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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‘Brave’ doesn’t always feel like certain, or strong, or ready. In fact, it rarely does. That what makes it brave.♥️
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#parenting #mindfulparenting #parentingtips
We teach our kids to respect adults and other children, and they should – respect is an important part of growing up to be a pretty great human. There’s something else though that’s even more important – teaching them to respect themselves first. 

We can’t stop difficult people coming into their lives. They might be teachers, coaches, peers, and eventually, colleagues, or perhaps people connected to the people who love them. What we can do though is give our kids independence of mind and permission to recognise that person and their behaviour as unacceptable to them. We can teach our kids that being kind and respectful doesn’t necessarily mean accepting someone’s behaviour, beliefs or influence. 

The kindness and respect we teach our children to show to others should never be used against them by those broken others who might do harm. We have to recognise as adults that the words and attitudes directed to our children can be just as damaging as anything physical. 

If the behaviour is from an adult, it’s up to us to guard our child’s safe space in the world even harder. That might be by withdrawing support for the adult, using our own voice with the adult to elevate our child’s, asking our child what they need and how we can help, helping them find their voice, withdrawing them from the environment. 

Of course there will be times our children do or say things that aren’t okay, but this never makes it okay for any adult in your child’s life to treat them in a way that leads them to feeling ‘less than’.

Sometimes the difficult person will be a peer. There is no ‘one certain way’ to deal with this. Sometimes it will involve mediation, role playing responses, clarifying the other child’s behaviour, asking for support from other adults in the environment, or letting go of the friendship.

Learning that it’s okay to let go of relationships is such an important part of full living. Too often we hold on to people who don’t deserve us. Not everyone who comes into our lives is meant to stay and if we can help our children start to think about this when they’re young, they’ll be so much more empowered and deliberate in their relationships when they’re older.♥️
When we are angry, there will always be another emotion underneath it. It is this way for all of us. 

Anger itself is a valid emotion so it’s important not to dismiss it. Emotion is e-motion - energy in motion. It has to find a way out, which is why telling an angry child to calm down or to keep their bodies still will only make things worse for them. They might comply, but their bodies will still be in a state of distress. 

Often, beneath an angry child is an anxious one needing our help. It’s the ‘fight’ part of the fight or flight response. As with all emotions, anger has a job to do - to help us to safety through movement, or to recruit support, or to give us the physical resources to meet a need or to change something that needs changing. It doesn’t mean it does the job well, because an angry brain means the feeling brain has the baton, while the thinking brain sits out for a while. What it means is that there is a valid need there and this young person is doing their very best to meet it, given their available resources in the moment or their developmental stage. 

Children need the same thing we all need when we’re feeling fierce - to be seen,  heard, and supported; to find a way to get the energy out, either with words or movement. Not to be shut down or ‘fixed’. 

Our job isn’t to stop their anger, but to help them find ways to feel it and express it in ways that don’t do damage. This will take lots of experience, and lots of time - and that’s okay.♥️
The SCCR Online Conference 2021 is a wonderful initiative by @sccrcentre (Scottish Centre for Conflict Resolution) which will explore ’The Power of Reconnection’. I’ve been working with SCCR for many years. They do incredible work to build relationships between young people and the important adults around them, and I’m excited to be working with them again as part of this conference.

More than ever, relationships matter. They heal, provide a buffer against stress, and make the world feel a little softer and safer for our young people. Building meaningful connections can take time, and even the strongest relationships can feel the effects of disconnection from time to time. As part of this free webinar, I’ll be talking about the power of attachment relationships, and ways to build relationships with the children and teens in your life that protect, strengthen, and heal. 

The workshop will be on Monday 11 October at 7pm Brisbane, Australia time (10am Scotland time). The link to register is in my story.
There are many things that can send a nervous system into distress. These can include physiological (tired, hungry, unwell), sensory overload/ underload, real or perceived threat (anxiety), stressed resources (having to share, pay attention, learn new things, putting a lid on what they really think or want - the things that can send any of us to the end of ourselves).

Most of the time it’s developmental - the grown up brain is being built and still has a way to go. Like all beautiful, strong, important things, brains take time to build. The part of the brain that has a heavy hand in regulation launches into its big developmental window when kids are about 6 years old. It won’t be fully done developing until mid-late 20s. This is a great thing - it means we have a wide window of influence, and there is no hurry.

Like any building work, on the way to completion things will get messy sometimes - and that’s okay. It’s not a reflection of your young one and it’s not a reflection of your parenting. It’s a reflection of a brain in the midst of a build. It’s wondrous and fascinating and frustrating and maddening - it’s all the things.

The messy times are part of their development, not glitches in it. They are how it’s meant to be. They are important opportunities for us to influence their growth. It’s just how it happens. We have to be careful not to judge our children or ourselves because of these messy times, or let the judgement of others fill the space where love, curiosity, and gentle guidance should be. For sure, some days this will be easy, and some days it will feel harder - like splitting an atom with an axe kind of hard.

Their growth will always be best nurtured in the calm, loving space beside us. It won’t happen through punishment, ever. Consequences have a place if they make sense and are delivered in a way that doesn’t shame or separate them from us, either physically or emotionally. The best ‘consequence’ is the conversation with you in a space that is held by your warm loving strong presence, in a way that makes it safe for both of you to be curious, explore options, and understand what happened.♥️
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