Diminished Stimulus-Evoked Activity During Sustained Attention Without Behavioural Cost in ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is often accompanied by attentional challenges, sleep difficulties and increased reports of daytime sleepiness, indicating potential links between attention and arousal mechanisms. Electroencephalographic (EEG) studies have shown that sleep-like wake slow wave (SW) activity during wakefulness, characterised by reduced cortical activity, corresponds with periods of inattention in both ADHD and neurotypical populations. However, it remains unclear whether group differences in waking SWs are consistent across different types of sustained attention tasks or may be context-dependent. The present study compared sustained attention performance and wake SW activity between adults with and without ADHD during a continuous visual target detection task. EEG data were collected while adults with (n = 52) and without ADHD (n = 49) completed a sustained attention paradigm. The task presented a continuous stream of rotating (anti-clockwise or clockwise) black-and-white checkerboard stimuli, and participants were required to detect infrequent targets that were marginally longer in duration than non-targets. Behavioural and neural measures (power spectra, steady-state visually evoked potentials (SSVEP), event-related potentials and SW density during wake) were analysed. No significant group differences were observed for task performance and wake SW activity. However, electrophysiological analyses revealed the ADHD group showed reduced P300, elevated beta-band power, and lower SSVEPs to target stimuli compared with the neurotypical group. These neural differences in the context of comparable performance suggest compensatory cortical recruitment in ADHD. The absence of SW differences further supports this, suggesting comparable performance and maintained arousal may reflect successful neural compensation in ADHD in this cognitive task. Significance StatementIndividuals with ADHD commonly experience attention differences, but emerging evidence suggests these difficulties may depend on task context. Using clinical diagnostic interviews, medication washout, and Bayesian statistics, we found strong evidence for comparable performance between ADHD and neurotypical adults on a sustained attention task. Notably, slow wave activity during wakefulness did not differ between groups, consistent with maintained arousal. Nevertheless, differences in brain activity, including altered target processing, increased cortical activation and reduced visual entrainment, suggested compensatory neural recruitment in ADHD. This context-dependent pattern has important theoretical and clinical implications: identifying task features that challenge or support performance in ADHD can reveal how individuals compensate neurally, and guide interventions that leverage task features to support attention in ADHD.