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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For way too long, there’s been an idea that discipline has to make kids feel bad if it’s going to steer them away from bad choices. But my gosh we’ve been so wrong. 

The idea is a hangover from behaviourism, which built its ideas on studies done with animals. When they made animals scared of something, the animal stopped being drawn to that thing. It’s where the idea of punishment comes from - if we punish kids, they’ll feel scared or bad, and they’ll stop doing that thing. Sounds reasonable - except children aren’t animals. 

The big difference is that children have a frontal cortex (thinking brain) which animals and other mammals don’t have. 

All mammals have a feeling brain so they, like us, feel sad, scared, happy - but unlike us, they don’t feel shame. The reason animals stop doing things that make them feel bad is because on a primitive, instinctive level, that thing becomes associated with pain - so they stay away. There’s no deliberate decision making there. It’s raw instinct. 

With a thinking brain though, comes incredibly sophisticated capacities for complex emotions (shame), thinking about the past (learning, regret, guilt), the future (planning, anxiety), and developing theories about why things happen. When children are shamed, their theories can too easily build around ‘I get into trouble because I’m bad.’ 

Children don’t need to feel bad to do better. They do better when they know better, and when they feel calm and safe enough in their bodies to access their thinking brain. 

For this, they need our influence, but we won’t have that if they are in deep shame. Shame drives an internal collapse - a withdrawal from themselves, the world and us. For sure it might look like compliance, which is why the heady seduction with its powers - but we lose influence. We can’t teach them ways to do better when they are thinking the thing that has to change is who they are. They can change what they do - they can’t change who they are. 

Teaching (‘What can you do differently next time?’ ‘How can you put this right?’) and modelling rather than punishing or shaming, is the best way to grow beautiful little humans into beautiful big ones.

#parenting
Sometimes needs will come into being like falling stars - gently fading in and fading out. Sometimes they will happen like meteors - crashing through the air with force and fury. But they won’t always look like needs. Often they will look like big, unreachable, unfathomable behaviour. 

If needs and feelings are too big for words, they will speak through behaviour. Behaviour is the language of needs and feelings, and it is always a call for us to come closer. Big feelings happen as a way to recruit support to help carry an emotional load that feels too big for our kids and teens. We can help with this load by being a strong, calm, loving presence, and making space for that feeling or need to be ‘heard’. 

When big behaviour or big feelings are happening, whenever you can be curious about the need behind it. There will always be a valid one. Meet them where they without needing them to be different. Breathe, validate, and be with, and you don’t need to do more than that. 

Part of building resilience is recognising that some days and some things are rubbish, and that sometimes those days and things last for longer than they should, but we get through. First we feel floored, then we feel stuck, then we shift because the only choices we have we have are to stay down or move, even when moving hurts. Then, eventually we adjust - either ourselves, the problem, or to a new ‘is’. 

But the learning comes from experience. They can’t learn to manage big feelings unless they have big feelings. They can’t learn to read the needs behind their feelings if they don’t have the space to let those big feelings come back to small enough so the needs behind them can step forward. 

When their world has spikes, and when we give them a soft space to ‘be’, we ventilate their world. We help them find room for their out breath, and for influence, and for their wisdom to grow from their experiences and ours. In the end we have no choice. They will always be stronger and bigger and wiser and braver when they are with you, than when they are without. It’s just how it is.♥️
When kids or teens have big feelings, what they need more than anything is our strong, safe, loving presence. In those moments, it’s less about what we do in response to those big feelings, and more about who we are. Think of this like providing a shelter and gentle guidance for their distressed nervous system to help it find its way home, back to calm. 

Big feelings are the way the brain calls for support. It’s as though it’s saying, ‘This emotional load is too big for me to carry on my own. Can you help me carry it?’ 

Every time we meet them where they are, with a calm loving presence, we help those big feelings back to small enough. We help them carry the emotional load and build the emotional (neural) muscle for them to eventually be able to do it on their own. We strengthen the neural pathways between big feelings and calm, over and over, until that pathway is so clear and so strong, they can walk it on their own. 

Big beautiful neural pathways will let them do big, beautiful things - courage, resilience, independence, self regulation. Those pathways are only built through experience, so before children and teens can do any of this on their own, they’ll have to walk the pathway plenty of times with a strong, calm loving adult. Self-regulation only comes from many experiences of co-regulation. 

When they are calm and connected to us, then we can have the conversations that are growthful for them - ‘Can you help me understand what happened?’ ‘What can help you so this differently next time?’ ‘How can you put things right? Do you need my help to do that?’ We grow them by ‘doing with’ them♥️
Big feelings, and the big behaviour that comes from big feelings, are a sign of a distressed nervous system. Think of this like a burning building. The behaviour is the smoke. The fire is a distressed nervous system. It’s so tempting to respond directly to the behaviour (the smoke), but by doing this, we ignore the fire. Their behaviour and feelings in that moment are a call for support - for us to help that distressed brain and body find the way home. 

The most powerful language for any nervous system is another nervous system. They will catch our distress (as we will catch theirs) but they will also catch our calm. It can be tempting to move them to independence on this too quickly, but it just doesn’t work this way. Children can only learn to self-regulate with lots (and lots and lots) of experience co-regulating. 

This isn’t something that can be taught. It’s something that has to be experienced over and over. It’s like so many things - driving a car, playing the piano - we can talk all we want about ‘how’ but it’s not until we ‘do’ over and over that we get better at it. 

Self-regulation works the same way. It’s not until children have repeated experiences with an adult bringing them back to calm, that they develop the neural pathways to come back to calm on their own. 

An important part of this is making sure we are guiding that nervous system with tender, gentle hands and a steady heart. This is where our own self-regulation becomes important. Our nervous systems speak to each other every moment of every day. When our children or teens are distressed, we will start to feel that distress. It becomes a loop. We feel what they feel, they feel what we feel. Our own capacity to self-regulate is the circuit breaker. 

This can be so tough, but it can happen in microbreaks. A few strong steady breaths can calm our own nervous system, which we can then use to calm theirs. Breathe, and be with. It’s that simple, but so tough to do some days. When they come back to calm, then have those transformational chats - What happened? What can make it easier next time?

Who you are in the moment will always be more important than what you do.
How we are with them, when they are their everyday selves and when they aren’t so adorable, will build their view of three things: the world, its people, and themselves. This will then inform how they respond to the world and how they build their very important space in it. 

Will it be a loving, warm, open-hearted space with lots of doors for them to throw open to the people and experiences that are right for them? Or will it be a space with solid, too high walls that close out too many of the people and experiences that would nourish them.

They will learn from what we do with them and to them, for better or worse. We don’t teach them that the world is safe for them to reach into - we show them. We don’t teach them to be kind, respectful, and compassionate. We show them. We don’t teach them that they matter, and that other people matter, and that their voices and their opinions matter. We show them. We don’t teach them that they are little joy mongers who light up the world. We show them. 

But we have to be radically kind with ourselves too. None of this is about perfection. Parenting is hard, and days will be hard, and on too many of those days we’ll be hard too. That’s okay. We’ll say things we shouldn’t say and do things we shouldn’t do. We’re human too. Let’s not put pressure on our kiddos to be perfect by pretending that we are. As long as we repair the ruptures as soon as we can, and bathe them in love and the warmth of us as much as we can, they will be okay.

This also isn’t about not having boundaries. We need to be the guardians of their world and show them where the edges are. But in the guarding of those boundaries we can be strong and loving, strong and gentle. We can love them, and redirect their behaviour.

It’s when we own our stuff(ups) and when we let them see us fall and rise with strength, integrity, and compassion, and when we hold them gently through the mess of it all, that they learn about humility, and vulnerability, and the importance of holding bruised hearts with tender hands. It’s not about perfection, it’s about consistency, and honesty, and the way we respond to them the most.♥️

#parenting #mindfulparenting

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