Abstract
Purpose The study aimed to assess the value of event-related potentials (ERP) of executive functions in distinguishing between attention deficit hyperactivity disorder (ADHD) and ADHD combined with autism spectrum disorder (ADHD&ASD). Methods This retrospective analysis included 204 participants divided into three groups: ADHD&ASD (64/204), ADHD (70/204), and typical development (TD) (70/204). Neuropsychological tests, including the Digit Span Test, Behavior Rating Inventory of Executive Function (BRIEF), Trail Making Test at its Chinese equivalent version, the Shape Trail Test (STT), and the Stroop Color Word Interference Test, were compared across groups. ERP measures, such as latency and amplitude at the frontal zone (Fz), central zone (Cz), and parietal zone (Pz), along with reaction times and target stimulus hits using an oddball paradigm, were analyzed. Post-hoc analyses and receiver operating characteristic (ROC) curves identified key indicators for distinguishing ADHD from ADHD&ASD. Results Significant differences were found in ERP and BRIEF indicators (P < 0.001), as well as selected TMT and Stroop parameters (P < 0.05) across the groups. The ADHD&ASD group exhibited notably higher Fz, Cz, and Pz latencies, interference times, and reaction times compared to the ADHD group (P < 0.05). With the exception of word meaning interference time, the area under ROC curves (AUC) of the remaining five indicators exceeds 0.8. Particularly noteworthy is the combined ROC curve of Fz latency and average reaction time, which demonstrated a sensitivity, specificity, and AUC of 88.68%, 97.14%, and 0.938 (95%CI: 0.885-0.990, P < 0.001), respectively. Conclusion ERP measurements using oddball paradigms hold strong potential for distinguishing ADHD from ADHD&ASD, enabling the development of more targeted treatment approaches through precise neurophysiological markers.