A Signature of Attention-Elicited Electrocortical Activity Distinguishes Response From Non-Response to the Non-Stimulant Atomoxetine in Children and Adolescents With ADHD

J Atten Disord. 2019 May;23(7):744-753. doi: 10.1177/1087054717733044. Epub 2017 Oct 3.


Objective: Atomoxetine has several characteristics that make it an attractive alternative to stimulants for treating ADHD, but there are currently no tests identifying individuals for whom the medication should be a first-line option.

Method: Within the ADHD Controlled Trial Investigation Of a Non-stimulant (ACTION) study, we examined neuro-cortical activity in 52 youth with ADHD. Baseline event-related potentials (ERP) were compared between those who subsequently responded to 6 weeks of atomoxetine versus those who did not.

Results: Responders were distinguished by significantly lower auditory oddball N2 amplitudes than both non-responders and typically developing controls, particularly in the right frontocentral region ( p = .002, Cohen's d = 1.1). Leave-one-out cross validation determined that N2 amplitude in this region was able to accurately predict non-responders with a specificity of 80.8%. There were no P3 differences between responders and non-responders.

Conclusion: The N2 amplitude is a biomarker that may have utility in predicting response to atomoxetine for youth with ADHD.

Keywords: ADHD; N200; P300; atomoxetine; event-related potentials.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adrenergic Uptake Inhibitors / therapeutic use*
  • Atomoxetine Hydrochloride / therapeutic use*
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Attention*
  • Biomarkers
  • Brain Mapping / methods
  • Central Nervous System Stimulants / therapeutic use
  • Child
  • Cross-Over Studies
  • Double-Blind Method
  • Electroencephalography / methods
  • Evoked Potentials / drug effects*
  • Female
  • Humans
  • Male
  • Sensitivity and Specificity


  • Adrenergic Uptake Inhibitors
  • Biomarkers
  • Central Nervous System Stimulants
  • Atomoxetine Hydrochloride