Is an Electroencephalogram (EEG) indicated for attention deficit hyperactivity disorder (ADHD) and lack of concentration?

From the Guidelines

An electroencephalogram (EEG) is generally not indicated for the diagnosis of attention deficit hyperactivity disorder (ADHD) or general concentration difficulties. Standard ADHD diagnosis relies primarily on clinical evaluation using established diagnostic criteria, behavioral assessments, rating scales, and interviews with the patient and others familiar with the patient's behavior [ 1 ]. EEGs show no consistent pattern of abnormalities in ADHD patients that would make them useful as a diagnostic tool. The American Academy of Pediatrics and other major medical organizations do not recommend routine EEG testing for ADHD evaluation [ 1 ].

Key Points to Consider

• EEGs are more appropriately used when there is suspicion of seizure disorders, which can sometimes present with attention problems, or when there are other neurological symptoms present.
• If concentration difficulties are accompanied by episodes of unconsciousness, unusual movements, or other neurological symptoms, then an EEG might be warranted to rule out seizures or other neurological conditions.
• For standard ADHD assessment, clinicians should focus on comprehensive behavioral evaluations rather than neuroimaging or electrophysiological tests like EEGs [ 1 ].
• The evaluation of a child or adolescent for ADHD should include a process to at least screen for comorbid conditions, including emotional or behavioral conditions, developmental conditions, and physical conditions [ 1 ].

Recommendations

• Do not use EEG as a routine diagnostic tool for ADHD or concentration difficulties.
• Use EEG only when there are specific neurological symptoms that warrant its use, such as suspicion of seizure disorders.
• Focus on comprehensive behavioral evaluations for standard ADHD assessment.

From the Research

EEG Indication for Attention Deficit Hyperactivity Disorder (ADHD) and Lack of Concentration

• EEG is used to assess neural function in children with ADHD, and studies have shown that it can be useful in detecting abnormal EEG findings and epileptiform discharges in patients with ADHD 2, 3.
• Approximately half of the children with ADHD have abnormal EEG findings, and 22.1% have epileptiform discharges, indicating a close relationship between ADHD and epileptiform discharges 2.
• EEG cannot currently be used as a diagnostic tool for ADHD, but it can be used to assess the neural function and detect potential comorbid epilepsy 4.
• The clinical utility of EEG in ADHD includes assessing the underlying neurophysiology of ADHD, making an ADHD diagnosis, and predicting stimulant response 5.
• Quantitative EEG (QEEG) has been used to evaluate the effects of drug treatment on EEG signals in children with ADHD, and studies have shown that QEEG rates can be statistically significant after treatment with methylphenidate and atomoxetine 6.

Use of EEG in ADHD Diagnosis and Treatment

• EEG is used to evaluate the extent to which EEG findings may explain the symptoms of ADHD and whether anti-epileptic drugs should be tried 3.
• Seizure symptoms, disturbed sleep quality, significant changes in behavior, or regression of cognitive ability in children with ADHD should lead to pediatric neurological assessment with EEG and possibly a 24-hour EEG 3.
• QEEG variables are artifact-prone and biologically unspecific, and therefore, QEEG should not be used as a stand-alone diagnostic marker 3.

EEG Findings in ADHD

• Abnormal EEG findings are common in children with ADHD, and epileptiform discharges are more frequent in patients with ADHD than in healthy children 2, 3.
• The significance of epileptiform EEG activity in children with ADHD without seizures is uncertain, and evaluating the extent to which EEG findings may explain the symptoms is a specialist task 3.
• Spectral analysis of the frequency content of the EEG (QEEG) has shown higher slow theta activity and a higher theta/beta ratio in children with ADHD 3.