Neurophysiological differentiation of children with ADHD alone and ADHD comorbid with dyslexia: a P600-like component analysis

Yu-Hao HUANG, Ke-Duo HUANG, Liu-Fang ZHAN, Li-Qun LIU, Ling-Juan LIU, Jie XIONG, Kai-Ju LUO, Fang YANG, Xiao-Xiang GONG, Xue-Mei LUO

Chinese Journal of Contemporary Pediatrics ›› 2026, Vol. 28 ›› Issue (10) : 1184-1192.

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Chinese Journal of Contemporary Pediatrics ›› 2026, Vol. 28 ›› Issue (10) : 1184-1192. DOI: 10.7499/j.issn.1008-8830.2605134
CLINICAL RESEARCH

Neurophysiological differentiation of children with ADHD alone and ADHD comorbid with dyslexia: a P600-like component analysis

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Abstract

Objective To investigate the clinical value of the latency of the P600-like event-related potential component during a spatial N-back task as a neurophysiological indicator for differentiating children with attention deficit hyperactivity disorder (ADHD) alone from those with ADHD comorbid with developmental dyslexia (DD). Methods In this prospective study, 66 ADHD children aged 6-10 years were enrolled from the Department of Child Health Care, Second Xiangya Hospital of Central South University between June and September 2025, including 28 with ADHD alone and 38 with ADHD+DD. An additional 20 healthy children were included solely as a visual reference for electroencephalogram (EEG) topographic mapping. Behavioral symptoms were assessed using the SNAP-IV, the Childhood Executive Functioning Inventory, the Conners Child Behavior Scale, and the Dyslexia Checklist for Chinese Children. EEG was recorded during a spatial N-back task, and the P600-like component was extracted from Fz, Cz, and Pz electrodes. A linear mixed model was applied to analyze the interactions among group, electrode site, and task load. Receiver operating characteristic (ROC) curves were used to evaluate discriminative performance, and 5-fold cross-validation was conducted to reduce overfitting risk. Results Under the 1-back condition, the latency of the P600-like component at Pz was significantly longer in the ADHD+DD group than in the ADHD-alone group (P<0.001). The area under the curve (AUC) for the P600-like component latency at Pz in distinguishing ADHD alone from ADHD+DD was 0.804 (95%CI: 0.697-0.910). Using a cut-off value of 688 ms, sensitivity was 63.2% and specificity 96.4%. Hierarchical logistic regression analysis showed that model 4 (P600-like component latency + N1 reaction time + age) achieved an AUC of 0.804, comparable to that of model 2 (model 1 + P600-like component peak value + P600-like component average amplitude; AUC=0.805), with superior cross-validation stability. Conclusions The latency of the P600-like component at the Pz electrode during an N-back task may serve as a neurophysiological indicator to assist in differentiating whether children with ADHD have comorbid DD. A parsimonious model incorporating this indicator has discriminative performance comparable to the full-indicator model, with superior cross-validation stability.

Key words

Attention deficit hyperactivity disorder / Dyslexia / Event-related potential / N-back task / Child

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Yu-Hao HUANG , Ke-Duo HUANG , Liu-Fang ZHAN , et al . Neurophysiological differentiation of children with ADHD alone and ADHD comorbid with dyslexia: a P600-like component analysis[J]. Chinese Journal of Contemporary Pediatrics. 2026, 28(10): 1184-1192 https://doi.org/10.7499/j.issn.1008-8830.2605134

References

[1]
《中华儿科杂志》编辑委员会, 中华医学会儿科学分会神经学组, 中华医学会儿科学分会儿童保健学组, 等. 儿童注意缺陷多动障碍诊疗建议[J]. 中华儿科杂志, 2006, 44(10): 758-759. DOI: 10.3760/j.issn:0578-1310.2006.10.012 .
[2]
王久菊, 孙黎, 舒华, 等. 注意缺陷多动障碍共患阅读障碍: 认知-脑-基因的多维度研究进展[J]. 生物化学与生物物理进展, 2020, 47(11): 1135-1144. DOI: 10.16476/j.pibb.2020.0096 .
[3]
余珍珠, 杨斌让, 张姗红, 等. 注意缺陷多动障碍共患发展性阅读障碍儿童的智力特征[J]. 中国当代儿科杂志, 2021, 23(2): 148-152. PMCID: PMC7921539. DOI: 10.7499/j.issn.1008-8830.2009095 .
[4]
崔楠, 王久菊, 赵婧. 注意缺陷多动障碍-发展性阅读障碍共患儿童的干预效果及其内在机理[J]. 心理科学进展, 2023, 31(4): 622-630. DOI: 10.3724/SP.J.1042.2023.00622 .
[5]
He H, Ji C, Gao X, et al. Associative gene networks reveal novel candidates important for ADHD and dyslexia comorbidity[J]. BMC Med Genomics, 2023, 16(1): 208. PMCID: PMC10478365. DOI: 10.1186/s12920-023-01502-1 .
[6]
刘世燕, 胡珍玉, 张文武, 等. 阅读障碍与注意缺陷多动障碍儿童的形似同音错字词组的N400研究[J]. 中国现代医生, 2019, 57(19): 22-26.
[7]
Breitling-Ziegler C, Tegelbeckers J, Flechtner HH, et al. Economical assessment of working memory and response inhibition in ADHD using a combined n-back/nogo paradigm: an ERP study[J]. Front Hum Neurosci, 2020, 14: 322. PMCID: PMC7426064. DOI: 10.3389/fnhum.2020.00322 .
[8]
Coulson S, King JW, Kutas M. Expect the unexpected: event-related brain response to morphosyntactic violations[J]. Lang Cogn Process, 1998, 13(1): 21-58. DOI: 10.1080/016909698386582 .
[9]
Jonkman LM, Hurks PP, Schleepen TM. Effects of memory strategy training on performance and event-related brain potentials of children with ADHD in an episodic memory task[J]. Neuropsychol Rehabil, 2016, 26(5-6): 910-941. DOI: 10.1080/09602011.2015.1070735 .
[10]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders[M]. 5th ed. Washington, DC, USA: APA, 2022.
[11]
Gau SS, Shang CY, Liu SK, et al. Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale-parent form[J]. Int J Methods Psychiatr Res, 2008, 17(1): 35-44. PMCID: PMC6878250. DOI: 10.1002/mpr.237 .
[12]
魏威, 谢庆斌, 朱晶晶, 等. 儿童执行功能量表在中国学前儿童中的信效度分析[J]. 中国临床心理学杂志, 2018, 26(1): 26-29. DOI:10.16128/j.cnki.1005-3611.2018.01.006 .
[13]
Conners CK, Sitarenios G, Parker JD, et al. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity[J]. J Abnorm Child Psychol, 1998, 26(4): 257-268. DOI: 10.1023/A:1022602400621 .
[14]
Hou F, Qi L, Liu L, et al. Validity and reliability of the Dyslexia Checklist for Chinese Children[J]. Front Psychol, 2018, 9: 1915. PMCID: PMC6189409. DOI: 10.3389/fpsyg.2018.01915 .
[15]
范奕敏, 张湘琳, 曹玉卿, 等. 小学生阅读障碍行为筛查家长问卷的编制及信效度检验[J]. 心理与行为研究, 2021, 19(4): 521-527. DOI: 10.3969/j.issn.1672-0628.2021.04.014 .
[16]
Osterhout L, Holcomb PJ. Event-related brain potentials elicited by syntactic anomaly[J]. J Mem Lang, 1992, 31(6): 785-806. DOI: 10.1016/0749-596X(92)90039-Z .
[17]
Vilà-Balló A, Salmi J, Soveri A, et al. Neural signatures for active maintenance and interference during working memory updating[J]. Biol Psychol, 2018, 132: 233-243. DOI: 10.1016/j.biopsycho.2018.01.007 .
[18]
Dhar M, Been PH, Minderaa RB, et al. Distinct information processing characteristics in dyslexia and ADHD during a covert orienting task: an event-related potential study[J]. Clin Neurophysiol, 2008, 119(9): 2011-2025. DOI: 10.1016/j.clinph.2008.05.027 .
[19]
Cantiani C, Lorusso ML, Guasti MT, et al. Characterizing the morphosyntactic processing deficit and its relationship to phonology in developmental dyslexia[J]. Neuropsychologia, 2013, 51(8): 1595-1607. DOI: 10.1016/j.neuropsychologia.2013.04.009 .
[20]
Kuperberg GR, Caplan D, Sitnikova T, et al. Neural correlates of processing syntactic, semantic, and thematic relationships in sentences[J]. Lang Cogn Process, 2006, 21(5): 489-530. DOI: 10.1080/01690960500094279 .
[21]
Li XQ, Zheng YY, Zhao HY, et al. How the speed of working memory updating influences the on-line thematic processing of simple sentences in Mandarin Chinese[J]. Cogn Neurodyn, 2014, 8(6): 447-464. PMCID: PMC4571645. DOI: 10.1007/s11571-014-9292-2 .
[22]
Fassbender C, Zhang H, Buzy WM, et al. A lack of default network suppression is linked to increased distractibility in ADHD[J]. Brain Res, 2009, 1273: 114-128. PMCID: PMC4721585. DOI: 10.1016/j.brainres.2009.02.070 .
[23]
Novak L, Malinakova K, Trnka R, et al. Neural bases of social deficits in ADHD: a systematic review. Does the theory of mind matter?[J]. Brain Res Bull, 2024, 215: 111011. DOI: 10.1016/j.brainresbull.2024.111011 .
[24]
Fassbender C, Schweitzer JB. Is there evidence for neural compensation in attention deficit hyperactivity disorder? A review of the functional neuroimaging literature[J]. Clin Psychol Rev, 2006, 26(4): 445-465. PMCID: PMC2677014. DOI: 10.1016/j.cpr.2006.01.003 .
[25]
Rosch KS, Khashab M, Ghanaiem S, et al. Differentiating the neurobiological correlates for reading gains in children with reading difficulties with and without attention-deficit/hyperactivity disorder using fMRI[J]. J Int Neuropsychol Soc, 2025, 31(1): 75-85. PMCID: PMC11957940. DOI: 10.1017/S1355617724000717 .
[26]
Wu ZM, Wang P, Zhong YY, et al. The underlying neuropsychological and neural correlates of the impaired Chinese reading skills in children with attention deficit hyperactivity disorder[J]. Eur Child Adolesc Psychiatry, 2024, 33(11): 3979-3992. PMCID: PMC11588871. DOI: 10.1007/s00787-024-02422-w .
[27]
Ashraf I, Jung S, Hur S, et al. A systematic literature review of neuroimaging coupled with machine learning approaches for diagnosis of attention deficit hyperactivity disorder[J]. J Big Data, 2024, 11: 140. DOI: 10.1186/s40537-024-00998-3 .

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