The present study was conceived with the objective to study the correlation between the Conners' Parent Rating score and autonomic functions in children with Attention-deficit/hyperactivity disorder (ADHD) before and after treatment with Methylphenidate. ADHD is associated with autonomic dysfunction which gets further modulated by drug therapy. There are few prospective studies to evaluate the correlation between the Conners' Parent Rating score and autonomic functions before and after 12 weeks of methylphenidate treatment in drug-naive patients with ADHD. The parasympathetic reactivity was tested with E: I ratio (Deep Breathing Test) and 30:15 ratio (Heart response to standing). On the Sympathetic reactivity tests, the Increase in Systolic blood pressure (SBP) & diastolic blood pressure (DBP) on exposure to cold (Cold Pressor test) and sustained handgrip (Handgrip test) was performed on the subjects. Cold Pressor Test SBP differences showed a negative correlation with Connors Parent Rating score signifying that the children with lower ADHD scores had higher responsiveness to CPT-induced SBP changes. Post-therapy Cold Pressor Test SBP differences showed a negative correlation with Connors ARS signifying that the children with lower ADHD scores had higher responsiveness to CPT-induced SBP changes. Hence with the improvement as shown by reduction in ADHD scores, the sympathovagal balance shifts towards the sympathetic arm.

Keywords: Conners' Parent Rating score, ADHD, methylphenidate, autonomic functions

1. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015 Apr 1;135(4):e994-1001.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, 5 th Washington, DC: American Psychiatric Publishing; 2013. P. 314-26
3. Taylor E, Döpfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, Steinhausen HC. European clinical guidelines for hyperkinetic disorder–first upgrade. European child & adolescent psychiatry. 2004 Jul 1;13(1):i7-30.
4. Seixas M, Weiss M, Müller U. Systematic review of national and international guidelines on attention-deficit hyperactivity disorder. Journal of Psychopharmacology. 2012 Jun;26(6):753-65.
5. Greenhill L, Beyer DH, Finkleson J, Shaffer D, Biederman J, Conners CK, Gillberg C, Huss M, Jensen P, Kennedy JL, Klein R. Guidelines and algorithms for the use of methylphenidate in children with Attention-Deficit/Hyperactivity Disorder. Journal of attention disorders. 2001 Dec;6:S89-100.
6. Negrao BL, Bipath P, van der Westhuizen D, Viljoen M. Autonomic correlates at rest and during evoked attention in children with attention-deficit/hyperactivity disorder and effects of methylphenidate. Neuropsych-obiology 2011;63:82–91.
7. Musser ED, Backs RW, Schmitt CF, Ablow JC, Measelle JR, Nigg JT. Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). Journal of abnormal child psychology. 2011 Aug 1;39(6):841-52.
8. Koenig J, Rash JA, Kemp AH, Buchhorn R, Thayer JF, Kaess M. Resting state vagal tone in attention deficit (hyperactivity) disorder: A meta-analysis. The World Journal of Biological Psychiatry. 2016 May 20:1-5.
9. Andrade ÊR, Scheuer C. Analysis of the methylphenidate's efficacy using the abbreviated version Conners' questionnaire in attention deficit hyperactivity disorder. Arquivos de neuro-psiquiatria. 2004 Mar;62(1):81-5.
10. Ewing DJ, Hume L, Campbell IW, Murray A, Neilson JM, Clarke BF. Autonomic mechanisms in the initial heart rate response to standing. Journal of Applied Physiology. 1980 Nov 1;49(5):809-14.
11. Ewing DJ, Borsey DQ, Bellavere F, Clarke BF. Cardiac autonomic neuropathy in diabetes: comparison of measures of RR interval variation. Diabetologia. 1981 Jul 1;21(1):18-24.
12. Ewing DJ, Clarke BF. Diagnosis and management of diabetic autonomic neuropathy. British medical journal (Clinical research ed.). 1982 Oct 2;285(6346):916.
13. Zygmunt A, Stanczyk J. Methods of evaluation of autonomic nervous system function. Archives of medical science: AMS. 2010 Mar 1;6(1):11.
14. Velasco M, Gómez J, Blanco M, Rodriguez I. The cold pressor test: pharmacological and therapeutic aspects. American journal of therapeutics. 1997 Jan 1;4(1):34-8.
15. von Baeyer CL, Piira T, Chambers CT, Trapanotto M, Zeltzer LK. Guidelines for the cold pressor task as an experimental pain stimulus for use with children. The Journal of Pain. 2005 Apr 30;6(4):218-27.
16. Lind AR, Taylor SH, Humphreys PW, Kennelly BM, Donald KW. The circulatory effects of sustained voluntary muscle contraction. Clinical science. 1964 Oct;27:229-44.
17. Victor r, Vissing s, Urias l, Scherrer u. Central motor command activates sympathetic outflow to skin during static exercise in humans. in clinical research 1989 apr 1 vol. 37, no. 2, pp. a524-a524.
18. Conners CK. Clinical use of rating scales in diagnosis and treatment of attention-deficit/hyperactivity disorder. Pediatric Clinics of North America. 1999 Oct 1;46(5):857-70.
19. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of abnormal child psychology. 1998 Aug 1;26(4):257-68.
20. Yeragani VK. Heart rate and blood pressure variability: implications for psychiatric research. Neuropsychobiology. 1995 Jul 1;32(4):182-91.

Dr Pramesh Dogra

Medical Officer, Directorate of Health Services, Department of Health and Family Welfare,

Govt. of Himachal Pradesh, SDA Complex, Kasumpti, Shimla, India – 171006
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob No.8010826664