To NEBA or Not to NEBA? That is the ADHD Question.

EEGleftThe traditional method of achieving a diagnosis of Attention Deficit – Hyperactivity Disorder has involved reviewing the patient’s clinical history, utilization of a variety of scales and psychological criteria, and the exclusion of other medical problems.

For the past few years, an additional diagnostic tool called the Neuropsychiatric EEG-Based Assessment Aid (NEBA), has become available. It is a specific type of electroencephalogram (EEG) that focuses on certain brain waves associated with children who are diagnosed with ADHD.

Advantages:
1) NEBA can be done in any doctor’s office. The reading is accomplished via computer evaluation of specific brain wave patterns. Results are interpreted by professionals, then transmitted to the practitioner.

2) It is relatively simple for some children, aged 6-18 years, to sit still for ~15 minutes, watching a video or being read to by Mom.

3) The FDA approved test has supporting scientific literature, which adds to validity.

4) It may assist parents who are uncertain about the diagnosis or treatment.

Disadvantages:
1) The cost is ~$450. In South Florida, patients have rarely succeeded in obtaining medical insurance coverage. The company does offer helpful resources.

NEBA 22) There are more than a few patients who cannot sit still while the electrodes are applied and the test is administered.

3) There are experts who feel that NEBA testing is not fully proven, and/or necessary.

4) It doesn’t take the place of a formal EEG, and if a patient has other neurologic signs or symptoms, such as staring spells.

Discussion
All the FAQs about NEBA, plus supporting literature, can be found at their website.

One opposing point of view was offered by the director of the Center for Children and Families at Florida International University. Dr. Pelham asked, “What’s the point? We’re not going to run out and buy one of these machines to do diagnoses, because it is totally unnecessary.”

Clinicians do not purchase the equipment. It is rented at a reasonable cost on a monthly basis. The physician receives a portion of the payment for administration and interpretation.

There are options. A thorough medical evaluation may reveal nutritional deficiencies or gastrointestinal conditions that correct signs and symptoms that are falsely diagnosed as ADHD. Getting sleep under control is essential for proper focus and attention.

In younger patients, patience may provide the best outcome. Certain diets can be quite effective. Supplements, such as 5-HTP, magnesium, and essential oils may provide enough relief.  Mild medications, such as guanfacine (Intuniv®), Vayarin®, or even caffeine, can buy a symptomatic child more time without stronger pharmaceuticals.

Without performing formal testing, a trial of one kind or another of stimulant medication is often attempted. Since there are so many types of meds, in so many different forms, with a wide range of therapeutic dosing, this approach can be hit-or-miss.

Conclusion
Without a more reliable objective test, ADHD remains an elusive condition. Parents often feel better when there is more evidence, especially when exploring the possibility of strong stimulant medications.

NeBa 3As a doctor caring for so many patients who present with this diagnosis, I have appreciated the format in which the results are provided to the pediatrician. Based on the score, we are presented with 3 categories; confirmation, support for further testing, and support for testing other conditions. The clinician and the family then discuss additional evaluation and treatment options.

With caveats, and at a cost, this technology represents an additional opportunity to get more complete information about your child’s development.

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2 Responses to “To NEBA or Not to NEBA? That is the ADHD Question.”

  1. Dr. Udell says:

    On Facebook, we received this post:
    DoTERRA’s InTune helps my kiddo and her Kindergarten teacher reported that when she began wearing it on her essential oil necklace, it assisted the entire table of kiddos to have better focus.

  2. Dr. Elsa Marban says:

    In my practice, I find that many children who do not suffer from ADHD are being misdiagnosed possibly due to learning disabilities when in fact taking psycho-stimulant medication does not improve their academic performance. Parents should verify an ADHD diagnosis with a skilled clinician specializing in the treatment of children with ADHD and not with a general practitioner. Furthermore, IQ and academic testing is very beneficial in ruling out ADHD and assisting with providing a differential diagnosis.

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