| Attention deficit hyperactive disorder(ADHD) is recognized as a common behavior disorder in children and adolescents.It is a syndrome caused by non-intelligence factors.ADHD has a negative impact on children,furthermore,it can adversely affect the family and society.ADHD children are always complicated by behavioral and (or) emotional problems. Studies have shown that the mental comorbidities are as follows,oppositional defiant disorder(ODD) (50%-60%),adjustment disorder (30%-60%),anxiety disorder (25%-40%),mood disorder (15%-75%) and antisocial behavior(eg:drug dependence and antisocial personality disorder).And it is always complicated by Tic disorder(TD)(30%-50%) and epilepsy.About 30%-40%ADHD children still have ADHD symptoms when they have grown up.In the recent years,people pay more and more attention to ADHD here and abroad. Studies on ADHD is increasing.With the improvement of our living standards,ADHD has gradually been of great importance to parents and teachers.According to Guideline of diagnosis,assessment and treatment on Children and adolescents with ADHD published by American academy of pediatrics(AAP) in 2001,ADHD ranges from preschoolers to adolescents, therefore the age of onset was changed to 4-18 years old in the new guideline. And the age was 6-12 years old before. The morbidity of ADHD is about 8% on the basis of the new guideline. Tong Lian conduct Meta-analysis about the epidemiology of ADHD in China and found the incidence was about 5.7%.The ratio between male and female is about 4-9:l.The reason is the clinical manifestation of girls with ADHD is attention deficit.As a result,it can’t capture the parents attention.On the other hand,boys are more hyperactive and always complicated by ODD and conduct disorder. So teachers and parents will pay more attention to boys.The clinical features of the disease are various. And it will change as in different age,environment and attitude of those around them.The core symptom of the disease is hyperactive,attention-deficit,emotional lability and impulsive.The key point is children with ADHD lack of self-control.It is divided into three types,they are ADHD combined type(ADHD-C),ADHD predominantly inattentive type(ADHD-I) and ADHD predominantly hyperactive-impulsive type(ADHD-H)。Different countries has different view on the aetiology and the clinical symptoms of the disease.There are three criterion, WHO International Classification of diseases 10th Edition(ICD-10),The Diagnostic and Statistical Manual 4th Edition (DSM-IV) published by American Psychiatric Association(APA),Chinese Classification of Mental Disorders 3rd Edition(CCMD-3)。 Three criterion were used in the research about the ADHD in our country and DSM-IV was mostly used.Since George still describe the disease in 1902,the pathogeny and etiology are the primary researches.Nowadays,people still can’t find the cause of diseaseA.DHD is considered to be a heterogeneous behavioral abnormalities.It is caused by Biology-psycho-social factors.It has been studied from molecular genetics, neurophysiology, neurological biochemistry, anatomy of the nervous system and many other aspects.But the exact aetiology hasn’t been found.Electroencephalogram(EEG) can record the sum of neuronal electrical activity from the extracranial or intracranial.It is an objective reflection of the brain function.It has close relationship with the age. The brain wave changes as a child grow up and we can observe this phenomenon with the help of EEG.This change reflect the development of the structural and function of the brain and directly make us known the functional status of the nerve cells.EEG is a an indicator of the development of the central nervous system(CNS).EEG mainly records alpha,beta and theta wave.Alpha rhythm is an important index in the analysis of EEG.It is closely related to the brain functional status.The most prominent feature of alpha rhythm is easily affected by external or endogenous stimuli.Beta activity is the main component of EEG. Drugs and emotional changes can affect it. Theta wave is associated with age. A lot of theta activities can be recorded in the EEG of Infants and children but little in adults. Only when drowsy,we can observed theta activities on the adult EEG.ADHD is recognized as an outcome of brain regulating function disorder.After studying the EEG and neural development,some propose two hypothesis about the ADHD development model.One is the maturation lag,the other is the hypoarouse of the CNS.This study is intend to investigate the differences in EEG between the children with attention deficit hyperactivity disorders and normal children.ObjectiveIn this study,we will analyze the quantitative EEG between ADHD children and normal children,and try to discover the EEG characteristic of the ADHD children. And we will test and verify the studies about ADHD here and abroad.Date and methods1 Clinical date1) Subject:There are 49 children with attention deficit hyperactive disorder diagnosed in Cangzhou People Hospital from January 2014 to March 2015.They all met the criteria of DSM-IV.Their age is range from 6 to 14 year old.Two of them was exclude for their EEG abnormality.47 children composed the subject group,37 are boys and 10 are girls.The average age is 7.99 ± 1.79 years old.23 boys and 7 girls composed the control group.The average age is 8.46+1.75 years old.2) The inclusion criteria for this study: ① Age from 4 to 18 years; ②Before treatment,, physical and metal condition was good when tested; ③No acute or chronic infection; ④ No neurological diseases, severe mental illness (such as Pervasive Developmental Disorders/childhood schizophrenia, etc.) and other major physical illness, no a history of trauma; ⑤No use of analeptic drug; ⑥With parental consent and approved by the the hospital ethics committee.3) The exclusion criteria for this study:①With learning disorder;②Epilepsy,metal disorder and other brain diseases.4) Diagnostic scale:To all of the children who met DSM-IV,his parents had to finish ADHD diagnostic scale and Corners parent symptom questionnaire(PSQ) if he was under 6 years old.For those who was more than 6 years old,he should finish integrated visual and auditory continuous performance test(IVA-CPT) by himself and his parent finished the Conners PSQ.2 Apparatus and method1) EEG Apparatus and methodEEG Apparatus:SOLAR 848 quantitative digital EEG made by Beijing Sun Electronic Technology Co., Ltd.Method:The 16 scalp record electrodes were applied according to the international 10-20 system referenced to the ears(FP1,FP2,F3,F4,F7,F8,C3,C4,T3,T4,T5, T6,P3,P4,O1,O2).All subject didn’t use special drugs.20 minutes duration were recorded in eye-closed status.All EEG studies were interpreted by EEG professional technician and EEG physician,and choose 30 second as initial data.The EEG data were fast Fourier transformed.And we recorded the relative and absolute al (7.8-9.0Hz),a2 (9.0-11.0Hz),a3 (11.0-12.8Hz),p (13.0-20.0Hz),θ C4.0-7.8Hz) and 8 (0.8-4.0Hz).The alpha power rate between the hemicerebrum was recorded as aL/aR.The ratio between the prefront and occiput of the alpha power was recorded as aFp/aO.The ratio of delta plus theta power between the hemicerebrum was recorded as δ+θL/R.The other ratio was recorded as θ/P and β/α.2) Head imagine instrument and MethodHead imaging instrument:Philips 64-slice spiral CT.MethodrRoutine head axial surface plain scan,thickness is 5mm,gap is 5mm,scan parameter is 120KvP, the current was less then 170mA.3 Statistic analysisThe data analysis was analyzed by SPSS 13.0.The comparison between two samples was used T test.P<0.05 was considered statistically significant.Results1. The subject group was 47 the Han nationality ADHD children aged from 6 to 14 years old,37 boys and 10 girls.The average age was 7.99+1.79 years old.23 boys and 7 girls composed the control group.The average age is 8.46+1.75 years old.We observe no difference between two groups on age(t=0.814,P=0.419) and sexuality(t=0.043,P=0.966).2. The head CT results of all the 47 ADHD cases were normal.3. All of the 47 cases met the scale diagnostic criteria of ADHD.4. We found relative alpha-1 in ADHD group significantly higher than control group in the prefrons,temporal and central(P< 0.01),significantly lower than control group in the right occipital(P< 0.05).Compare to control group,ADHD group had higher relative alpha-2 in right prefrons,frons, anterior and middle temporal region(P<0.01),and higher than control group in central region(P<0.05).We found ADHD group had lower relative alpha-2 than control group in the right occipital(P<0.05). Compare to the control group,ADHD group had higher relative alpha-3 than control group in prefrons,middle-temporal region and central region(P<0.05),lower than control group in the right occipital region(P<0.05).ADHD group had a higher relative beta in frons,central and middle-temporal region(P<0.01),lower relative beta in the occipital region(P<0.01).The case group had higher relative theta in prefrons,frons,central and middle-temporal region(P< 0.01).Compare to control group,the case group had higher relative delta in frons and central region(P<0.05).5. ADHD group had lower absolute alpha-1 in occipital region relative to control group,but the difference was not statistically significant(P>0.05)。 ADHD group had lower absolute alpha-2 in occipital region relative to control,it wasn’t statistically significant(P>0.05).ADHD group had lower absolute alpha-3 in occipital region and higher absolute alpha-3 in the other region relative to control group,but it didn’t have statistical significance(P>0.05)。 Compare to control group,we found higher absolute beta in the right prefrons,right anterior temporal,frons and central region(P<0.05).Though it was lower in occipital,it was not statistically significant(P >0.05).ADHD group had lower absolute theta in occipital region and higer absolute theta in other region,but it didn’t have statistical significance(P> 0.05).The case group had lower absolute delta in occipital region and higher absolute delta in other region,however,it wasn’t statistically significant.6. Compare to control,aFp/αO ratio increased(P< 0.01).aL/aR decreased in ADHD group in prefrons(P< 0.05).θ+δL/R ratio decreased in ADHD group but it wasn’t statistically significant.We observed no difference between ADHD group and control group about the δ+θ/a ratio(P> 0.05).Compare to control group,θ/α ratio of ADHD increased in prefrons region(P< 0.05).ADHD group’s β/α ratio increased all over the scalp(P< 0.05).We observed α1/α2 ratio in ADHD group decreased but it hadn’t statistical significance(P> 0.05).ADHD group’s a3/a2 ratio increased all over the scalp relative to control group(P< 0.05).Compare to control group,ADHD group’s δ+θ/a ratio increased in occipital region,however,it wasn’t statistically significant.Conclusion1. There is essential EEG difference between ADHD children and normal children.We didn’t exclude the impact of sexuality,age and different subtypes and still observe theta power increased in prefrons region in ADHD children.We infer that theta power increased in prefrons is characteristic change in ADHD children.2. We found alpha activities asymmetry in the prefrons.But it still needs to be proved on large sample.3. EEG still can’t be used to diagnosis ADHD independently.It can still be used as a secondary diagnosis. |
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