DSM-5 Adult Attention-Deficit/Hyperactivity Disorder: Sex Differences in EEG Activity.

This study examined sex differences in the EEG of adults diagnosed with Attention-Deficit/Hyperactivity Disorder (AD/HD) according to DSM-5 criteria. Sixteen females and 16 males with AD/HD, and age- and sex-matched control groups, had an eyes-closed resting EEG recorded from 19 electrode sites. EEGs were Fast Fourier transformed and estimates for total power, absolute and relative power in the delta, theta, alpha, beta and gamma bands, and the theta/beta ratio, were analysed across nine cortical regions. Males with AD/HD, compared with male controls, had globally reduced absolute beta, globally elevated relative theta, and a larger theta/beta ratio. In contrast, no global effects emerged between females with and without AD/HD. Significant group interactions indicated that globally elevated relative theta and elevated frontal-midline theta/beta ratio noted in males with AD/HD differed significantly from results in females. There are statistically significant EEG differences in relative theta and the theta/beta ratio between males and females with and without AD/HD. These results indicate that AD/HD affects the EEG activity of males and females differently. This study helps confirm the need for further independent examination of AD/HD within female populations.

Primary Care and Hepatology Provider-Perceived Barriers to and Facilitators of Hepatitis C Treatment Candidacy and Adherence.

BACKGROUND: Provider perceptions regarding barriers to and facilitators of hepatitis C (HCV) treatment initiation and adherence have not been fully evaluated in the interferon-free treatment era. New treatments have provided opportunities for non-specialists to treat HCV, underscoring the importance of understanding primary care provider (PCP) and specialist perspectives. METHODS: Based on qualitative sampling principles, 12 PCPs and 12 hepatology providers (HPs) from the VA Pittsburgh Healthcare System completed audio-recorded semi-structured interviews. Qualitative analysts coded perceived barriers and facilitators from the interviews with 100% double coding. Codes were thematized and analyzed using Atlas.ti. RESULTS: Key barriers to treatment described by HPs and PCPs included patients' substance use disorders, mental health, transportation availability, history of non-adherence, and concern about side effects. PCPs also focused on medication cost as a system-based barrier. The main facilitators of treatment initiation and adherence described by both HPs and PCPs were provider education and encouragement. HPs focused almost exclusively on provider-based facilitators, while PCPs noted patient-based facilitators including past adherence, media exposure to information about HCV medications, a desire to clear the virus, and positive feedback regarding treatment response. CONCLUSIONS: Providers generally focused on perceived patient-level barriers to HCV treatment initiation and adherence, as well as provider-level facilitators; PCPs additionally noted patient preferences and system-level issues that guide decision making regarding treatment initiation. While HPs focused almost exclusively on provider-level facilitators, PCPs additionally focused on patient-level facilitators of treatment. These data provide novel insights and suggest focusing on patient, provider, and system-level strategies to further improve HCV treatment initiation and adherence.

Social Fitness and the Social Domain: A Holistic Approach Based on Total Force Fitness.

The Total Force Fitness (TFF) framework was envisioned as a holistic framework of interrelated domains, whereby impact in one domain could have cascading implications for the others. For this reason, definitional clarity surrounding how to achieve fitness in the various domains is crucial. Social fitness definitions tend to focus on individual efforts and overlook the powerful impact of the social group and the social environment on the individual. In this article, various definitions of social fitness are analyzed in an effort to broaden the current understanding of the social domain. Some of the knowledge gaps in understanding social fitness and the resulting challenges are addressed before reviewing a few existing social fitness interventions. Finally, this study offers recommendations for improvement, along with future directions for the increased integration of the social domain into the TFF framework.

Critical Competencies of Military Embedded Health and Performance Professionals: The "Culture General" Approach.

Human performance teams (HPT) delivering a wide range of services within military unit communities serve as a model for advancing business practices in support of the 2018 National Defense Strategy. Relatively new, the demand for these embedded professionals continues to grow in response to its favorable proximity, community-based design, operationalized delivery system, and adaptive business practices. However, many civilian professionals come from diverse disciplines of specialties and experiences. As they integrate into unit communities, it becomes known that many do not possess formal training or experience working with the US military or its Servicemembers, delivering community-based services, operating in the capacity of a force multiplier, or culturally adapting their professional skills. Given the steep learning curve in transitioning from a conventional delivery model to the military embedded model, even newly minted military health and performance professionals may be underprepared when they arrive at their assigned military unit communities. In this article, we examine the military's embedded health and performance service delivery model. We add specific focus on those critical "embedded" professional competencies and skills foundational to establishing and sustaining thriving service delivery. We then offer strategies and tools collected from embedded health and performance professionals currently serving in military unit communities across the Department of Defense (DoD). Finally, we provide a rationale for the need for embedded competency training to improve the preparedness of professionals who are currently serving, will be serving, or have a general interest in serving as an embedded professional within DoD military unit communities.

Children with attention-deficit/hyperactivity disorder and autistic features: EEG evidence for comorbid disorders.

Attention-deficit/hyperactivity disorder (AD/HD) is the most common psychiatric disorder of childhood, although AD/HD is rarely the only diagnosis given to these children. Within the literature there is some debate as to whether it is valid to diagnose AD/HD with autism as a comorbid disorder, since the present diagnostic systems exclude the diagnosis of both disorders in the same child. The aim of this study was to determine whether electroencephalography (EEG) differences exist between two groups of children diagnosed with AD/HD, one scoring high (AD/HD+) and one scoring low (AD/HD-) on a measure of autism. The EEG was recorded during an eyes-closed resting condition from 19 electrodes, and Fourier transformed to provide absolute and relative power estimates in delta, theta, alpha and beta bands. Compared to age- and sex-matched controls, the AD/HD- group had increased absolute power in all frequency bands, somewhat higher relative theta activity and decreased relative delta. In comparison to the AD/HD- group, patients with autistic features (AD/HD+) had a number of qualitative differences in the beta and theta bands. These results indicate the presence of two comorbid conditions in the AD/HD+ group, which suggests that AD/HD and autism can occur in the same individual.

EEG coherence in children with attention-deficit/hyperactivity disorder: differences between good and poor responders to methylphenidate.

This retrospective study investigated differences in regional derivations of EEG coherence between good and poor responders to methylphenidate (MPH) in children (aged 8-12 years) with the combined type of attention-deficit/hyperactivity disorder (AD/HD). Participants included groups of good and poor male MPH responders and an aged-matched group of male controls. An eyes-closed, resting electroencephalogram (EEG) was recorded from 21 electrode sites. Coherence was calculated from eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta frequency bands. Compared with controls, the AD/HD participants had enhanced laterality over short-medium inter-electrode distances, and elevated frontal interhemispheric coherences, in the theta band. Good MPH responders had higher intrahemispheric coherences than poor MPH responders over short-medium and long inter-electrode distances in the beta band. Enhanced laterality at short-medium inter-electrode distances suggests that the AD/HD children may have a developmental lag in short-axonal connections in the left hemisphere. Elevated frontal interhemispheric theta coherence consistently indicates some frontal dysfunction in AD/HD. The beta coherence differences found between good and poor MPH responders could indicate that good MPH responders have some type of structural dysfunction associated with cortical connections involved in attention/arousal.

The Theta/Beta Ratio as an Index of Cognitive Processing in Adults With the Combined Type of Attention Deficit Hyperactivity Disorder.

An elevated theta/beta ratio in the EEG has long been observed among individuals with Attention Deficit Hyperactivity Disorder (ADHD). The theta/beta ratio was previously hypothesised to be an index of arousal, but a number of studies failed to find any association between the ratio and indices of arousal, instead proposing that the theta/beta ratio may actually be indicative of cognitive processing. This hypothesis was tested by Clarke et al using a sample of healthy adults, with results indicating that the theta/beta ratio correlated with a marker of cognitive processing (P300 latency in an auditory oddball task), while P300 amplitude correlated with an arousal marker (alpha power). The aim of this study was to test whether similar results could be found in a sample of 41 adults with the combined type of ADHD. EEGs were recorded during an eyes-closed resting condition and an auditory oddball task. Results demonstrated that the theta/beta ratio correlated significantly with P300 latency. Absolute alpha power did not correlate significantly with P300 amplitude or P300 latency. These results support the hypotheses that the theta/beta ratio is a marker of cognitive processing capacity in both the general population and in participants with ADHD, and that the alpha/arousal linkage is anomalous in ADHD.

EEG development in Attention Deficit Hyperactivity Disorder: From child to adult.

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders found in children. While an extensive literature has documented the EEG in this clinical population, few studies have investigated EEG throughout the lifespan in ADHD. This study aimed to investigate EEG maturational changes, in subjects with ADHD combined type, that spanned from childhood into adulthood. METHOD: Twenty five male adults with ADHD were assessed between the ages of 8-12 years and again as adults. At both ages, an EEG was recorded during an eyes-closed resting period, and power estimates were calculated for relative delta, theta, alpha and beta. RESULTS: At the childhood assessment, the ADHD subjects had elevated posterior delta. Relative theta was elevated, with diminished alpha activity across all sites. Significant maturational changes were observed, with reductions in the delta and theta bands, and increases in the alpha and beta bands across all electrodes. In adulthood, relative to controls, diminished frontal delta and elevated global theta activity were apparent. CONCLUSIONS: Substantial developmental changes occurred in the EEG of these subjects. These results identify important issues when using EEG as part of the diagnosis for ADHD. SIGNIFICANCE: This study is the first to explore EEG changes from childhood to adulthood over an 11 year period in the same subjects with ADHD.

Effects of imipramine hydrochloride on the EEG of children with Attention-Deficit/Hyperactivity Disorder who are non-responsive to stimulants.

Although stimulant medications are the most commonly-used treatments for Attention-Deficit/Hyperactivity Disorder (AD/HD), as many as 20% of treated children do not respond clinically to stimulants. One non-stimulant medication that has been widely used when the stimulants fail is a tricyclic antidepressant, imipramine hydrochloride. This study investigated the effects of imipramine on the EEG of children with AD/HD who were poor responders to dexamphetamine and ritalin, but who showed clinical improvement on a six month trial of imipramine. An initial pre-medication EEG was recorded during an eyes-closed resting condition, with data Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. A second EEG was recorded at the end of the imipramine trial. Compared to controls, the unmedicated AD/HD children had significant global increases in absolute and relative theta, with decreased global absolute and relative alpha, increased posterior relative delta, and decreased posterior absolute beta. No change in the EEG was found as a result of administering the medication. These results suggest that good responders to imipramine have an underlying EEG abnormality different from that in children who respond to the stimulants, and that an initial pre-treatment EEG may be useful in selecting a trial medication. However, as no change in the EEG was found with imipramine, it is unlikely that the EEG will be useful in evaluating responsivity to this medication.

EEG coherence in girls with attention-deficit/hyperactivity disorder: stimulant effects in good responders.

This study investigated the effects of stimulants on EEG coherence in girls with Attention-Deficit/Hyperactivity Disorder (AD/HD). Twenty girls with AD/HD (aged 7-12) and 20 age- and sex-matched controls had an eyes-closed resting electroencephalogram (EEG) recorded from 21 electrode sites. Coherence was calculated from eight intrahemispheric electrode pairs (four in each hemisphere), and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta frequency bands. AD/HD participants were tested twice: first, prior to medication being prescribed, and second, six months later on a therapeutic dose of a stimulant. With intrahemispheric coherences at short-medium inter-electrode distances, AD/HD girls off-medication had reduced lateralisation in the delta, theta and alpha bands. They also had reduced lateralisation in the theta band for longer inter-electrode distances, and increased frontal interhemispheric coherences in all frequency bands. Medication had no impact on the laterality anomalies, but produced novel increases in intrahemispheric coherences at short-medium inter-electrode distances, which reached significance in the delta band and approached significance in the alpha band. However, these increased coherences remained indistinguishable from control levels. Reduced hemispheric lateralisations found in these AD/HD participants illustrate cortical abnormalities consistent with maturational lag explanations. The widespread elevated frontal interhemispheric coherences found in these AD/HD girls could reflect the narrow profile of female medication responders identified in clinical settings. The lack of substantial coherence medication effects in good clinical responders supports a previous medication study with AD/HD boys, and suggests that these coherence anomalies reflect structural, rather than solely functional, differences in brain development in AD/HD.

EEG in adults with attention-deficit/hyperactivity disorder.

Attention-Deficit/Hyperactivity Disorder (AD/HD) is the most common psychiatric disorder of childhood, but it is becoming increasingly apparent that more than half the childhood sufferers will continue to manifest symptoms of the disorder as adults. While the EEG of children with AD/HD has been extensively examined, comparatively little research has been conducted into the EEG of adults with the disorder. This study thus investigated the EEG of 20 adult males with AD/HD, and an age- and gender-matched control group, during an eyes-closed resting condition. The EEG was Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The AD/HD group had significantly less absolute delta and more relative theta, across the entire scalp, than the control group. In absolute beta, the AD/HD group had less power at the midline, and an enhancement in power in the right posterior region. These results are similar to those found in children with AD/HD, and may suggest the presence of a processing deficit. A right posterior elevation in beta activity was also found, which could be related to the ongoing presence of reading disabilities in these subjects.

EEG coherence in adults with attention-deficit/hyperactivity disorder.

Attention-Deficit/Hyperactivity Disorder (AD/HD) is the most common psychiatric disorder of childhood, but it is becoming increasingly more apparent that more than half the childhood sufferers will continue to manifest symptoms of the disorder as adults. While EEG coherence in children with AD/HD has been examined extensively, no studies have investigated coherence in adults with the disorder. This study investigated EEG coherence in adults with AD/HD. EEG was recorded from 18 adult males with AD/HD, and an age- and gender-matched control group, during an eyes-closed resting condition. Waveshape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. A laterality effect was found for intrahemispheric coherence at long inter-electrode distances, with the AD/HD group showing reduced hemispheric differences in the delta band compared to the control group. In the alpha band, at short-medium inter-electrode distances, the AD/HD group also had lower coherences than the control group. The results suggest that theta coherence differences reported in children with AD/HD may be associated with hyperactivity, which is reduced in adults with AD/HD, while reduced alpha coherence could be associated with inattention, which remains in adult with AD/HD. Reduced delta coherence also appears to be an aspect of the disorder which may develop from later childhood into adolescence and adulthood.

Effects of stimulant medications on the EEG of girls with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Stimulant medications are the most commonly used treatments for Attention-Deficit/Hyperactivity Disorder (AD/HD) in North America and Australia, although it is still not entirely known how these medications work. This study investigated the effects of stimulant medications on the EEG of girls with AD/HD. METHODS: An initial EEG was recorded during an eyes-closed resting condition. Data from 19 electrode sites were Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The data were then averaged into 9 regions and an analysis of both global and regional differences was performed. Subjects were placed on a six-month trial of a stimulant and a second EEG was recorded at the end of the trial. RESULTS: The unmedicated girls had significantly greater total power, absolute delta and theta, more relative theta especially in the frontal regions, and reduced frontal relative delta and beta activity compared with controls. Medication resulted in normalisation of theta power, but after medication, increased relative beta was also apparent in the AD/HD group. CONCLUSIONS: These results indicate that stimulant medications result in a normalisation of slow wave activity in the EEG. In line with published research on the effects of arousal on the EEG, these results suggest that stimulant medications may have their therapeutic effect by improving the EEG substrate of processing deficits in these children. However, this requires further testing during active processing tasks. SIGNIFICANCE: This is the first study to investigate the effect of stimulant medications on the EEG of girls with AD/HD.

EEG coherence in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder.

OBJECTIVES: This study is the first to investigate EEG coherence differences between two groups of children with attention-deficit/hyperactivity disorder combined type (AD/HD), with or without comorbid oppositional defiant disorder (ODD), and normal control subjects. METHODS: Each group consisted of 20 males. All subjects were between the ages of 8 and 12 years, and groups were matched on age. EEG was recorded during an eyes-closed resting condition from 21 monopolar derivations. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha, and beta bands. RESULTS: Children with comorbid AD/HD and ODD had intrahemispheric coherences at shorter inter-electrode distances significantly reduced from those apparent in children with AD/HD without comorbid ODD. Such reduced coherences in the comorbid group appeared to wash out coherence elevations previously noted in AD/HD studies. CONCLUSIONS: The present results suggest that, rather than suffering an additional deficit, children with AD/HD and comorbid ODD show significantly less CNS impairment than AD/HD patients without comorbid ODD. SIGNIFICANCE: These results have treatment implications, suggesting that behavioural training, perhaps using family-based cognitive behavioural therapy, could be useful for those children with AD/HD and comorbid ODD. This should focus on the ODD symptoms, in association with a medication regime focussed on the AD/HD symptoms.

EEG abnormalities in adolescent males with AD/HD.

OBJECTIVE: This study investigated EEG abnormalities in adolescents with attention-deficit/hyperactivity disorder (AD/HD). METHODS: Fifteen AD/HD subjects and 15 control subjects participated in this study. All subjects were between 14 and 17 years of age. The EEG was recorded from 19 electrode sites and was analysed to provide estimates of both absolute and relative power in the delta, theta, alpha and beta bands. Theta/alpha and theta/beta ratio coefficients were also calculated. RESULTS: Across the scalp, AD/HD subjects were characterised by greater absolute delta and theta activity, and an increased theta/beta ratio compared to controls. No group differences were found for either absolute or relative alpha, or absolute beta. However, AD/HD subjects demonstrated a reduction in relative beta activity in the posterior regions. CONCLUSIONS: The AD/HD group showed significant deviations from normal CNS development, in particular in posterior regions. This supports previous suggestions that individuals with an EEG profile that is not indicative of a maturational lag are more likely to have AD/HD during adolescence. SIGNIFICANCE: This is the first study to investigate EEG abnormalities in adolescents with AD/HD during an eyes-closed resting condition.

Coherence in children with Attention-Deficit/Hyperactivity Disorder and excess beta activity in their EEG.

OBJECTIVE: This study investigated differences in coherence measures between two groups of children with Attention-Deficit/Hyperactivity Disorder (ADHD) - with the typical EEG profile (increased theta and decreased beta activity), and with excess beta activity - and a normal control group. METHODS: Thirty-four children with ADHD were included in each of the typical and excess beta groups, and were age and sex matched with 34 control subjects. EEG was recorded from 21 sites during an eyes-closed resting condition. Wave-shape coherence was calculated for eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta bands. RESULTS: In comparison to the controls, the typical ADHD group primarily had increased intrahemispheric theta and beta coherence at short-medium inter-electrode distances, and increased interhemispheric coherence for theta in the frontal and central/parietal/occipital regions. Their laterality effect for interhemispheric short-medium inter-electrode distances was reduced in the theta band. Differences between the excess beta group and the control group were primarily found in laterality of the intrahemispheric theta coherence at short-medium electrode distances, and increased interhemispheric theta coherence in the frontal regions. Reduced delta coherence in the temporal regions was also found. CONCLUSIONS: These results suggest that ADHD children with excess beta power have an underlying brain dysfunction in the frontal lobes which is found in common with children with the typical EEG profile. However a number of qualitative differences exist which could be associated with other aspects of the ADHD diagnosis or another comorbid condition. SIGNIFICANCE: This is the first study to investigate EEG coherence in ADHD children who have increased beta power.

An Investigation of Stimulant Effects on the EEG of Children With Attention-Deficit/Hyperactivity Disorder.

Stimulant medications are the most commonly prescribed treatment for Attention-Deficit/Hyperactivity Disorder (AD/HD). These medications result in a normalization of the EEG. However, past research has found that complete normalization of the EEG is not always achieved. One reason for this may be that studies have used different medications interchangeably, or groups of subjects on different stimulants. This study investigated whether methylphenidate and dexamphetamine produce different levels of normalization of the EEG in children with AD/HD. Three groups of 20 boys participated in this study. There were 2 groups with a diagnosis of AD/HD; one group, good responders to methylphenidate, and the second, good responders to dexamphetamine. The third group was a normal control group. Baseline EEGs were recorded using an eyes-closed resting condition, and analyzed for total power and relative delta, theta, alpha, and beta. Subjects were placed on a 6-month trial of methylphenidate or dexamphetamine, after which a second EEG was recorded. At baseline, the children with AD/HD had elevated relative theta, less relative alpha and beta compared with controls. Baseline differences were found between the two medication groups, with the dexamphetamine group having greater EEG abnormalities than the methylphenidate group. The results indicate that good responders to methylphenidate and dexamphetamine have different EEG profiles when assessed before medication, and these differences may represent different underlying central nervous system deficits. The 2 medications were found to result in substantial normalization of the EEG, with no significant differences in EEG changes occurring between the 2 medications. This indicates that the degree of pretreatment EEG abnormality was the major factor contributing to the degree of normalization of the EEG. As good responders to the 2 medications appear to have different central nervous system abnormalities, it is recommended that stimulant medications be treated independently and not used interchangeably in research and treatment of AD/HD.

Age and gender effects in EEG coherence: III. Girls with attention-deficit/hyperactivity disorder.

OBJECTIVE: This study investigated intrahemispheric and interhemispheric EEG coherences as a function of age in girls with different DSM-IV subtypes of Attention-Deficit/Hyperactivity Disorder (AD/HD). It completes a series of 3 studies aimed at clarifying developmental and gender impacts on the coupling between brain regions in this disorder. METHODS: Three groups of 40 children (AD/HD combined type, AD/HD inattentive type, and normal controls) participated. Each group contained 8 females in each of 5, 1-year age bands from 8 to 12 years. EEG was recorded from 21 sites during an eyes-closed resting condition. Wave-shape coherence was calculated for 8 intrahemispheric electrode pairs (4 in each hemisphere), and 8 interhemispheric electrode pairs, within each of the delta, theta, alpha and beta bands. RESULTS: Developmental effects in intrahemispheric coherences at shorter and longer inter-electrode distances were not as predicted by Thatcher's two-compartment model, contrary to previous findings in boys. Females with AD/HD showed evidence of developmental delay and widespread anomalous elevations in coherence. Girls with AD/HD of the combined type showed similar but greater anomalies than girls with AD/HD of the inattentive type. CONCLUSIONS: Girls with AD/HD show coherence anomalies relative to age- and gender-matched controls, which differ substantially from those shown by boys with AD/HD. These coherence anomalies did not differ in nature between girls with different DSM-IV subtypes of AD/HD, suggesting that subtype differences in girls reflect only symptom severity. SIGNIFICANCE: The data reported here indicate qualitative differences in EEG coherences in girls with AD/HD compared with controls, and quantitative differences between girls with different subtypes of AD/HD. Both sets of effects differ in nature from those previously found in boys with AD/HD, showing the need to carefully consider gender in future studies of AD/HD.

Quantitative EEG in low-IQ children with attention-deficit/hyperactivity disorder.

OBJECTIVE: This study investigated EEG differences between children with attention-deficit/hyperactivity disorder (AD/HD) and matched control subjects, with either normal or low IQs. METHODS: Twenty normal-IQ and 20 low-IQ children with AD/HD, and 40 age-, IQ- and sex-matched control subjects participated in this study. EEG was recorded from 21 sites during an eyes-closed resting condition and Fourier transformed to provide estimates for total power, and absolute and relative power in the delta, theta, alpha and beta bands. RESULTS: Children with AD/HD had increased theta activity with decreased levels of alpha and beta activity compared to control subjects. IQ was not found to impact on the EEG. No significant differences were found between subjects with normal and low IQs, with the low- and high-IQ AD/HD groups having similar EEG profiles. CONCLUSIONS: Low-IQ children with AD/HD have similar EEG abnormalities to those with normal IQs, and IQ does not appear to impact on EEG power measures. SIGNIFICANCE: This is the first study to investigate EEG differences in low-IQ children with and without AD/HD.

Coherence in children with AD/HD and excess alpha power in their EEG.

OBJECTIVE: This study investigated differences in EEG coherence measures between two groups of children with Attention-Deficit/Hyperactivity Disorder (AD/HD) - one with the more common EEG profile (increased theta), and a group with excess alpha activity as the dominant EEG abnormality. METHODS: 26 children (aged 9-13years) with AD/HD were included in each of the excess-theta and excess-alpha groups, and were age- and sex-matched with 26 control subjects. EEG was recorded from 19 electrode sites during an eyes-closed resting condition. Wave-shape coherence was calculated for eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta bands. RESULTS: In comparison with the controls, the excess-theta AD/HD group had increased theta intrahemispheric coherences at short-medium inter-electrode distances. Frontally, the excess-theta AD/HD group had increased interhemispheric theta and reduced beta coherences. The excess-alpha group primarily showed increased slow wave (delta and theta) intrahemispheric coherence at short-medium inter-electrode distances, and reduced alpha coherence at longer inter-electrode distances, compared with controls. An increase in frontal interhemispheric theta coherence was also found. CONCLUSIONS: These results suggest that AD/HD children with excess alpha power have an underlying connectivity dysfunction in the frontal lobes, which is found in common with other subjects with the excess-theta EEG profile. However, a number of qualitative differences exist that could be associated with other aspects of the AD/HD diagnosis. The excess-alpha group appeared to have fewer frontal-lobe abnormalities than the excess-theta AD/HD group. SIGNIFICANCE: This is the first study to investigate coherence in AD/HD children who have the atypical profile of increased alpha power in their EEG.