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

Leave a Reply

Your email address will not be published. Required fields are marked *

Follow Hey Sigmund on Instagram

When things feel hard or the world feels big, children will be looking to their important adults for signs of safety. They will be asking, ‘Do you think I'm safe?' 'Do you think I can do this?' With everything in us, we have to send the message, ‘Yes! Yes love, this is hard and you are safe. You can do hard things.'

Even if we believe they are up to the challenge, it can be difficult to communicate this with absolute confidence. We love them, and when they're distressed, we're going to feel it. Inadvertently, we can align with their fear and send signals of danger, especially through nonverbals. 

What they need is for us to align with their 'brave' - that part of them that wants to do hard things and has the courage to do them. It might be small but it will be there. Like a muscle, courage strengthens with use - little by little, but the potential is always there.

First, let them feel you inside their world, not outside of it. This lets their anxious brain know that support is here - that you see what they see and you get it. This happens through validation. It doesn't mean you agree. It means that you see what they see, and feel what they feel. Meet the intensity of their emotion, so they can feel you with them. It can come off as insincere if your nonverbals are overly calm in the face of their distress. (Think a zen-like low, monotone voice and neutral face - both can be read as threat by an anxious brain). Try:

'This is big for you isn't it!' 
'It's awful having to do things you haven't done before. What you are feeling makes so much sense. I'd feel the same!

Once they really feel you there with them, then they can trust what comes next, which is your felt belief that they will be safe, and that they can do hard things. 

Even if things don't go to plan, you know they will cope. This can be hard, especially because it is so easy to 'catch' their anxiety. When it feels like anxiety is drawing you both in, take a moment, breathe, and ask, 'Do I believe in them, or their anxiety?' Let your answer guide you, because you know your young one was built for big, beautiful things. It's in them. Anxiety is part of their move towards brave, not the end of it.
Sometimes we all just need space to talk to someone who will listen without giving advice, or problem solving, or lecturing. Someone who will let us talk, and who can handle our experiences and words and feelings without having to smooth out the wrinkles or tidy the frayed edges. 

Our kids need this too, but as their important adults, it can be hard to hush without needing to fix things, or gather up their experience and bundle it into a learning that will grow them. We do this because we love them, but it can also mean that they choose not to let us in for the wrong reasons. 

We can’t help them if we don’t know what’s happening in their world, and entry will be on their terms - even more as they get older. As they grow, they won’t trust us with the big things if we don’t give them the opportunity to learn that we can handle the little things (which might feel seismic to them). They won’t let us in to their world unless we make it safe for them to.

When my own kids were small, we had a rule that when I picked them up from school they could tell me anything, and when we drove into the driveway, the conversation would be finished if they wanted it to be. They only put this rule into play a few times, but it was enough for them to learn that it was safe to talk about anything, and for me to hear what was happening in that part of their world that happened without me. My gosh though, there were times that the end of the conversation would be jarring and breathtaking and so unfinished for me, but every time they would come back when they were ready and we would finish the chat. As it turned out, I had to trust them as much as I wanted them to trust me. But that’s how parenting is really isn’t it.

Of course there will always be lessons in their experiences we will want to hear straight up, but we also need them to learn that we are safe to come to.  We need them to know that there isn’t anything about them or their life we can’t handle, and when the world feels hard or uncertain, it’s safe here. By building safety, we build our connection and influence. It’s just how it seems to work.♥️
.
#parenting #parenthood #mindfulparenting
Words can be hard sometimes. The right words can be orbital and unconquerable and hard to grab hold of. Feelings though - they’ll always make themselves known, with or without the ‘why’. 

Kids and teens are no different to the rest of us. Their feelings can feel bigger than words - unfathomable and messy and too much to be lassoed into language. If we tap into our own experience, we can sometimes (not all the time) get an idea of what they might need. 

It’s completely understandable that new things or hard things (such as going back to school) might drive thoughts of falls and fails and missteps. When this happens, it’s not so much the hard thing or the new thing that drives avoidance, but thoughts of failing or not being good enough. The more meaningful the ‘thing’ is, the more this is likely to happen. If you can look behind the words, and through to the intention - to avoid failure more than the new or difficult experience, it can be easier to give them what they need. 

Often, ‘I can’t’ means, ‘What if I can’t?’ or, ‘Do you think I can?’, or, ‘Will you still think I’m brave, strong, and capable of I fail?’ They need to know that the outcome won’t make any difference at all to how much you adore them, and how capable and exceptional you think they are. By focusing on process, (the courage to give it a go), we clear the runway so they can feel safer to crawl, then walk, then run, then fly. 

It takes time to reach full flight in anything, but in the meantime the stumbling can make even the strongest of hearts feel vulnerable. The more we focus on process over outcome (their courage to try over the result), and who they are over what they do (their courage, tenacity, curiosity over the outcome), the safer they will feel to try new things or hard things. We know they can do hard things, and the beauty and expansion comes first in the willingness to try. 
.
#parenting #mindfulparenting #positiveparenting #mindfulparent
Never in the history of forever has there been such a  lavish opportunity for a year to be better than the last. Not to be grabby, but you know what I’d love this year? Less opportunities that come in the name of ‘resilience’. I’m ready for joy, or adventure, or connection, or gratitude, or courage - anything else but resilience really. Opportunities for resilience have a place, but 2020 has been relentless with its servings, and it’s time for an out breath. Here’s hoping 2021 will be a year that wraps its loving arms around us. I’m ready for that. x
The holidays are a wonderland of everything that can lead to hyped up, exhausted, cranky, excited, happy kids (and adults). Sometimes they’ll cycle through all of these within ten minutes. Sugar will constantly pry their little mouths wide open and jump inside, routines will laugh at you from a distance, there will be gatherings and parties, and everything will feel a little bit different to usual. And a bit like magic. 

Know that whatever happens, it’s all part of what the holidays are meant to look like. They aren’t meant to be pristine and orderly and exactly as planned. They were never meant to be that. Christmas is about people, your favourite ones, not tasks. If focusing on the people means some of the tasks fall down, let that be okay, because that’s what Christmas is. It’s about you and your people. It’s not about proving your parenting stamina, or that you’ve raised perfectly well-behaved humans, or that your family can polish up like the catalog ones any day of the week, or that you can create restaurant quality meals and decorate the table like you were born doing it. Christmas is messy and ridiculous and exhausting and there will be plenty of frayed edges. And plenty of magic. The magic will happen the way it always happens. Not with the decorations or the trimmings or the food or the polish, but by being with the ones you love, and the ones who love you right back.

When it all starts to feel too important, too necessary and too ‘un-let-go-able’, be guided by the bigger truth, which is that more than anything, you will all remember how you all felt – as in how happy they felt, how loved they felt were, how noticed they felt. They won’t care about the instagram-worthy meals on the table, the cleanliness of the floors, how many relatives they visited, or how impressed other grown-ups were with their clean faces and darling smiles. It’s easy to forget sometimes, that what matters most at Christmas isn’t the tasks, but the people – the ones who would give up pretty much anything just to have the day with you.

Pin It on Pinterest