Comparison of a standard psychiatric evaluation to rating scales and EEG in the differential diagnosis of attention-deficit/hyperactivity disorder

The objective was to investigate the effectiveness of rating scales and electroencephalography (EEG) in detecting the presence of attention-deficit/hyperactivity disorder (ADHD) within a diverse clinical sample. A standard psychiatric evaluation was used to assess 26 children/adolescents who presented to a clinic because a parent suspected the presence of ADHD. EEG data was collected in a blinded protocol, and rating scales were collected as well. Although all subjects had presented with ADHD-like symptoms, only 62% were diagnosed with ADHD, while the remaining 38% had other disorders or no diagnosis. Rating scales readily classified inattentive, impulsive, and/or hyperactive symptoms as being due to ADHD, regardless of the actual underlying disorder, leading to a sensitivity of 81% and a specificity of 22%. Previous studies have observed that there is an EEG marker that identifies ADHD vs. controls, and this marker was present in 15 out of 16 of the ADHD subjects (sensitivity = 94%) and in none of the subjects with ADHD-like symptoms due to other disorders (specificity = 100%). In the detection of ADHD in a diverse clinical sample, rating scales and EEG were both sensitive markers, whereas only EEG was specific. These results may have important implications to ADHD differential diagnosis.