Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent disorder of childhood that is behaviorally characterized by repeated episodes of inattention, impulsivity, and hyperactivity. Selecting appropriate treatment based on presenting behavior can be challenging and usually requires timeintensive medication trials. Clinical and research communities agree there is a need for an objective method to both evaluate symptoms of ADHD and determine appropriate treatment options (Barkley, 2009). We are proposing the use of qEEGs (quantitative electroencephalograms) in patients presenting with ADHD symptomology to provide an objective assessment of underlying neuropathology that can aid in diagnostic clarification, thus offering targeted treatment approaches. Current studies have identified three abnormal electrophysiological clusters (Chabot & Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001). This study was designed to examine these clusters of ADHD in a naturalistic sample to determine congruity between current research literature and frontline community treatment centers.
We evaluated 30 pediatric patients (6–17 yrs) in a naturalistic psychiatric setting. As described in Konopka (2005), participants completed an initial baseline study to examine brain electrophysiology through qEEG. Electrophysiological clusters were defined by (Chabot & Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001): cortical hypoarousal (excess theta), cortical hyperarousal (excess beta, decreased theta/ delta), and maturation lagged (excess delta/ theta). Neuroguide software and databases (Thatcher, 2009) were used for spectral analyses to convert raw EEG data to quantifiable form (qEEG). Fast Fourier Transformation was used to generate relative power maps for comparison of electrophysiological abnormalities. Comparisons were made for cortical activity levels of Delta, Theta, Alpha, and Beta. The database was used to statistically compare ADHD children to a control group (N=678), normed for gender, age, and handedness.
Results show that children with ADHD exhibited abnormal electrophysiological activity in comparison to age and gender matched norms. While we found the previously documented electrophysiological groups, there was a disproportionately high degree of cortically hyperaroused children within the sample. Specifically, the overwhelming majority of our sample presented with excess relative beta in the central-parietal regions. Additionally we identified a novel electrophysiological group, which displayed concurrent excesses of fast (beta) and slow (theta) activity in relative frequencies.
These findings illustrate discrepancies in ADHD populations studied in clinical centers and research laboratories. Given that there is agreement for the need of objective assessment tools and that imaging modalities provide promise (Chabot, Orgill, Crawford, Harris, & Serfontein, 1999), there is also a need for continuity between research and clinical communities. This study provides an important objective diagnostic and treatment paradigm that can be highly informative for the direction of future studies.
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Almeida, L. G., Ricardo-Garcell, J., Prado, H., Barajas, L. z., Fernndez-Bouzas, A., vila, D., et al. Reduced right frontal cortical thickness in children, adolescents and adults with ADHD and its correlation to clinical variables: A cross-sectional study. Journal of Psychiatric Research, 44(16), 1214–1223.
Association, A. P. (2000). DSM-IV Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC American Psychiatric Press
Barkley, R. A. (1990). A critique of current diagnostic criteria for attention deficit hyperactivity disorder: Clinical and research implications. Journal of Developmental and Behavioral Pediatrics, 11(6), 343–352. doi:10.1097/00004703–199012000–00014
Barkley, R. A. (2003). Child Psychopat hology (Vol. 2 ). New York: Guilford Press.
Loo, Hopfer, Teale, & Reite, (2004) EEG Correlates of Methylphenidate Response in ADHD: Association With Cognitive and Behavioral Measures. Journal of Clinical Neurophysiology 21 (6), 457–464.
Loo, S. K., & Barkley, R. A. (2005). Clinical Utility of EEG in Attention Deficit Hyperactivity Disorder. Applied Neuropsychology, 12(2), 64–76. doi:10.1207/ s15324826an1202_2
Barkley, R. A. (2009). Commentary on Hyper-activity in children having behavior disorders (Childers, 1935). Journal of Attention Disorders, 13(3), 229–231. doi: 13/ 3/ 229 [pii] 10.1177/ 1087054709338857
Barkley, R. A. (2010). Against the status quo: Revising the diagnostic criteria for ADHD. Journal of the American A cademy of Child & Adolescent Psychiatry, 49(3), 205–207. doi:10.1097/ 00004583–201003000–00002
Barry, R. J., Clarke, A. R., & Johnstone, S. J. (2003). A review of electrophysiology in attention -deficit/ hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114(2), 171–183.
Castellanos, F. X. (2001). Neural substrates of attention -deficit hyperactivity disorder. Advances in Neurology, 85, 197–206.
Castellanos, F. X., Giedd, J. N., Marsh, W. L., Hamburger, S. D., Vaituzis, A. C., Dickstein, D. P., et al. (1996). Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. A rchives of General Psychiatry, 53(7), 607–616.
Castellanos, F. X., Lee, P. P., Sharp, W., Jeffries, N. O., Greenstein, D. K., Clasen, L. S., et al. (2002). Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/ hyperactivity disorder. Journal of American Medical Association, 288(14), 1740–1748. doi: joc20194 [pii]
Chabot, R. J., di Michele, F., & Prichep, L. (2005). The role of quantitative electroencephalography in child and adolescent psychiatric disorders. Child and Adolescent Psychiatric Clinics of North America, 14(1), 21–53.
Chabot, R. J., Orgill, A. A., Crawford, G., Harris, M. J., & Serfontein, G. (1999). Behavioral and electrophysiologic predictors of treatment response to stimulants in children with attention disorders. Journal of Child Neurology, 14(6), 343–351.
Chabot, R. J., & Serfontein, G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40(10), 951–963.
Clarke, A. R., Barry, R. J., McCarthy, R., & Selikowitz, M. (2001a). EEG-defined subtypes of children with attention-deficit/ hyperactivity disorder. Clinical Neurophysiology, 112(11), 2098–2105.
Clarke, A. R., Barry, R. J., McCarthy, R., & Selikowitz, M. (2001b). Excess beta activity in children with attention-deficit/ hyperactivity disorder: An atypical electrophysiological group. Psychiatry Research, 103(2), 205–218.
Clarke, A. R., Barry, R. J., McCarthy, R., Selikowitz, M., & Brown, C. R. (2002). EEG evidence for a new conceptualisation of attention deficit hyperactivity disorder. Clinical Neurophysiology, 113(7), 1036–1044.
Clarke, A. R., Barry, R. J., McCarthy, R., Selikowitz, M, Clarke, D.C., & Croft, R.J. (2003) Effects of stimulant medications on children with attention-deficit/ hyperactivity disorder and excessive beta activity in their EEG. Clinical Neurophysiology, 114(9), 1729–1737.
Conners, C. K. (2004). Validation of Adhd Rating Scales. Journal of American A cademy of Child & A dolescent Psychiatry, 43(10), 1190–1191.
Cubillo, A., Halari, R., Ecker, C., Giampietro, V., Taylor, E., & Rubia, K. Reduced activation and interregional functional connectivity of fronto-striatal networks in adults with childhood Attention-Deficit Hyperactivity Disorder (ADHD) and persisting symptoms during tasks of motor inhibition and cognitive switching. Journal of Psychiatric Research, 44(10), 629–639.
Durston, S., Hulshoff Pol, H. E., Schnack, H. G., Buitelaar, J. K., Steenhuis, M. P., Minderaa, R. B., et al. (2004). Magnetic resonance imaging of boys with attention-deficit/ hyperactivity disorder and their unaffected siblings. Journal of American A cademy of Child and A dolescen t Psychiatry, 43(3), 332–340. doi: 00004583–200403000–00016 [pii]
Durston, S., & Konrad, K. (2007). Integrating genetic, psychopharmacological and neuroimaging studies: A converging methods approach to understanding the neurobiology of ADHD. D evelopmental Review, 27(3), 374–395.
Filipek, P. A., Semrud-Clikeman, M., Steingard, R. J., Renshaw, P. F., Kennedy, D. N., & Biederman, J. (1997). Volumetric MRI analysis comparing subjects having attention -deficit hyperactivity disorder with normal controls. Neurology, 48(3), 589–601.
Gupta, R., & Kar, B. R. (2010). Specific cognitive deficits in ADHD: A diagnostic concern in differential diagnosis. Journal of Child and Family Studies, 19(6), 778–786. doi:10.1007/ s10826–010–9369–4
Hill, D. E., Yeo, R. A., Campbell, R. A., Hart, B., Vigil, J., & Brooks, W. (2003). Magnetic resonance imaging correlates of attention-deficit/ hyperactivity disorder in children. Neuropsychology, 17(3), 496–506.
Hoffman, D. A., Lubar, J. F., Thatcher, R. W., Sterman, M. B., Rosenfeld, P. J., Striefel, S., et al. (1999). Limitations of the American Academy of Neurology and American Clinical Neurophysiology Society paper on QEEG. Journal of Neuropsychiatry and Clinical Neuroscience, 11(3), 401–407.
Hynd, G. W., Semrud-Clikeman, M., Lorys, A. R., Novey, E. S., & Eliopulos, D. (1990). Brain morphology in developmental dyslexia and attention deficit disorder/ hyperactivity. Archives of Neurology, 47(8), 919–926.
Jensen, P. S., Kettle, L., Roper, M. T., Sloan, M. T., Dulcan, M. K., Hoven, C., et al. (1999). Are stimulants overprescribed’ Treatment of ADHD in four U.S. communities. Journal of American A cademy of Child and A dolescent Psychiatry, 38(7), 797–804.
Kates, W. R., Frederikse, M., Mostofsky, S. H., Folley, B. S., Cooper, K., Mazur-Hopkins, P., et al. (2002). MRI parcellation of the frontal lobe in boys with attention deficit hyperactivity disorder or Tourette syndrome. Psychiatry Research, 116(1–2), 63–81. doi: S0925492702000665 [pii]
Konopka, L. M., & Poprawski, T. J. (2008). qEEG Studies of Attention Disorders and Mood Disorders in Children In A. Ivanenko (Ed.), Sleep and Psychiatric Disorders in Children and A dolescents Informa Healthcare.
Lubar, J. F. (1985). EEG biofeedback and learning disabilities. Theory Into Practice, 24(2), 106–111.
Monastra, V. J., Lubar, J. F., & Linden, M. (2001). The development of a quantitative electroencephalographic scanning process for attention deficit Äìhyperactivity disorder: Reliability and validity studies. Neuropsychology, 15(1), 136–144.
Morley, C. P. (2010). Disparities in ADHD assessment, diagnosis, and treatment. International Journal of Psychiatry in Medicine, 40(4), 383–389. doi:10.2190/ PM.40.4.b
Mostofsky, S. H., Cooper, K. L., Kates, W. R., Denckla, M. B., & Kaufmann, W. E. (2002). Smaller prefrontal and premotor volumes in boys with attention-deficit/ hyperactivity disorder. Biological Psychiatry, 52(8), 785–794. doi: S0006322302014129 [pii]
McGough, J. J., & Barkley, R. A. (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. The American Journal of Psychiatry, 161(11), 1948–1956.
Passarotti, AM, Sweeney, A., Pavuluri MN. Neural Correlates of Response Inhibition Deficits in Pediatric Bipolar Disorder and Attention Deficit Hyperactivity Disorder (2010). Psychiatry Research: Neuroimaging. Psychiatry Research, 181(1); 36–43.
Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review Neuroscience, 13, 25–42. doi: 10.1146/ annurev.ne.13.030190.000325
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis (2007). American Journal of Psychiatry 164(6):942–8.
Raz, S., Debastos, A. K., Newman, J. B., & Batton, D. Extreme prematurity and neuropsychological outcome in the preschool years. Journal of the International Neuropsychological Society, 16(1), 169–179.
Rimm, S. (2011). Attention deficit/ hyperactivity disorder: A difficult diagnosis. In J. L. Jolly, D. J. Treffinger, T. Inman, J. Smutny, J. L. Jolly, D. J. Treffinger,... J. Smutny (Eds.), Parenting gifted children: The authoritative guide from the National Association for Gifted Children (pp. 399–404). Waco, TX US: Prufrock Press. Retrieved from EBSCOhost.
Rubia, K., Overmeyer, S., Taylor, E., Brammer, M., Williams, S. C., Simmons, A., et al. (1999). Hypofrontality in attention deficit hyperactivity disorder during higher-order motor control: a study with functional MRI. American Journal of Psychiatry, 156(6), 891–896.
Shaw, P., Eckstrand, K., Sharp, W., Blumenthal, J., Lerch, J. P., Greenstein, D., et al. (2007). Attention -deficit/ hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Science USA, 104(49), 19649–19654.
Sowell, E. R., Thompson, P. M., Welcome, S. E., Henkenius, A. L., Toga, A. W., & Peterson, B. S. (2003). Cortical abnormalities in children and adolescents with attention -deficit hyperactivity disorder. Lancet, 362(9397), 1699–1707.
Thatcher, R. W., Lubar, Joel, F. (2009). History of the scientific standards of QEEG normative databases In A. Press (Ed.), Introduction to EEG and Neurofeedback (Second ed., pp. 29–59). San Diego: Academic Press
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Martin, C.N., Konopka, L.M. Community-Based Electrophysiological Abnormalities in Children With ADHD: Translating Research Findings into a Clinical Setting. Act Nerv Super 53, 129–140 (2011). https://doi.org/10.1007/BF03379936
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DOI: https://doi.org/10.1007/BF03379936