Blinded, multi-center validation of EEG and rating scales in identifying ADHD within a clinical sample

• Published in: Psychiatry research Vol. 159; no. 3; pp. 346 - 358
• Main Authors: Snyder, Steven M, Quintana, Humberto, Sexson, Sandra B, Knott, Peter, Haque, A.F.M, Reynolds, Donald A
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 30-06-2008; Elsevier
• Subjects: Adolescent; Age Distribution; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Attention Deficit and Disruptive Behavior Disorders - diagnosis; Attention Deficit and Disruptive Behavior Disorders - epidemiology; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit/hyperactivity disorder; Beta Rhythm - statistics & numerical data; Biological and medical sciences; Child; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; EEG; Electroencephalography - statistics & numerical data; Female; Humans; Learning Disorders - diagnosis; Learning Disorders - epidemiology; Male; Medical sciences; Mood Disorders - diagnosis; Mood Disorders - epidemiology; Prevalence; Prospective Studies; Psychiatric Status Rating Scales - statistics & numerical data; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Rating scales; Sensitivity; Sensitivity and Specificity; Specificity; Techniques and methods; Theta Rhythm - statistics & numerical data; Rating scales; Sensitivity; Specificity; EEG; Adolescent; Child; Attention deficit/hyperactivity disorder; Human; Evaluation scale; Multicenter study; Electrophysiology; Psychometrics; Electroencephalography; Revised drafting; Test validation; Electrodiagnosis; Concomitant disease; School age; Follow up study; Attention disorder with hyperactivity; Predictive validity; Rating Scale Conners
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2007.05.006

Abstract Previous validation studies of attention deficit/hyperactivity disorder (ADHD) assessment by rating scales or EEG have provided Class-IV evidence per standards of the American Academy of Neurology. To investigate clinical applications, we collected Class-I evidence, namely from a blinded, prospective, multi-center study of a representative clinical sample categorized with a clinical standard. Participating males (101) and females (58) aged 6 to 18 had presented to one of four psychiatric and pediatric clinics because of the suspected presence of attention and behavior problems. DSM-IV diagnosis was performed by clinicians assisted with a semi-structured clinical interview. EEG (theta/beta ratio) and ratings scales (Conners Rating Scales-Revised and ADHD Rating Scales-IV) were collected separately in a blinded protocol. ADHD prevalence in the clinical sample was 61%, whereas the remainder had other childhood/adolescent disorders or no diagnosis. Comorbidities were observed in 66% of ADHD patients and included mood, anxiety, disruptive, and learning disorders at rates similar to previous findings. EEG identified ADHD with 87% sensitivity and 94% specificity. Rating scales provided sensitivity of 38–79% and specificity of 13–61%. While parent or teacher identification of ADHD by rating scales was reduced in accuracy when applied to a diverse clinical sample, theta/beta ratio changes remained consistent with the clinician's ADHD diagnosis. Because theta/beta ratio changes do not identify comorbidities or alternative diagnoses, the results do not support the use of EEG as a stand-alone diagnostic and should be limited to the interpretation that EEG may complement a clinical evaluation for ADHD.