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.

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Anxiety shows up to check that you’re okay, not to tell you that you’re not. It’s your brain’s way of saying, ‘Not sure - there might be some trouble here, but there might not be, but just in case you should be ready for it if it comes, which it might not – but just in case you’d better be ready to run or fight – but it might be totally fine.’ Brains can be so confusing sometimes! 

You have a brain that is strong, healthy and hardworking. It’s magnificent and it’s doing a brilliant job of doing exactly what brains are meant to do – keep you alive. 

Your brain is fabulous, but it needs you to be the boss. Here’s how. When you feel anxious, ask yourself two questions:

- ‘Do I feel like this because I’m in danger or because there’s something brave or important I need to do?’

- Then, ‘Is this a time for me to be safe (sometimes it might be) or is this a time for me to be brave?

And remember, you will always have ‘brave’ in you, and anxiety doesn’t change that a bit.♥️

#positiveparenting #mindfulparenting #parenting #childanxiety #heywarrior #heywarriorbook
The temptation to fix their big feelings can be seismic. Often this is connected to needing to ease our own discomfort at their discomfort, which is so very normal.

Big feelings in them are meant to raise (sometimes big) feelings in us. This is all a healthy part of the attachment system. It happens to mobilise us to respond to their distress, or to protect them if their distress is in response to danger.

Emotion is energy in motion. We don’t want to bury it, stop it, smother it, and we don’t need to fix it. What we need to do is make a safe passage for it to move through them. 

Think of emotion like a river. Our job is to hold the ground strong and steady at the banks so the river can move safely, without bursting the banks.

However hard that river is racing, they need to know we can be with the river (the emotion), be with them, and handle it. This might feel or look like you aren’t doing anything, but actually it’s everything.

The safety that comes from you being the strong, steady presence that can lovingly contain their big feelings will let the emotional energy move through them and bring the brain back to calm.

Eventually, when they have lots of experience of us doing this with them, they will learn to do it for themselves, but that will take time and experience. The experience happens every time you hold them steady through their feelings. 

This doesn’t mean ignoring big behaviour. For them, this can feel too much like bursting through the banks, which won’t feel safe. Sometimes you might need to recall the boundary and let them know where the edges are, while at the same time letting them see that you can handle the big of the feeling. Its about loving and leading all at once. ‘It’s okay to be angry. It’s not okay to use those words at me.’

Ultimately, big feelings are a call for support. Sometimes support looks like breathing and being with. Sometimes it looks like showing them you can hold the boundary, even when they feel like they’re about to burst through it. And if they’re using spicy words to get us to back off, it might look like respecting their need for space but staying in reaching distance, ‘Ok, I’m right here whenever you need.’♥️
We all need certain things to feel safe enough to put ourselves into the world. Kids with anxiety have magic in them, every one of them, but until they have a felt sense of safety, it will often stay hidden.

‘Safety’ isn’t about what is actually safe or not, but about what they feel. At school, they might have the safest, most loving teacher in the safest, most loving school. This doesn’t mean they will feel enough relational safety straight away that will make it easier for them to do hard things. They can still do those hard things, but those things are going to feel bigger for a while. This is where they’ll need us and their other anchor adult to be patient, gentle, and persistent.

Children aren’t meant to feel safe with and take the lead from every adult. It’s not the adult’s role that makes the difference, but their relationship with the child.

Children are no different to us. Just because an adult tells them they’ll be okay, it doesn’t mean they’ll feel it or believe it. What they need is to be given time to actually experience the person as being safe, supportive and ready to catch them.

Relationship is key. The need for safety through relationship isn’t an ‘anxiety thing’. It’s a ‘human thing’. When we feel closer to the people around us, we can rise above the mountains in our way. When we feel someone really caring about us, we’re more likely to open up to their influence
and learn from them.

But we have to be patient. Even for teachers with big hearts and who undertand the importance of attachment relationships, it can take time.

Any adult at school can play an important part in helping a child feel safe – as long as that adult is loving, warm, and willing to do the work to connect with that child. It might be the librarian, the counsellor, the office person, a teacher aide. It doesn’t matter who, as long as it is someone who can be available for that child at dropoff or when feelings get big during the day and do little check-ins along the way.

A teacher, or any important adult can make a lasting difference by asking, ‘How do I build my relationship with this child so s/he trusts me when I say, ‘I’ve got you, and I know you can do this.’♥️
There is a beautiful ‘everythingness’ in all of us. The key to living well is being able to live flexibly and more deliberately between our edges.

So often though, the ‘shoulds’ and ‘should nots’ we inhale in childhood and as we grow, lead us to abandon some of those precious, needed parts of us. ‘Don’t be angry/ selfish/ shy/ rude. She’s not a maths person.’ ‘Don’t argue.’ Ugh.

Let’s make sure our children don’t cancel parts of themselves. They are everything, but not always all at once. They can be anxious and brave. Strong and soft. Angry and calm. Big and small. Generous and self-ish. Some things they will find hard, and they can do hard things. None of these are wrong ways to be. What trips us up is rigidity, and only ever responding from one side of who we can be.

We all have extremes or parts we favour. This is what makes up the beautiful, complex, individuality of us. We don’t need to change this, but the more we can open our children to the possibility in them, the more options they will have in responding to challenges, the everyday, people, and the world. 

We can do this by validating their ‘is’ without needing them to be different for a while in the moment, and also speaking to the other parts of them when we can. 

‘Yes maths is hard, and I know you can do hard things. How can I help?’

‘I can see how anxious you feel. That’s so okay. I also know you have brave in you.’

‘I love your ‘big’ and the way you make us laugh. You light up the room.’ And then at other times: ‘It can be hard being in a room with new people can’t it. It’s okay to be quiet. I could see you taking it all in.’

‘It’s okay to want space from people. Sometimes you just want your things and yourself for yourself, hey. I feel like that sometimes too. I love the way you know when you need this.’ And then at other times, ‘You looked like you loved being with your friends today. I loved watching you share.’

The are everything, but not all at once. Our job is to help them live flexibly and more deliberately between the full range of who they are and who they can be: anxious/brave; kind/self-ish; focussed inward/outward; angry/calm. This will take time, and there is no hurry.♥️

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