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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Anxiety will always tilt our focus to the risks, often at the expense of the very real rewards. It does this to keep us safe. We’re more likely to run into trouble if we miss the potential risks than if we miss the potential gains. 

This means that anxiety will swell just as much in reaction to a real life-threat, as it will to the things that might cause heartache (feels awful, but not life-threatening), but which will more likely come with great rewards. Wholehearted living means actively shifting our awareness to what we have to gain by taking a safe risk. 

Sometimes staying safe will be the exactly right thing to do, but sometimes we need to fight for that important or meaningful thing by hushing the noise of anxiety and moving bravely forward. 

When children or teens are on the edge of brave, but anxiety is pushing them back, ask, ‘But what would it be like if you could?’ ♥️

#parenting #parent #mindfulparenting #childanxiety #positiveparenting #heywarrior #heyawesome
Except I don’t do hungry me or tired me or intolerant me, as, you know … intolerably. Most of the time. Sometimes.
Growth doesn’t always announce itself in ways that feel safe or invited. Often, it can leave us exhausted and confused and with dirt in our pores from the fury of the battle. It is this way for all of us, our children too. 

The truth of it all is that we are all born with a profound and immense capacity to rise through challenges, changes and heartache. There is something else we are born with too, and it is the capacity to add softness, strength, and safety for each other when the movement towards growth feels too big. Not always by finding the answer, but by being it - just by being - safe, warm, vulnerable, real. As it turns out, sometimes, this is the richest source of growth for all of us.
When the world feel sunsettled, the ripple can reach the hearts, minds and spirits of kids and teens whether or not they are directly affected. As the important adult in the life of any child or teen, you have a profound capacity to give them what they need to steady their world again.

When their fears are really big, such as the death of a parent, being alone in the world, being separated from people they love, children might put this into something else. 

This can also happen because they can’t always articulate the fear. Emotional ‘experiences’ don’t lay in the brain as words, they lay down as images and sensory experiences. This is why smells and sounds can trigger anxiety, even if they aren’t connected to a scary experience. The ‘experiences’ also don’t need to be theirs. Hearing ‘about’ is enough.

The content of the fear might seem irrational but the feeling will be valid. Think of it as the feeling being the part that needs you. Their anxiety, sadness, anger (which happens to hold down other more vulnerable emotions) needs to be seen, held, contained and soothed, so they can feel safe again - and you have so much power to make that happen. 

‘I can see how worried you are. There are some big things happening in the world at the moment, but my darling, you are safe. I promise. You are so safe.’ 

If they have been through something big, the truth is that they have been through something frightening AND they are safe, ‘We’re going through some big things and it can be confusing and scary. We’ll get through this. It’s okay to feel scared or sad or angry. Whatever you feel is okay, and I’m here and I love you and we are safe. We can get through anything together.’
I love being a parent. I love it with every part of my being and more than I ever thought I could love anything. Honestly though, nothing has brought out my insecurities or vulnerabilities as much. This is so normal. Confusing, and normal. 

However many children we have, and whatever age they are, each child and each new stage will bring something new for us to learn. It will always be this way. Our children will each do life differently, and along the way we will need to adapt and bend ourselves around their path to light their way as best we can. But we won't do this perfectly, because we can't always know what mountains they'll need to climb, or what dragons they'll need to slay. We won't always know what they’ll need, and we won't always be able to give it. We don't need to. But we'll want to. Sometimes we’ll ache because of this and we’ll blame ourselves for not being ‘enough’. Sometimes we won't. This is the vulnerability that comes with parenting. 

We love them so much, and that never changes, but the way we feel about parenting might change a thousand times before breakfast. Parenting is tough. It's worth every second - every second - but it's tough. Great parents can feel everything, and sometimes it can turn from moment to moment - loving, furious, resentful, compassionate, gentle, tough, joyful, selfish, confused and wise - all of it. Great parents can feel all of it.

Because parenting is pure joy, but not always. We are strong, nurturing, selfless, loving, but not always. Parents aren't perfect. Love isn't perfect. And it was meant to be. We’re raising humans - real ones, with feelings, who don't need to be perfect, and wont  need others to be perfect. Humans who can be kind to others, and to themselves first. But they will learn this from us. Parenting is the role which needs us to be our most human, beautifully imperfect, flawed, vulnerable selves. Let's not judge ourselves for our shortcomings and the imperfections, and the necessary human-ness of us.❤️

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