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Updated: May 8, 2026

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents
Published on: July 10, 2017
Children's heart rate variability as stress indicator: association with reported stress and cortisol
Nathalie Michels1, Isabelle Sioen, Els Clays
1Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 2 Blok A, B-9000 Ghent, Belgium.
Unlabelled:
Stress is a complex phenomenon coordinated by two main neural systems: the hypothalamic-pituitary-adrenal system with cortisol as classical stress biomarker and the autonomic nervous system with heart rate variability (HRV) as recently suggested stress marker. To test low HRV (5 minute measurements) as stress indicator in young children (5-10 y), associations with self-reported chronic stress aspects (events, emotions and problems) (N=334) and salivary cortisol (N=293) were performed. Peer problems, anger, anxiety and sadness were associated with lower root mean square of successive differences (RMSSD) and high frequency power (i.e. lower parasympathetic activity). Anxiety and anger were also related to a higher low frequency to high frequency ratio. Using multilevel modelling, higher cortisol levels, a larger cortisol awakening response and steeper diurnal decline were also associated with these HRV patterns of lower parasympathetic activity.
Conclusion:
Low HRV (lower parasympathetic activity) might serve as stress indicator in children.
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