BlueCross BlueShield of Tennessee Medical Policy Manual

Quantitative Electroencephalography as a Diagnostic Aid for Attention-Deficit/Hyperactivity Disorder (ADHD)

DESCRIPTION

Commercially available systems (e.g., the Neuropsychiatric EEG-based ADHD Assessment Aid [NEBA®]) are available that can measure the resting theta/beta ratio of an EEG.  This assessment or quantitative electroencephalography (QEEG) has been proposed as an aid in the diagnosis of individuals who are suspected of having ADHD. EEG patterns are typically categorized into four frequency ranges: delta, theta, alpha, and beta. There has been a substantial amount of research over the last several decades on whether electroencephalography (EEG) derived brain wave patterns in individuals with ADHD differ from those without ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a common disorder in children, adolescents, and adults defined by pervasive symptoms of inattention and/or hyperactivity-impulsivity, which lead to impairment in at least two domains of the work, school, or home environments.  Presently, ADHD is diagnosed clinically by assessing behavioral symptoms and impairment via interviews and standard questionnaires.  Diagnosis can be challenging as the core symptoms are non-specific.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

Published peer-reviewed studies that evaluate the accuracy of commercially available devices (e.g., NEBA®) in the diagnosis of ADHD are scant. The effect/impact of this technology on patient outcomes is not known.

SOURCES

American Academy of Neurology. (2016, November). Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis. Retrieved April 23, 2018 from https://www.aan.com.

BlueCross BlueShield Association. Evidence Positioning System. (10:2018). Quantitative electroencephalography as a diagnostic aid for attention-deficit/hyperactivity disorder (3.01.03). Retrieved March 19, 2019 from http://www.evidencepositioningsystem.com. (14 articles and/or guidelines reviewed)

Kim, J. W., Lee, J., Kim, H. J., Lee Y. S., & Min, K. J. (2015). Relationship between theta-phase gamma-amplitude coupling and attention-deficit/hyperactivity behavior in children. Neuroscience Letters, 590, 12-17. Abstract retrieved July 24, 2015 from PubMed database.

Kim, J., Lee, Y., Han, D., Min, K., Kim, D., & Lee, C. (2015). The utility of quantitative electroencephalography and integrated visual and auditory continuous performance test as auxiliary tools for the Attention Deficit Hyperactivity Disorder diagnosis. Clinical Neurophysiology, 126 (3), 532-40. Abstract retrieved April 20, 2017 from PubMed database.

Snyder, S. M., Rugino, T. A., Hornig, M., & Stein, M. A. (2015). Integration of an EEG biomarker with a clinician’s ADHD evaluation. Brain and Behavior, 5 (4). (Level 3 evidence)

Technology Evaluation Center. (2014, October). Quantitative electroencephalography as a diagnostic aid for attention-deficit/hyperactivity disorder in children. (Vol. 29, No. 1). Retrieved July 24, 2015 from http://www.bcbs.com.

U.S. Food and Drug Administration. (2013, July). Center for Devices and Radiological Health. De novo classification request for Neuropsychiatric EEG-Based Assessment Aid for ADHD (NEBA) System. Retrieved November 18, 2013 from http://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  4/10/2014

MOST RECENT REVIEW DATE:  4/11/2019

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