Heart rate variability and methylphenidate in children with ADHD
Abstract
Although an extensive number of studies support the efficacy and tolerability of stimulants in the treatment of attention deficit/hyperactivity disorder (ADHD), in recent years, increasing concerns have been raised about their cardiovascular safety. We investigated whether a time domain analysis of heart rate variability (HRV) recordings in 24-h ECG under medication with stimulants yielded new information about therapy control in ADHD. We analysed the HRV parameter standard deviation of all normal sinus RR intervals over 24 h (SDNN), percentage of successive normal sinus RR intervals > 50 ms (pNN50) and root-mean-square of the successive normal sinus RR interval difference (rMSSD) from 23 children diagnosed by ADHD (19 boys and 4 girls), aged 10.5 ± 2.2 years, who were consecutively referred to our outpatient clinic for paediatric cardiology. Eleven children received medication with methylphenidate (MPH), while twelve children were initially examined without medication. Of these, eight probands were re-examined after therapy with MPH was established. Controls comprised 19 children (10 boys, 9 girls) from our Holter ECG data base without any cardiac or circulatory disease. Compared to healthy controls, the ADHD children with and without MPH treatment showed significantly higher mean heart rates (ADHD without MPH: 94.3 ± 2.2; ADHD with MPH: 90.5 ± 1.8, controls: 84.7 ± 1.8). pNN50 (ADHD without MPH: 6.5 ± 2.7; ADHD with MPH: 14.2 ± 6.9, controls: 21.5 ± 9.0) and rMSSD (ADHD without MPH: 26.1 ± 4.1; ADHD with MPH: 36.7 ± 8.3, controls: 44.5 ± 10.1) were lowest in ADHD children without MPH, middle in ADHD children with MPH and highest in controls. SDNN values were not significantly different. The hourly analysis shows highly significant reduced pNN50 and rMSSD values in untreated ADHD children between 5:00 pm and 6:00 am while the pattern approaches to levels of controls during MPH treatment. Data of this pilot study indicate a decreased vagal tone with significantly diminished HRV and higher heart rates in unmedicated ADHD children. These parameters of autonomic activation are ameliorated by MPH treatment. No evidence for negative impact of MPH on HRV was detected. Further studies will clarify a potential cardio-protective effect of MPH in ADHD.
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In 31 children with ADHD, ADHD is associated with a marked increase in heart rate in the afternoon.
“Buchhorn et al. (2012) also examined diurnal changes in heart rate, and heart rate variability, in a case-control study of 31 children with ADHD, and report that ADHD was associated with a marked increase in heart rate in the afternoon and less pronounced diurnal variation in heart rate variability.”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Buchhorn et al. (2012)
In 31 children with ADHD, there is less pronounced diurnal variation in heart rate variability.
“Buchhorn et al. (2012) also examined diurnal changes in heart rate, and heart rate variability, in a case-control study of 31 children with ADHD, and report that ADHD was associated with a marked increase in heart rate in the afternoon and less pronounced diurnal variation in heart rate variability.”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Buchhorn et al. (2012)
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- Authors
- Buchhorn, R., Conzelmann, A., Willaschek, C., Störk, D., Taurines, R., & Renner, T. J.
- Affiliations
- Caritas-Krankenhaus Bad Mergentheim (DE)
- University of Würzburg (DE)
- Corresponding author
- Buchhorn, Reiner
- Venue
- ADHD Attention Deficit and Hyperactivity Disorders
- Published
- 2012-02-11
- Volume
- 4
- Issue
- 2
- Pages
- 85-91
- ISSN
- 1866-6116 (ISSN-L)
- 1866-6647
- OpenAlex
- W1976593625
- Cited by
- 79
- References
- 31
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 4 · 2020: 7 · 2019: 2 · 2018: 4 · 2017: 5 · 2016: 6 · 2015: 5 · 2014: 7 · 2013: 7 · 2012: 5
- FWCI
- 5.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- ADHD Attention Deficit and Hyperactivity Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- heart rate variability, methylphenidate, attention deficit hyperactivity disorder, children, stimulant medication, cardiovascular safety, vagal tone, autonomic nervous system, heart rate, pNN50, RMSSD, SDNN, Holter monitoring, time-domain analysis, treatment response monitoring, pediatric cardiology
- MeSH terms
- Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Circadian Rhythm, Female, Heart Rate, Humans, Male, Methylphenidate, Electrocardiography, Ambulatory
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