Allen was in the second grade and was causing problems for his teachers. He was unable to sit and listen, write, or read. He was very physically active. His mom was not interested in putting him on amphetamines for this, so I sent Allen to a specialist in Los Angeles who used brain mapping to look at his brain function.

The child was found to have an abnormal electrical pattern consistent with ADHD. He was then told to come into the office where he was connected to an EEG and put in front of a screen with his favorite video games. Then he was given specific cognitive behavioral therapy. When the brain waves reached the desired level, the video game would work. Within a short time, the child did not need to be told what to do.

The brain automatically did whatever was necessary to make the video game work, putting him in a more normal mode of functioning. It worked, and he was admitted back into his class at school, never needing medications. (I suspect this is the only way a video game can help a child perform better in school!) 

Brain Mapping 

There is a lot of talk about using brain mapping for many different conditions. Brain mapping encompasses a variety of techniques used to study the structure, function, and connectivity of the brain. These methods come from neuroscience, medical imaging, and related fields, each offering unique insights into how the brain works. Below is a list of the main types of functional brain mapping:  

Functional Brain Mapping – These methods measure brain activity, or how the brain is working.  

Functional Magnetic Resonance Imaging (fMRI)

Detects changes in metabolism to map brain activity during tasks like thinking, moving, or resting. It’s widely used for cognitive and behavioral studies. 

Electroencephalography (EEG)

Records electrical activity via electrodes on the scalp. 

Quantitative EEG (qEEG)

An advanced form of EEG that analyzes brain wave patterns statistically, creating visual “brain maps” to pinpoint dysregulation linked to conditions like ADHD or anxiety. 

Magnetoencephalography (MEG)

Measures magnetic fields produced by neural activity. It provides precise timing and location of brain function, often used alongside EEG. 

Positron Emission Tomography (PET)

Uses a radioactive tracer (e.g., glucose-based) to image metabolic activity in the brain, showing which areas are active during specific processes. 

Single Photon Emission Computed Tomography (SPECT)

 Similar to PET but uses a different tracer to map blood flow, often applied in epilepsy or dementia studies. 

Functional Near-Infrared Spectroscopy (fNIRS)

 Measures blood oxygenation using infrared light through the scalp. It’s portable and useful for studying brain activity in naturalistic settings. 

Transcranial Magnetic Stimulation (TMS) Mapping

 Applies magnetic pulses to stimulate specific brain regions, mapping their functional roles by observing behavioral or cognitive effects. 

Of these, the two most commonly used in practice to “map the brain” are the qEEG and the SPECT scan. The SPECT scan is most often used for brain injury or Alzheimer’s disease, and qEEG is most commonly used to diagnose and treat ADHD and other mental illnesses. In honor of Allen’s success. We will use this last one as an example.  

 

qEEG for ADHD 

Quantitative Electroencephalogram has been used for over twenty years to diagnose and treat ADHD and other mental health issues.i Initial studies showed that there was a difference in people with ADHD compared to people who did not have the symptoms.ii More recent studies have shown that the symptoms of ADHD, which are commonly used to diagnose the illness are less helpful in directing treatment than qEEG. After reporting on two studies, researchers concluded that:  

“While behaviour is of paramount importance in the initial diagnosis of ADHD, it has little predictive value. The addition of causal factors to the diagnostic criteria has the potential to substantially improve treatment outcomes.”iii 

In other words, we use behavior to determine if a child has ADHD, but using the qEEG to map out the specific brain issues will be more helpful in determining the proper treatment.  

Brain Mapping to Prescribe the Best Treatment:  

Quantitative EEG (qEEG) brain mapping can significantly influence ADHD treatment by providing a detailed, individualized picture of brain activity patterns. Unlike traditional ADHD diagnosis, which relies heavily on behavioral assessments (e.g., DSM-5 criteria, rating scales), qEEG measures electrical activity of 19 electrodes across the scalp, analyzing brain wave patterns (delta, theta, alpha, beta, gamma) comparing them to “normal” subjects.

These insights can guide treatment by revealing specific subtypes of ADHD, allowing for more tailored interventions. Here’s how qEEG-informed findings can shape ADHD treatment: 

Identifying ADHD Subtypes via qEEG 

qEEG often uncovers distinct brain wave abnormalities in ADHD, which can vary between individuals, even within the same diagnostic category (e.g., inattentive, hyperactive-impulsive, or combined). Common patterns include: 

• Excess Theta Activity (4-8 Hz): Slow waves, often in frontal regions, linked to inattention and sluggish cognitive processing. 

• Reduced Beta Activity (13-30 Hz): Lower fast-wave activity, associated with poor focus and impulsivity. 

• Theta/Beta Ratio (TBR): Elevated TBR in frontal areas was historically a hallmark of ADHD, indicating under-arousal. 

• Excess Alpha (8-12 Hz) in Eyes-Open States: Seen in some inattentive types, suggesting a “daydreaming” brain state during tasks requiring focus. 

• Hypercoherence or Hypocoherence: Abnormal connectivity between brain regions, reflecting over- or under-coordination of neural networks. 

By pinpointing these patterns, qEEG helps clinicians move beyond a one-size-fits-all approach, tailoring treatment to the individual’s brain profile. I was curious as to how this could affect treatment options.  

 

Treatment Adjustments Based on qEEG Findings 

qEEG doesn’t diagnose ADHD but refines treatment plans by matching interventions to the observed brain activity.iv Here’s how it impacts common ADHD treatments: 

Medication 

• Stimulants (e.g., Methylphenidate, Amphetamines): Best for patients with high theta or elevated TBR, as these drugs increase arousal by boosting dopamine and norepinephrine, normalizing slow-wave dominance. If qEEG shows normal or excessive beta, stimulants might overstimulate, suggesting a lower dose or alternative. 

• Non-Stimulants (e.g., Atomoxetine, Guanfacine):Preferred if qEEG reveals excessive frontal alpha or atypical connectivity, as these target norepinephrine systems to enhance focus without over-arousal. 

• Personalized Dosing: qEEG can monitor pre- and post-treatment brain activity to adjust dosages, ensuring the brain moves toward normative patterns without side effects like anxiety or lethargy. 

Neurofeedback 

EEG Biofeedback Training: qEEG guides neurofeedback by targeting specific abnormalities (e.g., reducing theta in frontal areas or boosting beta). Patients learn to self-regulate brain activity via real-time feedback (e.g., games or visuals). For excess theta, training might focus on “speeding up” the brain; for low beta, it might emphasize sustaining focus. 

Studies show neurofeedback can improve attention and reduce impulsivity long-term, especially when qEEG pinpoints trainable abnormalities.v 

Behavioral Therapy 

Cognitive Behavioral Therapy (CBT): If qEEG shows under-arousal (high theta), CBT might emphasize arousal strategies (e.g., breaking tasks into short bursts). For hyperactive patterns (e.g., excess beta in motor areas), therapy might focus on calming techniques or impulse control. 

Parent/Teacher Training: qEEG can guide environmental changes (e.g., reducing distractions for high-theta kids). 

Lifestyle and Adjunct Interventions 

• Diet: qEEG evidence of inflammation-related patterns (e.g., diffuse slow waves) could suggest dietary changes (e.g., omega-3s). 

• Exercise: High theta might prompt recommendations for physical activity to boost arousal. 

• Sleep Optimization: qEEG often reveals sleep dysregulation in ADHD (e.g., excess delta during wakefulness); addressing sleep hygiene can enhance treatment outcomes. 

Examples of Treatment Shifts 

Case 1: High Frontal Theta 

Profile: Inattentive child, “spacey,” slow to process. 

Treatment: Start with methylphenidate + neurofeedback to reduce theta and train self-regulation. Avoid over-reliance on high doses if qEEG normalizes quickly. As neurofeedback progresses, wean off methylphenidate.  

Case 2: Low Beta, Normal Theta 

Profile: Impulsive teen, struggles with sustained effort. 

Treatment: Lower-dose atomoxetine, paired with beta-enhancing neurofeedback and CBT for impulse control. As she gains more control, wean off atomoxetine.  

Case 3: Excess Alpha, Poor Connectivity 

Profile: Adult with inattentive ADHD, daydreams during tasks. 

Treatment: therapy to build task engagement. (Stimulants might be less effective.) 

Benefits and Limitations of qEEG for ADHD 

Benefits:  

Precision: Matches treatment to brain function, not just symptoms. 

Monitoring: Tracks progress objectively (e.g., pre/post qEEG). 

Reduces Trial-and-Error: Avoids ineffective meds or therapies. 

Limitations: 

Training: It should be noted that this modality is operator dependent. It requires significant skill and experience to place the electrodes properly, be sure the environment is right, make sure the patient hasn’t taken any stimulants (e.g. caffeine), and keep the sensory stimuli at a minimum.  

Variability: Brain patterns can differ day-to-day or due to external factors (e.g., fatigue). Such factors must be taken into account with every qEEG.  

Access: Requires specialized equipment and trained clinicians, which may not be widely available. 

Practical Impact 

In practice, qEEG shifts ADHD treatment from a symptom-based guessing game to a data-driven strategy. For example, a child failing on stimulants might show atypical qEEG patterns (e.g., high alpha instead of theta), prompting a switch to non-stimulants or neurofeedback. Clinicians often combine qEEG with clinical judgment, using it to fine-tune rather than dictate care entirely. 

What about other brain issues?  

Depression

qEEG findings can shape treatment strategies for depression: 

Medication:  

• High frontal theta might suggest a trial of SSRIs (e.g., sertraline) or SNRIs (e.g., duloxetine), which can normalize slow-wave activity by boosting serotonin or norepinephrine. 

• Alpha asymmetry might predict response to antidepressants targeting prefrontal function (e.g., bupropion). 

Neurofeedback: 

• Training to increase left frontal alpha symmetry (balancing activity) has shown promise in reducing depressive symptoms. Protocols often reward increased beta or reduced theta in frontal areas.vi 

Transcranial Magnetic Stimulation (TMS): 

• qEEG can guide TMS targeting (e.g., stimulating the left dorsolateral prefrontal cortex if asymmetry is present), enhancing efficacy for treatment-resistant depression. 

Psychotherapy: Excess coherence might prompt CBT focused on breaking rumination cycles.vii 

Anxiety:  

Anxiety is a multifactorial state that includes anything from worrying to severe panic attacks. Since there are many causes, qEEG offers some advantages because it tailors interventions to the brain’s state:viii 

Medication: 

• High beta might suggest benzodiazepines or SSRIs to calm overactive circuits. 

• If qEEG shows low alpha, anxiolytics that enhance relaxation (e.g., buspirone) could be prioritized. 

Neurofeedback: 

• Training to reduce beta and increase alpha  

Biofeedback and Relaxation:  

• qEEG-guided breathing or mindfulness exercises can target low alpha states, enhancing self-regulation. 

Transcranial magnetic stimulation (TMS):  

• High beta in anxiety might guide TMS to inhibitory protocols (e.g., low-frequency stimulation to the right prefrontal cortex). 

Beyond depression and anxiety, qEEG is also explored for: 

• PTSD:

Identifies hyperarousal (high beta) or dissociation (high theta), guiding trauma-focused neurofeedback or EMDR.

• OCD:
  

Detects frontostriatal dysregulation, informing CBT or SSRI adjustments. 

• Bipolar Disorder:

Tracks mania (high beta) vs. depression (high theta), aiding mood stabilizer titration. This could be important for treatment because people with bipolar should not be given SSRI antidepressants.  

• Schizophrenia:

Reveals disorganized connectivity or excess delta, though its practical use is limited. 

qEEG is not widely accepted in the standard medical community. Most doctors believe that symptoms are the best way to diagnose and treat these issues, but the only tools they have in their toolbox are drugs. Brain mapping with qEEG is another diagnostic help that may help to direct treatment that also includes many other non-drug options.  

While the diagnostic criteria are all based on symptoms, we know that many different problems can create the same symptoms. qEEG brain mapping can be an adjunct tool to guide treatment, often helping to avoid medications that give only temporary relief, or give no help at all, which allows people with brain problems to use treatments that could be a more permanent solution, like young Allen.   

 

Sources:

[i] Psychiatry Research 81 1998 19 Ž . ]29; EEG analysis in Attention-Deficit Hyperactivity Disorder: a comparative study of two subtypes; Adam R. Clarke, et al.
[ii] Psychiatry Research 81 1998 19 Ž . ]29; EEG analysis in Attention-Deficit Hyperactivity Disorder:a comparative study of two subtypes; Adam R. Clarke, et al.
[iii] Clinical Neurophysiology 113 (2002) 1036–1044; EEG evidence for a new conceptualisation of attention deficit hyperactivity disorder; Adam R. Clarke, et al.
[iv] Clinical Neurophysiology 116 (2005) 1033–1040; Examining the diagnostic utility of EEG power measures in children with attention deficit/hyperactivity disorder; Christopher A. Magee, et al.
[v] Journal of Child Psychology and Psychiatry; A randomized controlled trial into the effects of neurofeedback, methylphenidate, and physical activity on EEG power spectra in children with ADHD; Tieme W. P. Janssen, et al.
[vi] NeuroRegulation; Home / Archives / Vol. 8 No. 2 (2021) / Research Papers; A Meta-Analysis of the Effect of Neurofeedback on Depression; Demir Barlas
[vii] J Med Life. 2020 Jan-Mar;13(1):8–15. doi: 10.25122/jml-2019-0085; The Role of Quantitative EEG in the Diagnosis of Neuropsychiatric Disorders; Livia Livint Popa, et al.
[viii] Clinical EEG and Neuroscience; EEG and Clinical Neuroscience Society; A Review of EEG Biofeedback Treatment of Anxiety Disorders; Norman C. Moore, M.D; Volume 31, Issue 1