ADHD Diagnosis: Finally A Foolproof, Accurate Measure

ADHD Diagnosis: Finally an Foolproof Measure

The diagnosis – and misdiagnosis – of ADHD has risen steeply over the last decade. Australia saw a 72.9% rise in the prescription of ADHD medication between 2000 and 2011. Most of these were for mild to moderate ADHD.

In Britain, the rate of medication prescriptions has seen a twofold increase for children and a fourfold increase for adolescents and children.

The sharp increase has in part been attributed to the diagnostic criteria for and ADHD diagnosis being expanded, a response to the concern that the disorder was being underdiagnosed.

‘The kids who don’t get diagnosed or don’t get treatment are at heightened risk for substance abuse, at higher risk for school dropout, for having more car accidents, and having a higher risk of having an interaction with the juvenile justice system,’ explained Harold S. Koplewicz, MD, president of the Child Mind Institute in New York City.

The problem with a broader definition, however, is that it ‘devalues the diagnosis in those with serious problems’, said Dr Rae Thomas, a senior researcher at Australia’s Bond University who published an analysis of the problem in the British Medical Journal.

Like many things, the response to the pendulum swinging too far one way, has sent it swinging too far in the other direction.

Accurate diagnosis of any disorder is necessary to shepherd effective and appropriate treatment, however ADHD has been particularly vulnerable to misdiagnosis because there has been no reliable physiological markers to diagnose disorder.

ADHD diagnosis is based on observed or self-reported behavior in at least two different settings (usually school or home) by different people (generally parents and teachers). Symptoms exist on a spectrum from normal to abnormal and include difficulty sustaining attention, disorganisation, restlessness, distractibility, and a tendency to persistently interrupt.

Whether or not the symptoms are at sufficiently abnormal levels as to warrant a diagnosis is subjective and open to interpretation, or misinterpretation.

With less restrictive criteria and a spike in diagnosis, particularly on the mild to moderate end, the diagnosis of ADHD risks being met with skepticism. This will ultimately compromise those with more severe symptoms who require targeted treatment.

A diagnosis can come loaded with stigma, nudged along by stereotypes, the ill-informed and the judgemental. For example, some teachers have lower academic expectations of children with ADHD. Expectations have a way of creating self-fulfilling prophecies. Children will live up to them – and down to them.

Overdiagnosis of any disorder comes with a financial costs. Medication costs of the misdiagnosis of ADHD have been estimated to be between $320-$500 million in the US.

The medication for ADHD is not without potential side effects, further highlighting the importance of an accurate diagnosis.

In severe cases of ADHD the symptoms are obvious and potential for misdiagnosis is greatly diminished. However, in mind and moderate ADHD, which make up the bulk of all ADHD diagnoses, the measure of symptoms and subsequent diagnosis is subjective and fraught with the potential for misdiagnosis.

Problems with the lack of an accurate diagnostic tool for ADHD have plagued the field, but a recent study may change this.


 

The Research: What They Did

In a study published in Vision Research, researchers from Tel Aviv University reported that they may have found an objective and physiological way to accurately diagnose ADHD – the presence of involuntary eye movements.

Researchers used an eye-tracking system to monitor the involuntary eye movements of two groups of 22 adults as they completed an ADHD diagnostic computer test.

Each participant did the test twice.

Participants in the first group had all been previously diagnosed with ADHD and were unmedicated when they first took the test. They then repeated the test after they had taken methylphenidate, an ADHD medication.

The second group did not have ADHD.

What They Found

‘We had two objectives going into this research,’ explained researcher Dr. Moshe Fried, who was diagnosed with ADHD as an adult. ‘The first was to provide a new diagnostic tool for ADHD, and the second was to test whether ADHD medication really works – and we found that it does. There was a significant difference between the two groups, and between the two sets of tests taken by ADHD participants un-medicated and later medicated.’

The researchers found that those participants with ADHD were unable to suppress eye movement in the anticipation of visual stimuli when unmedicated.

When these participants took methylphenidate, their involuntary eye movements were suppressed to the same as that of the non-ADHD group, demonstrating the effectiveness of ADHD medication.


 ‘This test is affordable and accessible, rendering it a practical and foolproof tool for medical professionals,’ said Dr. Fried. ‘With other tests, you can slip up, make ‘mistakes’ – intentionally or not. But our test cannot be fooled. Eye movements tracked in this test are involuntary, so they constitute a sound physiological marker of ADHD. Our study also reflected that methylphenidate does work. It is certainly not a placebo, as some have suggested.’

Further trials on larger groups are necessary, but initial results look promising.

11 Comments

Lars Lidén

There is an objective and non-invasive method that can diagnose and differentiate between child/adult ADHD, schizophrenia, Asperger, bipolar disorder (manic-depressive illness) and dementia: Brainstem audiometry.

Measuring equipment and diagnosis is provided by the company “SensoDetect”:
http://www.sensodetect.com/

For scientific publications, see the SensoDetect website under “Research”.

As far as I know the method is, at present, not available outside Scandinavia.

Reply
Mavis

If eye movements are related to this conditioning, why not use a therapy such as Integral EyeMovement Therapy. I’ve found as a tutor-therapist that if I use this process with children who find it difficult to concentrate and focus, their concentration improves. I haven’t done a controlled study on this though.

Reply
Hey Sigmund

Thank you for sharing your experience. According to this study, involuntary eye movements can indicate ADHD, but it doesn’t mean they are a cause. In the same way that a fever can indicate the presence of a virus, but it doesn’t mean that if you treat the fever the virus can go away. It’s all food for thought though.

Reply
Jordan

Hi Karen,

Loved the article. Very interesting to learn about how diagnoses are developing in this area as it is present in my family.

Do you have any more articles on this subject?

Reply
Melody

I’m wondering if they specifically looked at anxiety-related symptoms, and whether this may also produce a similar pattern of involuntary eye movements. I’ve seen a number of cases in which children with anxiety or trauma-related disorders have been mistaken for having ADHD, and I wonder whether this test would distinguish between them.

Reply
heysigmund

That’s a good question. By all reports, the promise of this study is that the involuntary eye movements are something specific to ADHD and that’s why they can differentiate it from other disorders. The researchers are conducting more trials on bigger groups of people so it will be interesting to see where it ends up.

Reply

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Behaviour is never from ‘bad’. It’s from ‘big’. Big hungry, big tired, big disconnection, big missing, big ‘too much right now’. The reason our responses might not work can often be because we’ve misread the story, or we’ve missed an important piece of it. Their story might be about now, today, yesterday, or any of the yesterdays before now. 

Our job isn’t to fix them. They aren’t broken. Our job is to understand them. Only then can we steer our response in the right direction. Otherwise we’re throwing darts at the wrong target - behaviour, instead of the need behind the behaviour. 

Watch, listen, breathe and be with. Feel what they feel. This will help them feel you with them. We all feel safer and calmer when we feel our people beside us - not judging or hurrying or questioning. What don’t you know, that they need you to know?♥️
We all have first up needs. The difference between adults and children is that we can delay the meeting of these needs for a bit longer than children - but we still need them met. 

The first most important question the brain needs answered is, ‘Is my body safe?’ - Am I free from threat, hunger, exhaustion, pain? This is usually an easier one to take care of or to recognise when it might need some attention. 

The next most important question is, ‘Is my heart safe?’ - Am I loved, noticed, valued, claimed, wanted, welcome? This can be an easy one to overlook, especially in the chaos of the morning. Of course we love them and want them - and sometimes we’ll get distracted, annoyed, frustrated, irritated. None of this changes how much we love and want them - not even for a second. We can feel two things at once - madly in love with them and annoyed/ distracted/ frustrated. Sometimes though, this can leave their ‘Is my heart safe?’ needs a little hungry. They have less capacity than us to delay the meeting of these needs. When these needs are hungry, we’ll be more likely to see big feelings or big behaviour. 

The more you can fill their love tanks at the start of the day, the more they’ll be able to handle the bumps. This doesn’t have to be big. It just has to be enough. It might look like having a cuddle, reading a story, having a chat, sitting with them while they have breakfast or while they pat the dog, touching their back when they walk past, telling them you love them.

All brains need to feel loved and wanted, and as though they aren’t a nuisance, but sometimes they’ll need to feel it more. The more their felt sense of relational safety is met, the more they’ll be able to then focus on ‘thinking brain’ things, such as planning, making good decisions, co-operating, behaving. 

(And if this today was a bumpy one, that’s okay. Those days are going to happen. If most of the time their love tanks are full, they’ll handle when it drops a little. Just top it up when you can. And don’t forget to top yours up too. Be kind to yourself. You deserve it as much as they do.)♥️
Things will always go wrong - a bad decision, a good decision with a bad outcome, a dilemma, wanting something that comes with risk. 

Often, the ‘right thing’ lives somewhere in the very blurry bounds of the grey. Sometimes it will be about what’s right for them. Sometimes what’s right for others. Sometimes it will be about taking a risk, and sometimes the ‘right’ thing just feels wrong right now, or wrong for them. Even as adults, we will often get things wrong. This isn’t because we’re bad, or because we don’t know the right thing from the wrong thing, but because few things are black and white. 

The problem with punishment and harsh consequences is that we remove ourselves as an option for them to turn to next time things end messy, or as a guide before the mess happens. 

Feeling safe in our important relationships is a primary need for all of us humans. That means making sure our relationships are free from judgement, humiliation, shame, separation. If our response to their ‘wrong things’ is to bring all of these things to the table we share with them with them, of course they’ll do anything to avoid it. This isn’t about lying or secrecy. It’s about maintaining relational ‘safety’, or closeness.

Kids want to do the right thing. They want us to love and accept them. But they’re going to get things wrong sometimes. When they do, our response will teach them either that we are safe for them to come to no matter what, or that we aren’t. 

So what do we do when things go wrong? Embrace them, reject the behaviour:

‘I love that you’ve been honest with me. That means everything to me. I know you didn’t expect things to end up like this, but here we are. Let’s talk about what’s happened and what can be different next time.’

Or, ‘Something must have made this (wrong thing) feel like the right thing to do, otherwise you wouldn’t have done it. We all do that sometimes. What do you think it was that was for you?’

Or, ‘I know you know lying isn’t okay. What made you feel like you couldn’t tell me the truth? How can we build the trust again. Let’s talk about how to do that.’

You will always be their greatest guide, but you can only be that if they let you.♥️
Whenever there is a call to courage, there will be anxiety - every time. That’s what makes it brave. This is why challenging things, brave things, important things will often drive anxiety. 

At these times - when they are safe, but doing something hard - the feelings that come with anxiety will be enough to drive avoidance. When it is avoidance of a threat, that’s important. That’s anxiety doing it’s job. But when the avoidance is in response to things that are important, brave, meaningful, that avoidance only serves to confirm the deficiency story. This is when we want to support them to take tiny steps towards that brave thing. It doesn’t have to happen all at once.l and it doesn’t matter how long it takes. Brave is about being able to handle the discomfort of anxiety enough to do the important, challenging thing. It’s built in tiny steps, one after the other. 

We don’t have to get rid of their anxiety and neither do they. They can feel anxious, and do brave. At these times (safe, but scary) they need us to take a posture of validation and confidence. ‘I believe you, and I believe in you.’ ‘I know this feels big, and I know you can handle it.’ 

What we’re saying is we know they can handle the discomfort of anxiety. They don’t have to handle it well, and they don’t have to handle it for too long. Handling it is handling it, and that’s the substance of ‘brave’. 

Being brave isn’t about doing the brave thing, but about being able to handle the discomfort of the anxiety that comes with that. And if they’ve done that today, at all, or for a moment longer than yesterday, then they’ve been brave today. It doesn’t matter how messy it was or how small it was. Let them see their brave through your eyes.‘That was big for you wasn’t it. And you did it. You felt anxious, and you stayed with it. That’s what being brave is all about.’♥️
A relationally unsafe (emotionally unsafe) environment can cause as much breakage as as a physically unsafe one. 

The brain’s priority will always be safety, so if a person or environment doesn’t feel emotionally safe, we might see big behaviour, avoidance, or reduced learning. In this case, it isn’t the child that’s broken. It’s the environment.

But here’s the thing, just because a child doesn’t feel safe, doesn’t mean the person or environment isn’t safe. What it means is that there aren’t enough signals of safety - yet, and there’s a little more work to do to build this. ‘Safety’ isn’t about what is actually safe or not, it’s about what the brain perceives. Children might have the safest, warmest, most loving adult in front of them, but that doesn’t mean they’ll feel safe. This is when we have to look at how we might extend bigger cues of warmth, welcome, inclusiveness, and what we can do (or what roles or responsibilities can we give them) to help them feel valued and needed. This might take time, and that’s okay. Children aren’t meant to feel safe with every adult in front of them, so sometimes what they need most is our patience and understanding as we continue to build this. 

This is the way it works for all of us, everywhere. None of us will be able to give our best or do our best if we don’t feel welcome, liked, valued, and free from hostility, humiliation or judgement. 

This is especially important for our schools. A brain that doesn’t feel safe can’t learn. For schools to be places of learning, they first have to be places of relationship. Before we focus too sharply on learning support and behaviour management, we first have to focus on felt sense of safety support. The most powerful way to do this is through relationship. Teachers who do this are magic-makers. They show a phenomenal capacity to expand a child’s capacity to learn, calm big behaviour, and open up a child’s world. But relationships take time, and felt safety takes time. The time it takes for this to happen is all part of the process. It’s not a waste of time, it’s the most important use of it.♥️

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