Medscape Medical News > Psychiatry EEG-Based Biomarker May Improve ADHD Diagnosis (1028 hits)
Adding an electroencephalography (EEG)-based biomarker to standard clinician judgement may improve the accuracy of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and reduce the likelihood of overdiagnosis, new research suggests.
The Neuropsychiatric EEG-Based Assessment Aid (NEBA) System uses electroencephalography to measure beta and theta waves. Previous studies have shown that the theta/beta ratio is increased in children and adolescents with ADHD.
The research was by led NEBA Health, the company behind the system. It showed that adding the EEG test to standard clinical assessment raised the accuracy of ADHD diagnosis to that of a multidisciplinary team (MDT) and reduced the proportion of overdiagnoses by more than a third.
"Our multidisciplinary results showed ADHD may be overdiagnosed in the clinic as much as one third of the time," Steven Snyder, PhD, head of research at NEBA Health, said in a release. "And NEBA separately identified most of those cases."
"Integrating the NEBA biomarker with a clinician's regular evaluation can bring the diagnosis more in line with that of a multidisciplinary team."
In both the DSM-IV and the DSM-5, ADHD is characterized by developmentally inappropriate attentional and behavioral symptoms, as set out in a series of criteria.
Criterion E requires that the symptoms are not better explained by another disorder in which the symptoms are present, which can complicate ADHD evaluation and necessitate a comprehensive evaluation.
To aid in the differentiation of ADHD and non-ADHD cases and lessen criterion E uncertainty, Dr Snyder and colleagues integrated the EEG biomarker with a clinician's regular evaluation.
In a 13-site prospective clinical cohort study, the team obtained comprehensive clinical evaluation data on 275 children and adolescents presenting with attentional and behavioral concerns.
At each site, a qualified clinician performed a differential diagnosis. EEG data were collected at a different site. The reference standard was assessment by an MDT, consisting of a psychiatrist, a psychologist, and a neurodevelopmental pediatrician.
In all, 209 children were deemed to have met the criteria for ADHD by the individual clinician. However, the MDT judged that 93 children were less likely to have met criterion E, suggesting a potential overdiagnosis of 34%.
Of those 93 children, 85 (91%) were also identified on EEG as being less likely to meet criterion E, because they had a lower beta/theta ratio.
Furthermore, integrating clinician judgement with EEG measurement in the 36 cases identified by the clinician as being uncertain led to agreement with the judgement of the MDT in 97% of children.
The team also found that integrating EEG measurement with clinician judgement improved the accuracy of the clinician's ADHD evaluation, increasing it from 61% to 88% in patients with a relatively lower theta/beta ratio.
