title: Heart Rate Variability in Children with Attention-Deficit/Hyperactivity Disorder: A Pilot Study.
abstract: BACKGROUND
  Attention deficit/hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Autonomic nervous system plays a vital role in attention, self-regulation, emotional stability and social affiliation, which are affected in ADHD. The prefrontal cortex, which is vital for attention, motor control, emotional regulation and higher order autonomic control, is hypofunctional in ADHD. In addition, catecholamine dysregulation is there.
  
  
  OBJECTIVE
  We hypothesized that there is autonomic dysfunction: reduction in overall heart rate variability (HRV) and sympathovagal imbalance in children with ADHD.
  
  
  METHODS
  Study criteria were drug-naïve ADHD children who were 7-12 years of age of either gender who fulfilled DSM-IV criteria for ADHD and did not have any associated comorbid psychiatric/neurological/medical disorders. Two hundred and seventy ADHD children were screened out of which only 12 were found eligible and 10 participated. Sample size was 20 (cases = 10, age- and gender-matched healthy controls = 10). Short-term HRV of both time and frequency domains were assessed by recording lead II electrocardiogram after using Tell-Show-Do, a behavior shaping technique. Comparison between groups was done using Mann-Whitney and Wilcoxon test. Demographic variables like age, height, weight and body mass index were similar between groups.
  
  
  RESULTS
  Among time domain parameters, SD of all NN intervals, square root of the mean of the sum of squares of differences between adjacent NN intervals and percentage of count of number of pairs of adjacent NN intervals differing by more than 50 ms were reduced in ADHD group with p < 0.05. Among frequency domain parameters, total power was reduced in ADHD group with p < 0.05, high frequency power (HF) was reduced in ADHD group with p < 0.01 and low frequency power to HF ratio was higher in ADHD group with p < 0.01.
  
  
  CONCLUSIONS
  There is autonomic dysfunction in children with ADHD - reduction in overall HRV with sympathovagal imbalance with sympathetic dominance.
authors.affiliation: Department of Neurophysiology, Bangalore, India.
authors.forename: Malligurki Raghurama
authors.initials: MR
authors.lastname: Rukmani
authors.affiliation: Department of Child and Adolescent Psychiatry, Bangalore, India.
authors.forename: Shekhar P
authors.initials: SP
authors.lastname: Seshadri
authors.affiliation: Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
authors.forename: Kandavel
authors.initials: K
authors.lastname: Thennarasu
authors.affiliation: Department of Neurophysiology, Bangalore, India.
authors.forename: Trichur R
authors.initials: TR
authors.lastname: Raju
authors.affiliation: Department of Neurophysiology, Bangalore, India.
authors.forename: Talakad N
authors.initials: TN
authors.lastname: Sathyaprabha
keywords: Attention-deficit/hyperactivity disorder; Autonomic dysfunction; Heart rate variability; Prefrontal cortex; Smart vagus; Sympathovagal balance