EEG Activity in Females with Attention-Deficit/Hyperactivity Disorder

Although Attention-Deficit/Hyperactivity Disorder (AD/HD) affects millions of females worldwide, our understanding of AD/HD continues to be based heavily on male-dominated research. Significant sex differences reported in the presentation and diagnosis of AD/HD can no longer be ignored; females with AD/HD are different from males with the disorder. Electroencephalography (EEG) is a valuable tool for measuring electro-cortical activity and has been found useful in AD/HD research. Preliminary studies have shown that females with AD/HD have EEG abnormalities different from those found in males with AD/HD. This article reviews the current literature on EEG activity of females with AD/HD and concludes that the lack of comprehensive research draws attention to the necessity for sex-specific EEG research within AD/HD populations.     

EEG Activity in Subtypes of Attention-Deficit/Hyperactivity Disorder

ABSTRACT

This article is a review of electroencephalography (EEG) studies of different types and subtypes of Attention-Deficit/Hyperactivity Disorder (AD/HD). The review outlines the definitional history of AD/HD, and changes that have been made to the conceptualization of the disorder as these different definitions have impacted on the EEG literature. EEG studies are examined using various models of AD/HD based on either behaviour or underlying central nervous system (CNS) abnormalities. From these studies, it appears that AD/HD children generally have increased absolute and relative power in the theta band, either at the frontal electrode sites or over the entire scalp. Reductions in absolute and relative power in the alpha and beta bands have also been found in several studies, although relative power measures appear to be more reliable than absolute power. Increased delta activity in both absolute and relative power has also been noted in several studies. These results are discussed in terms of existing CNS-based models of AD/HD, which attribute the disorder to hypoarousal or a maturational lag in CNS development. Implications of these data for clinical use and future research and development in AD/HD are considered.     

Effects of Acute Exercise on Resting EEG in Children with Attention-Deficit/Hyperactivity Disorder

This two stage study examined the effects of acute exercise on resting electroencephalographic (EEG) patterns of children with attention-deficit hyperactivity disorder (ADHD). The first stage compared the neural oscillatory patterns of children with and without ADHD. Resting EEGs were recorded under an open-eyes condition from 24 boys with ADHD and 28 matched controls. The second stage of the study employed a randomized cross-over trial design. The 24 boys with ADHD engaged in a 30-min intervention that consisted of either running on a treadmill or watching a video on alternative days, with resting EEGs recorded before and after treatment. The first stage found that children with ADHD exhibited significantly higher theta/beta ratios over the midline electrodes sites than controls. The second stage further indicated that children with ADHD displayed smaller theta/beta ratios following the exercise condition compared with the video-watching condition. This finding suggests that acute exercise normalizes arousal and alertness of children with ADHD, as reflected in resting EEG readings.     

EEG and electrodermal activity in girls with Attention-Deficit/Hyperactivity Disorder

ObjectiveThis study investigated the Hypoarousal Model of Attention-Deficit/Hyperactivity Disorder (AD/HD) in girls.Methods40 girls with AD/HD and 40 girl controls (aged 7–12 years) had an eyes-closed resting EEG recorded from 19 electrodes and Fourier transformed. Estimates for total power, absolute and relative power in the delta, theta, alpha, beta and gamma frequency bands, and theta/beta ratio were analysed in nine cortical regions. Skin conductance level (SCL) was simultaneously recorded. Regression analyses explored relationships between symptoms and physiology.ResultsCompared with controls, girls with AD/HD had globally elevated relative delta, globally reduced absolute beta, and globally reduced absolute and relative gamma activity. Girls with AD/HD also had lower mean SCL. Inattentive symptoms were predicted by elevated frontal relative delta, reduced SCL, and reduced temporal relative gamma activity, while elevated hyperactive–impulsive symptoms correlated with elevated frontal relative delta activity in both the patient and control groups.ConclusionsThese EEG results are comparable with the limited female AD/HD literature. Girls with AD/HD are hypoaroused, indicated by reduced SCL, and appear to have an anomalous arousal mechanism. Absolute and relative gamma results are similar to previous findings in AD/HD children. Symptom correlations with physiology offer intriguing insights for future research.SignificanceThis is the first study to examine CNS arousal exclusively in girls with AD/HD.     

Resting-state EEG gamma activity in children with Attention-Deficit/Hyperactivity Disorder

Objective

Children with Attention-Deficit/Hyperactivity Disorder (AD/HD) have well-described abnormalities in the four traditional EEG bands. However, to date the gamma band has not been widely investigated. This study investigated resting-state EEG in children with AD/HD and matched controls, with a particular focus on gamma activity.

Method

Forty children with AD/HD, and 40 age- and sex-matched controls, participated. EEG was recorded from 19 sites during an eyes-closed resting condition and Fourier transformed to provide estimates for absolute and relative power in the delta, theta, alpha, beta and gamma bands.

Results

Children with AD/HD had elevated levels of absolute delta and theta power, and decreased levels of absolute beta and gamma power, compared to controls. With relative power measures, children with AD/HD showed enhanced delta and theta activity, with reduced alpha, beta and gamma activity. Inattention scores on the Conners’ Parent Rating Scale were negatively correlated with absolute gamma.

Conclusions

These patients demonstrate the typical EEG profile in the eyes-closed resting state, over the delta, theta, alpha and beta bands, associated with AD/HD. In addition, compared with controls, they demonstrate reduced absolute and relative gamma activity. These differences appear to contribute importantly to their dysfunctional stimulus processing, and impact their behavioural outcomes.

Significance

This resting-state study extends the well-established fast-wave EEG deficits in children with AD/HD to the gamma band, and links that to increased inattention, which is of special importance in understanding their cognitive-processing problems.     

Megalographia in Children with Cerebellar Lesions and in Children with Attention-Deficit/Hyperactivity Disorder

Structural changes of the cerebellum have been reported in attention-deficit/hyperactivity disorder (ADHD) in several studies. The cerebellum is a structure essential for motor coordination and motor learning. Beside behavioral deficits, children with ADHD often show slight motor abnormalities. In the present study, handwriting was examined in both children with ADHD and children with cerebellar lesions. By writing the same sentence several times, letter height increased in the ADHD and cerebellar groups but not in controls. Comparable disorders of handwriting in cerebellar and ADHD children support previous studies, which suggest a contribution of cerebellar dysfunction to motor abnormalities in ADHD. However, an involvement of non-cerebellar dysfunctions in ADHD cannot be excluded.     

Motor Function in School-Aged Children with Attention-Deficit/Hyperactivity Disorder in Korea

Objective

Motor function critically influences daily activities and academic performance. We compared motor function in school-aged children with Attention-Deficit/Hyperactivity Disorder (ADHD) to that of normal children.

Methods

Participants were 58 children with ADHD [51 males, 7 females; mean age 9 years 6 months±2 years 0 months (SD)] and 70 normal controls [56 males, 14 females; mean age 9 years 2 months±1 years 7 months (SD)]. We assessed motor function with the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition.

Results

The ADHD group had a significantly lower total motor composite score (t=-9.32, p<0.001) than that of the control group. Standard scores of four motor-area composites such as fine manual control (t=-3.76, p<0.001), manual coordination (t=-6.87, p<0.001), body coordination (t=-7.14, p<0.001), and strength and agility (t=-8.54, p<0.1) were significantly lower in the ADHD group than those in the control group. Among the subtests, scores on fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, and strength were significantly lower in the ADHD group than those in the controls, whereas upper-limb coordination was not significantly different between the groups.

Conclusion

School-aged children with ADHD in Korea had significantly lower motor function compared to that of controls. Thus, it is suggested that appropriate target intervention for motor function is important in children with motor impairment in addition to pharmacotherapy or psychosocial therapy for improving the core symptoms.     

Possible Link Between Attention-Deficit/Hyperactivity Disorder and Reproductive Complications

BACKGROUND: Initially conceptualized as a disorder of childhood, attention-deficit/hyperactivity disorder (ADHD) is now emerging as a chronic disorder that may present in adolescence and persist into adulthood. Failure to recognize this common disorder in childhood may lead to disabling comorbid symptoms and a poor long-term prognosis in adulthood. Young adults with undiagnosed ADHD experience significant psychiatric comorbidity, including high rates of drug dependency and lower levels of global functioning. The public health consequences of poor impulse control (e.g., delinquency, criminal activity, drug use, risky sexual behaviors, high-risk pregnancies) are emerging, and a link between ADHD and poverty seems highly probable. CASE REPORT: I explore the sexual behaviors, and their consequences, of a young adolescent female. Her reproductive complications led me to consider undiagnosed ADHD. CONCLUSION: The long-term prognosis when ADHD is unrecognized and untreated in the adolescent is discouraging: maternal and perinatal morbidity may be anticipated and are biologically plausible. The actual assessment of risk in the setting of pregnancy and unrecognized ADHD remains largely unknown, and the benefits of timely diagnosis and appropriate treatment of ADHD during pregnancy have yet to be addressed. The following case presentation suggests an association between undiagnosed ADHD and reproductive complications.     

Emerging Association Between Addictive Gaming and Attention-Deficit/Hyperactivity Disorder

Children's and adolescent's use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012.     

Peripheral Vasculopathy Associated with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Psychostimulants (methylphenidate and amphetamine salt) are the pharmacologic treatment of choice for children with attention-deficit/hyperactivity disorder. However, psychostimulants have been linked to a variety of vascular problems, including peripheral vasculopathy. This article describes four boys with attention-deficit/hyperactivity disorder who developed vasculopathy during treatment with psychostimulants.     

EEG Biofeedback Training and Attention-Deficit/Hyperactivity Disorder in an Elementary School Setting

Abstract

Introduction: EEG biofeedback was conducted on site in an elementary school.

Method: An experimental group of eight children ages 8-10 completed 35-47 sessions of EEG biofeedback training over a six-month period. Four participants in the experimental group were diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) and four were not diagnosed with ADHD. Eight children in the waitlist control group were matched to the experimental group on age, grade, teacher, and diagnosis. None of the 16 participants were medicated for ADHD.

Results: Attention abilities as measured by the Test of Variables of Attention showed the experimental group of children with ADHD reduced errors of commission and anticipation, indicating a reduction in impulsivity. Teacher reports using the McCarney Scale indicated improvements in attention but no changes in impulsivity and hyperactiv-ity.

Discussion: Several confounds require exploration before attribution of changes are assigned to neurofeedback. Whether the effects are due to the neurofeedback protocols, attendance at individual sessions away from the classroom, the attention of the technician, or the excitement of a special program cannot be determined with this study. It will be necessary to have a placebo group in order to separate systematically the variables in the training program.     

Effects of stimulant medications on the EEG of girls with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE: Stimulant medications are the most commonly used treatments for Attention-Deficit/Hyperactivity Disorder (AD/HD) in North America and Australia, although it is still not entirely known how these medications work. This study investigated the effects of stimulant medications on the EEG of girls with AD/HD. METHODS: An initial EEG was recorded during an eyes-closed resting condition. Data from 19 electrode sites were Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The data were then averaged into 9 regions and an analysis of both global and regional differences was performed. Subjects were placed on a six-month trial of a stimulant and a second EEG was recorded at the end of the trial. RESULTS: The unmedicated girls had significantly greater total power, absolute delta and theta, more relative theta especially in the frontal regions, and reduced frontal relative delta and beta activity compared with controls. Medication resulted in normalisation of theta power, but after medication, increased relative beta was also apparent in the AD/HD group. CONCLUSIONS: These results indicate that stimulant medications result in a normalisation of slow wave activity in the EEG. In line with published research on the effects of arousal on the EEG, these results suggest that stimulant medications may have their therapeutic effect by improving the EEG substrate of processing deficits in these children. However, this requires further testing during active processing tasks. SIGNIFICANCE: This is the first study to investigate the effect of stimulant medications on the EEG of girls with AD/HD.     

Attention-Deficit/Hyperactivity Disorder and Telemental Health

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders diagnosed in children and adolescents (youth). ADHD is equally distributed geographically, but services are not. Access to expert evaluation and treatment remains limited for youth with ADHD living in rural areas, as well as for ethnic and racial minority youth. Telepsychiatry is a service delivery model with the potential to reach these youth and to develop collaborative models of care among local primary care physicians, remote telepsychiatrists, and local families. Care delivered through telepsychiatry can readily adhere to the practice parameters of the American Academy of Child and Adolescent Psychiatry. Work to date indicates that ADHD is the most common disorder treated through telepsychiatry. This article reviews the status of child and adolescent telepsychiatry, with particular focus on its potential to improve the care and outcomes of underserved populations of youth diagnosed with ADHD.