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Browse courses and booksModule 13
Chapter 13 · 2 h · 8 quiz items · pass at 80%
This module sits in IQCB Domain V (QEEG), 21% of the exam, and carries a higher 85% pass threshold because the report is the Diplomate's deliverable and its language is a matter of professional responsibility. A report that over-claims is a scope violation regardless of how good the analysis was. The higher threshold holds the learner to the scope-limited language an IQCB review demands.
Everything in this book converges on a document you will hand to someone else. The referring physician never watches you select epochs. The patient never sees the artifact rejected at T3, the average-reference montage you ran for the source analysis, or the moment you noticed the alpha peak sitting a full hertz low. They see a report. The care team acts on the report. A plaintiff's attorney, years later, reads the report. The report is the only part of your work that survives contact with the rest of the world, and it is the only part most readers will ever evaluate you by.
The IQCB exam tests report writing for that reason. A Diplomate's job is not to produce a brain map. Software produces the map. The Diplomate's job is to read the map against the patient, decide what the quantitative findings can and cannot support, and write that judgment in language that holds up when a skeptical reader pushes on it. The exam blueprint folds report writing into the QEEG domain, the largest single domain at 21% of the test. You will be asked what belongs in a report, what language is defensible, and where a report crosses from description into a claim QEEG cannot make.
It is also the chapter where the cost of a sloppy habit is highest. A loose sentence in your interpretation section ("the QEEG confirms ADHD") is not a style problem. It is a scope violation, a diagnostic claim a QEEG cannot support, and in a forensic context it is the sentence opposing counsel reads aloud to the jury. You write reports defensively because the report is the thing that gets attacked.
This chapter covers the required elements of an IQCB-standard report, the structure that makes a report defensible, the language rules that keep you inside scope, how to describe findings without over-reading them, how to write clinical-correlation and referral statements, the disclaimer your report cannot omit, the difference between the document you send the referring clinician and the document that lives in the patient record, and the IQCB mentoring review your reports pass through before you practice on your own. The actual annotated templates live in the back matter (Appendix D, Templates A and B). This chapter teaches you what those templates contain and why each block is there.
For most of QEEG's history there was no published, field-wide standard for what a report had to contain. Practitioners borrowed structure from neuropsychology reports, from clinical EEG reads, or from whatever their training program modeled. In March 2025 the International QEEG Certification Board published the field's first formal report-writing guideline, which specifies a core seven-section structure (acquisition through recommendations), a mandatory disclaimer, and explicit cautions about software-assisted drafting. The nine blocks below add identification at the top and signature at the bottom, bracketing the guideline's seven. If you are certifying through IQCB, this is the standard your reports are measured against, and it is the standard the mentoring review applies.
Treat the published guideline as the floor, not the ceiling. It tells you the minimum a report must contain to be defensible. It does not relieve you of judgment about how to describe a borderline finding, how to phrase a correlation that the patient's history only partly supports, or when a finding is too state-contaminated to report as anything but provisional. The standard governs the skeleton. You supply the clinical reasoning that fills it.
Two things the standard makes non-negotiable, and that the rest of this chapter keeps returning to:
A report describes patterns and compares them to a normative database. It does not diagnose, and it does not infer the cause of a finding.
Every report carries a disclaimer stating those limits in plain language, positioned where the reader will actually see it.
Internalize those two. Most failed reports fail because they drift across one of those lines.
An IQCB-standard report is built from blocks, each one answering a specific reader's question. Build them in order. A reader should move from "who recorded this and are they qualified" through "how was it recorded" to "what did it show" and "what should I do about it" in a single, linear pass.
Identification and credentials. Patient or client name and identifier, date of birth or age, date of recording, referral source, and the referral question. Then your name, your credentials, and the scope those credentials authorize. A QEEG-T does not sign an independent interpretation; a QEEG-D does. The reader needs to know which they hold (scope by credential is the subject of Chapter 16). Put the disclaimer here too, near the top, before any finding, so no reader reaches a result without first reading the limits on it.
Acquisition parameters. This is the auditable block, the one a reviewer or opposing expert checks first. Hardware and amplifier, electrode system and montage, sampling rate, reference used for acquisition and any re-reference applied for analysis, recording conditions (eyes-closed, eyes-open, task, and the duration of each), and the impedance you achieved. If a reader cannot reconstruct how the data were collected, the report is not defensible. Write this block so a competent stranger could repeat your recording.
Artifact management. What you removed and how. State the method (visual rejection, ICA-assisted decomposition, automated thresholding), the bands or channels most affected, and how much clean data survived. "82% of epochs retained after ICA-assisted artifacting" tells a reviewer the recording was usable. Silence on artifacting tells a reviewer you either did not do it or do not want to say. Chapter 10 covers the pipeline; the report documents you followed it.
Normative database identification. Name the database, the version, and the age range and reference montage it requires. "Compared to the NeuroGuide normative database, version 3.0, eyes-closed, linked-ears reference" is a complete identification. A z-score is meaningless without the database that produced it, because the z-score is a statement about distance from that specific database's mean. A reader who knows the database can evaluate whether it was the right reference for the patient (right age band, compatible recording conditions). A reader who does not know the database cannot evaluate the finding at all. Database identification is not a formality. It is the thing that makes every z-value in the report interpretable.
Findings. Quantitative, specific, and free of diagnosis. Name the site, the band, the metric, and the z-value or magnitude. "Elevated frontal-midline theta, Fz relative theta z = +2.4" is a finding. "Evidence of attentional dysregulation" is an interpretation, and it belongs in the correlation section, downstream, where you have to justify it. Keep the findings block descriptive. Separating what the map shows from what you think it means is most of what makes a report hold up.
Clinical correlation. Where you connect findings to the patient's presentation, history, and the referral question, within scope. This is the section that earns its keep and the section most likely to overreach. It is treated in detail in §13.7.
Recommendations. What follows from the findings, stated as options for the treating clinician rather than mandates. Covered in §13.8.
Disclaimer. Restated in the summary, not only at the top. The reader who skims to the bottom for the recommendation should hit the limits there too. Covered in §13.9.
Signature and credentials. You sign your own work. The report carries the name and credentials of the Diplomate responsible for the interpretation, and where a QEEG-T performed acquisition and processing, the report names the supervising Diplomate who reviewed and signed it (Chapter 16).
The language standard is a scope standard. A QEEG report describes electrical patterns and their statistical relationship to a normative sample. It does not establish disease, and it does not establish cause. Every sentence in the interpretive sections has to stay inside that boundary, and the difference between a defensible report and an indefensible one is usually a verb.
What a QEEG report can say:
A pattern is present and how far it sits from the normative mean. "Frontal-midline theta is elevated relative to the age-matched database, z = +2.4."
A pattern is consistent with a body of literature. "This pattern is consistent with findings reported in the attention-regulation literature." Consistent with is the workhorse phrase. It claims an association, not an identity.
A pattern converges with, or diverges from, other data you hold. "The elevated theta is convergent with elevated reaction-time variability on the patient's continuous performance test." Convergence across independent measures is the strongest honest statement a report can make.
A finding may inform a clinical consideration. "These findings may inform consideration of attention-regulation interventions, pending clinical confirmation."
What a QEEG report cannot say:
It cannot diagnose. "The QEEG shows ADHD" is false on its face. QEEG does not show ADHD. It shows a spectral pattern occurring more often in groups carrying the diagnosis and also in people who do not. Diagnosis integrates history, examination, and other data, and it belongs to the treating clinician.
It cannot assert cause. "Frontal theta elevation due to early hypoxia" attributes etiology the QEEG cannot establish. The map shows the pattern. It does not show why.
It cannot mandate treatment. "The patient requires neurofeedback at Cz" converts a finding into a prescription. The report informs treatment decisions; it does not make them.
It cannot promise an outcome. "Training this pattern will resolve the patient's symptoms" claims a result no resting map can guarantee.
The reliable test: would the sentence survive cross-examination by someone who understands QEEG's limits? "Consistent with" survives, because it claims an association the literature supports. "Confirms" does not survive, because nothing about a resting spectral pattern confirms a clinical diagnosis. Write every interpretive sentence as though the reader's job is to find the verb overreaching, because in a forensic context, it is.
A z-score is a distance, not a verdict. It says the observed value sits a certain number of standard deviations from the database mean. It does not say the deviation matters clinically, and the report's job is to characterize magnitude honestly while refusing to inflate it.
Describe magnitude in the language of statistics, then let the clinical-correlation section decide whether the magnitude means anything. A z of +2.0 is "elevated"; the value sits about two standard deviations above the mean, at roughly the 98th percentile of the reference sample. A z of +3.5 is "markedly elevated." Anchor the descriptor to the number, and avoid descriptors that smuggle in clinical weight. "Severe theta excess" sounds like a diagnosis. "Theta z = +3.1, markedly elevated relative to the age-matched database" is a measurement.
Three habits keep z-score description honest.
State the metric and the reference together. A z-score belongs to a specific metric (absolute power, relative power, a ratio, a coherence value) computed against a specific database. "z = +2.4" floating alone is uninterpretable. "Fz relative theta z = +2.4 (NeuroGuide, eyes-closed)" is complete.
The report carries many z-scores, and many z-scores inflate the chance one crosses a threshold by chance alone. Nineteen sites across several bands and several metrics is a large number of simultaneous comparisons, and at conventional thresholds some will deviate in any healthy brain. Chapter 11 covers the multiple-comparison problem and the corrections (Bonferroni, FDR) that address it. The report should reflect a single isolated z = +2.0, unsupported by a coherent regional pattern or by the patient's presentation, is weaker evidence than the same value embedded in a consistent topographic story. Do not report every flagged site as though each carried equal weight.
Resist the gradient from "deviation" to "abnormality" to "pathology." Each step adds a claim. "Deviation" is what the statistic licenses. "Abnormality" implies the deviation is outside normal variation, which a single z-score does not establish. "Pathology" implies disease, which QEEG cannot establish at all. Stay at "deviation" in the findings block and let the correlation section, with the patient's history in hand, decide how far up that gradient the evidence actually reaches.
Coherence findings carry an extra burden, because the reader is less likely to know what they mean and more likely to over-read them. A coherence value describes a statistical relationship between two sites, not a physical wire between two regions. The report language has to keep the distinction visible.
Describe the direction and the sites, and name the metric. "Reduced coherence between F3 and F4 in the alpha band" states a finding. Specify whether the metric excludes zero-lag relationships, because zero-lag coherence is inflated by volume conduction and the reader needs to know whether you controlled for it. "Reduced lagged coherence" is a stronger and cleaner statement than "reduced coherence," because lagged measures exclude the zero-lag artifact (Chapter 10).
Avoid the language of anatomy and causation. "Disconnection between the frontal lobes" sounds like a structural claim about white matter. The coherence value does not establish a structural disconnection. It establishes reduced statistical coupling between two scalp sites in one band, in one recording. "Reduced interhemispheric alpha coherence at F3-F4" is what you can defend. The reader can decide, with the rest of the clinical picture, whether that statistical finding is worth anything.
Frame over-coherence and under-coherence as what they are: excess or reduced coupling, each potentially meaningful, neither inherently good or bad. Over-coherence is not automatically pathological and under-coherence is not automatically a deficit. Their significance depends on region, band, the patient's presentation, and convergence with other findings. The report describes the coupling. The correlation section, cautiously, says what it might mean.
When a report includes LORETA, sLORETA, eLORETA, or a beamforming result, the caveats are not optional politeness. They are part of the finding. Source-localization methods estimate cortical generators of a scalp pattern by solving an inverse problem with no unique solution, and the report has to make the limitation visible to a reader who will otherwise treat a colored brain-volume image as a measurement of activity inside the head.
State the method and its resolution. "sLORETA estimated the maximal current-source density for the elevated theta in the region of the anterior cingulate." Estimated, in the region of: these are not hedges you can drop. The method produces a low-resolution estimate, not a pinpoint localization, and the report language has to carry the resolution honestly.
Do not let a source image become a structural or diagnostic claim. A bright voxel over a region is not evidence of a lesion there, not evidence of disease in that structure, and not a diagnosis of any condition associated with that structure. It is a low-resolution estimate of where a scalp-level statistical deviation might be generated. The report says so, in those words, every time it reports a source result.
Where the report includes a source-localization figure, the same rule that governs every figure applies: the figure supports a finding stated in the text, and no finding rests on a figure the text does not also state. A source image with no corresponding sentence is decoration, and decoration in a clinical report invites the reader to draw their own conclusion.
The clinical-correlation section is where a report stops being a printout and becomes a clinical document. It is also where most over-reading happens, because it is the section that invites you to say what the findings mean. The discipline is to connect findings to the patient's presentation and the referral question, and to stop at the edge of what the data support.
Correlate to the referral question. A report exists because someone asked a question. If the referral asks about attention, the correlation section addresses whether QEEG findings are consistent with, or divergent from, an attention problem, and says so plainly. A correlation section that wanders through every flagged z-score, ignoring the reason the patient was sent, is a database readout, not a clinical correlation.
Anchor the correlation in convergence, and say so when the data diverge. The strongest correlation statement names independent measures pointing the same way. "The elevated frontal theta is consistent with the patient's reported difficulty sustaining attention and convergent with elevated reaction-time variability on the continuous performance test." When the data do not converge, the report says that too, because divergence is information, not failure. "The QEEG shows frontal theta elevation. Performance testing was within normal limits. These findings diverge, and the QEEG pattern should be interpreted as provisional pending further clinical correlation." A report that smooths over divergence to manufacture a clean story is the report that fails under scrutiny.
Keep cause out of it. Correlation states a pattern is consistent with a presentation. It does not state the pattern caused the presentation, or an event in the patient's history caused the pattern. "Consistent with" is an associational claim and it is the strongest claim the correlation section is entitled to make.
Defer to the treating clinician. The correlation section coordinates with the referring clinician's evaluation. It does not replace it. A finding "consistent with" a clinical picture is offered to the clinician who will integrate it with history, examination, and other testing. The report informs the integration. It does not perform it, and it does not pre-empt it.
The first-person clinical voice is allowed here, sparingly, when it adds judgment the bare findings cannot. After reading enough maps, you develop a sense for when an isolated z-score is noise and when a regional pattern is a signal, and a single sentence of clinical judgment ("in my reading, the isolated F4 elevation is most consistent with residual muscle artifact rather than a cortical finding") can be worth more to the referring clinician than a paragraph of statistics. Use it where it earns its place. Do not let it become the report's substitute for showing the data.
Recommendations are the section a busy clinician reads first and the section most likely to be quoted back to you. Write them as options that follow from the findings, scoped to what QEEG can support, and always subordinate to the treating clinician's judgment.
Offer, do not command. "These findings may inform consideration of attention-regulation interventions, pending clinical confirmation" offers a direction. "The patient should begin SMR training at Cz" issues an order the report has no standing to issue. The verb does the work again: may inform, may warrant consideration, could support further evaluation. The recommendation points. It does not push.
Refer when the findings exceed your scope or suggest something a QEEG was not asked to evaluate. A QEEG sometimes surfaces a pattern warranting clinical attention beyond the referral question, and the right move is a referral statement, not a diagnosis. "The recording showed an asymmetric pattern of focal slowing over the left temporal region that exceeds the expected range. Correlation with clinical evaluation and consideration of further neurological workup is recommended" flags the finding and routes it to the clinician who can act on it, without the QEEG report claiming to know what it is. You are not diagnosing a lesion. You are saying the pattern is outside what you would expect and belongs in front of someone who can evaluate it clinically. The referral sentence is one of the most important sentences a QEEG report can contain, because the alternative, staying silent about a pattern that worried you, is the failure mode that gets a practitioner sued.
Match the recommendation to the strength of the finding. A markedly elevated, regionally coherent finding that converges with the patient's presentation and with performance data supports a more confident recommendation than an isolated borderline z-score. Calibrate the language to the evidence. A recommendation written with more confidence than the findings carry does not survive review.
Every QEEG report carries a disclaimer, in plain language, positioned where the reader will see it. The IQCB's 2025 report-writing guideline specifies the disclaimer must state the report does not infer etiology, does not diagnose medical or psychological conditions, is not a substitute for medical or psychological evaluation, and is based on research linking neuromarkers to functional dysregulation. Place it near the top, before any finding, and restate it in the summary, because the reader who skims to the recommendation needs to meet the limits there too.
A serviceable disclaimer states four things: the report describes resting-state EEG patterns and compares them to a normative database; it does not diagnose medical, psychiatric, or neurological conditions; it is not a substitute for evaluation by a qualified physician, psychologist, or neuropsychologist; and clinical decisions should integrate it with history, examination, other testing, and the judgment of the treating clinician. The exact wording is yours, and you should confirm any required language against the current IQCB standard, but those four elements are the floor.
Two failure modes around the disclaimer are worth naming. The first is burying it: a disclaimer in eight-point type on the last page, after the recommendation, is a disclaimer engineered to be missed, and a reader who missed it took your "consistent with" as a diagnosis. The second is contradicting it: a disclaimer that says "does not diagnose" followed three pages later by an interpretation section that says "the QEEG confirms ADHD" is worse than no disclaimer at all, because it documents you knew the limit and crossed it anyway. The disclaimer is only as good as the body of the report that has to honor it.
A report including automated output (a discriminant score, a normative-database classifier flag, a probability from a screening tool) reports the output as one feature with the citation for the tool that produced it, never as a diagnosis. A discriminant is validated only for the specific contrast it was trained on, and a classifier probability is a number from a model, not a clinical conclusion. The disclaimer's logic extends to every automated number the report carries: describe it, cite it, and refuse to let it stand in for the judgment the report is not entitled to make.
The report you send to a referring physician and the document that lives in the patient's record are not always the same document, and conflating them causes problems in both directions. Know which one you are writing.
The report to the referring clinician is a consultation. It assumes a clinical reader who can interpret z-scores, weigh a "consistent with" statement against their own examination, and integrate the QEEG into a larger formulation. It can carry the full technical block, the quantitative findings, the source caveats, and a correlation section written for a colleague. It is dense, it is auditable, and it is written for someone who will do something clinical with it.
The patient-facing explanation is a different act of communication, and most of it does not happen in the written report at all; it happens in the conversation where you show the patient their map (covered in the clinical-communication material of Chapter 17). When something written goes to the patient or into a record the patient will read, the same scope rules apply (no diagnosis, no etiology, no overclaim) and the language has to be comprehensible to a non-specialist without becoming false through simplification. The risk in patient-facing language is not being too technical. The risk is simplifying "frontal theta elevation consistent with attention-regulation findings in the literature" into "your brain map shows you have ADHD" turns a scoped finding into a diagnosis the report was built specifically to avoid making.
Whatever the audience, the patient record version is a legal document. It is discoverable, it is permanent, and it is read by people you will never meet under circumstances you cannot predict. The acquisition parameters, the database identification, the artifact documentation, and the disclaimer are not there to satisfy a formatting rule. They are there because the report has to defend itself when you are not in the room to defend it.
You do not begin writing independent reports the day you finish the didactic. Between coursework and independent practice sits a mentoring requirement, and a substantial part of it is having your reports read by a certified Diplomate before they go out the door. The requirement calls for at least ten contact hours with a supervising Diplomate, covering at least ten patient or client data analyses and five QEEG report presentations, with at least two of those hours conducted as direct observation. The mentor documents the work on a mentorship verification form (the specifics are covered in Chapter 16, and you should confirm the current numbers against the IQCB standard, because they are the kind of requirement boards revise).
The point of the report review is calibration. Reading your own report, you cannot see the place where "consistent with" slid into "indicates," because you know what you meant. A mentor reading the same report sees the verb overreaching, the finding stated without a database, the source image with no sentence to anchor it, the recommendation written more confidently than the z-scores support. The review is where the abstract rules in this chapter become habits, because a mentor catches the specific sentence in your specific report and makes you fix it, and after enough of those corrections you stop writing the sentence in the first place.
Treat the review as the thing making your reports defensible before a real patient depends on one, not as a hurdle between you and certification. The reports you write under review are the reports where it is cheapest to learn that the disclaimer was buried, the artifact block was thin, or the correlation section drifted past scope. Every one of those is a mistake that costs nothing to fix in mentoring and a great deal to fix in litigation.
The back matter carries the annotated templates (Appendix D, Template A for a clinical report and Template B for a forensic report). An annotated sample is not a fill-in-the-blank form. It is a worked example with margin notes showing why each block is there, what language was chosen and what was rejected, and where a reader's eye should land. Reading one teaches the structure faster than any rule list, because it shows the rules operating on a real case.
A complete annotated clinical report walks through the full block stack: the identification and disclaimer at the top, the acquisition parameters written so a stranger could reconstruct the recording, the artifact documentation with epochs retained, the database identification with version and reference, a representative raw-trace exhibit, the topographic figures (each tied to a stated finding), the narrative of findings framed against the patient's symptoms and history and any performance data, and a summary that delivers a one-sentence headline, recommendations within scope, any automated output with its citation, and the restated disclaimer. The annotations call out the load-bearing choices: why this finding is described as "elevated" rather than "abnormal," why the source result carries its caveat, why the recommendation says "may inform" rather than "should begin." The annotated forensic template adds the elements a courtroom demands and is the subject of Chapter 18.
A report fails the IQCB review standard for a short list of recurring reasons, and every one of them is a habit this chapter has tried to break. It fails when it diagnoses, because diagnosis is outside scope. It fails when it asserts cause, because etiology is outside scope. It fails when a z-score appears without the database producing it, because the number is then uninterpretable. It fails when a figure has no finding behind it, or a finding has no figure, because the report no longer governs the reader's conclusion. It fails when the disclaimer is missing, buried, or contradicted by the body. It fails when the recommendation is written with more confidence than the findings support, or when it issues a treatment order the report has no standing to give. And it fails when the acquisition and artifact documentation is too thin for a reviewer to tell whether the recording was usable, because a finding from an undocumented recording is not one a careful reader will trust.
A report that survives review does the opposite of each of those, and it does them in plain, scoped, auditable language. Write the report so a skeptical Diplomate, a busy referring physician, and a hostile attorney all reach the same conclusion about what it claims, which is exactly as much as the data support and not one verb more. That is the standard. The next time you sit down to read a map, you are not reading it for yourself. You are reading it for the document, and the document is the only part of the work that has to stand on its own.