Brain-Behavior Relationships in Children With ADHD: Resting-state EEG Networks Underlying Executive Function and Neurological Soft Signs

PURPOSE: To investigate sex-stratified brain-behavior relationships between large-scale functional brain network topology and executive-motor profiles in pediatric ADHD, using a multi-dimensional parameter exploration approach. METHOD: Graph-theoretical connectivity measures were derived from resting-state EEG in 41 medication-naïve children with ADHD (10 girls) and 42 healthy controls (HCs) (10 girls), aged 6-12 years. Sex-specific within- and between-group differences were examined across temporal windows (1-2-4 s), frequency bands, and network densities (10%-30%). Associations between connectivity measures and behavioral/clinical profiles (Stroop, PANESS, Turgay DSM-IV scales) were also assessed. FINDINGS: Directed Transfer Function showed more reliable predictions than phase-sensitive estimators. ADHD-girls showed lower local connectivity, and HC-girls showed higher integration/segregation in within-group gender differences in lower alpha at sparse network densities (10%-15%). Network alterations and meaningful brain-behavioral relationships were limited to upper alpha and beta at denser network configurations (20%-30%) in ADHD-girls. Total gait/station was negatively correlated with integration in HC, positively correlated with hub-to-hub organization in ADHD. The edge-level differences were localized at right centro-temporal locations (FC6-T8) in boys, while the fewer and weaker differences were localized at antero-posterior, occipital-centric connections converging onto AF3 locus in girls. CONCLUSION: The density-dependent emergence of brain-behavior correlations in girls offers a plausible network-level explanation for the diagnostic camouflage effect reported in females with ADHD. Pediatric ADHD manifests through sex-specific network reconfigurations, a right-hemispheric inhibitory-circuit deficit in boys versus an antero-posterior sensory-gating alteration in girls.