Heart Rate Variability in Children With Autism Spectrum Disorder and Associations With Medication and Symptom Severity

Abstract Decreased heart rate variability (HRV) is considered a common marker of autonomic dysfunction that contributes to poor health outcomes. While some studies have suggested that children with autism spectrum disorder (ASD) show reduced HRV, research is yet to consider whether this may be associated with medication use and symptom severity. This study examined the relationship between resting state HRV, medication use and symptom severity in children diagnosed with ASD. Children with ASD ( N = 86), aged between 3 and 12 years ( M = 8.09), were compared to 44 neurotypical children of similar age ( M = 7.15). Laboratory assessment of HRV involved 5 min of non‐invasive baseline electrocardiogram assessments while participants viewed an age‐appropriate non‐verbal animated video. Time‐domain and frequency‐domain HRV measures were analyzed. ASD symptom severity was assessed using the Autism Diagnostic Observation Schedule‐Second Edition (ADOS‐2) and Social Responsiveness Scale (SRS‐2). Results indicated that children with ASD exhibited reduced resting HRV relative to neurotypical children. Subsequent analyses within the ASD group suggested that this group difference was greater in children who were taking psychotropic medication ( N = 36). Our data also provides tentative evidence of a relationship between HRV and social impairment symptoms in children with ASD, with more severe repetitive behaviors (as measured by the ADOS‐2) associated with decreased resting HRV. Overall, these findings suggest that HRV may be atypical in children with ASD and suggest the importance of exploring HRV as a risk factor for cardiovascular health in this group. Lay Summary Cardiac activity, such as heart rate variability (HRV), can provide insight into the autonomic nervous system. This study reports on the association between resting‐state HRV and autonomic nervous system activity in young children with autism spectrum disorder (ASD) compared to neurotypical children. These results may help us understand what underlies autonomic nervous system dysfunction and the potential pathophysiological mechanisms leading to increased cardiovascular risk in ASD.