Altered neural prioritization of auditory information during cross-modal attention in children with ADHD

Efficient auditory attention requires prioritizing target over nontarget information. Although attentional deficits are a core feature of attention-deficit/hyperactivity disorder (ADHD), the neural mechanisms underlying auditory prioritization during cross-modal attention remain unclear. We examined neural differentiation between target and nontarget auditory information in children with ADHD. Ninety-five school-aged children (mean age = 10.81 years), including 46 children with ADHD and 49 typically developing (TD) children, performed a visually cued auditory spatial attention task during electroencephalography (EEG) recording. Auditory selective attention was assessed using the N2-anterior-contralateral (N2ac) component and multivariate pattern analysis (MVPA). TD children showed enhanced MVPA decoding of target locations and reduced decoding of nontarget locations. Greater target-nontarget neural differentiation was associated with larger N2ac amplitudes. In contrast, children with ADHD showed reduced target lateralization, smaller N2ac amplitudes, weaker target decoding, and enhanced nontarget decoding, resulting in diminished neural differentiation between relevant and irrelevant auditory information. Reduced target-related lateralization was associated with greater response-time variability, whereas reduced target decoding accuracy was linked to more severe hyperactivity-impulsivity symptoms. Together, these findings indicate that children with ADHD show altered neural prioritization of auditory information within a visually cued attention context. Altered neural prioritization was associated with behavioral variability and symptom severity, providing new insight into the neurocognitive mechanisms underlying attentional dysfunction in ADHD.