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Background: Better indicators are needed for identifying children with early signs of developmental psychopathology.

Aims: To identify measures of autonomic nervous system reactivity that discriminate children with internalising and externalising behavioural symptoms.

Method: A cross-sectional study of 122 children aged 6-7 years examined sympathetic and parasympathetic reactivity to standardised field-laboratory stressors as predictors of parent- and teacher-reported mental health symptoms.

Results: Measures of autonomic reactivity discriminated between children with internalising behaviour problems, externalising behaviour problems and neither. Internalisers showed high reactivity relative to low-symptom children, principally in the parasympathetic branch, while externalisers showed low reactivity, in both autonomic branches.

Conclusions: School-age children with mental health symptoms showed a pattern of autonomic dimorphism in their reactivity to standardised challenges. This observation may be of use in early identification of children with presyndromal psychopathology.

Declaration of interest: Funded by the John D. and Catherine T. MacArthur Foundation Research Network on Psychopathology and Development and the National Institute of Mental Health (R01-MH44340).

(C) 2001 The Royal College of Psychiatrists