control Questionnaire, and the Pittsburg Sleep Questionnaire were completed by parents at baseline and after the intervention in both groups. Hair cortisol concentrations were measured in both groups at the two time-points (i.e. before and after the intervention).

Results: Statistically significant decreases before and after the intervention were found in the subscales of the DuPaul questionnaire scores (inattention, hyperactivity-impulsivity and total, P<0.001 for all three scales) only within the stress-management intervention group. Similarly, the intervention group showed decreases before and after the intervention in most scales of the CBCL questionnaire (academic performance and learning, P<0.001; internalizing problems P=0.001; thought problems P=0.006; externalizing problems P=0.001; affective problems P−0.001; anxiety problems P=0.02; ADHD problems P<0.001; oppositional-defiant problems P=0.001; conduct problems P=0.001; sluggish-cognitive tempo P<0.001; obsessive-compulsive problems P=0.001; PTSD problems P<0.001). Improvement was shown in the Pittsburg Sleep Quality questionnaire scores, after the intervention (P=0.003). Although an increase trend was noted after the intervention, no statistically significant differences in hair cortisol concentrations were found between or within groups (P=0.309 & P=0.061, respectively).

Conclusion: The intervention group exhibited ameliorated ADHD symptomatology, decreased anxiety, and better sleep quality, as well as reduced internalizing and externalizing problems after the implementation of the stress management program. The lack of a statistically significant difference in the hair cortisol concentrations after the 8-week intervention period, may be attributed to the short time interval between the two assessments. We conclude that a stress management program as a supportive intervention to behavioral therapy, may be beneficial in children with ADHD.