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Electroencephalographic Biomarkers in Psychiatry—How Do We Make Good on Promises?

      Biomarkers represent a holy grail in psychiatric research, particularly for disorders with strong evidence for biological etiology, such as attention-deficit/hyperactivity disorder (ADHD). In the case of ADHD specifically, growing evidence suggests that core ADHD symptoms causally influence other negative outcomes, pointing to the need for precise identification and intervention (
      • Boland H.
      • DiSalvo M.
      • Fried R.
      • Woodworth K.Y.
      • Wilens T.
      • Faraone S.V.
      • et al.
      A literature review and meta-analysis on the effects of ADHD medications on functional outcomes.
      ). Yet the field’s ability to provide an accurate diagnosis of ADHD and effective interventions remains limited. The diagnosis of ADHD remains controversial, particularly in adolescence and adulthood when no clear best practices exist for assessing and combining symptom reports across informants or establishing a developmental course (
      • Sibley M.H.
      • Mitchell J.T.
      • Becker S.P.
      Method of adult diagnosis influences estimated persistence of childhood ADHD: A systematic review of longitudinal studies.
      ). Even when a clear diagnosis can be established, interventions for core ADHD symptoms remain limited. The best medication treatments for ADHD still result in no response or partial response in many individuals (
      • Spencer T.
      • Biederman J.
      • Wilens T.
      • Harding M.
      • O’Donnell D.
      • Griffin S.
      Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle.
      ), and providers are sometimes hesitant to prescribe stimulants to adolescents and adults because of concerns about misuse or abuse. Behavioral treatments appear to have minimal or short-lived effects on core ADHD symptoms (although there are many benefits of these treatments for co-occurring behavioral and emotional symptoms) (
      • Sonuga-Barke E.J.
      • Brandeis D.
      • Cortese S.
      • Daley D.
      • Ferrin M.
      • Holtmann M.
      • et al.
      Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments.
      ). There is an urgent need for improved diagnosis and for treatments that target the mechanisms of core symptoms.
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