Clinical Utility of EEG in Attention-Deficit/Hyperactivity Disorder: A Research Update
Open accessAbstract
Psychiatric research applications of electroencephalography (EEG), the earliest approach to imaging human cortical brain activity, are attracting increasing scientific and clinical interest. For more than 40 years, EEG research has attempted to characterize and quantify the neurophysiology of attention-deficit/hyperactivity disorder (ADHD), most consistently associating it with increased frontocentral theta band activity and increased theta to beta (θ/β) power ratio during rest compared to non-ADHD controls. Recent reports suggest that while these EEG measures demonstrate strong discriminant validity for ADHD, significant EEG heterogeneity also exists across ADHD-diagnosed individuals. In particular, additional studies validating the use of the θ/β power ratio measure appear to be needed before it can be used for clinical diagnosis. In recent years, the number and the scientific quality of research reports on EEG-based neurofeedback (NF) for ADHD have grown considerably, although the studies reviewed here do not yet support NF training as a first-line, stand-alone treatment modality. In particular, more research is needed comparing NF to placebo control and other effective treatments for ADHD. Currently, after a long period of relative stasis, the neurophysiological specificity of measures used in EEG research is rapidly increasing. It is likely, therefore, that new EEG studies of ADHD using higher density recordings and new measures drawn from viewing EEG as a 3-dimensional functional imaging modality, as well as intensive re-analyses of existing EEG study data, can better characterize the neurophysiological differences between and within ADHD and non-ADHD subjects, and lead to more precise diagnostic measures and effective NF approaches.
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Theta reduction can be used to improve attention skill.
“While theta reduction can be used to improve attention skill,16”
From Evaluation of a manualised neurofeedback training in psychosomatic-psychotherapeutic outpatient treatment (Neuro-pp-out): study protocol for a clinical mixed-methods pilot study (2024) · cites this paper as [16]
The Theta/Beta Protocols section (page unavailable) describes neurofeedback that rewards reduced theta activity, so the paper supports theta reduction as a treatment target. But Specific versus Nonspecific Treatment Effects (page unavailable) reports mixed theta changes and no significant association between changes in the theta/beta ratio and ADHD symptoms. The paper does not establish that reducing theta improves attention skills. (LLM, conf=0.85)
Experimental — accuracy not yet measuredMore recent evidence from EEG studies calls into question the reliability of findings of increased slow relative to fast EEG waves in ADHD.
“Interestingly, more recent evidence from EEG studies also calls into question the reliability of the findings of increased slow relative to fast EEG waves in ADHD (see Saad et al (2015) and Loo and Makeig (2012) for reviews)”
From Is autonomic nervous system function atypical in Attention Deficit Hyperactivity Disorder (ADHD)? A systematic review of the evidence (2020) · cites this paper as Loo and Makeig (2012)
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Research works printed but not linked: 2
- Loo SK, Hale TS, Hanada G, et al., Familial clustering and DRD4 effects on electroencephalogram measures in multiplex families with ADHD. J Am Acad Child Adolesc Psychiatry 2010;29:368-377.
- Nazari MA, Wallois F, Aarabi A, Berquin P. Dynamic changes in quantitative electroencephalogram during continuous performance test in children with attention-deficit/hyperactivity disorder. Int J Psychophysiol 2011;81:230-236.
Cited by
Sorted by citations
EEG and MEG: Relevance to Neuroscience
Lopes da Silva, F. (2013) · Neuron · doi:10.1016/j.neuron.2013.10.017 · Cited by 900 · see citing works
EEG frequency bands in psychiatric disorders: a review of resting state studies
Newson, J. J., & Thiagarajan, T. C. (2019) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00521 · Cited by 863 · see citing works
Buzsáki, G., & Watson, B. O. (2012) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2012.14.4/gbuzsaki · Cited by 579 · see citing works
Bolea-Alamañac, B., Nutt, D. J., Adamou, M., Asherson, P., Bazire, S., Coghill, D., Heal, D., Müller, U., Nash, J., Santosh, P., et al. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881113519509 · Cited by 287 · see citing works
Bellato, A., Arora, I., Hollis, C., & Groom, M. J. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.11.001 · Cited by 172 · see citing works
Is the Theta/Beta EEG Marker for ADHD Inherently Flawed?
Saad, J. F., Kohn, M. R., Clarke, S., Lagopoulos, J., & Hermens, D. F. (2018) · Journal of Attention Disorders · doi:10.1177/1087054715578270 · Cited by 125 · see citing works
Zuberer, A., Brandeis, D., & Drechsler, R. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00135 · Cited by 113 · see citing works
Pulini, A. A., Kerr, W. T., Loo, S. K., & Lenartowicz, A. (2019) · Biological Psychiatry: Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.06.003 · Cited by 85 · see citing works
Self-citationJanssen, T. W. P., Bink, M., Geladé, K., van Mourik, R., Maras, A., & Oosterlaan, J. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0144 · Cited by 58 · see citing works
Neurofeedback training content for treatment of stress
Hafeez, Y., Azhar Ali, S. S., & Malik, A. S. (2016) · 2016 IEEE EMBS Conference on Biomedical Engineering and Sciences (IECBES) · doi:10.1109/iecbes.2016.7843429 · Cited by 8 · see citing works
Chen, Y., Chang, W., Liang, K., Chen, C., Chen, H., Chen, S., & Chan, P. S. (2024) · Child: Care, Health and Development · doi:10.1111/cch.13231 · Cited by 5 · see citing works
Continuous performance task in attention deficit hyperactivity disorder children
El Sayed, B., Abdel Kader, A., Mohamed, N., Amin, O., & Halawa, I. (2016) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.4103/1110-1083.176340 · Cited by 4 · see citing works
Schmidt, K. L., Kowalski, A., Schweda, A., Dörrie, N., Skoda, E. M., Bäuerle, A., & Teufel, M. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-079098 · Cited by 3 · see citing works
“15 While theta reduction can be used to improve attention skill, 16 the high-beta band is associated with stress experience.”
Method
- Authors
- Loo, S. K., & Makeig, S.
- Affiliations
- University of California, Los Angeles (US)
- University of California San Diego (US)
- Corresponding author
- Loo, Sandra K.
- Venue
- Neurotherapeutics
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 9
- Issue
- 3
- Pages
- 569-587
- ISSN
- 1878-7479 (ISSN-L)
- PMC
- PMC3441927
- OpenAlex
- W2092515476
- Cited by
- 306
- References
- 98
- Citations by year
- 2026: 26 · 2025: 23 · 2024: 26 · 2023: 18 · 2022: 17 · 2021: 28 · 2020: 19 · 2019: 27 · 2018: 23 · 2017: 19 · 2016: 23 · 2015: 15 · 2014: 27 · 2013: 10 · 2012: 5
- FWCI
- 2.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Neurotherapeutics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- University of California, San Diego
- National Institute of Mental Health (1R03MH92829, R01MH084819, R03MH092829)
- National Institute of Neurological Disorders and Stroke (R01NS047293)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- attention deficit hyperactivity disorder, EEG, EEG-based neurofeedback, ADHD diagnosis, discriminant validity, ADHD treatment
- MeSH terms
- Attention Deficit Disorder with Hyperactivity, Brain, Brain Mapping, Electroencephalography, Humans, Biomedical Research, Brain Waves
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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