UUnniivveerrssiittyy ooff SSoouutthh CCaarroolliinnaa SScchhoollaarr CCoommmmoonnss Theses and Dissertations 2017 TThhee RReellaattiioonn bbeettwweeeenn QQuuaannttiittaattiivvee EEEEGG CCoohheerreennccee aanndd SSeellff-- RReeppoorrtt AADDHHDD BBeehhaavviioorr SSccaallee RReessppoonnsseess Tayllor Vetter University of South Carolina Follow this and additional works at: https://scholarcommons.sc.edu/etd Part of the School Psychology Commons RReeccoommmmeennddeedd CCiittaattiioonn Vetter, T.(2017). The Relation between Quantitative EEG Coherence and Self-Report ADHD Behavior Scale Responses. (Master's thesis). Retrieved from https://scholarcommons.sc.edu/etd/4360 This Open Access Thesis is brought to you by Scholar Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. THE RELATION BETWEEN QUANTITATIVE EEG COHERENCE AND SELF-REPORT ADHD BEHAVIOR SCALE RESPONSES by Tayllor Vetter Bachelor of Science Centre College, 2013 Submitted in Partial Fulfillment of the Requirements For the Degree of Master of Arts in School Psychology College of Arts and Sciences University of South Carolina 2017 Accepted by: Scott Decker, Director of Thesis Kate Flory, Reader Cheryl L. Addy, Vice Provost and Dean of the Graduate School © Copyright by Tayllor Vetter, 2017 All Rights Reserved. ii ABSTRACT Differences in brain wave activity during resting states between adults with and without Attention-Deficit/Hyperactivity Disorder (ADHD) have been detected with electroencephalography (EEG). However, the relation between these patterns of brain wave activity and a dimensional, self-report measure of ADHD symptoms in male and female college students has never been investigated. The present study aimed to determine whether coherence, a measure of brain wave activity, can predict self-report symptoms of inattentiveness and hyperactivity in male and female college students. The analyses consisted of 14 male and 28 female adults between 18 and 27 years of age. Regression analyses were utilized to determine whether EEG coherence values were related to ADHD Current Symptoms Scale (CSS) scores of inattentiveness and hyperactivity in males and females by including sex as a covariate in the models. The current study found that several coherence measures across all frequency bands could significantly predict symptoms of inattentiveness and hyperactivity in male and female college students, consistent with prior research. Findings from this study provide preliminary evidence for including EEG in diagnostic assessments of ADHD in college settings. iii TABLE OF CONTENTS ABSTRACT .......................................................................................................................... iii LIST OF ABBREVIATIONS .......................................................................................................v CHAPTER 1: INTRODUCTION ..................................................................................................1 CHAPTER 2: METHOD ..........................................................................................................24 CHAPTER 3: RESULTS ..........................................................................................................34 CHAPTER 4: DISCUSSION .....................................................................................................43 REFERENCES .......................................................................................................................51 iv LIST OF ABBREVIATIONS ADHD .................................................................. Attention Deficit Hyperactivity Disorder CSS ................................................................................................Current Symptoms Scale EEG ................................................................................................. Electroencephalography qEEG .......................................................................... Quantitative Electroencephalography v CHAPTER 1 INTRODUCTION ADHD is a common neurodevelopmental disorder among children and adults that is well understood from a behavioral perspective (Centers for Disease Control and Prevention, 2005; American Psychiatric Association, 2013). Specifically, when assessing for ADHD, clinicians and researchers typically rely on a multimethod, empirically supported assessment approach, including clinical interviews, observations of the individual in various settings, and the integration of ADHD behavior rating scales completed by several informants (Montano, 2004; Gomez, 2011; Taylor, Deb, & Unwin, 2011). However, further exploring the neurological underpinnings of ADHD symptoms in individuals of all ages through the use of neuroimaging techniques has the potential to contribute to ADHD assessment (Gunkelman, 2014; Steriade, Gloor, Llinás, Lopes da Silva, & Mesulam, 1990). Understanding the dimensional relation between brain wave activity and inattentive and hyperactive behaviors could lead to the development of a supplemental diagnostic and/or prognostic tool for ADHD assessment. Specifically, a diagnostic tool linking brainwave activity to ADHD behavior rating scale scores could be particularly useful in the college student population in which ADHD assessment heavily relies on self-report of current ADHD symptoms and patient recall of ADHD symptoms from earlier in life rather than the best practice, multimethod ADHD assessment due to a lack of access to multiple informants (Dupaul et al., 2009; Green & Rabiner, 2012; McGough & Barkley, 2004). 1 Determining the relation between behavior rating scale scores for ADHD and brainwave activity has never been investigated before. Therefore, the purpose of the present study was to determine whether a relation exists between EEG coherence and CSS scores of inattentiveness and hyperactivity in male and female college students. ADHD in College Students ADHD is a neurodevelopmental disorder categorized by a persistent pattern of hyperactivity-impulsivity and/or inattention that negatively impacts social and academic/occupational activities in both children and adults, including those within the young adult age range who attend college (American Psychiatric Association, 2013; CDC, 2005). Impairments related to ADHD symptoms often exist across the lifespan. Specifically, several studies have found that ADHD in college students is associated with increased risk for academic problems, lower GPA, poor academic coping skills, illicit substance use, poor interpersonal relationships, and higher psychological distress compared to students without ADHD (Weyandt & Dupaul, 2006; Dupaul et al., 2009; Upadhyaya et al., 2005; American Academy of Pediatrics, 2000; American Psychiatric Association, 2013; Johnston, Mash, Miller, & Ninowski, 2012; Resnick, 2005). For decades, it was thought that children who were diagnosed with ADHD would develop out of their symptoms as they matured and began puberty (DuPaul, Guevremont, & Barkley, 1991; Barkley & Murphy, 2006; Weyandt & DuPaul, 2008; Green & Rabiner, 2012). By the 1990s, researchers had determined that this was inaccurate. Recent longitudinal studies have revealed that between one half and two thirds of children diagnosed with ADHD continued to display symptoms of ADHD into adulthood (Shekim, Asarnow, Hess, Zaucha, & Wheeler, 1990; Spencer, Biederman, Wilens, & 2 Faraone, 1994; Biederman, Mick, & Faraone, 2000; Goldstein, 2002; Barkley, Fischer, Smallish, & Fletcher, 2002; Resnick, 2005; Green & Rabiner, 2012). According to a recent literature review, approximately 2 to 8% of college students self-report clinically significant amounts of ADHD symptoms (Dupaul, Weyandt, O’Dell, & Varejao, 2009). Even though children with ADHD are less likely than peers to achieve academic success in high school and decide to attend college, researchers estimate that about 25% of college students who receive disability services are diagnosed with ADHD. Furthermore, this percentage appears to be on the rise, specifically in college populations (Wilens et al., 2008 for review; Dupaul et al., 2009; Green & Rabiner, 2012; Advokat, Lane, & Luo, 2011). These statistics exhibit the importance of understanding ADHD within the young adult population in order to promote social and academic success within the university setting (Green & Rabiner, 2012). Best practices for ADHD assessment include multimethod, multi-informant approaches (Barkley, 2006; Dupaul et al., 2009). However, ADHD assessment of college students presents its own subset of issues. While the best practice for ADHD assessment in college students utilizes similar methods as assessment for ADHD in children, studies of ADHD assessment in college settings have revealed that these guidelines are rarely entirely followed (Green & Rabiner, 2012). ADHD assessment of college students often improperly investigate the presence of symptoms prior to age 12, do not always utilize multiple informants, and may not carefully consider the potential for ADHD symptoms to be best explained by another disorder, despite that these data are essential to making a DSM-V diagnosis of ADHD (McGough & Barkley, 2004; Green & Rabiner, 2012). Therefore, practitioners within the college setting may be relying heavily on self-reports 3 of symptomology from college students, potentially resulting in inappropriate ADHD diagnosis. Furthermore, studies have indicated that while 2 to 8% of college students self- report clinically significant ADHD symptoms, it is estimated that closer to 1% of students meet criteria for ADHD when there is also a parent report of symptoms (Dupaul et al., 2009). Research suggests that the high rate of college students self-reporting clinically significant amounts of ADHD symptoms may be influenced by the nature of the university setting. First, the high achieving environment of this setting may encourage previously unidentified students who meet ADHD diagnostic criteria to seek out a diagnosis in order to receive a prescription for ADHD medication to enhance their ability to work efficiently, focus, and concentrate (Advokat et al., 2011). Unidentified students with ADHD may first seek ADHD assessment in university settings because college may be the first environment in which students are far away from their at-home support systems resulting in less access to coping strategies for ADHD, (Heiligenstein, Guenther, Levy, Savino, & Fulwiner, 1999; Dupaul et al., 2009; Thomas, Rostain, Corso, Babcock, & Madhoo, 2015). This can be problematic since ADHD assessment in college students does not typically utilize the multimethod best practice for ADHD assessment, and solely relying on self-reported ADHD symptoms in adults is unreliable (Green & Rabiner, 2012). First, research has found that adults with ADHD tend to self-report less symptoms of ADHD, while informants for these same clients endorse more ADHD symptoms (Barkley et al., 2002; Zucker, Morris, Ingram, Morris, & Bakeman, 2002; Katz, Pescher, & Welles, 2009). Second, adult clients without ADHD tend to self-report more symptoms of ADHD, while informants for these same clients endorse less ADHD symptoms 4