medRxiv (Medicine)
2026-06-18
DOI: HASH:6a31e9bebe50cbbe383b90b06e4a0a10
Objective. The autonomic nervous system, which regulates cardiac rhythm, undergoes pronounced maturation across adolescence. How cardiac rhythm develops over this period, however, and whether individual differences in its development forecast mental and physical illness, remain open questions. We used three waves of Fitbit data from the Adolescent Brain Cognitive Development (ABCD) Study to characterize the developmental trajectory of the cardiac rhythm and to test whether variation in that trajectory predicts onset of psychopathology and cardiometabolic disease. Methods. 8,301 adolescents contributed 242,811 valid Fitbit wear days across Waves 2 (Mage=12), 4 (Mage=14), and 6 (Mage=16). Cosinor mixed-effects models yielded three rhythm parameters per session: mesor (24-hour mean), amplitude (diurnal swing), and acrophase (peak timing). We first characterized age- and sex-specific trajectories, cross-wave stability, and factors shaping the rhythm. We then used parallel-process latent growth models to test whether within-person changes in rhythm tracked symptom trajectories, and hierarchical logistic models to test whether rhythm parameters predicted the first clinical onset of psychopathology and of obesity and hypertension. Results. The cardiac rhythm changed substantially across adolescence: mesor decreased, amplitude flattened, and acrophase shifted later. Within-person change in the rhythm tracked change in blood pressure, BMI, and trajectories of depression and ADHD symptoms. Higher mesor predicted incident onset of all five outcomes controlling for demographics, baseline symptoms, and behavior (ORs 1.36-1.54); amplitude, acrophase, and rhythm instability conferred additional risk. Conclusions. The 24-hour cardiac rhythm is a passively measurable substrate of adolescent autonomic development that indexes transdiagnostic risk for psychiatric and cardiometabolic illness.