Speech-Based Markers in Paediatric ADHD: A Longitudinal Case-Control Study of Voice Features and Medication Effects

medRxiv

Abstract

Abstract Background Diagnosis and treatment monitoring of attention-deficit/hyperactivity disorder (ADHD) largely rely on subjective assessments, highlighting the need for objective markers. Voice features and speech embeddings represent promising candidates for such markers, as they may capture alterations in speech production relevant to ADHD. However, it remains unclear which speech features are most informative for distinguishing ADHD and monitoring treatment effects, and which speech tasks most reliably elicit such differences. Methods Twenty-seven children with ADHD and 27 age-matched neurotypical controls completed six speech tasks across two study visits. Children with ADHD were unmedicated at baseline (first visit) and were assessed under prescribed methylphenidate treatment at follow-up, whereas controls underwent repeated assessment without intervention. Established acoustic voice features (eGeMAPS) and high-dimensional speech embeddings (WavLm, Whisper) were extracted and analysed using linear mixed models to examine baseline group differences and group-by-time interaction effects reflecting medication-associated change patterns. Results At baseline, children with ADHD differed significantly from controls in frequency, spectral, and temporal voice features, characterized by lower and more variable pitch, altered spectral properties, and reduced rhythmic stability. Group-by-time interaction effects indicated medication-associated modulation in the ADHD group, including reduced loudness variability and increased precision of vowel articulation at follow-up, changes not observed in controls. Speech embeddings revealed additional baseline and interaction effects beyond established acoustic features. Free speech tasks, particularly picture description, yielded the most robust and consistent effects. Conclusion Children with ADHD differed from neurotypical controls in vocal features at baseline and showed distinct longitudinal change patterns consistent with medication-related change. These findings support further investigation of speech-based measures as candidate digital phenotypes and potential digital biomarkers in ADHD, with picture description emerging as a particularly promising task for future clinical assessment protocols.

Authors 9

1. Rachel Bamberger Aachen Department of Child and Adolescent Psychiatry Institute of Medical Psychology and Medical Sociology Faculty of Medicine

   Forschungszentrum Jülich · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany

   Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany

   Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany

2. Gianna Kuhles

   Forschungszentrum Jülich · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany

   Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

3. Leon D. Lotter

   Forschungszentrum Jülich · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany

   Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

4. Juergen Dukart

   Forschungszentrum Jülich · Heinrich Heine University Düsseldorf

   Affiliation as printed

   Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany

   Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany

5. Kerstin Konrad Aachen Institute of Medical Psychology and Medical Sociology Faculty of Medicine

   Forschungszentrum Jülich · Jülich Aachen Research Alliance · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany

   Institute of Neuroscience and Medicine, JARA-Institute Brain structure-function relationships (INM-10), Research Centre Jülich, Jülich, Germany

6. Thomas Günther Aachen Department of Psychological Assessment and Intervention Institute of Psychology

   RWTH Aachen University

   Affiliation as printed

   Department of Psychological Assessment and Intervention, Institute of Psychology, RWTH Aachen University, Aachen, Germany

7. Michael Siniatchkin Aachen Department of Child and Adolescent Psychiatry

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany

8. Michael Fuchs

   University Hospital Leipzig

   Affiliation as printed

   Section of Phoniatrics and Audiology, Department of Otorhinolaryngology, University Hospital Leipzig, Leipzig, Germany

9. Georg G. von Polier corresponding Aachen Department of Child and Adolescent Psychiatry

   Forschungszentrum Jülich · Universitätsklinikum Aachen · University Hospital Leipzig · RWTH Aachen University

   Affiliation as printed

   Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Leipzig, Leipzig, Germany

   Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany

   Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany