Diagnosis of attention-deficit/hyperactivity disorder

In their article “Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis,” Dr. Gloss et al.1 question the available evidence regarding the usefulness of EEG in the diagnosis of attention-deficit/hyperactivity disorder (ADHD). In October 2013, the US Food and Drug Administration (FDA) approved the Neuropsychiatric EEG-Based Assessment Aid (NEBA).2 The NEBA test calculates the ratio of the theta and beta brain waves obtained by EEG. The brain wave pattern that seems to occur more often in people with ADHD is called the theta-beta ratio. The American Academy of Neurology (AAN) assembled a panel of experts to evaluate NEBA carefully and to develop a practice advisory. In developing the practice advisory, the panel looked at the published medical literature, and also reviewed the data presented to the FDA. When evaluating the medical articles, the panel used very strict criteria, developed by the AAN. These criteria carefully classify the level of evidence, giving higher levels (there are 5 levels: Level 1 is the highest, and mainly refers to randomized case-controlled clinical trials; Level 5 is the lowest, often referring to information derived from expert opinion) to studies that answer a question most clearly and with the fewest biases. When they looked through the medical literature, the panel found 959 abstracts and articles that discussed theta/beta and the diagnosis of ADHD. Using strict criteria, the panel found 1 article (Level 3 evidence) that addressed a specific question: If EEG is added to the usual examination of people with ADHD, does it help to make the diagnosis clearer? There are 2 considerations when evaluating a medical test in this circumstance. First, how sensitive is the test? Sensitivity also …