By Ron Bashian, MD, Guest Contributor
Everyone involved in any way with diagnosing ADHD understands the need for thorough clinical evaluation and careful psychological testing in making that diagnosis. But many also search for some biomarker, some measurable biologic activity that would be a reliable way to identify ADHD. Depending on what it measured, the uses for such a biomarker could be multiple and include things like confirming diagnosis, disproving bogus fabrications, assessing medication use or misuse, improving diagnostic accuracy, measuring improvement, and documenting objective need for services. Doubtlessly, other applications would soon arise.
Therefore, a real buzz arose when the FDA announced that it would allow marketing of “the first brain wave test to help assess children and teens for ADHD.” It is called the Neuropsychiatric EEG-Based Assessment Aid, or NEBA for short. It records the theta/beta wave ratio, which is known to be higher in children and adolescents with ADHD. The test itself is painless and takes 15-20 minutes to run.
Fantastic! Right? Well, maybe.
Here’s the problem. Yes, technologic assistance of many varieties has dramatically assisted learning, diagnostics, therapy, and every human interaction conceivable. And NEBA may prove to fall in this category as well. But we need to ask ourselves, what are the limits of technology, and where do we put the complex, non-linear, and richly intuitive human factors of evaluation?
The FDA has “allowed marketing” of NEBA, with the caveat that the data upon which this permission has been granted were submitted by the manufacturer.
Before embracing NEBA, we need to know more about the science. Can the results be duplicated? How objective can an EEG evaluation be? What is our justification for apply population data, without a shred of ecologic validity, to single individuals?
On a more philosophical level, could such a test eventually be legally allowed to contradict and countermand the prudent judgment and evaluation of a trained psychologist? I think not.
Most scientists are skeptical of NEBA. Some claim it could it be improved and better standardized, at which point I imagine they expect it to be broadly embraced. Others, for reasons mentioned above, are not so sure.
But either way, let us not forget this: human support—for any individual suffering from demonstrable real-life executive function deficits—is essential. No biomarker will ever eliminate that need or thwart the response of those of us whose vocation and avocation is to serve those affected by ADHD.
Ron Bashian, MD, is both a pediatrician, who has worked for years with young people with ADHD, and an active ADHD coach getting certified by traditional training and hours. You can contact him at firstname.lastname@example.org.