Blinded, multi-center validation of EEG and rating scales in identifying ADHD within a clinical sample

Steven M. Snyder, Humberto Quintana, Sandra B. Sexson, Peter Knott, A. F.M. Haque, Donald A. Reynolds

Research output: Contribution to journalArticlepeer-review

100 Scopus citations


Previous validation studies of attention deficit/hyperactivity disorder (ADHD) assessment by rating scales or EEG have provided Class-IV evidence per standards of the American Academy of Neurology. To investigate clinical applications, we collected Class-I evidence, namely from a blinded, prospective, multi-center study of a representative clinical sample categorized with a clinical standard. Participating males (101) and females (58) aged 6 to 18 had presented to one of four psychiatric and pediatric clinics because of the suspected presence of attention and behavior problems. DSM-IV diagnosis was performed by clinicians assisted with a semi-structured clinical interview. EEG (theta/beta ratio) and ratings scales (Conners Rating Scales-Revised and ADHD Rating Scales-IV) were collected separately in a blinded protocol. ADHD prevalence in the clinical sample was 61%, whereas the remainder had other childhood/adolescent disorders or no diagnosis. Comorbidities were observed in 66% of ADHD patients and included mood, anxiety, disruptive, and learning disorders at rates similar to previous findings. EEG identified ADHD with 87% sensitivity and 94% specificity. Rating scales provided sensitivity of 38-79% and specificity of 13-61%. While parent or teacher identification of ADHD by rating scales was reduced in accuracy when applied to a diverse clinical sample, theta/beta ratio changes remained consistent with the clinician's ADHD diagnosis. Because theta/beta ratio changes do not identify comorbidities or alternative diagnoses, the results do not support the use of EEG as a stand-alone diagnostic and should be limited to the interpretation that EEG may complement a clinical evaluation for ADHD.

Original languageEnglish (US)
Pages (from-to)346-358
Number of pages13
JournalPsychiatry Research
Issue number3
StatePublished - Jun 30 2008


  • Adolescent
  • Attention deficit/hyperactivity disorder
  • Child
  • EEG
  • Rating scales
  • Sensitivity
  • Specificity

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry


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