Community-Based Electrophysiological Abnormalities in Children With ADHD: Translating Research Findings into a Clinical Setting

Abstract

Abstract Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent disorder of childhood that is behaviorally characterized by repeated episodes of inattention, impulsivity, and hyperactivity. Selecting appropriate treatment based on presenting behavior can be challenging and usually requires timeintensive medication trials. Clinical and research communities agree there is a need for an objective method to both evaluate symptoms of ADHD and determine appropriate treatment options (Barkley, 2009). We are proposing the use of qEEGs (quantitative electroencephalograms) in patients presenting with ADHD symptomology to provide an objective assessment of underlying neuropathology that can aid in diagnostic clarification, thus offering targeted treatment approaches. Current studies have identified three abnormal electrophysiological clusters (Chabot & Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001). This study was designed to examine these clusters of ADHD in a naturalistic sample to determine congruity between current research literature and frontline community treatment centers. We evaluated 30 pediatric patients (6–17 yrs) in a naturalistic psychiatric setting. As described in Konopka (2005), participants completed an initial baseline study to examine brain electrophysiology through qEEG. Electrophysiological clusters were defined by (Chabot & Serfontein, 1996; Clarke, et al., 2001; Monastra, et al., 2001): cortical hypoarousal (excess theta), cortical hyperarousal (excess beta, decreased theta/ delta), and maturation lagged (excess delta/ theta). Neuroguide software and databases (Thatcher, 2009) were used for spectral analyses to convert raw EEG data to quantifiable form (qEEG). Fast Fourier Transformation was used to generate relative power maps for comparison of electrophysiological abnormalities. Comparisons were made for cortical activity levels of Delta, Theta, Alpha, and Beta. The database was used to statistically compare ADHD children to a control group (N=678), normed for gender, age, and handedness. Results show that children with ADHD exhibited abnormal electrophysiological activity in comparison to age and gender matched norms. While we found the previously documented electrophysiological groups, there was a disproportionately high degree of cortically hyperaroused children within the sample. Specifically, the overwhelming majority of our sample presented with excess relative beta in the central-parietal regions. Additionally we identified a novel electrophysiological group, which displayed concurrent excesses of fast (beta) and slow (theta) activity in relative frequencies. These findings illustrate discrepancies in ADHD populations studied in clinical centers and research laboratories. Given that there is agreement for the need of objective assessment tools and that imaging modalities provide promise (Chabot, Orgill, Crawford, Harris, & Serfontein, 1999), there is also a need for continuity between research and clinical communities. This study provides an important objective diagnostic and treatment paradigm that can be highly informative for the direction of future studies.