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Abstract
The quantification of differences in alpha electroencephalograph (EEG) activity between the eyes-closed and eyes-open resting
conditions could be used as a measure of resting state arousal. The objective of this study was to evaluate the contribution of EEG
alpha reactivity on opening the eyes, to the neurophysiology of children with attention-deficit hyperactivity disorder (ADHD).
Thirty-eight children with ADHD were assessed using quantitative EEG (qEEG) analysis of absolute band power at rest, with eyes
open and closed. Alpha reactivity index was calculated on opening the eyes, defined from the relationship between the absolute
powers in the respective bands in the periods with the eyes open and closed. EEG data of 38 sex- and age-matched controls, with no
neurological or psychiatric problems, were collected for comparison. There was a significant reduction in absolute alpha power at all
electrodes for both ADHD and control groups with eyes open, indicating an increase in the arousal level. However, the alpha
reactivity index was greater, corresponding to less reactivity, in the frontal regions of the children with ADHD (P < .01). Such a
finding suggests alterations in arousal mechanisms in ADHD. This research suggests that alpha reactivity on opening the eyes, allied
with other variables from the qEEG, may improve diagnostic accuracy in ADHD.
Keywords
attention-deficit hyperactivity disorder, EEG, children, arousal
Received June 6, 2011; accepted September 8, 2011.
Introduction
A diagnosis of ADHD is based on the Diagnostic and
Statistical Manual of Mental Disorders (Fourth Edition
Text Revision {DSM-IV-TR}) criteria,1 of which the basic
characteristic is the persistence of a standard of lack of
attention and/or hyperactivity impulsivity, more frequent,
and serious than that typically observed in individuals at
an equivalent developmental level. Currently, there is no
laboratory examination that can serve as a marker for
ADHD. Thus, the assessment procedure should consist of a
review of the medical, developmental and family histories,
as well as an examination of intellectual function and
academic performance.
There is wide agreement that ADHD occurs as the result of a
dysfunction in the central nervous system, but the mechanisms
are still not well known. Zentall and Zentall2 raised the hypothesis that ADHD symptoms, such as restlessness and hyperactivity, could be associated with chronic underarousal.
However, a number of researchers have suggested different
mechanisms by which there would be a compromise of arousal,
alertness and activation in ADHD.3-5
1
School of Medicine, Pontifcia Universidade Catolica de Campinas (PUCCampinas), Campinas, Sao Paulo, Brazil
2
Scholarship holder, School of Psychology (PUC-Campinas); FAPESP, The
State of Sao Paulo Research Foundation
3
Scholarship holder, School of Psychology (PUC-Campinas); FAPIC/Reitoria
(PUC-Campinas)
Corresponding Author:
Lineu C. Fonseca, Rua Sebastiao de Souza 205, cj 122, CEP 13.013.173,
Campinas, Sao Paulo, Brazil.
Email: lineu.fonseca@uol.com.br
54
EEG
EEG was recorded with a resolution of 12 bits, 0.5 and 35 Hz
filters, and 200 samples/second, using the BrainNet BNT 36
equipment (EMSA Equipamentos Medicos), with impedance
maintained below 10 kO. The examination was carried out with
the patients lying on their backs in a silent environment with
low-intensity lighting. The electrodes were placed according
to the International 10-20 System, with the use of an additional
2 electrodes placed 1 cm below (left side) and above (right
side) the external angle of the eyelid, with the objective of evaluating eye movements. The data referring to the electrodes
Fp1, Fp2, F8, and F7 were not computed due to frequent contamination by artifacts related to eye movements. The
The Statistical Packages for Social Sciences (SPSS 10.0.1) statistical program was used, applying both parametric and nonparametric tests, according to the data distribution. In order
to minimize the possibility of errors due to multiple comparisons, means of measurements involving various electrodes
positions were used instead of individual electrode position
measurements, and the level of significance was P .01.
Ethical aspects
The Ethics Commission for Research with Human Beings of
PUC-Campinas, Brazil, approved the project, and the participants signed an informed consent.
Results
Table 1 shows the data for age, sex, maternal scholastic level,
and school grade of the 38 children with ADHD and of the control group (CG). Table 2 shows the mean obtained for the logarithms of the absolute alpha powers, with eyes closed and open,
by location of electrodes and by groups. There was no statistically significant difference between the ADHD and CG for
absolute alpha power, whether eyes were closed or open (T test,
P > .05, values for P not presented in table).
A decrease in the absolute alpha power occurred with the
eyes open for all the regions studied, with a significance level
below .001. Table 3 shows the alpha reactivity indices obtained
at the various locations of the electrodes for ADHD and CG. The
alpha indices were greater (less reactivity) for ADHD, but statistically significant only in the frontal regions (T test, P < .01).
Fonseca et al
55
Table 1. Data for Age, Gender, School Grade, and Maternal Scholastic Level for the ADHD and Control Groups.a
Participants
Age (years)
Gender (male/female)
School grade (years)
Maternal scholastic level (years)
ADHD
CG
P Value
38
8.97 (1.15)
(28/10)
3.05 (1.11)
2.74 (1.62)
38
8.97 (1.15)
(28/10)
2.87 (1.07)
2.63 (1.62)
1.00 b
1.0 c
.510 b
.772 b
Table 2. EEG Absolute Alpha Power With the Eyes Both Closed and Open for the ADHD and Control Groups.
ADHD
Average
(Log-Transformed)
Frontal
Occipital
Centrotemporal
CG
Eyes Closed
Eyes Open
Eyes Closed
Eyes Open
Eyes Closed
Eyes Opened
52.6 (6.9)
69.5 (9.8)
53.4 (7.5)
50.1 (5.9)
58.4 (8.9)
48.7 (6.9)
.000 a
.000 a
.000 a
52.2 (6.1)
71.7 (9.1)
53.1 (6.9)
47.9 (5.4)
58.0 (9.0)
47.8 (6.4)
.000 a
.000 a
.000 a
.783
.328
.854
.101
.841
.548
Table 3. Alpha Reactivity Indices on the qEEG for the ADHD and
Control Groups.
Alpha Indices
Electrodes
Frontal
Occipital
Centrotemporal
ADHD
CG
P Value
0.96 (0.05)
0.84 (0.08)
0.91 (0.05)
0.92 (0.04)
0.81 (0.07)
0.90 (0.05)
0.002 a
0.060
0.273
Discussion
No significant differences were found between ADHD and CG
in absolute alpha power, in agreement with the literature, since
increases in absolute power occur predominantly in delta and
theta bands7-11 and are expressed in a relevant way in the
theta/beta index.14,15
Opening of the eyes, from the eyes-closed resting state, is
classical practice in conventional EEG.20 It results in desynchronization of electrical brain activity, and the alpha rhythm
is reduced, giving rise to rapid rhythms. Alpha reactivity to
visual stimuli is well known; however, it is not exclusively
related to visual information, since it has connections with
memory and cognition in general.21 This is traditionally evaluated by visual analysis of the EEG, although with the advances
in computer technology, it may be the object of multiple quantitative analyses of qEEG.
Alpha reactivity can be quantified by indices such as the
alpha power index, obtained by dividing the values obtained
56
with the results of the present study. However, there are relevant differences between the findings of EEG at rest in children
with ADHD as compared to those of adults with ADHD, since in
the latter the data are scarce, disparate, and less consistent, 31-33
suggesting neurophysiologic modifications during the development of the individuals into adult life. Earlier research on ADHD
was directed essentially at evaluating brain activation, that is,
making recordings during different tasks. The researchers did
not search for a characterization of the state of arousal.15,32-37
The fact that in the present study the difference in alpha reactivity was only observed in a significant way in the frontal regions
is supported by various other evidences of dysfunction in the
frontal cortex. In the study of ADHD in children, alterations in
coherence6,38,39 and an increase in theta activity40 in the frontal
regions were found. Frontal alterations have been found in studies with positron emission tomography39 and single photon
emission computed tomography.41
In summary, elements suggesting alterations in the arousal
mechanisms that probably involve the frontal regions were
found in the present research. On the other hand, this research
opens opportunities for the use of alpha reactivity on opening
the eyes, obtained using different evaluation methods,42 and
allied to other variables of the qEEG, with the objective of providing an increment in diagnostic accuracy of ADHD.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship,
and/or publication of this article.
References
1. American Psychiatric AssociationAPA. Diagnostic and Statistical Manual of Mental Disorders IV. Washington, DC: American
Psychiatric Association, 1994.
2. Zentall SS, Zentall TR. Optimal stimulation: a model of disordered activity and performance in normal and deviant children.
Psychol Bull. 1983;94(3):446-471.
3. Sergeant JA. Modeling attention-deficit/hyperactivity disorder: a
critical appraisal of the cognitive-energetic model. Biol Psychiatry. 2005;57(11):1248-1255.
4. Halperin JM, Schulz KP. Revisiting the role of the prefrontal
cortex in the pathophysiology of attention-deficit/hyperactivity
disorder. Psychol Bull. 2006;132(4):560-581.
5. Sikstrom S, Soderlund G. Stimulus-dependent dopamine release
in attention-deficit/hyperactivity disorder. Psychol Rev. 2007;
114(4):1047-1075.
6. Barry RJ, Clarke AR, McCarthy R, Selikowitz M. EEG coherence
in attention-deficit/hyperactivity disorder: a comparative study of
two DSM-IV types. Clin Neurophysiol. 2002;113(4):579-585.
7. Jansen T, Graap K, Stephanseon S, Marshall W, Fitzsimmons G.
Differences in baseline EEG measures for ADD and normally
achieving preadolescent males. Biofeedback Self Regul. 1995;
20(1):65-82.
Fonseca et al
57
34. Crawford HJ, Barabasz M. Quantitative EEG magnitudes in children with and without attention deficit disorder during neurological screening and cognitive tasks. Child Study J. 1996;26(1):
71-86.
35. Kovatchev B, Cox D, Hill R, Reeve R, Robeva R, Loboschefski T.
A psychophysiological marker of attention deficit/hyperactivity
disorder (ADHD)Defining the EEG consistency index. Appl
Psychophysiol Biof. 2001;26(2):127-140.
36. Swartwood JN, Swartwood MO, Lubar JF, Timmermann DL.
EEG differences in ADHD-combined type during baseline and
cognitive tasks. Pediatr Neurol. 2003;28(3):199-204.
37. Bakhtadze S, Janelidze M. Quantitative EEG during baseline and
various cognitive tasks in children with attention deficit/hyperactivity disorder. Georgian Med News. 2010;186:50-56.
38. Murias M, Swanson JM, Srinivasan R. Functional connectivity of
frontal in healthy and ADHD children reflected in EEG coherence.Cerebral Cortex. 2007;17(8):1788-1799.
39. Mazaheri A, Coffey-Corina S, Mangun GR, Bekker EM, Berry
AS, Corbett BA. Functional disconnection of frontal cortex and
visual cortex in attention-deficit/hyperactivity disorder. Biol Psychiatry. 2010;67(7):617-623.
40. Clarke AR, Barry RJ, McCarthy R, Selikowitz M, Brown CR.
EEG evidence for a new conceptualisation of attention deficit
hyperactivity disorder. Clin Neurophysiol. 2002;113(7):
1036-1044.
41. Amen DG, Carmichael BD. High-resolution brain SPECT imaging in ADHD. Ann Clin Psychiatry. 1997;9(2):81-86.
42. Cuspineda ER, Machado C, Virues T, et al. Source analysis of
alpha rhythm reactivity using LORETA imaging with 64-Channel EEG individual MRI. Clin EEG Neurosci. 2009;40(3):
150156.