Event-related brain oscillations in attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis

Previous studies have associated attention-deficit/hyperactivity disorder (ADHD) with several alterations in electroencephalographic (EEG) activity. Time-frequency analyses capturing event-related power modulations are becoming an increasingly popular approach, but a systematic synthesis of the time-frequency literature in ADHD is currently lacking. We conducted the first systematic review and meta-analysis of time-frequency studies of children and adults with ADHD in comparison to neurotypical controls. Searches via Medline, Embase, and Web of Science, as well as reference lists, identified 28 eligible articles published until March 2021. Of these, 13 articles with relevant data were included in a multi-level meta-analysis. Most studies examined power modulations of alpha, theta and/or beta frequencies (N = 21/28), and focused on children (N = 17/28). Meta-analyses showed significantly weaker theta increases (Cohen's d = 0.25, p = 0.039; N-ADHD = 346, N-CONTROL = 327), alpha decreases (d = 0.44, p < 0.001; N-ADHD = 564, N-CONTROL = 450), and beta increases (Cohen's d = 0.33, p < 0.001; N-ADHD = 222, N-CONTROL = 263) in individuals with ADHD relative to controls. These patterns indicate broad brain-oscillatory alterations in individuals with ADHD with small (theta) and small-to-moderate (alpha and beta) effect sizes. These group differences were partly consistent when repeating analyses by age group (<18 and 18+ years) and task type (cognitive control, working memory, and simple attention tasks). Overall, our findings identify widespread event-related brain-oscillatory alterations in individuals with ADHD during a range of neurocognitive functions. Future research requires larger samples, a broader range of frequency bands (including delta and gamma) during a wider type of cognitive-affective processes, and should clarify whether atypical event-related power profiles are ADHD-specific or shared with other neuropsychiatric conditions.