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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“Karen Young - Hey Sigmund has such a wonderful way with words especially around anxiety. This is her latest beautiful picture book that explains anxiety through the lens of the Polyvagal theory using the metaphor of a house. This shows how sometimes anxiety can be hard to notice. I think this book can help kids and teens better understand stress and anxiety. I loved it! This would be great for homes, schools and in libraries.
Congratulations Karen.💛”
Of course we love them, no matter what - but they need to feel us loving them, no matter what. Especially when they are acting in unlovable ways, or saying unlovable things. Especially then.

This is not ‘rewarding bad behaviour’. To think this assumes that they want to behave badly. They don’t. What they want is to feel calm and safe again, but in that moment they don’t have the skills to do that themselves, so they need us to help them. 

It’s leading with love. It’s showing up, even when it’s hard. The more connected they feel to us, the more capacity we will have to lead them - back to calm, into better choices, towards claiming their space in the world kindly, respectfully, and with strength. 

This is not about dropping the boundary, but about holding it lovingly, ‘I can see you’re doing it tough right now. I’m right here. No, I won’t let you [name the boundary]. I’m right here. You’re not in trouble. We’ll get through this together.’

If you’re not sure what they need, ask them (when they are calm), ‘When you get upset/ angry/ anxious, what could I do that would help you feel loved and cared for in that moment? And this doesn’t mean saying ‘yes’ to a ‘no’ situation. What can I do to make the no easier to handle? What do I do that makes it harder?’♥️
Believe them AND believe in them. 

‘Yes this is hard. I know how much you don’t want to do this. It feels big doesn’t it. And I know you can do big things, even when it feels like you can’t. How can I help?’

They won’t believe in themselves until we show them what they are capable of. For this, we’ll have to believe in their ‘can’ more than they believe in their ‘can’t’.♥️
Sometimes it feels as though how we feel directs what we do, but it also works the other way: What we do will direct how we feel. 

When we avoid, we feel more anxious, and a bigger need to avoid. But when we do brave - and it only needs to be a teeny brave step - we feel brave. The braver we do, the braver we feel, and the braver we do… This is how we build brave - with tiny, tiny uncertain steps. 

So, tell me how you feel. All feelings are okay to be there. Now tell me what you like to do if your brave felt a little bigger. What tiny step can we take towards that. Because that brave is always in you. Always. And when you take the first step, your brave will rise bigger to meet you.♥️
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#anxietyinkids #consciousparenting #parentingtips #gentleparent #parentinglife #mindfulparenting #childanxiety #heywarrior
If anxiety has had extra big teeth lately, I know how brutal this feels. I really do. Think of it as the invitation to strengthen your young ones against anxiety. It’s not the disappearance of brave, or the retreat of brave. It’s the invitation to build their brave.

This is because the strengthening against anxiety happens only with experience. When the experience is in front of you, it can feel like bloodshed. I know that. I really do. But this is when we fight for them and with them - to show them they can do this.

The need to support their avoidance can feel relentless. But as long as they are safe, we don’t need to hold them back. We’ll want to, and they’ll want us to, but we don’t need to. 

Handling the distress of anxiety IS the work. Anxiety isn’t the disruption to building brave, it’s the invitation to build brave. As their important adult who knows they are capable, strong, and brave, you are the one to help them do that.

The amygdala only learns from experience - for better or worse. So the more they avoid, the more the amygdala learns that the thing they are avoiding is ‘unsafe’, and it will continue to drive a big fight (anger, distress) or flight (avoidance) response. 

On the other hand, when they stay with the discomfort of anxiety - and they only need to stay with it for a little longer each time (tiny steps count as big steps with anxiety) - the amygdala learns that it’s okay to move forward. It’s safe enough.

This learning won’t happen quickly or easily though. In fact, it will probably get worse before it gets better. This is part of the process of strengthening them against anxiety, not a disruption to it. 

As long as they are safe, their anxiety and the discomfort of that anxiety won’t hurt them. 
What’s important making sure they don’t feel alone in their distress. We can do this with validation, which shows our emotional availability. 

They also need to feel us holding the boundary, by not supporting their avoidance. This sends the message that we trust their capacity to handle this.

‘I know this feels big, and I know you can do this. What would feel brave right now?’♥️

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