EEG in Children with Mental Health Disorders: Why and When?

Open Access

Abstract

Background: Pediatric mental health disorders are challenging for both parents and clinicians. These challenges often raise greater concern when accompanied by symptoms such as seizures, sleep disturbances, or recent-onset behavioral changes that are difficult to manage. In such cases, an Electroencephalogram (EEG) is frequently recommended to rule out underlying neurological causes. Aim of the study: To evaluate the clinical indications, EEG findings, and diagnostic utility of EEG in children presenting with mental health and behavioral disorders, and to clarify when EEG should be appropriately used in pediatric mental health disorders. Methods & Materials: This retrospective observational study was conducted at the Neurophysiology Laboratory of Bangladesh Shishu Hospital and Institute over one year, and included children aged 6 months to 15 years referred for EEG due to mental health or neurodevelopmental disorders. Standard EEG recordings using the international 10–20 system were analyzed. EEG findings were categorized as normal or abnormal, with abnormalities further classified into focal epileptiform discharges, generalized epileptiform discharges, or background dysfunction. Data were analyzed using SPSS version 26. Descriptive statistics were used for frequencies and percentages, and associations between clinical variables and EEG findings were assessed using Chi-square or Fisher’s exact tests. Result: Among 230 children included, EEG recordings were normal in 178 cases and abnormal in 52. Abnormal EEGs included focal epileptiform discharges (n=23), generalized epileptiform discharges (n=15), and background dysfunction (n=14). Abnormal findings were most frequent in children with disruptive behavior disorders (11/23) and intellectual disability (9/33), compared with autism spectrum disorder (15/79) and ADHD (12/58). The most common referral indications associated with abnormal EEGs were sleep disturbance (19/74), episodic abnormal body or eye movements (13/46), and febrile convulsions (8/36). Conclusion: EEG has a selective but clinically relevant role in the evaluation of children with mental health disorders. Its use is best justified in cases with atypical features, neurological symptoms, or treatment-resistant behavioral presentations, rather than as a routine screening investigation.