EEG evidence for a new conceptualisation of attention deficit hyperactivity disorder

Objectives: This study investigated the presence of electroencephalographic (EEG) clusters within a sample of children with the inattentive type of attention-deficit/hyperactivity disorder (ADHD). Methods: Subjects consisted of 100 boys with ADHD and 40 age-matched controls. EEG was recorded from 21 sites during an eyes-closed resting condition and Fourier transformed to provide estimates for total power, and relative power in the delta, theta, alpha and beta bands. Factor analysis was used to group sites into 3 regions; frontal, central and posterior. These data were subjected to cluster analysis. Results: Two distinct EEG clusters of children with the inattentive type of ADHD were found. These were characterised by (a) increased high-amplitude theta with deficiencies of delta and beta activities, and (b) increased slow wave and deficiencies of fast wave activity. Conclusions: These two subtypes are independent of current diagnostic categories, and consist of a cortically hypoaroused group and a group typified by a maturational lag in central nervous system (CNS) development. These results support a re-conceptualisation of ADHD based on the CNS abnormality underlying the disorder rather than the behavioural profile of the child. This has the potential to add a level of predictive validity, which is currently lacking in the present diagnostic systems.