1
|
Modarres M, Cochran D, Kennedy DN, Frazier JA. Comparison of comprehensive quantitative EEG metrics between typically developing boys and girls in resting state eyes-open and eyes-closed conditions. Front Hum Neurosci 2023; 17:1237651. [PMID: 38021243 PMCID: PMC10659091 DOI: 10.3389/fnhum.2023.1237651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction A majority of published studies comparing quantitative EEG (qEEG) in typically developing (TD) children and children with neurodevelopmental or psychiatric disorders have used a control group (e.g., TD children) that combines boys and girls. This suggests a widespread supposition that typically developing boys and girls have similar brain activity at all locations and frequencies, allowing the data from TD boys and girls to be aggregated in a single group. Methods In this study, we have rigorously challenged this assumption by performing a comprehensive qEEG analysis on EEG recoding of TD boys (n = 84) and girls (n = 62), during resting state eyes-open and eyes-closed conditions (EEG recordings from Child Mind Institute's Healthy Brain Network (HBN) initiative). Our qEEG analysis was performed over narrow-band frequencies (e.g., separating low α from high α, etc.), included sex, age, and head size as covariates in the analysis, and encompassed computation of a wide range of qEEG metrics that included both absolute and relative spectral power levels, regional hemispheric asymmetry, and inter- and intra-hemispheric magnitude coherences as well as phase coherency among cortical regions. We have also introduced a novel compact yet comprehensive visual presentation of the results that allows comparison of the qEEG metrics of boys and girls for the entire EEG locations, pairs, and frequencies in a single graph. Results Our results show there are wide-spread EEG locations and frequencies where TD boys and girls exhibit differences in their absolute and relative spectral powers, hemispheric power asymmetry, and magnitude coherence and phase synchrony. Discussion These findings strongly support the necessity of including sex, age, and head size as covariates in the analysis of qEEG of children, and argue against combining data from boys and girls. Our analysis also supports the utility of narrow-band frequencies, e.g., dividing α, β, and γ band into finer sub-scales. The results of this study can serve as a comprehensive normative qEEG database for resting state studies in children containing both eyes open and eyes closed paradigms.
Collapse
Affiliation(s)
- Mo Modarres
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - David Cochran
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, United States
| | - David N. Kennedy
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jean A. Frazier
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- The Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Chan Medical School/UMass Memorial Health Care, Worcester, MA, United States
| |
Collapse
|
2
|
Links between excessive daytime sleepiness and EEG power and activation in two subtypes of ADHD. Biol Psychol 2023; 177:108504. [PMID: 36681294 DOI: 10.1016/j.biopsycho.2023.108504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study aimed to replicate previously reported EEG characteristics between typically developing (TD) children and two subtypes of Attention Deficit Hyperactivity Disorder (ADHD) using a frontal, single-channel, dry-sensor portable EEG device, and explore whether differences are moderated by excessive daytime sleepiness (EDS). METHODS Children with ADHD Inattentive (ADHD-I) and ADHD Combined presentation (ADHD-C) and typically-developing (TD) children (N = 34 in each group) had frontal EEG recorded during eyes-closed resting, eyes-open resting, and focus tasks. Participants also completed the Children's Self-Report Sleep Patterns - Sleepiness Scale as a measure of EDS. RESULTS Consistent with previous literature, there were increases in frontal delta and theta power in the ADHD-C compared to ADHD-I and TD groups, in all conditions. Novel power and activation effects in ADHD subtypes, as well as significant group and EDS interactions for alpha and beta power were also found. CONCLUSIONS These findings highlight the importance of considering ADHD subtypes and EDS when exploring EEG characteristics, and have important implications for the diagnosis and treatment of children with ADHD.
Collapse
|
3
|
Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder. Sci Rep 2023; 13:1678. [PMID: 36717626 PMCID: PMC9887013 DOI: 10.1038/s41598-023-28931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been reported to be associated with primary chronic pain syndromes, such as fibromyalgia, migraine, and chronic low back pain. Although idiopathic orofacial pain (IOP) is classified as burning mouth syndrome or persistent idiopathic facial or dentoalveolar pain and as a primary chronic pain, the association between IOP and ADHD has not been investigated. This retrospective cohort study investigated the severity of ADHD symptoms measured using the ADHD scale and the effects of treatment using ADHD drugs and the dopamine system stabilizer aripiprazole. The participants were 25 consecutive patients with refractory IOP referred to a psychiatrist and diagnosed with coexisting ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5. The ADHD scale scores were higher in patients with intractable IOP than those in the general population. Pharmacotherapy used in this study led to clinically significant improvements in pain, anxiety/depression, and pain catastrophizing. Intractable IOP and ADHD were shown to be associated. In the future, screening and pharmacotherapy for ADHD should be considered in the treatment of intractable IOP.
Collapse
|
4
|
Kerr-German A, White SF, Santosa H, Buss AT, Doucet GE. Assessing the relationship between maternal risk for attention deficit hyperactivity disorder and functional connectivity in their biological toddlers. Eur Psychiatry 2022; 65:e66. [PMID: 36226356 PMCID: PMC9641653 DOI: 10.1192/j.eurpsy.2022.2325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder associated with increased risk for poor educational attainment and compromised social integration. Currently, clinical diagnosis rarely occurs before school-age, despite behavioral signs of ADHD in very early childhood. There is no known brain biomarker for ADHD risk in children ages 2-3 years-old. METHODS The current study aimed to investigate the functional connectivity (FC) associated with ADHD risk in 70 children aged 2.5 and 3.5 years via functional near-infrared spectroscopy (fNIRS) in bilateral frontal and parietal cortices; regions involved in attentional and goal-directed cognition. Children were instructed to passively watch videos for approximately 5 min. Risk for ADHD in each child was assessed via maternal symptoms of ADHD, and brain data was evaluated for FC. RESULTS Higher risk for maternal ADHD was associated with lower FC in a left-sided parieto-frontal network. Further, the interaction between sex and risk for ADHD was significant, where FC reduction in a widespread bilateral parieto-frontal network was associated with higher risk in male, but not female, participants. CONCLUSIONS These findings suggest functional organization differences in the parietal-frontal network in toddlers at risk for ADHD; potentially advancing the understanding of the neural mechanisms underlying the development of ADHD.
Collapse
Affiliation(s)
- Anastasia Kerr-German
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, Nebraska68131, USA
| | - Stuart F. White
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska68010, USA
- Department of Pharmacology and Neuroscience, Creighton School of Medicine, Omaha, Nebraska68124, USA
| | - Hendrik Santosa
- Department of Radiology, University of Pittsburg, Pittsburg, Pennsylvania15260, USA
| | - Aaron T. Buss
- Department of Psychology, University of Tennessee, Knoxville, Tennessee37996, USA
| | - Gaelle E. Doucet
- Boys Town National Research Hospital, Institute for Human Neuroscience, Boys Town, Nebraska68010, USA
- Department of Pharmacology and Neuroscience, Creighton School of Medicine, Omaha, Nebraska68124, USA
| |
Collapse
|
5
|
Can electroencephalography (EEG) identify ADHD subtypes? A systematic review. Neurosci Biobehav Rev 2022; 139:104752. [PMID: 35760387 DOI: 10.1016/j.neubiorev.2022.104752] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) has been associated with atypical patterns of neural activity measured by electroencephalography (EEG). However, the identification of EEG diagnostic biomarkers has been complicated by the disorder's heterogeneity. The objective of this review was to synthesize the literature investigating EEG variation in patients diagnosed with ADHD, addressing the following questions: 1) Are the diagnostic ADHD subtypes associated with different EEG characteristics? 2) Are EEG measures correlated with ADHD traits and/or symptom severity? and 3) Do classification techniques using EEG measures reveal different clinical presentations of ADHD? Outcomes highlight the potential for electrophysiological measures to provide meaningful insights into the heterogeneity of ADHD, although direct translation of EEG biomarkers for diagnostic purposes is not yet supported. Key measures that show promise for the discrimination of existing ADHD subtypes and symptomatology include: resting state and task-related modulation of alpha, beta and theta power, and the event-related N2 and P3 components. Prescriptions are discussed for future studies that may help to bridge the gap between research and clinical application.
Collapse
|
6
|
Male sex bias in early and late onset neurodevelopmental disorders: shared aspects and differences in autism spectrum disorder, attention deficit/hyperactivity disorder, and schizophrenia. Neurosci Biobehav Rev 2022; 135:104577. [DOI: 10.1016/j.neubiorev.2022.104577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
|
7
|
Mason LM, Clarke AR, Barry RJ. Age-related changes in the EEG in an eyes-open condition: II. Subtypes of AD/HD. Int J Psychophysiol 2022; 174:83-91. [DOI: 10.1016/j.ijpsycho.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/06/2021] [Accepted: 01/16/2022] [Indexed: 11/16/2022]
|
8
|
DSM-5 Adult Attention-Deficit/Hyperactivity Disorder: Sex Differences in EEG Activity. Appl Psychophysiol Biofeedback 2021; 46:377-388. [PMID: 34529233 DOI: 10.1007/s10484-021-09522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
This study examined sex differences in the EEG of adults diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD) according to DSM-5 criteria. Sixteen females and 16 males with AD/HD, and age- and sex-matched control groups, had an eyes-closed resting EEG recorded from 19 electrode sites. EEGs were Fast Fourier transformed and estimates for total power, absolute and relative power in the delta, theta, alpha, beta and gamma bands, and the theta/beta ratio, were analysed across nine cortical regions. Males with AD/HD, compared with male controls, had globally reduced absolute beta, globally elevated relative theta, and a larger theta/beta ratio. In contrast, no global effects emerged between females with and without AD/HD. Significant group interactions indicated that globally elevated relative theta and elevated frontal-midline theta/beta ratio noted in males with AD/HD differed significantly from results in females. There are statistically significant EEG differences in relative theta and the theta/beta ratio between males and females with and without AD/HD. These results indicate that AD/HD affects the EEG activity of males and females differently. This study helps confirm the need for further independent examination of AD/HD within female populations.
Collapse
|
9
|
Kim S, Kim JS, Kwon YJ, Lee HY, Yoo JH, Lee YJ, Shim SH. Altered cortical functional network in drug-naive adult male patients with attention-deficit hyperactivity disorder: A resting-state electroencephalographic study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110056. [PMID: 32777325 DOI: 10.1016/j.pnpbp.2020.110056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/08/2020] [Accepted: 08/03/2020] [Indexed: 02/03/2023]
Abstract
Relatively little is known about the neurophysiology of adult Attention-deficit/hyperactivity disorder (ADHD). Brain network analysis can yield important insights into the neuropathology in adult ADHD. The objective of this study was to investigate source-level cortical functional network using resting-state electroencephalography (EEG) in drug-naive adult patients with ADHD. Resting-state EEG was performed for 30 adult male patients with ADHD and 27 male healthy controls. Source-level weighted functional networks based on graph theory were evaluated, including strength, clustering coefficient (CC) and path length (PL) in six frequency bands. At the global level, strength (η2 = 0.167) and CC (η2 = 0.156) were lower while PL (η2 = 0.159) was higher for the high beta band in the ADHD patient group compared to healthy controls. At the nodal level, CCs of the high beta band were lower in the left middle temporal gyrus (η2 = 0.244), right inferior occipital cortex (η2 = 0.214), right posterior transverse collateral sulcus (η2 = 0.237), and right anterior occipital sulcus (η2 = 0.251) for the adult ADHD group. Furthermore, the nodal-level high beta band CCs of the left middle temporal gyrus and right anterior occipital sulcus were significantly negatively correlated with ADHD symptoms. The altered cortical functional network showed inefficient connectivity in the left middle temporal gyrus, belonging to the default mode network, the right inferior occipital cortex, belonging to the extrastriate visual resting state network, the right posterior transverse collateral sulcus, belonging to the visual network, and the anterior occipital sulcus, reflecting visual attention, which might affect the pathophysiology of ADHD. Taken together, these attenuated network inefficiencies in adult patients with ADHD may lead to suboptimal information processing and affect symptoms of ADHD, such as inattention and hyperactivity. Our findings should be further replicated using longitudinal study designs.
Collapse
Affiliation(s)
- Sungkean Kim
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Young Joon Kwon
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hwa Young Lee
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Jae Hyun Yoo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
| |
Collapse
|
10
|
Ahmadi M, Kazemi K, Kuc K, Cybulska-Klosowicz A, Zakrzewska M, Racicka-Pawlukiewicz E, Helfroush MS, Aarabi A. Cortical source analysis of resting state EEG data in children with attention deficit hyperactivity disorder. Clin Neurophysiol 2020; 131:2115-2130. [DOI: 10.1016/j.clinph.2020.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/03/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022]
|
11
|
Clarke AR, Barry RJ, Johnstone S. Resting state EEG power research in Attention-Deficit/Hyperactivity Disorder: A review update. Clin Neurophysiol 2020; 131:1463-1479. [DOI: 10.1016/j.clinph.2020.03.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/20/2020] [Accepted: 03/16/2020] [Indexed: 01/19/2023]
|
12
|
Bioulac S, Taillard J, Philip P, Sagaspe P. Excessive Daytime Sleepiness Measurements in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry 2020; 11:3. [PMID: 32174847 PMCID: PMC7055535 DOI: 10.3389/fpsyt.2020.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood. It is a heterogeneous disorder in terms of clinical presentation that is probably due to the frequent occurrence of comorbidity. Children with ADHD more frequently report sleep disorders (notably delayed sleep phase syndrome) and excessive daytime sleepiness (EDS) than typically developing children. The aim of this article is to propose a narrative review of the assessment of EDS in the context of ADHD with first a summary of the subjective and objective tools used to measure it. Secondly, perspectives in terms of electroencephalogram (EEG) markers and neurofeedback are proposed. Then, possibilities for new kinds of evaluation are discussed (virtual reality, ecological momentary assessment, etc.). Lastly, we discuss specific clinical situations with EDS in the context of ADHD as links with narcolepsy, the comorbidity with other psychiatric disorders, and the context of sluggish cognitive tempo.
Collapse
Affiliation(s)
- Stéphanie Bioulac
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Jacques Taillard
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Pierre Philip
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- Université de Bordeaux, Sommeil, Attention et Neuropsychiatrie, USR 3413, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| | - Patricia Sagaspe
- CHU Pellegrin, Clinique du Sommeil, Bordeaux, France
- CNRS, SANPSY, USR 3413, Bordeaux, France
| |
Collapse
|
13
|
Clarke AR, Barry RJ, Johnstone SJ, McCarthy R, Selikowitz M. EEG development in Attention Deficit Hyperactivity Disorder: From child to adult. Clin Neurophysiol 2019; 130:1256-1262. [PMID: 31163371 DOI: 10.1016/j.clinph.2019.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/24/2019] [Accepted: 05/01/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders found in children. While an extensive literature has documented the EEG in this clinical population, few studies have investigated EEG throughout the lifespan in ADHD. This study aimed to investigate EEG maturational changes, in subjects with ADHD combined type, that spanned from childhood into adulthood. METHOD Twenty five male adults with ADHD were assessed between the ages of 8-12 years and again as adults. At both ages, an EEG was recorded during an eyes-closed resting period, and power estimates were calculated for relative delta, theta, alpha and beta. RESULTS At the childhood assessment, the ADHD subjects had elevated posterior delta. Relative theta was elevated, with diminished alpha activity across all sites. Significant maturational changes were observed, with reductions in the delta and theta bands, and increases in the alpha and beta bands across all electrodes. In adulthood, relative to controls, diminished frontal delta and elevated global theta activity were apparent. CONCLUSIONS Substantial developmental changes occurred in the EEG of these subjects. These results identify important issues when using EEG as part of the diagnosis for ADHD. SIGNIFICANCE This study is the first to explore EEG changes from childhood to adulthood over an 11 year period in the same subjects with ADHD.
Collapse
Affiliation(s)
- Adam R Clarke
- School of Psychology, University of Wollongong, Wollongong 2522, Australia; Brain & Behaviour Research Institute, University of Wollongong, Wollongong 2522, Australia.
| | - Robert J Barry
- School of Psychology, University of Wollongong, Wollongong 2522, Australia; Brain & Behaviour Research Institute, University of Wollongong, Wollongong 2522, Australia
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong 2522, Australia; Brain & Behaviour Research Institute, University of Wollongong, Wollongong 2522, Australia
| | - Rory McCarthy
- Sydney Developmental Clinic, 6/30 Carrington St., Sydney 2000, Australia
| | - Mark Selikowitz
- Sydney Developmental Clinic, 6/30 Carrington St., Sydney 2000, Australia
| |
Collapse
|
14
|
Chow JC, Ouyang CS, Tsai CL, Chiang CT, Yang RC, Wu RC, Wu HC, Lin LC. Entropy-Based Quantitative Electroencephalogram Analysis for Diagnosing Attention-Deficit Hyperactivity Disorder in Girls. Clin EEG Neurosci 2019; 50:172-179. [PMID: 30497294 DOI: 10.1177/1550059418814983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnosis of attention-deficit hyperactivity disorder (ADHD) is currently based on core symptoms or checklists; however, the inevitability of practitioner subjectivity leads to over- and underdiagnosis. Although the Federal Drug Administration has approved an elevated theta/beta ratio (TBR) of the electroencephalogram (EEG) band as a tool for assisting ADHD diagnosis, several studies have reported no significant differences of the TBR between ADHD and control subjects. This study detailed the development of a method based on approximate entropy (ApEn) analysis of EEG to compare ADHD and control groups. Differences between ADHD presentation in boys and girls indicate the necessity of separate investigations. This study enrolled 30 girls with ADHD and 30 age-matched controls. The results revealed significantly higher ApEn values in most brain areas in the control group than in the ADHD group. Compared with TBR-related feature descriptors, ApEn-related feature descriptors can produce the higher average true positive rate (0.846), average true negative rate (0.814), average accuracy (0.817), and average area under the receiver operating characteristic curve value (0.862). Therefore, compared with TBR, ApEn possessed the better potential for differentiating between girls with ADHD and controls.
Collapse
Affiliation(s)
| | - Chen-Sen Ouyang
- 2 Department of Information Engineering, I-Shou University, Kaohsiung
| | - Chin-Ling Tsai
- 3 Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
| | - Ching-Tai Chiang
- 4 Department of Computer and Communication, National Pingtung University, Kaohsiung
| | - Rei-Cheng Yang
- 5 Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Rong-Ching Wu
- 6 Department of Electrical Engineering, I-Shou University, Kaohsiung
| | - Hui-Chuan Wu
- 5 Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Lung-Chang Lin
- 5 Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,7 Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| |
Collapse
|
15
|
Chow JC, Ouyang CS, Chiang CT, Yang RC, Wu RC, Wu HC, Lin LC. Novel method using Hjorth mobility analysis for diagnosing attention-deficit hyperactivity disorder in girls. Brain Dev 2019; 41:334-340. [PMID: 30473392 DOI: 10.1016/j.braindev.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/03/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Diagnosis of ADHD is based on core symptoms or checklists; however, practitioner subjectivity inevitably results in instances of over- or under-diagnosis. Although an elevated theta/beta ratio (TBR) of the electroencephalography (EEG) band has been approved by the Food and Drug Administration as a factor that may be used in diagnosis of ADHD, several studies have reported no significant differences between the TBR of patients with ADHD and controls. PURPOSE In this study, a method was developed based on Hjorth Mobility (M) analysis of EEG to compare patients with ADHD and controls. METHODS Differences in the presentations of ADHD between boys and girls are well established; therefore, separate investigations are required. The present study enrolled 30 girls with ADHD and 30 age-matched controls. RESULTS The results revealed that the control group had significantly higher Hjorth M values in most brain areas in EEG readings compared with the values for the ADHD group. Compared with TBR, our method revealed a greater number of more significant differences between the girls in the ADHD group and the controls. Moreover, our method can produce the higher average sensitivity (0.796), average specificity (0.796), average accuracy (0.792), and average area under the curve of receiver operating characteristic curve (AUC) value (0.885). Therefore, compared with TBR, Hjorth M possessed the better potential for differentiating between girls with ADHD and controls. CONCLUSION The proposed method was more accurate than the TBR in diagnosing ADHD. Therefore, Hjorth M may be a promising tool for differentiating between children with ADHD and controls.
Collapse
Affiliation(s)
| | - Chen-Sen Ouyang
- Department of Information Engineering, I-Shou University, Taiwan
| | - Ching-Tai Chiang
- Department of Computer and Communication, National Pingtung University, Taiwan
| | - Rei-Cheng Yang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan.
| | - Rong-Ching Wu
- Department of Electrical Engineering, I-Shou University, Taiwan
| | - Hui-Chuan Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Lung-Chang Lin
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan.
| |
Collapse
|
16
|
Newson JJ, Thiagarajan TC. EEG Frequency Bands in Psychiatric Disorders: A Review of Resting State Studies. Front Hum Neurosci 2019; 12:521. [PMID: 30687041 PMCID: PMC6333694 DOI: 10.3389/fnhum.2018.00521] [Citation(s) in RCA: 361] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
A significant proportion of the electroencephalography (EEG) literature focuses on differences in historically pre-defined frequency bands in the power spectrum that are typically referred to as alpha, beta, gamma, theta and delta waves. Here, we review 184 EEG studies that report differences in frequency bands in the resting state condition (eyes open and closed) across a spectrum of psychiatric disorders including depression, attention deficit-hyperactivity disorder (ADHD), autism, addiction, bipolar disorder, anxiety, panic disorder, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and schizophrenia to determine patterns across disorders. Aggregating across all reported results we demonstrate that characteristic patterns of power change within specific frequency bands are not necessarily unique to any one disorder but show substantial overlap across disorders as well as variability within disorders. In particular, we show that the most dominant pattern of change, across several disorder types including ADHD, schizophrenia and OCD, is power increases across lower frequencies (delta and theta) and decreases across higher frequencies (alpha, beta and gamma). However, a considerable number of disorders, such as PTSD, addiction and autism show no dominant trend for spectral change in any direction. We report consistency and validation scores across the disorders and conditions showing that the dominant result across all disorders is typically only 2.2 times as likely to occur in the literature as alternate results, and typically with less than 250 study participants when summed across all studies reporting this result. Furthermore, the magnitudes of the results were infrequently reported and were typically small at between 20% and 30% and correlated weakly with symptom severity scores. Finally, we discuss the many methodological challenges and limitations relating to such frequency band analysis across the literature. These results caution any interpretation of results from studies that consider only one disorder in isolation, and for the overall potential of this approach for delivering valuable insights in the field of mental health.
Collapse
|
17
|
Clarke AR, Barry RJ, Baker IE, McCarthy R, Selikowitz M. An Investigation of Stimulant Effects on the EEG of Children With Attention-Deficit/Hyperactivity Disorder. Clin EEG Neurosci 2017; 48:235-242. [PMID: 27552823 DOI: 10.1177/1550059416664657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stimulant medications are the most commonly prescribed treatment for Attention-Deficit/Hyperactivity Disorder (AD/HD). These medications result in a normalization of the EEG. However, past research has found that complete normalization of the EEG is not always achieved. One reason for this may be that studies have used different medications interchangeably, or groups of subjects on different stimulants. This study investigated whether methylphenidate and dexamphetamine produce different levels of normalization of the EEG in children with AD/HD. Three groups of 20 boys participated in this study. There were 2 groups with a diagnosis of AD/HD; one group, good responders to methylphenidate, and the second, good responders to dexamphetamine. The third group was a normal control group. Baseline EEGs were recorded using an eyes-closed resting condition, and analyzed for total power and relative delta, theta, alpha, and beta. Subjects were placed on a 6-month trial of methylphenidate or dexamphetamine, after which a second EEG was recorded. At baseline, the children with AD/HD had elevated relative theta, less relative alpha and beta compared with controls. Baseline differences were found between the two medication groups, with the dexamphetamine group having greater EEG abnormalities than the methylphenidate group. The results indicate that good responders to methylphenidate and dexamphetamine have different EEG profiles when assessed before medication, and these differences may represent different underlying central nervous system deficits. The 2 medications were found to result in substantial normalization of the EEG, with no significant differences in EEG changes occurring between the 2 medications. This indicates that the degree of pretreatment EEG abnormality was the major factor contributing to the degree of normalization of the EEG. As good responders to the 2 medications appear to have different central nervous system abnormalities, it is recommended that stimulant medications be treated independently and not used interchangeably in research and treatment of AD/HD.
Collapse
Affiliation(s)
- Adam R Clarke
- 1 Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Robert J Barry
- 1 Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Iris E Baker
- 1 Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rory McCarthy
- 2 Sydney Developmental Clinic, Sydney, New South Wales, Australia
| | - Mark Selikowitz
- 2 Sydney Developmental Clinic, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Forethought in Youth with Attention Deficit/Hyperactivity Disorder: An fMRI Study of Sex-Specific Differences. PSYCHIATRY JOURNAL 2016; 2016:6810215. [PMID: 27529063 PMCID: PMC4978833 DOI: 10.1155/2016/6810215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/03/2016] [Indexed: 11/18/2022]
Abstract
Objective. The majority of studies investigating neurocognitive processing in attention deficit/hyperactivity disorder (ADHD) have been conducted on male participants. Few studies evaluated females or examined sex differences. Among various cognitive anomalies in ADHD, deficit in forethought seems particularly important as children with ADHD often fail to adequately use previous information in order to prepare for responses. The main goal of this study was to assess sex-specific differences in behavioral and neural correlates of forethought in youth with ADHD. Methods. 21 typically developing (TD) youth and 23 youth with ADHD were asked to judge whether two pictures told a congruent or incongruent story. Reaction time, performance accuracy, and cerebral activations were recorded during functional magnetic resonance imaging (fMRI). Results. Significant sex-specific differences in cerebral activations appeared, despite equivalent performance. Relative to the boys TD participants, boys with ADHD had extensive bilateral frontal and parietal hypoactivations, while girls with ADHD demonstrated more scattered hypoactivations in the right cerebral regions. Conclusion. Present results revealed that youth with ADHD exhibit reduced cerebral activations during forethought. Nevertheless, the pattern of deficits differed between boys and girls, suggesting the use of a different neurocognitive strategy. This emphasizes the importance of including both genders in the investigations of ADHD.
Collapse
|
19
|
Vollebregt MA, Zumer JM, Ter Huurne N, Buitelaar JK, Jensen O. Posterior alpha oscillations reflect attentional problems in boys with Attention Deficit Hyperactivity Disorder. Clin Neurophysiol 2016; 127:2182-91. [PMID: 27072088 DOI: 10.1016/j.clinph.2016.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/29/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to characterize alpha modulations in children with ADHD in relation to their attentional performance. METHODS The posterior alpha activity (8-12Hz) was measured in 30 typically developing children and 30 children with ADHD aged 7-10years, using EEG while they performed a visuospatial covert attention task. We focused the analyses on typically developing boys (N=9) and boys with ADHD (N=17). RESULTS Alpha activity in typically developing boys was similar to previous results of healthy adults: it decreased in the hemisphere contralateral to the attended hemifield, whereas it relatively increased in the other hemisphere. However, in boys with ADHD this hemispheric lateralization in the alpha band was not obvious (group contrast, p=.018). A robust relation with behavioral performance was lacking in both groups. CONCLUSIONS The ability to modulate alpha oscillations in visual regions with the allocation of spatial attention was clearly present in typically developing boys, but not in boys with ADHD. SIGNIFICANCE These results open up the possibility to further study the underlying mechanisms of ADHD by examining how differences in the fronto-striatal network might explain different abilities in modulating the alpha band activity.
Collapse
Affiliation(s)
- Madelon A Vollebregt
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6526 GC Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Johanna M Zumer
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands.
| | - Niels Ter Huurne
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6526 GC Nijmegen, The Netherlands.
| | - Jan K Buitelaar
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6526 GC Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Ole Jensen
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands.
| |
Collapse
|
20
|
Snyder SM, Rugino TA, Hornig M, Stein MA. Integration of an EEG biomarker with a clinician's ADHD evaluation. Brain Behav 2015; 5:e00330. [PMID: 25798338 PMCID: PMC4356845 DOI: 10.1002/brb3.330] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 01/22/2015] [Accepted: 02/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study is the first to evaluate an assessment aid for attention-deficit/hyperactivity disorder (ADHD) according to both Class-I evidence standards of American Academy of Neurology and De Novo requirements of US Food and Drug Administration. The assessment aid involves a method to integrate an electroencephalographic (EEG) biomarker, theta/beta ratio (TBR), with a clinician's ADHD evaluation. The integration method is intended as a step to help improve certainty with criterion E (i.e., whether symptoms are better explained by another condition). METHODS To evaluate the assessment aid, investigators conducted a prospective, triple-blinded, 13-site, clinical cohort study. Comprehensive clinical evaluation data were obtained from 275 children and adolescents presenting with attentional and behavioral concerns. A qualified clinician at each site performed differential diagnosis. EEG was collected by separate teams. The reference standard was consensus diagnosis by an independent, multidisciplinary team (psychiatrist, psychologist, and neurodevelopmental pediatrician), which is well-suited to evaluate criterion E in a complex clinical population. RESULTS Of 209 patients meeting ADHD criteria per a site clinician's judgment, 93 were separately found by the multidisciplinary team to be less likely to meet criterion E, implying possible overdiagnosis by clinicians in 34% of the total clinical sample (93/275). Of those 93, 91% were also identified by EEG, showing a relatively lower TBR (85/93). Further, the integration method was in 97% agreement with the multidisciplinary team in the resolution of a clinician's uncertain cases (35/36). TBR showed statistical power specific to supporting certainty of criterion E per the multidisciplinary team (Cohen's d, 1.53). Patients with relatively lower TBR were more likely to have other conditions that could affect criterion E certainty (10 significant results; P ≤ 0.05). Integration of this information with a clinician's ADHD evaluation could help improve diagnostic accuracy from 61% to 88%. CONCLUSIONS The EEG-based assessment aid may help improve accuracy of ADHD diagnosis by supporting greater criterion E certainty.
Collapse
Affiliation(s)
- Steven M Snyder
- Department of Research and Development, NEBA Health Boulder, Colorado ; Department of Psychiatry and Health Behavior, Georgia Regents University Augusta, Georgia
| | - Thomas A Rugino
- Children's Specialized Hospital Toms River, New Jersey ; Robert Wood Johnson School of Medicine Piscataway, New Jersey
| | - Mady Hornig
- Department of Epidemiology, Mailman School of Public Health, Columbia University New York, New York
| | - Mark A Stein
- Department of Psychiatry and Behavioral Science, and Pediatrics, University of Washington Seattle, Washington ; Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital Seattle, Washington
| |
Collapse
|
21
|
Buyck I, Wiersema JR. Electroencephalographic activity before and after cognitive effort in children with attention deficit/hyperactivity disorder. Clin EEG Neurosci 2015; 46:88-93. [PMID: 25326289 DOI: 10.1177/1550059414553244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 11/15/2022]
Abstract
Numerous studies have detected elevated electroencephalographic (EEG) theta/beta ratio (TBR) or theta power in children with attention deficit/hyperactivity disorder (ADHD) and therefore TBR has been suggested to be a promising biomarker of ADHD. At the same time, recent theoretical models have emphasized the heterogeneity of ADHD and the notion that cognitive deficits in ADHD are not fixed but fluctuate according to contextual and state factors. Surprisingly, so far the context- or state-dependency of EEG abnormalities in ADHD has hardly been addressed. Therefore, in the current study, 3 minutes eyes closed resting EEG before and after execution of 3 n-back tasks were compared between 21 children with ADHD and 22 typically developing children. No difference between groups was found for TBR or theta power (or other frequency bands), neither before nor after task execution, indicating that enhanced TBR or theta power is not to be considered universal for the disorder. Hence, cautiousness is warranted in using these indices for diagnostic purposes in ADHD. Across groups, posterior theta power, as well as central and posterior beta power was attenuated after task execution, which was interpreted as the children experiencing a more alert state after cognitive effort. Yet, this EEG modulation was similar in both groups, providing no support for a context-or state-dependency of EEG abnormalities in ADHD. However, in light of the absence of any group differences in EEG parameters, further research is warranted.
Collapse
Affiliation(s)
- Inez Buyck
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan R Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
22
|
Buyck I, Wiersema JR. State-related electroencephalographic deviances in attention deficit hyperactivity disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3217-3225. [PMID: 25178704 DOI: 10.1016/j.ridd.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 06/03/2023]
Abstract
This study investigated the stability and state-related characteristics of electroencephalographic (EEG) deviances in attention-deficit/hyperactivity disorder (ADHD). Three minutes resting EEG with eyes closed and eyes open were compared between 21 children with ADHD and 29 typically developing children. Across resting conditions, children with ADHD exhibited divergent topographic distribution for theta, alpha and beta power compared to typically developing children. In addition, less alpha and theta suppression to eye opening was found in children with ADHD, but only in those without comorbid ODD/CD. Findings of the present study refer to a consistent divergence in topographic distribution in ADHD across resting state conditions, yet demonstrate that state-related factors and comorbidity may also contribute to resting EEG deviances in ADHD. The state-related findings are in accord with several theoretical accounts emphasizing the role of contextual and state factors defining deficits in ADHD.
Collapse
Affiliation(s)
- Inez Buyck
- Ghent University, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, 9000 Gent, Belgium.
| | - Jan R Wiersema
- Ghent University, Department of Experimental-Clinical and Health Psychology, Henri Dunantlaan 2, 9000 Gent, Belgium.
| |
Collapse
|
23
|
Wang CC, Hsu MC. An exploratory study using inexpensive electroencephalography (EEG) to understand flow experience in computer-based instruction. INFORMATION & MANAGEMENT 2014. [DOI: 10.1016/j.im.2014.05.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Abstract
Electroencephalography (EEG) has, historically, played a focal role in the assessment of neural function in children with attention deficit hyperactivity disorder (ADHD). We review here the most recent developments in the utility of EEG in the diagnosis of ADHD, with emphasis on the most commonly used and emerging EEG metrics and their reliability in diagnostic classification. Considering the clinical heterogeneity of ADHD and the complexity of information available from the EEG signals, we suggest that considerable benefits are to be gained from multivariate analyses and a focus towards understanding of the neural generators of EEG. We conclude that while EEG cannot currently be used as a diagnostic tool, vast developments in analytical and technological tools in its domain anticipate future progress in its utility in the clinical setting.
Collapse
Affiliation(s)
- Agatha Lenartowicz
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Pl. Suite 17-369, Los Angeles, CA, 90095, USA,
| | | |
Collapse
|
25
|
Age dependent electroencephalographic changes in attention-deficit/hyperactivity disorder (ADHD). Clin Neurophysiol 2014; 125:1626-38. [DOI: 10.1016/j.clinph.2013.12.118] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/11/2013] [Accepted: 12/17/2013] [Indexed: 01/20/2023]
|
26
|
Dupuy F, Clarke A, Barry R, Selikowitz M, McCarthy R. EEG and electrodermal activity in girls with Attention-Deficit/Hyperactivity Disorder. Clin Neurophysiol 2014; 125:491-9. [DOI: 10.1016/j.clinph.2013.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
|
27
|
Weder N. Are we there yet? Electroencephalography as a diagnostic tool for attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:1119-20. [PMID: 24157383 DOI: 10.1016/j.jaac.2013.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 11/16/2022]
|