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Heart rate and reinforcement sensitivity in ADHD


  • Conflict of interest statement: No conflicts declared.

Marjolein Luman, Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Tel: +31 (0)20 59 89255; Fax: +31 (0)20 59 88971; Email:


Background:  Both theoretical and clinical accounts of attention-deficit/hyperactivity disorder (ADHD) implicate a dysfunctional reinforcement system. This study investigated heart rate parameters in response to feedback associated with reward and response cost in ADHD children and controls aged 8 to 12.

Methods:  Heart rate responses (HRRs) following feedback and heart rate variability (HRV) in the low frequency band (.04–.08 Hz), a measure of mental effort, were calculated during a time production paradigm. Performance was coupled to monetary gain, loss or feedback-only in a cross-over design.

Results:  Children with ADHD exhibited smaller HRRs to feedback compared to controls. HRV of children with ADHD decreased when performance was coupled to reward or response cost compared to feedback-only. HRV of controls was similar across conditions.

Conclusions:  Children with ADHD were characterised by (a) possible abnormalities in feedback monitoring and (b) motivational deficits, when no external reinforcement is present.