There is an extensive body of literature to support a relationship between neuroendocrine abnormalities of the HPA system and various forms of psychopathology (Pariante and Lightman 2008; Stansbury and Gunnar 1994; Susman 2006; Walker et al. 2008). More specifically, differences in basal cortisol levels as well as the adrenal response to stress have been noted in studies of childhood behavioral problems (Klimes-Dougan et al. 2001; Shirtcliff et al. 2005). Heightened cortisol secretion has been linked to internalizing symptoms, including anxiety and withdrawal (Brown et al. 1996; Colomina et al. 1997; Schmidt et al. 1997; Windle 1994). Baseline and post-dexamethasone elevation in cortisol levels is associated with depression in adults (Nelson et al. 1997; Rush et al. 1996), adolescents (Foreman and Goodyer 1988), and prepubertal children (Puig-Antioch et al. 1989). Conversely, attenuated activity of the HPA system has been identified as a risk factor for antisocial behavior (Susman 2006).
