Abstract
A large number of youngsters with autism spectrum disorders (ASD) display comorbid attention deficit/hyperactivity disorder (ADHD) symptoms. However, previous studies are not conclusive whether psychophysiological correlates, like cardiac reactivity, are different for ASD with comorbid ADHD (ASD+) compared to ADHD. Therefore, the current study investigated (dis)similarities in cardiac reactivity and attention task performance. In a clinical sample, adolescents diagnosed with ASD+ (n = 20) versus ADHD (n = 36) and stimulant medication use (56 %) were compared during a baseline with eyes closed and task performance. Results for cardiac reactivity were similar for both diagnostic groups. Stimulant-medicated adolescents showed decreased adaptation of LF/HF ratio and faster reaction times than stimulant-free adolescents. The current study underlines the psychophysiological overlap of ADHD symptoms in adolescents with ASD+ and adolescents with ADHD.
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Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR and TRF profiles. Burlington: University of Vermont Department of Psychiatry.
Althaus, M., Mulder, L. J., Mulder, G., Aarnoudse, C. C., & Minderaa, R. B. (1999). Cardiac adaptivity to attention-demanding tasks in children with a pervasive developmental disorder not otherwise specified (PDD-NOS). Biological Psychiatry, 46(6), 799–809. doi:10.1016/S0006-3223(98)00374-6.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Fourth Edn, Text Revision Ed.). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2012). American Psychiatric Association DSM-5 Development. http://www.dsm5.org/.
Bal, E., Harden, E., Lamb, D., Van Hecke, A. V., Denver, J. W., & Porges, S. W. (2010). Emotion recognition in children with autism spectrum disorders: Relations to eye gaze and autonomic state. Journal of Autism and Developmental Disorders, 40(3), 358–370. doi:10.1007/s10803-009-0884-3.
Banaschewski, T., Brandeis, D., Heinrich, H., Albrecht, B., Brunner, E., & Rothenberger, A. (2003). Association of ADHD and conduct disorder—brain electrical evidence for the existence of a distinct subtype. Journal of Child Psychology and Psychiatry, 44(3), 356–376. doi:10.1111/1469-7610.00127.
Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1991). Attention deficit disorder with and without hyperactivity: Clinical response to three dose levels of methylphenidate [controlled clinical trial, research support, U.S. Gov’t, P.H.S.]. Pediatrics, 87(4), 519–531.
Baron-Cohen, S., Hoekstra, R. A., Knickmeyer, R., & Wheelwright, S. (2006). The autism-spectrum quotient (AQ)—adolescent version. Journal of Autism and Developmental Disorders, 36(3), 343–350. doi:10.1007/s10803-006-0073-6.
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.
Beauchaine, T. P., Katkin, E. S., Strassberg, Z., & Snarr, J. (2001). Disinhibitory psychopathology in male adolescents: Discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states. Journal of Abnormal Psychology, 110(4), 610–624.
Borger, N., & van der Meere, J. (2000). Motor control and state regulation in children with ADHD: A cardiac response study. Biological Psychology, 51(2–3), 247–267. doi:10.1016/S0301-0511(99)00040-X.
Borger, N., van der Meere, J., Ronner, A., Alberts, E., Geuze, R., & Bogte, H. (1999). Heart rate variability and sustained attention in ADHD children. Journal of Abnormal Child Psychology, 27(1), 25–33.
Buchhorn, R., Conzelmann, A., Willaschek, C., Stork, D., Taurines, R., & Renner, T. J. (2012). Heart rate variability and methylphenidate in children with ADHD [controlled clinical trial]. Attention Deficit Hyperactivity Disorders, 4(2), 85–91. doi:10.1007/s12402-012-0072-8.
Cox, D. J., Davis, M., Mikami, A. Y., Singh, H., Merkel, R. L., & Burket, R. (2012). Long-acting methylphenidate reduces collision rates of young adult drivers with attention-deficit/hyperactivity disorder. Journal of Clinical Psychopharmacology, 32(2), 225–230. doi:10.1097/JCP.0b013e3182496dc5.
Daluwatte, C., Miles, J. H., Christ, S. E., Beversdorf, D. Q., Takahashi, T. N., & Yao, G. (2012). Atypical pupillary light reflex and heart rate variability in children with autism spectrum disorder. Journal of Autism and Developmental Disorders,. doi:10.1007/s10803-012-1741-3.
Donner, R., Michaels, M. A., & Ambrosini, P. J. (2007). Cardiovascular effects of mixed amphetamine salts extended release in the treatment of school-aged children with attention-deficit/hyperactivity disorder. Biological Psychiatry, 61(5), 706–712. doi:10.1016/j.biopsych.2006.05.002.
DuPaul, G. J., Anastopoulos, A. D., Power, T. J., Reid, R., Ikeda, M. J., & McGoey, K. E. (1998). Parent ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data. Journal of Psychopathology and Behavioral Assessment, 20(1), 83–102.
Epstein, J. N., Brinkman, W. B., Froehlich, T., Langberg, J. M., Narad, M. E., Antonini, T. N., et al. (2011). Effects of stimulant medication, incentives, and event rate on reaction time variability in children with ADHD. Neuropsychopharmacology, 36(5), 1060–1072. doi:10.1038/npp.2010.243.
Faulkner, M. S., Hathaway, D., & Tolley, B. (2003). Cardiovascular autonomic function in healthy adolescents. Heart and Lung, 32(1), 10–22. doi:10.1067/mhl.2003.6.
Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36(2), 271–283. doi:10.1007/s10803-005-0060-3.
Goldstein, S., & Schwebach, A. J. (2004). The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: Results of a retrospective chart review. Journal of Autism and Developmental Disorders, 34(3), 329–339.
Gorman, E. B., Klorman, R., Thatcher, J. E., & Borgstedt, A. D. (2006). Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder [Randomized Controlled Trial, Research Support, N.I.H., Extramural]. Journal of the American Academy of Child and Adolescent Psychiatry, 45(7), 808–816. doi:10.1097/01.chi.0000214191.57993.dd.
Greenhill, L. L., Swanson, J. M., Vitiello, B., Davies, M., Clevenger, W., Wu, M., et al. (2001). Impairment and deportment responses to different methylphenidate doses in children with ADHD: The MTA titration trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 180–187. doi:10.1097/00004583-200102000-00012.
Groen, Y., Wijers, A. A., Mulder, L. J., Waggeveld, B., Minderaa, R. B., & Althaus, M. (2008). Error and feedback processing in children with ADHD and children with autistic spectrum disorder: An EEG event-related potential study. Clinical Neurophysiology, 119(11), 2476–2493. doi:10.1016/j.clinph.2008.08.004.
Hammerness, P. G., Perrin, J. M., Shelley-Abrahamson, R., & Wilens, T. E. (2011). Cardiovascular risk of stimulant treatment in pediatric attention-deficit/hyperactivity disorder: Update and clinical recommendations. Journal of American Academy of Child and Adolescent Psychiatry, 50(10), 978–990. doi:10.1016/j.jaac.2011.07.018.
Holtmann, M., Bolte, S., & Poustka, F. (2007). Attention deficit hyperactivity disorder symptoms in pervasive developmental disorders: Association with autistic behavior domains and coexisting psychopathology. Psychopathology, 40(3), 172–177. doi:10.1159/000100007.
Jennings, J. R., van der Molen, M. W., Pelham, W., Debski, K. B., & Hoza, B. (1997). Inhibition in boys with attention deficit hyperactivity disorder as indexed by heart rate change. Developmental Psychology, 33(2), 308–318.
Jorna, P. G. (1992). Spectral analysis of heart rate and psychological state: A review of its validity as a workload index. Biological Psychology, 34(2–3), 237–257.
Kooij, J. J. S. (2002). ADHD in adults. Introduction to diagnosis and treatment (in Dutch (1st ed.). Lisse: Swets & Zeitlinger.
Kooij, J. J. S., Boonstra, A. M., Swinkels, S. H. N., Bekker, E. M., de Noord, I., & Buitelaar, J. K. (2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders, 11(4), 445–458. doi:10.1177/1087054707299367.
Kooij, J. J. S., Buitelaar, J. K., van den Oord, E. J., Furer, J. W., Rijnders, C. A., & Hodiamont, P. P. (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35(6), 817–827.
Lackschewitz, H., Huther, G., & Kroner-Herwig, B. (2008). Physiological and psychological stress responses in adults with attention-deficit/hyperactivity disorder (ADHD). Psychoneuroendocrinology, 33(5), 612–624. doi:10.1016/j.psyneuen.2008.01.016.
Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., et al. (1989). Autism diagnostic observation schedule: A standardized observation of communicative and social behavior. Journal of Autism and Developmental Disorders, 19(2), 185–212.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
Luman, M., Oosterlaan, J., Hyde, C., van Meel, C. S., & Sergeant, J. A. (2007). Heart rate and reinforcement sensitivity in ADHD. Journal of Child Psychology and Psychiatry, 48(9), 890–898. doi:10.1111/j.1469-7610.2007.01769.x.
Malliani, A., Pagani, M., Lombardi, F., & Cerutti, S. (1991). Cardiovascular neural regulation explored in the frequency domain. Circulation, 84(2), 482–492.
Negrao, B. L., Bipath, P., van der Westhuizen, D., & Viljoen, M. (2011). Autonomic correlates at rest and during evoked attention in children with attention-deficit/hyperactivity disorder and effects of methylphenidate. Neuropsychobiology, 63(2), 82–91. doi:10.1159/000317548.
Niskanen, J. P., Tarvainen, M. P., Ranta-Aho, P. O., & Karjalainen, P. A. (2004). Software for advanced HRV analysis. Computer Methods and Programs in Biomedicine, 76(1), 73–81. doi:10.1016/j.cmpb.2004.03.004.
Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology, 32(4), 301–318.
Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116–143. doi:10.1016/j.biopsycho.2006.06.009.
Rash, J. A., & Aguirre-Camacho, A. (2012). Attention-deficit hyperactivity disorder and cardiac vagal control: A systematic review. Attention Deficit Hyperactivity Disorders, 4(4), 167–177. doi:10.1007/s12402-012-0087-1.
Reyes del Paso, G. A., Langewitz, W., Mulder, L. J., van Roon, A., & Duschek, S. (2013). The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: A review with emphasis on a reanalysis of previous studies. Psychophysiology, 50(5), 477–487. doi:10.1111/psyp.12027.
RUPP. (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62(11), 1266–1274. doi:10.1001/archpsyc.62.11.1266.
Schlögl, A. (2009). “The BioSig project 2003–2009”. http://biosig.sf.net/.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22–33. quiz 34–57.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., et al. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232–241.
Stein, M. A., Sarampote, C. S., Waldman, I. D., Robb, A. S., Conlon, C., Pearl, P. L., et al. (2003). A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder [controlled clinical trial, research support, U.S. Gov’t, P.H.S.]. Pediatrics, 112(5), e404.
Tanaka, H., Borres, M., Thulesius, O., Tamai, H., Ericson, M. O., & Lindblad, L. E. (2000). Blood pressure and cardiovascular autonomic function in healthy children and adolescents. Journal of Pediatrics, 137(1), 63–67. doi:10.1067/mpd.2000.108098.
Tarvainen, M. P., & Niskanen, J. P. (2008). Kubios HRV version 2.0 user guide. Finland: Biosignal Analysis and Medical Imaging Group (BSAMIG) Department of Physics University of Kuopio.
Task Force. (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. European Heart Journal, 17(3), 354–381.
Toichi, M., & Kamio, Y. (2003). Paradoxical autonomic response to mental tasks in autism. Journal of Autism and Developmental Disorders, 33(4), 417–426.
Van Hecke, A. V., Lebow, J., Bal, E., Lamb, D., Harden, E., Kramer, A., et al. (2009). Electroencephalogram and heart rate regulation to familiar and unfamiliar people in children with autism spectrum disorders. Child Development, 80(4), 1118–1133. doi:10.1111/j.1467-8624.2009.01320.x.
Vasey, M. W., & Thayer, J. F. (1987). The continuing problem of false positives in repeated measures ANOVA in psychophysiology: A multivariate solution. Psychophysiology, 24(4), 479–486.
Vink, M., & Van Wamel, A. (2007). Dutch basic ADHD program for children and adolescents (in Dutch). Leidraad voor regionale zorgprogrammering. Utrecht: Trimbos-instituut, Netherlands Institute of Mental Health and Addiction.
Wechsler, D. (1991). Wechsler intelligence scale for children (3rd ed.). San Antonio, TX: The Psychological Corporation.
Wechsler, D. (1997). Wechsler adult intelligence scale (3rd ed.). San Antonio, TX: The Psychological Corporation.
Wilens, T. E., Biederman, J., & Lerner, M. (2004). Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder: Results from a one-year follow-up study. Journal of Clinical Psychopharmacology, 24(1), 36–41. doi:10.1097/01.jcp.0000106223.36344.df.
Acknowledgments
The authors thank Carlijn Berghout, Marilyn Peeters, Thomas Widdershoven and the students and research assistants for their valuable support as well as all participating adolescents and families for their contribution and persistence. This study is part of a larger intervention study for adolescents with ADHD-features, which is registered in the Dutch trial register (www.trialregister.nl Ref. No.: NTR1759). This study is funded by The Netherlands Organisation for Health Research and Development (ZonMw number 157 002 004).
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Bink, M., Popma, A., Bongers, I.L. et al. Cardiac Reactivity and Stimulant Use in Adolescents with Autism Spectrum Disorders with Comorbid ADHD Versus ADHD. J Autism Dev Disord 45, 481–494 (2015). https://doi.org/10.1007/s10803-013-1929-1
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DOI: https://doi.org/10.1007/s10803-013-1929-1