Clinical utility of EEG in attention-deficit/hyperactivity disorder: a research update

Abstract

Psychiatric research applications of electroencephalography (EEG), the earliest approach to imaging human cortical brain activity, are attracting increasing scientific and clinical interest. For more than 40 years, EEG research has attempted to characterize and quantify the neurophysiology of attention-deficit/hyperactivity disorder (ADHD), most consistently associating it with increased frontocentral theta band activity and increased theta to beta (θ/β) power ratio during rest compared to non-ADHD controls. Recent reports suggest that while these EEG measures demonstrate strong discriminant validity for ADHD, significant EEG heterogeneity also exists across ADHD-diagnosed individuals. In particular, additional studies validating the use of the θ/β power ratio measure appear to be needed before it can be used for clinical diagnosis. In recent years, the number and the scientific quality of research reports on EEG-based neurofeedback (NF) for ADHD have grown considerably, although the studies reviewed here do not yet support NF training as a first-line, stand-alone treatment modality. In particular, more research is needed comparing NF to placebo control and other effective treatments for ADHD. Currently, after a long period of relative stasis, the neurophysiological specificity of measures used in EEG research is rapidly increasing. It is likely, therefore, that new EEG studies of ADHD using higher density recordings and new measures drawn from viewing EEG as a 3-dimensional functional imaging modality, as well as intensive re-analyses of existing EEG study data, can better characterize the neurophysiological differences between and within ADHD and non-ADHD subjects, and lead to more precise diagnostic measures and effective NF approaches.

Fig. 1

Propagation of cortical electroencephalography (EEG) source potentials to scalp electrodes. A simulated (roughly cm²) cortical EEG source region (left) is shown, and its broad potentials projected to the scalp by volume conduction (right). For example, the source of the positive (red) scalp potential on the left frontal scalp is not a frontal brain source. Similar animations further illustrating the complexity of spatial relationships between brain source activities and scalp EEG activities are available at: http://www.youtube.com/playlist?list=PLDF9D201769ADC62D. (Image credit: Zeynep Akalin Acar [83])