BlueCross BlueShield of Tennessee Medical Policy Manual

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

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. EEG patterns are typically categorized into four frequency ranges: delta, theta, alpha, and beta. 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.




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


American Academy of Neurology (2016, November) Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis. Neurology®. 2016; 87:2375-2379.

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2016). Quantitative electroencephalography as a diagnostic aid for attention-deficit/hyperactivity disorder (3.01.03). Retrieved April 20, 2017 from BlueWeb. (15 articles and/or guidelines reviewed)

Buyck, I. & Wiersema, J. R. (2015). Task-related electroencephalographic deviances in adults with attention deficit hyperactivity disorder. Neuropsychology, 20 (3), 433-444. Abstract retrieved July 6, 2016 from PubMed database.

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, 12-7. Abstract retrieved July 24, 2015 from PubMed database.

Kim, J., Lee, Y., Han, D., Min, K., Kim, D., and Lee, C. (2015, March) 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. 2015 Mar; 126(3):532-40. Abstract retrieved April 20, 2017 from PubMed database.

Ogrim, G., Kropotov, J., & Hestad, K. (2012). The quantitative EEG theta/beta ratio in attention deficit/hyperactivity disorder and normal controls: Sensitivity, specificity, and behavioral correlates. Psychiatry Research, 198 (3), 482-488. (Level 3 evidence)

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, 2015; 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

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




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