Using Brain-Based Cognitive Measures to Support Clinical Decisions in ADHD

Williams, Leanne M.; Hermens, Daniel F.; Thein, Thida; Clark, C. Richard; Cooper, Nicholas; Clarke, Simon; Lamb, Chris; Gordon, Evian; Kohn, Michael

doi:10.1016/j.pediatrneurol.2009.08.010

Cited by 71 publications

(53 citation statements)

References 45 publications

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“…Because ERPs have been shown to possess adequate retest reliability (r = 0.75) 30 and for the purposes of statistical power, we focused our analyses on the test-retest comparison of AN participants relative to baseline controls.…”

Section: Methodsmentioning

confidence: 99%

Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment

Hatch

Madden²,

Kohn³

et al. 2010

jpn

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267Background: Identification of the biological markers of anorexia nervosa (AN) is crucial for the development of new treatments. We aimed to determine whether AN is associated with disturbances in the nonconscious neural processing of innate signals of emotion and whether these disturbances persist after weight gain. Methods: In a retest design, 28 adolescent females with AN were tested at first admission to hospital and again after they had gained weight. Matched healthy control participants were tested at the same times. We assessed emotion-elicited event-related potentials (ERPs) during overt and covert presentation of emotion expressions, scores on an emotion-identification behavioural task, and symptom measures. We performed between and within group analyses. Results: Individuals with AN had a marked alteration in ERPs relative to healthy controls. Irrespective of the form of stimulus, early and late ERP components were significantly reduced in AN patients at baseline (when underweight) and on retest (after weight gain), especially in the temporo-occipital regions, suggesting a persistent disruption of the early automatic appraisal of salient emotional signals. Limitations: This study could have been improved with a longer standardized retest interval. Conclusion: There is likely a core, generic disturbance in AN in the early "automatic" neural processing of emotion irrespective of weight or nutritional status. New innovative emotion-based psychologic or pharmacologic treatments targeting these nonconscious processes may prove beneficial.

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Section: Methodsmentioning

confidence: 99%

Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment

Hatch

Madden²,

Kohn³

et al. 2010

jpn

Self Cite

View full text Add to dashboard Cite

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“…The controversy results from a series of recent studies by independent research groups that were not supportive of the association between the TBR and ADHD [30][31][32][33][34][35][36]. These negative findings were reflected in a recent meta-analysis by Arns et al…”

Section: Diagnostic Biomarkers In Attention Deficit Hyperactivity Dismentioning

confidence: 99%

Electrophysiological biomarkers of diagnosis and outcome in neurodevelopmental disorders

Jeste¹,

Frohlich²,

Loo³

2015

Current Opinion in Neurology

142

104

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“…6 TBR findings in adults correlated with response times that were used as a marker for attention. 7 However, problems began to appear with the accuracy of TBR when attempted as a diagnostic test.…”

mentioning

confidence: 77%

Quantitative EEG in attention-deficit/hyperactivity disorder

2016

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Quantitative EEG measurement of the scalp vertex theta/beta ratio (TBR) is marketed as a tool for use in the evaluation of patients who may have attentiondeficit/hyperactivity disorder (ADHD). The American Academy of Neurology (AAN) recently assessed the literature about this tool. The assessment urged caution, considering that the TBR remains an investigational research tool at this time. This perspective comments further on that assessment and its rationale, and recommends a perspective for the clinician and payer. Neurol 2016;6:543-548 T he use of quantitative EEG (QEEG) continues to receive attention as a controversial diagnostic aid for attention-deficit/ hyperactivity disorder (ADHD). For the purposes of this perspective piece, attention-deficit disorder is included in the definition of ADHD. Clin PractThe QEEG generally considered in the United States is the theta/beta ratio (TBR). TBR is the ratio of the amount of theta activity divided by the amount of beta activity, where both are measured at the scalp vertex site Cz. The ears are linked to use as reference electrode sites for the measurements, so these measurements include the EEG activity from both the scalp vertex and the lower temporal regions. In many studies, the TBR measurement is a single channel EEG based on 1-3 minutes of EEG.TBR measurement is available in commercial equipment. Commercial units display results as low, moderate, or high TBR without giving specific numeric values or raw EEG displays. The norms are age-adjusted. American Academy of Neurology practice and advisory findings The American Academy of Neurology (AAN) assessment 1 found a relative lack of support for the use of TBR tests for the diagnosis of ADHD. The 3 conclusions from that assessment are as follows:• Clinicians should inform patients with suspected ADHD and their families that the combination of TBR and frontal EEG beta power should not replace a standard clinical evaluation.• There is a risk for substantial harm to patients misdiagnosed with ADHD, given the high false-positive diagnostic rate of TBR and frontal EEG beta power.• Clinicians should inform patients with suspected ADHD and their families that the TBR should be used neither to confirm an ADHD diagnosis nor to support further testing after a clinical evaluation, unless such diagnostic assessments take place within the limits of a research study.Although some studies showed that TBR has a relatively high sensitivity and specificity for ADHD, the published literature was inconclusive.For example, one large recent study 2 based TBR measurements on 60 seconds of EEG. The gold standard for ADHD was unusual or unclear because patients with the most ADHD symptoms constituted the "ADHD-negative" control group. All patients were children referred to a specialized center for assessment of ADHD. Those considered to have a primary diagnosis of an anxiety, anger, or another disorder along with ADHD as a secondary diagnosis were considered ADHD-negative for this study, a classification that seemed peculiar b...

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Using Brain-Based Cognitive Measures to Support Clinical Decisions in ADHD

Cited by 71 publications

References 45 publications

Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment

Emotion brain alterations in anorexia nervosa: a candidate biological marker and implications for treatment

Electrophysiological biomarkers of diagnosis and outcome in neurodevelopmental disorders

Quantitative EEG in attention-deficit/hyperactivity disorder

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