Dear reader of, please excuse the disruption. needs about $63500 in 2024. In 2023 we received donations of about $ 32200. Unfortunately, 99.8% of our readers do not donate. If everyone who reads this request makes a small contribution, our fundraising campaign for 2024 would be over after a few days. This donation request is displayed 23,000 times a week, but only 75 people donate. If you find useful, please take a minute and support with your donation. Thank you!

Since 01.06.2021 is supported by the non-profit ADxS e.V..

$8975 of $63500 - as of 2024-02-29
Header Image
Heart rate variability (HRV) in ADHD

Heart rate variability (HRV) in ADHD

Heart rate variability (HRV) is also known as heart rate variability.

The heart regulates blood pressure through small fluctuations in pulse rate. The better the heart can regulate blood pressure by slightly lengthening or shortening the time between two beats, the better the blood pressure is balanced. This balancing ability of the heart is measured as HRV.
HRV can be measured using various parameters such as rMSSD, HFA, HF, LFA, LF/HF ratio, SD and TP.
In the non-medical field, simple HRV measurement is possible using sports trackers.

HRV is a stress marker. HRV is reduced in ADHD.123
Methylphenidate improves HRV in ADHD sufferers, but it does not reach the level of non-affected people.

1. Heart rate variability (HRV)

It is certain that the heart’s ability to adapt to small fluctuations in blood pressure, measured as heart rate variability, is a highly significant marker for stress. The higher the heart rate variability (HRV), the lower the stress level. Many thousands of years ago, Chinese doctors already knew that patients whose heart beats like clockwork in an absolutely constant rhythm, i.e. who have a very low to non-existent HRV, are seriously ill.

HRV is the standard measuring instrument for the activity of the parasympathetic nervous system, which is part of the autonomic nervous system.4

ADHD is characterized by reduced heart rate variability (HRV), which indicates a reduced stress regulation capacity of the autonomic (vegetative) nervous system 5 6 7 8 9 10 11 12 1 13 141

Heart rate variability can be measured using various parameters.

1.1. RMSSD

rMSSD: Root Mean Square of successive differences between inter-beat intervals

  • No differences between ADHD sufferers and non-sufferers, even when tested separately by gender, age or ADHD subtype.15 One small study found reduced rMSSD scores.16
  • Low values correlate with15
    • Fears
    • Oppositional behavior
    • Social problems

1.2. HFA

The HFA is the absolute high frequency power.
HFA maps the parasympathetic (= vagal) tone.

  • With regard to HFA, the results in relation to ADHD are unclear.
    One large study found no differences between ADHD sufferers and non-sufferers, even when tested separately by gender, age or ADHD subtype.15 One small study found decreased HFA scores.16 Another study found increased scores in boys with inattention and oppositional defiant behavior (ODD).17
  • Low values correlate with15
    • Fears
    • Oppositional behavior
    • Social problems

1.3. HF

In one study, the normalized high-frequency band of heart rate variability was referred to as HF and described as representing the parasympathetic nervous system. This study found a 20% reduction in HF in boys with ADHD compared to those not affected.18

1.4. LFA

The LFA is the absolute low frequency power.
LFA maps both sympathetic and parasympathetic tone, but in practice represents the sympathetic tone.

  • Low values correlate with boys17
    • Inattention
    • Hyperactivity/impulsivity
    • Oppositional Deficit Disorder (ODD)

1.5. LF / HF ratio

LF / HF: Ratio of low frequency power to high frequency power

LF / HF ratio means sympathovagalance. An increase / high values of the LF / HF ratio mean sympathetic dominance, a decrease / low values of the LF / HF ratio mean parasympathetic dominance.

  • In ADHD, the LF / HF ratio is higher in both resting and sustained attention states, especially in male children1516
  • Low values correlate with boys17
    • Inattention
    • Hyperactivity/impulsivity
    • Oppositional Deficit Disorder (ODD)
  • Higher LF / HF ratio during sustained attention correlates with poorer attention performance in ADHD sufferers and non-sufferers15

1.6. SD

SD: Square of the interval differences

A small study found reduced SD values in children with ADHD.16

1.7. TP

TP: Total power of HRV

A small study found reduced TP levels in children with ADHD.16

In children, emotional dysregulation is associated with heart rate variability.19

2. HRV measurement with sports tracker

HRV can now be measured and evaluated using a simple sports watch (fitness tracker).

2.1. Garmin vivosmart 3 to 5

The Garmin vivosmart 3 or the successor models vivosmart 4 and vivosmart 5 (be careful, there are some other models that sound similar but do not have HRV measurement) is a standard sports watch that measures the usual data such as heart rate, calorie consumption, sleep, movement, etc. It also measures heart rate variability and provides a granular picture of HRV progression throughout the day. However, as a function rarely found in such fitness tracker sports watches, it also measures heart rate variability and provides a granular picture of HRV progression throughout the day. Long-term evaluations are available via the Garmin app. The cost of this device is between €80 and €140. However, the device only shows an overall HRV value, which is not specified in more detail.

According to this assessment, the evaluations are nevertheless meaningful enough to be able to analyze parameters influencing HRV. For example, it is clearly recognizable when sleep has not entered the recovery range, e.g. due to alcohol consumption.

The clear daily evaluation enables a rough biofeedback utilization. It becomes clear which stressors influence the HRV value. The development of the HRV value shows, for example, whether sleep allows sufficient recovery or whether certain situations lead to particular stress levels. Smoking, for example, directly worsens the HRV value.

Long-term measurement over weeks or months provides insights into which circumstances reduce the stress level and which increase it.

For example, under suitable circumstances, the effects of food intolerances can be recognized in the HRV level. The stress level of a person known to us is significantly increased for approx. 2 days after consuming an intolerable food.

2.2. Apple Watch

Although the Apple Watch offers HRV measurement, this is far less detailed than that of the Garmin vivosmart. In addition, we are not aware of any app that displays the values in a meaningful way. In our opinion, the Apple Watch is not particularly useful even for non-medical analyses.

2.3. Polar H10 chest strap with V800 sports watch

A more precise option that can also be used for medical analyses (although not approved as a medical device for this purpose) is to measure heartbeats using a chest strap. A combination of an H10 chest strap and a V800 tracking watch (both from Polar), which together cost around €300 (as of May 2018), make it possible to read out the raw heartbeat data over 24 hours. The results can then be analyzed by companies such as Autonom Health. As of May 2018, a single evaluation costs €50 and enables an analysis of the parasympathetic nervous system and (to a slightly limited extent) the sympathetic nervous system. Specific evaluation analyses are provided that are understandable for the person concerned.

To date, no evaluations or data analyses are available in relation to ADHD.

3. HRV influence through medication

Methylphenidate improves heart rate variability and control of the autonomic nervous system in ADHD sufferers.620

A compilation of the influence of medication on heart rate variability can be found at,2122 , although the information on methylphenidate is contradictory. As a result, methylphenidate is likely to increase (improve) the HVR, although the value of non-affected persons is not reached.

  1. Tonhajzerova, Farsky, Mestanik, Visnovcova, Mestanikova, Hrtanek, Ondrejka (2016): Symbolic dynamics of heart rate variability – a promising tool to investigate cardiac sympathovagal control in attention deficit/hyperactivity disorder (ADHD)? Can J Physiol Pharmacol. 2016 Jun;94(6):579-87. doi: 10.1139/cjpp-2015-0375.

  2. Crone, Jennings, van der Molen (2003): Sensitivity to interference and response contingencies in attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2003 Feb;44(2):214-26. doi: 10.1111/1469-7610.00115. PMID: 12587858.

  3. Iaboni, Douglas, Ditto (1997): Psychophysiological response of ADHD children to reward and extinction. Psychophysiology. 1997 Jan;34(1):116-23. doi: 10.1111/j.1469-8986.1997.tb02422.x. PMID: 9009815.

  4. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996): Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Circulation, 93, 1043–1065.

  5. Robe, Dobrean, Cristea, Păsărelu, Predescu (2019): Attention-Deficit/Hyperactivity Disorder and task-related heart rate variability: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2019 Jan 24. pii: S0149-7634(18)30800-5. doi: 10.1016/j.neubiorev.2019.01.022.

  6. Buchhorn, Conzelmann, Willaschek, Störk, Taurines, Renner (2012): Heart rate variability and methylphenidate in children with ADHD. Atten Defic Hyperact Disord. 2012 Jun;4(2):85-91. doi: 10.1007/s12402-012-0072-8.

  7. Buchhorn (2015): Autonome Prägung in den ersten 1.000 Tagen: Konsequenzen für die kognitive Entwicklung (ADHS) und das kardiovaskuläre Risiko; Vortrag

  8. Kinne (2013): Langzeitwirkung eines ADHS-Summercamps auf klinische Parameter bei Kindern mit ADHS); Dissertation, Seite 12 f

  9. Tonhajzerova, Ondrejka. Adamik, Hruby, Javorka, Trunkvalterova, Mokra, Javorka (2009): Changes in the cardiac autonomic regulation in children with attention deficit hyperactivity disorder (ADHD). Indian Journal of Medical Research, 130, 44-50., n = 36

  10. Börger, Van der Meere, Ronner, Alberts, Geuze, Bogte (1999): Heart rate variability and sustained attention in ADHD children. Journal of Abnormal Child Psychology, 27, 25-33.

  11. Börger, Van der Meere (2000): Motor control and state regulation in children with ADHD: a cardiac response study. Biological Psychology, 51, 247-267.

  12. Luman, Osterlaan, Hyde, van Meel, Sergeant (2007): Heart rate and reinforcement sensitivity in ADHD. Journal of Child Psychology and Psychiatry, 48, 890-898.

  13. Tonhajzerová, Ondrejka, Farský, Višňovcová, Mešťaník, Javorka, Jurko, Čalkovská (2016): Attention deficit/hyperactivity disorder (ADHD) is associated with altered heart rate asymmetry. Physiol Res. 2014;63 Suppl 4:S509-19.

  14. Sekaninova, Mestanik, Mestanikova, Hamrakova, Tonhajzerova (2019): Novel approach to evaluate central autonomic regulation in attention deficit/hyperactivity disorder (ADHD). Physiol Res. 2019 Aug 29;68(4):531-545.

  15. Griffiths, Quintana, Hermens, Spooner, Tsang, Clarke, Kohn (2017): Sustained attention and heart rate variability in children and adolescents with ADHD. Biol Psychol. 2017 Mar;124:11-20. doi: 10.1016/j.biopsycho.2017.01.004. n = 473

  16. Rukmani, Seshadri, Thennarasu, Raju, Sathyaprabha (2016): Heart Rate Variability in Children with Attention-Deficit/Hyperactivity Disorder: A Pilot Study. Ann Neurosci. 2016 Jul;23(2):81-8. doi: 10.1159/000443574. n = 20

  17. Wang, Huang, Kuo, Lee, Yang (2013): Inattentive and hyperactive preschool-age boys have lower sympathetic and higher parasympathetic activity. J Physiol Sci. 2013 Mar;63(2):87-94. doi: 10.1007/s12576-012-0238-3. n = 88

  18. Gomez, Domondon, Tsang, Chan, Lai (2021): Sensory Behaviours and Resting Parasympathetic Functions among Children with and without ADHD. ScientificWorldJournal. 2021 Nov 16;2021:6615836. doi: 10.1155/2021/6615836. PMID: 34824559; PMCID: PMC8610664. n = 64

  19. Bunford, Evans, Zoccola, Owens, Flory, Spiel (2017): Correspondence between Heart Rate Variability and Emotion Dysregulation in Children, Including Children with ADHD. J Abnorm Child Psychol. 2017 Oct;45(7):1325-1337. doi: 10.1007/s10802-016-0257-2.

  20. Kim, Yang, Lee (2015): Changes of Heart Rate Variability during Methylphenidate Treatment in Attention-Deficit Hyperactivity Disorder Children: A 12-Week Prospective Study. Yonsei Med J. 2015 Sep;56(5):1365-71. doi: 10.3349/ymj.2015.56.5.1365.