Effective connectivity alterations of the triple network model in the co-occurrence of autism spectrum disorder and attention deficit hyperactivity disorder

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are both highly prevalent disorders and frequently co-occur. The underlying neurological mechanisms of the co-occurrence of ASD and ADHD (ASD + ADHD) remain unknown. This study focuses on investigating the effective connectivity (EC) alterations within the triple network model in individuals with ASD + ADHD. Resting-state functional magnetic resonance imaging data were obtained from 44 individuals with ASD + ADHD, 60 individuals with ASD without ADHD (ASD-only), 35 individuals with ADHD without ASD (ADHD-only), and 81 healthy controls (HC) from the Autism Brain Imaging Data Exchange II and the ADHD-200 Sample database. Spectral dynamic causal modeling was employed to explore the EC alterations within and between the default mode network, salience network, and central executive network. Our analysis showed that compared to HC, ASD + ADHD, ASD-only, and ADHD-only exhibited both shared and disorder-specific EC alterations within the triple-network model. These results have potential clinical implications for identifying ASD + ADHD, facilitating diagnostic accuracy, guiding targeted treatment approaches, and informing etiological studies.