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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We have to change the way we talk about anxiety. If we talk about it as a disorder, this is how it feels.

Yes anxiety can be so crushing, and yes it can intrude into every part of their everyday. But the more we talk about anxiety as a disorder, the more we drive ‘anxiety about the anxiety’. Even for big anxiety, there is nothing to be served in talking about it as a disorder. 

There is another option. We change the face of it - from an intruder or deficiency, to an ally. We change the story - from ‘There’s something wrong with me’ to, ‘I’m doing something hard.’ I’ve seen the difference this makes, over and over.

This doesn’t mean we ignore anxiety. Actually we do the opposite. We acknowledge it. We explain it for what it is: the healthy, powerful response of a magnificent brain that is doing exactly what brains are meant to do - protect us. This is why I wrote Hey Warrior.

What we focus on is what becomes powerful. If we focus on the anxiety, it will big itself up to unbearable.

What we need to do is focus on both sides - the anxiety and the brave. Anxiety, courage, strength - they all exist together. 

Anxiety isn’t the absence of brave, it’s the calling of brave. It’s there because you’re about to do something hard, brave, meaningful - not because there’s something wrong with you.

First, acknowledge the anxiety. Without this validation, anxiety will continue to do its job and prepare the body for fight or flight, and drive big feelings to recruit the safety of another human.

Then, we speak to the brave. We know it’s there, so we usher it into the light:

‘Yes I know this is big. It’s hard [being away from the people you love] isn’t it. And I know you can do this. We can do hard things can’t we.

You are one of the bravest, strongest people I know. Being brave feels scary and hard sometimes doesn’t it. It feels like brave isn’t there, but it’s always there. Always. And you know what else I know? It gets easier every time. I’ve know this because I’ve seen you do hard things, and because I’ve felt like this too, so many times. I know that you and me, even when we feel anxious, we can do brave. It’s always in you. I know that for certain.’♥️
Our job as parents isn’t to remove their distress around boundaries, but to give them the experiences to recognise they can handle boundaries - holding theirs and respecting the boundaries others. 

Every time we hold a boundary, we are giving our kids the precious opportunity to learn how to hold their own.

If we don’t have boundaries, the risk is that our children won’t either. We can talk all we want about the importance of boundaries, but if we don’t show them, how can they learn? Inadvertently, by avoiding boundary collisions with them, we are teaching them to avoid conflict at all costs. 

In practice, this might look like learning to put themselves, their needs, and their feelings away for the sake of peace. Alternatively, they might feel the need to control other people and situations even more. If they haven’t had the experience of surviving a collision of needs or wants, and feeling loved and accepted through that, conflicting needs will feel scary and intolerable.

Similarly, if we hold our boundaries too harshly and meet their boundary collisions with shame, yelling, punishment or harsh consequences, this is how we’re teaching them to respond to disagreement, or diverse needs and wants. We’re teaching them to yell, fight dirty, punish, or overbear those who disagree. 

They might also go the other way. If boundaries are associated with feeling shamed, lonely, ‘bad’, they might instead surrender boundaries and again put themselves away to preserve the relationship and the comfort of others. This is because any boundary they hold might feel too much, too cruel, or too rejecting, so ‘no boundary’ will be the safest option. 

If we want our children to hold their boundaries respectfully and kindly, and with strength, we will have to go first.

It’s easy to think there are only two options. Either:
- We focus on the boundary at the expense of the relationship and staying connected to them.
- We focus on the connection at the expense of the boundary. 

But there is a third option, and that is to do both - at the same time. We hold the boundary, while at the same time we attend to the relationship. We hold the boundary, but with warmth.♥️
Sometimes finding the right words is hard. When their words are angry and out of control, it’s because that’s how they feel. 

Eventually we want to grow them into people who can feel all their feelings and lasso them into words that won’t break people, but this will take time.

In the meantime, they’ll need us to model the words and hold the boundaries firmly and lovingly. This might sound like:

‘It’s okay to be angry, and it’s okay not to like my decision. It’s not okay to speak to me like that. I know you know that. My answer is still no.’

Then, when they’re back to calm, have the conversation: 

‘I wonder if sometimes when you say you don’t like me, what you really mean is that you don’t like what I’ve done. It’s okay to be angry at me. It’s okay to tell me you’re angry at me. It’s not okay to be disrespectful.

What’s important is that you don’t let what someone has done turn you into someone you’re not. You’re such a great kid. You’re fun, funny, kind, honest, respectful. I know you know that yelling mean things isn’t okay. What might be a better way to tell me that you’re angry, or annoyed at what I’ve said?’♥️
We humans feel safest when we know where the edges are. Without boundaries it can feel like walking along the edge of a mountain without guard rails.

Boundaries must come with two things - love and leadership. They shouldn’t feel hollow, and they don’t need to feel like brick walls. They can be held firmly and lovingly.

Boundaries without the ‘loving’ will feel shaming, lonely, harsh. Understandably children will want to shield from this. This ‘shielding’ looks like keeping their messes from us. We drive them into the secretive and the forbidden because we squander precious opportunities to guide them.

Harsh consequences don’t teach them to avoid bad decisions. They teach them to avoid us.

They need both: boundaries, held lovingly.

First, decide on the boundary. Boundaries aren’t about what we want them to do. We can’t control that. Boundaries are about what we’ll do when the rules are broken.

If the rule is, ‘Be respectful’ - they’re in charge of what they do, you’re in charge of the boundary.

Attend to boundaries AND relationship. ‘It’s okay to be angry at me. (Rel’ship) No, I won’t let you speak to me like that. (Boundary). I want to hear what you have to say. (R). I won’t listen while you’re speaking like that. (B). I’m  going to wait until you can speak in a way I can hear. I’m right here. (R).

If the ‘leadership’ part is hard, think about what boundaries meant for you when you were young. If they felt cruel or shaming, it’s understandable that that’s how boundaries feel for you now. You don’t have to do boundaries the way your parents did. Don’t get rid of the boundary. Add in a loving way to hold them.

If the ‘loving’ part is hard, and if their behaviour enrages you, what was it like for you when you had big feelings as a child? If nobody supported you through feelings or behaviour, it’s understandable that their big feelings and behaviour will drive anger in you.

Anger exists as a shield for other more vulnerable feelings. What might your anger be shielding - loneliness? Anxiety? Feeling unseen? See through the behaviour to the need or feeling behind it: This is a great kid who is struggling right now. Reject the behaviour, support the child.♥️

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