European Child & Adolescent Psychiatry

, Volume 16, Issue 2, pp 71–78 | Cite as

Autonomic reactivity in clinically referred children attention-deficit/hyperactivity disorder versus anxiety disorder

  • Natasja D.J. van Lang
  • Joke H.M. Tulen
  • Victor L. Kallen
  • Bianca Rosbergen
  • Gwen Dieleman
  • Robert F. FerdinandEmail author


This study examined whether children with attention-deficit/hyperactivity disorder (ADHD) have lower autonomic nervous system (ANS) activity and show less stress reactivity than children with an anxiety disorder. It also explored whether such a difference was accounted for by comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) in some of the ADHD children. Forty-three referred children performed a stress task, during which skin conductance (SCL) and heart rate (HR) levels were measured. Results showed that the ADHD group had similar SCL responses as the anxiety disorder group, but showed less HR reactivity immediately after the stress task. The ADHD with ODD/CD group had a slightly higher HR level than the pure ADHD group, but showed similar SCL and HR reactivity and recovery. It was concluded that ADHD children have less HR reactivity immediately after stress than children with an anxiety disorder, which was not accounted for by comorbid ODD/CD symptoms, and which may be related to a stronger parasympathetic than sympathetic activation.


attention-deficit/hyperactivity disorder anxiety disorder stress heart rate skin conductance 



This study was financially supported by the Sophia Foundation for Scientific Research (SSWO: grant number 328 and Endowed chair grant), the National Fund for Mental Health (NFGV), and the Revolving Fund of the Leiden University Medical Center. In addition, the researchers thank the parents and children who took part in this study, and Yvette Groeneveld who helped us collect data.


  1. 1.
    Achenbach TM (1991) Integrative guide for the 1991 CBCL/4-18, YSR and TRF profiles. Burlington: University of Vermont Department of PsychiatryGoogle Scholar
  2. 2.
    Beauchaine TP, Katkin ES, 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. J Abnormal Psychol 110: 610–624CrossRefGoogle Scholar
  3. 3.
    Boyce WT, Quas J, Alkon A, Smider NA, Essex MJ, Kupfer DJ (2001) Autonomic reactivity and psychopathology in middle childhood. Br J Psychiatry 179: 144–150PubMedCrossRefGoogle Scholar
  4. 4.
    Garralda ME, Connell J, Taylor DC (1991) Psychophysiological anomalies in children with emotional and conduct disorders. Psychol Med 21: 947–957PubMedCrossRefGoogle Scholar
  5. 5.
    Herpertz SC, Mueller B, Wenning B, Qunaibi M, Lichterfeld C, Herpertz-Dahlmann B (2003) Autonomic responses in boys with externalizing disorders. J Neural Trans 110: 1181–1195CrossRefGoogle Scholar
  6. 6.
    Herpertz SC, Wenning B, Mueller B, Qunaibi M, Sass H, Herpertz-Dahlmann B (2001) Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior. J Am Acad Child Adolesc Psychiatry 40: 1222–1230PubMedCrossRefGoogle Scholar
  7. 7.
    Jorgensen LS, Christiansen P, Raundahl U, Ostgaard S, Christensen NJ, Fenger M, Flachs H (1990) Autonomic response to an experimental psychological stressor in healthy subjects: measurement of sympathetic, parasympathetic, and pituitary-adrenal parameters: test-retest reliability. Scand J Clin Lab Invest 50: 823–829PubMedGoogle Scholar
  8. 8.
    Kamarck TW, Lovallo WR (2003) Cardiovascular reactivity to psychological challenge: conceptual and measurement considerations. Psychosom Med 65: 9–21PubMedCrossRefGoogle Scholar
  9. 9.
    Kirschbaum C, Pirke KM, Hellhammer DH (1993) The ‘Trier Social Stress Test’—a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology 28: 76–81PubMedCrossRefGoogle Scholar
  10. 10.
    Lahey BB, Loeber R, Quay HC, Frick PJ, Grimm J (1992) Oppositional defiant and conduct disorders: issues to be resolved for DSM-IV. J Am Acad Child Adolesc Psychiatry 31: 539–546PubMedCrossRefGoogle Scholar
  11. 11.
    Mezzacappa E, Tremblay RE, Kindlon D, Saul JP, Arseneault L, Seguin J, Pihl RO, Earls F (1997) Anxiety, antisocial behavior, and heart rate regulation in adolescent males. J Child Psychol Psychiatry 38: 457–469PubMedCrossRefGoogle Scholar
  12. 12.
    Negrao AB, Deuster PA, Gold PW, Singh A, Chrousos GP (2000) Individual reactivity and physiology of the stress response. Biomed Pharmacother 54: 122–128PubMedCrossRefGoogle Scholar
  13. 13.
    NIHM (1992) Diagnostic interview schedule for children, version 2.3. New York: New York State Psychiatric Institute Division of Child and Adolescent PsychiatryGoogle Scholar
  14. 14.
    Ortiz J, Raine A (2004) Heart rate level and antisocial behavior in children and adolescents: a meta-analysis. J Am Acad Child Adolesc Psychiatry 43: 154–162PubMedCrossRefGoogle Scholar
  15. 15.
    Raine A, Venables PH, Dalais C, Mellingen K, Reynolds C, Mednick SA (2001) Early educational and health enrichment at age 3–5 years is associated with increased autonomic and central nervous system arousal and orienting at age 11 years: evidence from the Mauritius Child Health Project. Psychophysiology 38: 254–266PubMedCrossRefGoogle Scholar
  16. 16.
    Rogeness GA, Cepeda C, Macedo CA, Fischer C, Harris WR (1990) Differences in heart rate and blood pressure in children with conduct disorder, major depression, and separation anxiety. Psychiatry Res 33: 199–206PubMedCrossRefGoogle Scholar
  17. 17.
    Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH Diagnostic Interview Schedule for Children Version IV: description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39: 28–38PubMedCrossRefGoogle Scholar
  18. 18.
    Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV child version, parent interview schedule. San Antonio: The Psychological CorporationGoogle Scholar
  19. 19.
    Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40: 937–944PubMedCrossRefGoogle Scholar
  20. 20.
    van Goozen SH, Matthys W, Cohen-Kettenis PT, Buitelaar JK, van Engeland H (2000) Hypothalamic-pituitary-adrenal axis and autonomic nervous system activity in disruptive children and matched controls. J Am Acad Child Adolesc Psychiatry 39: 1438–1445PubMedCrossRefGoogle Scholar
  21. 21.
    van Goozen SH, Matthys W, Cohen-Kettenis PT, Gispen-de Wied C, Wiegant VM, van Engeland H (1998) Salivary cortisol and cardiovascular activity during stress in oppositional-defiant disorder boys and normal controls. Biol Psychiatry 43: 531–539PubMedCrossRefGoogle Scholar
  22. 22.
    Verhulst FC, van der Ende J, Koot HM (1996) Handleiding voor de CBCL/4-18 [Manual for the CBCL/4-18]. Rotterdam: Erasmus Medical Center/Sophia Children’s Hospital Department of Child and Adolescent PsychiatryGoogle Scholar
  23. 23.
    Wilens TE, 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. J Clin Psychopharmacol 24: 36–41PubMedCrossRefGoogle Scholar
  24. 24.
    Zahn TP, Kruesi MJ (1993) Autonomic activity in boys with disruptive behavior disorders. Psychophysiology 30: 605–614PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Natasja D.J. van Lang
    • 1
    • 2
  • Joke H.M. Tulen
    • 3
  • Victor L. Kallen
    • 1
  • Bianca Rosbergen
    • 1
  • Gwen Dieleman
    • 1
  • Robert F. Ferdinand
    • 1
    Email author
  1. 1.Department of Child and Adolescent PsychiatryErasmus Medical Center Rotterdam/Sophia Children’s HospitalRotterdamThe Netherlands
  2. 2.Academic Center for Child and Adolescent PsychiatryCuriumThe Netherlands
  3. 3.Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands

Personalised recommendations