Cortisol and α-amylase awakening response in children and adolescents with functional neurological (conversion) disorder.

This article focuses on examining hypothalamic–pituitary–adrenal (HPA) axis and sympathetic system activation patterns in children with functional neurological (conversion) disorder (FND) through salivary cortisol and α-amylase awakening responses. The study found that children with FND exhibit dysregulation of the HPA axis, characterized by either an attenuated or reversed cortisol awakening response (CAR), which correlated negatively with adverse childhood experiences (ACEs) and subjective distress, while total cortisol levels remained similar to healthy controls. No significant differences were observed in α-amylase awakening responses between groups, suggesting sympathetic system activation on awakening was not markedly altered. These findings support the role of stress system dysregulation in FND pathophysiology and highlight the potential impact of cumulative early life stress and neuroendocrine alterations on symptom manifestation and comorbidities in pediatric FND.