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A Four-Step Approach for Developing Diagnostic Tests in Psychiatry: EEG in ADHD as a Test Case

Received September 13, 2004; revised October 21, 2004; accepted October 22, 2004. From the Department of Psychiatry, Yale University, West Haven, Connecticut; the Department of Epidemiology, Yale University, West Haven, Connecticut; BioStatistics, New York, New York. Address correspondence to Dr. Boutros, Professor of Psychiatry and Neurology, Wayne State University, School of Medicine, UPC-Jefferson, Suite 305, 2751 E. Jefferson, Detroit, MI 48207; nboutros{at}med.wayne.edu (E-mail).

A four-step approach for developing diagnostic tests in psychiatry is proposed. The approach was applied to a promising finding (increased electroencephalogram [EEG] Theta in attention deficit hyperactivity disorder [ADHD]). A meta-analysis for the effect sizes was performed. Seventeen studies were included (12 met criteria for inclusion in the meta-analysis). The majority of papers met criteria for Step 1. A number of papers qualified for Step 2 or Step 3. The effect size of the total sample for absolute theta was 0.58 and for relative theta 0.92. The proposed schema was able to classify a representative biological finding into a specific phase of development as a diagnostic tool. Based on the meta-analysis, the authors conclude that increased EEG theta activity in ADHD is promising and should be further developed as a diagnostic test.

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