FDA Approval of EEG Aid for ADHD

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There has been a lot of discussion since the FDA announced approving a new medical device just approved to assist in the diagnosis of ADHD in children and adolescents. “The device, the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, is based on electroencephalogram technology, which records different kinds of electrical impulses given off by neurons in the brain and the number of times the impulses are given off each second. The NEBA System is a 15- to 20-minute noninvasive test that calculates the ratio of two standard brain-wave frequencies, known as theta and beta waves; the ratio has been shown to be higher in children and adolescents with ADHD than in those without it, according to FDA” (http://alert.psychiatricnews.org/2013/07/ fda-approves-device-to-help-diagnose.html). However, the use of this technology to assist in the diagnosis of ADHD is not new.

David Rabiner, Ph.D. (Senior Research Scientist, Duke University) published a report (Attention Research Update April 2001) titled “New Support for the Use of qEEG scanning in Diagnosing ADHD” (http://www.helpforadd.com/2001/april.htm). This report acknowledged utilizing the measure of the ratio of theta to beta waves in the prefrontal cortex as a marker for ADHD (ages 6-20). Therefore the technology is not new, and although the NEBA System is helping to bring scientific evidence into the realm of psychiatric diagnosis, there is more to it then has been discussed thus far.

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Technology Helps Explain Medication Failure

In almost every area of medicine, doctors can order tests to provide objective physical data to guide their medication selection. However, the practice of psychiatry is most often based on observation, self-report and psychological testing. It appears that we are better at measuring impairment than we are at identifying the source and prescribing an effective medication. Is there a way we can do better?

The director of the National Institute of Mental Health, Tomas Insel, suggests there are many medicines, but they are not working adequately. This is because the symptoms of mental illness are too illusive and are shared by many diagnoses. Insel (2012) says, “It’s much harder to fix something if you don’t know what is going wrong.” Medications are being prescribed to treat a set of symptoms suggestive of a specific disorder without any objective evidence of the cause. Additionally, the practice of polypharmacy has become way too common in children and adolescents.

Pharmaceutical industry advertising promotes adding a medication when the first medication fails to produce the desired results (i.e., adding Abilify to your antidepressant). The message is that when one medication fails, keep adding more in an effort to address the additional symptoms. Each additional medication increases the risk of side effects. It is not uncommon for children to come to us with several medications prescribed. Last month, for example, we saw a 9-year-old female with prescriptions for Olanzapine three times a day, Lithium Carbonate daily and Amphetamine Salts three times a day. Also, a 10-year-old male came to us on Focolin three times a day, Seroquel twice a day, Lexipro daily and Zyprexa daily. If there was a way to determine why a medication failed, would it not be prudent to investigate why? If current technology could help?

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