title: Blinded, multi-center validation of EEG and rating scales in identifying ADHD within a clinical sample.
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.
authors.affiliation: Department of Psychology, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA. ssnyder@hsc.unt.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Snyder
authors.forename: Humberto
authors.initials: H
authors.lastname: Quintana
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Sexson
authors.forename: Peter
authors.initials: P
authors.lastname: Knott
authors.forename: A F M
authors.initials: AF
authors.lastname: Haque
authors.forename: Donald A
authors.initials: DA
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D001611:Beta Rhythm / Q000706:statistics & numerical data; D002648:Child; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004569:Electroencephalography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D013826:Theta Rhythm / Q000706:statistics & numerical data