Background: Both theoretical and clinical accounts of attention-deficit/hyperactivity disorder (ADHD) implicate a dysfunctional reinforcement system. This study investigated heart rate parameters in response to feedback associated with reward and response cost in ADHD children and controls aged 8 to 12. Methods: Heart rate responses (HRRs) following feedback and heart rate variability (HRV) in the low frequency band (0.04-0.08 Hz), a measure of mental effort, were calculated during a time production paradigm. Performance was coupled to monetary gain, loss or feedback-only in a cross-over design. Results: Children with ADHD exhibited smaller HRRs to feedback compared to controls. HRV of children with ADHD decreased when performance was coupled to reward or response cost compared to feedback-only. HRV of controls was similar across conditions. Conclusions: Children with ADHD were characterised by (a) possible abnormalities in feedback monitoring and (b) motivational deficits, when no external reinforcement is present.