Introduction
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and adolescents.1 2 People diagnosed with ADHD not only exhibit core symptoms (inattentiveness, hyperactivity and impulsivity) but also experience the apparent consequences of these symptoms, including problems in school and social interactions.1 2 As with other psychiatric disorders, diagnosis remains exclusively based on a checklist of symptoms. However, why symptoms manifest as they do and what mechanism, if any, they share remain elusive.3 Therefore, novel conceptual approaches are required to explain at least some of the symptoms and, ideally, to shift from a purely symptom-descriptive to an explanatory-mechanistic view.
Typical ADHD diagnostic symptoms such as interrupting or intruding on others violate general expectations regarding the structure of interpersonal exchange. So far, these behaviours have mostly been subsumed more generally under the core symptoms of impulsivity and inattentiveness,4–8 and possible underlying mechanisms have not been examined in detail. For a deeper understanding of the underlying processes that are altered in ADHD, we sought to move beyond observable core symptoms and test the hypothesis that these behaviours reflect differences in the ‘segmentation of events’. In this regard, we suggest that people with ADHD might perceive the pace of unfolding events differently from neurotypically developing (NT) peers, potentially viewing these events as unfolding more slowly. Alternatively, they might perceive cues marking the end and beginning of sequential events differently, so that, for example, the end of an unpleasant event is less predictable. In either case, a person diagnosed with ADHD might have the impression that situations last too long, and in turn, they may become bored more quickly or feel fatigued sooner than NT peers. This assumption also might be related to findings that timing and time perception are altered in ADHD so that the purely temporal perception of ‘events’ might differ as well.9–12
A theoretical framework for this partitioning of events can be derived from event segmentation theory (EST).13–15 EST suggests that each current situation and its expected trajectory are mentally represented in a so-called ‘working event model’ (WEM). The WEM is influenced by prior experiences with similar situations, stored in long-term memory (so-called ‘event schemata’) and by the sum of the perceptual input from the environment. Based on the WEM, expectations arise about how a situation will probably unfold, and these expectations are constantly compared with the actual perceptual input.13–15 Whenever the expectation is unmet, the current WEM is updated and adjusted based on available event schemata to better represent the current situation. Moreover, this updating of one WEM leads to its closure and to the opening of a new one,13–15 marking recognition that a new situation is beginning.
Based on these considerations, we hypothesised that the mechanisms described in the EST might be altered in ADHD and that these alterations would in turn be reflected at the neurophysiological level. More specifically, we posited that altered event segmentation in ADHD might be related to alterations in specific electroencephalography (EEG) frequency bands that are linked to distinct, general cognitive functions16 and specifically to event segmentation.17 The ‘alpha frequency band’ reflects a selection mechanism guiding which information is further processed within a so-called ‘knowledge system’,18 19 presumably storing event schemata. The ‘beta frequency band’ is likely associated with maintenance of the ‘status quo’,20–22 which may reflect maintenance of the current WEM. The ‘theta frequency band’ is associated with prediction error signalling,23 24 which might underlie the operation of comparing the WEM and related expectations to current perceptual input from the environment. All of these processes, reflected by distinct frequency bands, could give rise to the alterations/deficits observed in ADHD.
Following the rationale of spatiotemporal neuroscience,25–27 it is not only the information about the power in a specific frequency band that will provide more detailed insights into the expected alterations in event segmentation in ADHD compared with neurotypical development. Instead, the functional neuroanatomical localisation of the activity in these frequency bands and particularly the communication among brain regions within these frequency bands are of equal importance. As suggested by a previous study,17 the interplay of brain regions associated with the activity of different frequency bands is important in the event segmentation process. For other aspects of cognitive functions, previous studies have already shown ADHD-related changes in structural and functional connectivity profiles between brain regions within these frequency bands.28 29
Here, we specifically examined communication among brain regions within the alpha, beta and theta frequency bands, evaluating which functional neuroanatomical structures are associated with altered dynamics in these frequency bands. Furthermore, to gain insights into information flow among brain regions as a neural basis for the segmentation of incoming information into discrete events, we examined the directed exchange of information among brain regions. To investigate the effective connectivity among the sources of the frequency band activity, we applied a machine-learning approach (non-linear Causal Relationship Estimation by Artificial Neural Network (nCREANN)).30 We hypothesised that, compared with NT participants, individuals with ADHD would have weaker directed communication among brain regions.