Co‐activation of SAM and HPA responses to acute stress: A review of the literature and test of differential associations with preadolescents’ internalizing and externalizing

Abstract

Understanding co‐activation patterns of the hypothalamic‐pituitary‐adrenal axis (HPA) and sympathetic adrenal medullary (SAM) during early adolescence may illuminate risk for development of internalizing and externalizing problems. The present study advances empirical work on the topic by examining SAM‐HPA co‐activation during both the reactivity and recovery phases of the stress response following acute stress exposure. Fourth and fifth grade boys and girls (N = 149) provided cortisol and alpha‐amylase via saliva at seven times throughout a 95‐min assessment in which they were administered the modified Trier Social Stress Test. Parents reported on adolescents’ life stress, pubertal development, medication use, and externalizing problems. Adolescents reported their own internalizing symptoms. Multiple linear regressions tested both direct and interactive effects of SAM and HPA reactivity and recovery on internalizing and externalizing problems. Results from these analyses showed that whereas SAM and HPA reactivity interacted to predict internalizing symptoms, it was their interaction during the recovery phase that predicted externalizing. Concurrent high SAM and HPA reactivity scores predicted high levels of internalizing and concurrently low SAM and HPA recovery scores predicted high levels of externalizing. Implications of the findings for further study and clinical application are discussed.

Environmental determinants of physiological reactivity to stress: The interacting effects of early life deprivation, caregiving quality, and stressful life events

“…More recent evidence suggests that hypo-responsiveness of the HPA axis may be more strongly linked to externalizing problems, whereas hyper-reactivity may be more strongly linked to internalizing problems (e.g. Hagan, Roubinov, Mistler, & Luecken, 2014; Hartman, Hermanns, de Jong, & Ormel, 2013; Martinez-Torteya, Bogat, Levendosky, & Von Eye, 2016; Ruttle et al, 2011; Wadsworth et al, 2019). This dissociation is not always observed, however, as meta-analyses of adult studies suggest that blunted stress reactivity may also be a hallmark of internalizing disorders such as depression and anxiety (Miller & Kirschbaum, 2019; Zorn et al, 2017).…”

Stress sensitization among severely neglected children and protection by social enrichment

“…Lower cortisol levels and blunted reactivity of the HPA-axis to stress-inducing stimuli has been linked to higher levels of externalizing problems 26 . Furthermore, there is some evidence that hyporeactivity of stress systems may associate more strongly with externalizing problems, while hyperreactivity may relate more strongly to internalizing problems 27–30 . Within the BEIP, children with prolonged institutional rearing show blunted HPA-axis and sympathetic nervous system reactivity to laboratory stressors in preadolescence.…”

Stress Monitoring and Recent Advancements in Wearable Biosensors

“…Alpha-amylase is present in the saliva at concentrations of 0.6–2.6 mg/mL ( Nater and Rohleder, 2009 ). As seen in Figure 1 , alpha-amylase release is controlled by the SAM axis, and the co-activation patterns between SAM and HPA axes is being studied as indications of a stress response ( Wadsworth et al, 2020 ).…”