Neurophysiology of perceptual decision-making and its alterations in attention deficit hyperactivity disorder (ADHD)

Abstract

AbstractADHD is a prevalent neurodevelopmental disorder associated with adverse outcomes and significant social and economic cost. However, efforts to develop a more detailed understanding of the neuropsychology of ADHD are complicated by the diversity of interindividual presentation and the inability of current clinical tests to distinguish between its sensory, attentional, arousal or motoric contributions. Identifying objective methods that can decompose the clinical heterogeneity of ADHD is a long-held goal that will advance our understanding of aetiological processes and aid the development of personalised treatment approaches. Here, we examine key neuropsychological components of ADHD with an electrophysiological (EEG) decision making paradigm capable of isolating distinct neural signals of several key information processing stages necessary for sensory-guided actions from initial sensory processing to motor responses. We show that compared to typically developing children, children with ADHD display slower and less accurate behavioural performance driven by the atypical dynamics of discrete electrophysiological signatures of attentional allocation, the accumulation of sensory evidence, and strategic adjustments reflecting urgency of response. These findings offer an integrated account of impairments in ADHD and establish neural signals that can serve as critical guidance in constructing or constraining mechanistic accounts in future research, as well as in ADHD diagnosis and treatment tailoring.