Hair Cortisol and Perceived Stress—Predictors for the Onset of Tics? A European Longitudinal Study on High-Risk Children

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Some retrospective studies suggest that psychosocial stressors trigger the onset of tics. This study examined prospective hypothalamic-pituitary-adrenal (HPA) axis activity and perceived stress prior to tic onset. In the present study, 259 children at high risk for developing tics were assessed for hair cortisol concentration (HCC) and parent-on-child-reported perceived stress four-monthly over a three-year period. We used (i) generalised additive modelling (GAM) to investigate the time effects on HCC (hair samples n = 765) and perceived stress (questionnaires n = 1019) prior to tic onset and (ii) binary logistic regression to predict tic onset in a smaller subsample with at least three consecutive assessments (six to nine months before, two to five months before, and at tic onset). GAM results indicated a non-linear increasing course of HCC in children who developed tics, and a steady HCC course in those without tics, as well as a linear-increasing course of perceived stress in both groups. Logistic regression showed that with a higher HCC in hair samples collected in a range of two to five months before tic onset (which refers to cortisol exposure in a range of four to eight months), the relative likelihood of tic onset rose. Our study suggests increased stress prior to tic onset, as evidenced by higher HCC several months before tic onset.


Original languageEnglish
Issue number6
Publication statusPublished - 27 May 2023

External IDs

unpaywall 10.3390/biomedicines11061561
PubMed 37371656
WOS 001016919900001
Scopus 85163958398
ORCID /0000-0002-1753-7811/work/142248184
Mendeley 6b709772-89e0-3e97-b405-763bc455ed38


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  • Hair cortisol, Onset of tics, Perceived stress, Physiological stress marker, Tic disorder, tic disorder, perceived stress, onset of tics, hair cortisol, physiological stress marker