Is an electroencephalogram (EEG) indicated for attention deficit hyperactivity disorder (ADHD) with symptoms of lack of concentration?

From the Guidelines

An electroencephalogram (EEG) is not routinely indicated for the diagnosis of attention deficit hyperactivity disorder (ADHD) with symptoms of lack of concentration. The diagnosis of ADHD is primarily clinical, based on a comprehensive evaluation of behavioral symptoms, developmental history, and functional impairment across different settings. Standard diagnostic procedures include structured interviews, rating scales completed by parents and teachers, and direct behavioral observations. EEG testing does not provide specific markers for ADHD and would only be indicated if there is clinical suspicion of seizure disorders, which can sometimes mimic or coexist with ADHD symptoms.

Key Points to Consider

• The American Academy of Pediatrics and other major medical organizations do not recommend routine EEG testing for uncomplicated ADHD 1.
• EEG might be considered only in cases where there are atypical features such as sudden onset of symptoms, episodes of staring or unresponsiveness, or other neurological concerns that suggest possible seizure activity.
• The diagnostic focus for ADHD should remain on thorough clinical assessment rather than neuroimaging or electrophysiological testing.
• Recent guidelines, such as those discussed in 1, emphasize the importance of pharmacological treatment and behavioral interventions for ADHD, without mentioning EEG as a diagnostic tool.
• The use of EEG is more relevant in other contexts, such as in the diagnosis of hepatic encephalopathy, as discussed in 1, but this is not applicable to the diagnosis of ADHD.

From the Research

EEG Indications for Attention Deficit Hyperactivity Disorder (ADHD)

• EEG can be used to evaluate ADHD, particularly when there are concerns about comorbid epilepsy or seizure-like symptoms 2.
• Studies have shown that children with ADHD may have elevated slow theta activity and a higher theta/beta ratio on EEG, which can be indicative of the disorder 2, 3.
• Focal EEG abnormalities, such as paroxysmal discharges at the frontopolar-frontal or central-temporal regions, may also be associated with ADHD and can help distinguish it from other conditions like pervasive developmental disorder (PDD) 4.

EEG Findings in ADHD

• Elevated theta activity is a common finding in adults with ADHD, and can be used to differentiate them from non-ADHD individuals 3, 5.
• Reduced beta activity has also been reported in some studies, although this finding is not consistent across all research 5.
• EEG abnormalities, including background EEG abnormalities and paroxysmal discharges, may be useful in diagnosing ADHD and distinguishing it from other conditions 4.

Clinical Use of EEG in ADHD Evaluation

• EEG should be used judiciously in the evaluation of ADHD, and only when there is a strong clinical suspicion of epilepsy or other seizure-like disorders 6.
• The use of quantitative EEG (QEEG) as a stand-alone diagnostic marker for ADHD is not recommended due to its lack of specificity and potential for artifacts 2.
• EEG findings should be interpreted in the context of clinical symptoms and other diagnostic criteria to ensure accurate diagnosis and treatment of ADHD 2, 4, 3, 5.