title: Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
abstract: OBJECTIVE
  To evaluate the evidence for EEG theta/beta power ratio for diagnosing, or helping to diagnose, attention-deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  We identified relevant studies and classified them using American Academy of Neurology criteria.
  
  
  RESULTS
  Two Class I studies assessing the ability of EEG theta/beta power ratio and EEG frontal beta power to identify patients with ADHD correctly identified 166 of 185 participants. Both studies evaluated theta/beta power ratio and frontal beta power in suspected ADHD or in syndromes typically included in an ADHD differential diagnosis. A bivariate model combining the diagnostic studies shows that the combination of EEG frontal beta power and theta/beta power ratio has relatively high sensitivity and specificity but is insufficiently accurate.
  
  
  CONCLUSIONS
  It is unknown whether a combination of standard clinical examination and EEG theta/beta power ratio increases diagnostic certainty of ADHD compared with clinical examination alone.
  
  
  CONCLUSIONS
  Level B: Clinicians should inform patients with suspected ADHD and their families that the combination of EEG theta/beta power ratio and frontal beta power should not replace a standard clinical evaluation. There is a risk for significant harm to patients from ADHD misdiagnosis because of the unacceptably high false-positive diagnostic rate of EEG theta/beta power ratio and frontal beta power. Level R: Clinicians should inform patients with suspected ADHD and their families that the EEG theta/beta power ratio should not be used to confirm an ADHD diagnosis or to support further testing after a clinical evaluation, unless such diagnostic assessments occur in a research setting.
authors.affiliation: From the Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Department of Neurology (J.K.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Clinical Neurosciences (T.P.), University of Calgary, Canada; and Department of Neurological Services (M.R.N.), University of California at Los Angeles.
authors.forename: David
authors.initials: D
authors.lastname: Gloss
authors.affiliation: From the Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Department of Neurology (J.K.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Clinical Neurosciences (T.P.), University of Calgary, Canada; and Department of Neurological Services (M.R.N.), University of California at Los Angeles.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Varma
authors.affiliation: From the Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Department of Neurology (J.K.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Clinical Neurosciences (T.P.), University of Calgary, Canada; and Department of Neurological Services (M.R.N.), University of California at Los Angeles.
authors.forename: Tamara
authors.initials: T
authors.lastname: Pringsheim
authors.affiliation: From the Department of Neurology (D.G.), CAMC Physicians, Charleston, WV; Department of Neurology (J.K.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Clinical Neurosciences (T.P.), University of Calgary, Canada; and Department of Neurological Services (M.R.N.), University of California at Los Angeles.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Nuwer
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000503:physiopathology*; D001611:Beta Rhythm; D003951:Diagnostic Errors / Q000517:prevention & control; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D013826:Theta Rhythm