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Electrophysiology in ADHD Diagnosis, predictions, and treatment

Øgrim, Geir
Doctoral thesis
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URI
http://hdl.handle.net/11250/278938
Date
2014
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Abstract
Study 1: The theta/beta ratio (TBR) study

Significantly elevated levels of power in the QEEG theta band or the theta/beta ratio (TBR) were

found in 26% of the ADHD patients compared with 2.5% of controls. Excess theta was correlated with

inattention and executive problems. Finding excess theta or TBR in a patient strengthens the

hypothesis that ADHD is a correct diagnosis, as this pattern is not associated with common comorbid

diagnoses in child psychiatry. Our findings were in agreement with most of the recent research.

Study 2: The neurofeedback (NF) study

In this randomized pilot study, 30 sessions of NF were compared with stimulant medication. At

evaluation, 6 to 9 months after onset of treatment, we found significant reductions of ADHD

symptoms in the medication group, with large effect sizes, but no significant reductions in the NF

group. We argue that NF is best suited for carefully selected groups.

Study 3: Predicting acute side effects of stimulant medication

In general, about 30 % of ADHD patients treated with stimulants suffer from acute side effects

requiring adjustments, like regulations of doses and timing, change to an alternative drug, counseling

regarding sleep patterns and food intake, or a total reliance on nonpharmacological treatments. The

most common side effects (SEs) within our sample were increased irritability, anxiety, and problems

with sleep and appetite. In this study of 37 patients without SEs and 33 with SEs, a logistic regression

model showed that three variables contributed significantly to the prediction of SEs: an elevated ERP

index of anxiety; a close-to-normal ERP component, measuring action preparation; and a fast

reaction time in the VCPT task.

Study 4: Predicting the clinical outcome of stimulant medication

In this study (N = 98), 76% of the ADHD patients treated with stimulants were considered responders.

The clinical outcome (i.e. responder or nonresponder, based on interviews and rating scales) was

best predicted by electrophysiological parameters. Compared with norms, responders were

characterized by excess theta—a close-to-normal ERP component related to identification of targets,

and a smaller-than-normal ERP component related to inhibition. The brain dysfunctions of the

responders appear to be primarily associated with prefrontal lobe hypo-activation. The

nonresponders seemed to be more deviant in parietal-occipital functions. A significant moderate

negative correlation was found between side effects and clinical response.

Our conclusions

Diagnoses in psychiatry are based on observed behavior. Supplementing these observations with

variables from neurophysiology (QEEG and ERP components) and neuropsychology may increase the

professional and public credibility of diagnoses like ADHD by documenting deviances in brain

function. Such data are potentially helpful in making differential diagnoses, especially in cases in

which data from different informants do not coincide. The same parameters are promising

candidates for predictions of treatment effects. Our studies can be seen as making small

contributions to the development of biomarkers for ADHD.

Neurofeedback for ADHD cannot yet be considered evidence-based treatment. It seems to be best

suited for carefully selected cases.
Publisher
NTNU
Series
Doctoral thesis at NTNU;2014:328

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