Heart rate variability in children with autism spectrum disorder and associations with medication and symptom severity
Abstract
Decreased heart rate variability (HRV) is considered a common marker of autonomic dysfunction that contributes to poor health outcomes. While some studies have suggested that children with autism spectrum disorder (ASD) show reduced HRV, research is yet to consider whether this may be associated with medication use and symptom severity. This study examined the relationship between resting state HRV, medication use and symptom severity in children diagnosed with ASD. Children with ASD (N = 86), aged between 3 and 12 years (M = 8.09), were compared to 44 neurotypical children of similar age (M = 7.15). Laboratory assessment of HRV involved 5 min of non-invasive baseline electrocardiogram assessments while participants viewed an age-appropriate non-verbal animated video. Time-domain and frequency-domain HRV measures were analyzed. ASD symptom severity was assessed using the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Social Responsiveness Scale (SRS-2). Results indicated that children with ASD exhibited reduced resting HRV relative to neurotypical children. Subsequent analyses within the ASD group suggested that this group difference was greater in children who were taking psychotropic medication (N = 36). Our data also provides tentative evidence of a relationship between HRV and social impairment symptoms in children with ASD, with more severe repetitive behaviors (as measured by the ADOS-2) associated with decreased resting HRV. Overall, these findings suggest that HRV may be atypical in children with ASD and suggest the importance of exploring HRV as a risk factor for cardiovascular health in this group. LAY SUMMARY: Cardiac activity, such as heart rate variability (HRV), can provide insight into the autonomic nervous system. This study reports on the association between resting-state HRV and autonomic nervous system activity in young children with autism spectrum disorder (ASD) compared to neurotypical children. These results may help us understand what underlies autonomic nervous system dysfunction and the potential pathophysiological mechanisms leading to increased cardiovascular risk in ASD.
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Thapa et al. confirmed that in autistic children not on psychotropic medication, there were no differences in heart rate, RMSSD, nor high-frequency power compared to a control group.
“Thapa et al. confirmed this in autistic children: no differences in heart rate, RMSSD, nor high-frequency power were observed in children not on psychotropic medication, compared to a control group (61).”
From Autism Spectrum Disorder in Children Is Not Associated With Abnormal Autonomic Nervous System Function: Hypothesis and Theory (2022) · cites this paper as [61]
Medication is likely a major factor in the higher heart rate found in ASD groups.
“Hence, medication is likely a major factor in the higher heart rate found in ASD groups.”
From Autism Spectrum Disorder in Children Is Not Associated With Abnormal Autonomic Nervous System Function: Hypothesis and Theory (2022) · cites this paper as [61]
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- Authors
- Thapa, R., Pokorski, I., Ambarchi, Z., Thomas, E., Demayo, M., Boulton, K., Matthews, S., Patel, S., Sedeli, I., Hickie, I. B., & Guastella, A. J.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Guastella, Adam J.
- ORCID
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2020-11-22
- Volume
- 14
- Issue
- 1
- Pages
- 75-85
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- OpenAlex
- W3108238914
- Cited by
- 44
- References
- 75
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 6 · 2023: 8 · 2022: 5 · 2021: 2
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Autism Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bupa Health Foundation
- National Health and Medical Research Council
- Sydney Medical School
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Keywords
- heart rate variability, autism spectrum disorder, children, autonomic dysfunction, psychotropic drugs, symptom severity, repetitive behavior, social dysfunction, cardiovascular risk, electrocardiogram
- MeSH terms
- Autism Spectrum Disorder, Autistic Disorder, Autonomic Nervous System, Child, Child, Preschool, Heart Rate, Humans, Biomarkers
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