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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The more we treat anxiety as a problem, or as something to be avoided, the more we inadvertently turn them away from the safe, growthful, brave things that drive it. 

On the other hand, when we make space for anxiety, let it in, welcome it, be with it, the more we make way for them to recognise that anxiety isn’t something they need to avoid. They can feel anxious and do brave. 

As long as they are safe, let them know this. Let them see you believing them that this feels big, and believing in them, that they can handle the big. 

‘Yes this feels scary. Of course it does - you’re doing something important/ new/ hard. I know you can do this. How can I help you feel brave?’♥️
I’ve loved working with @sccrcentre over the last 10 years. They do profoundly important work with families - keeping connections, reducing clinflict, building relationships - and they do it so incredibly well. @sccrcentre thank you for everything you do, and for letting me be a part of it. I love what you do and what you stand for. Your work over the last decade has been life-changing for so many. I know the next decade will be even more so.♥️

In their words …
Posted @withregram • @sccrcentre Over the next fortnight, as we prepare to mark our 10th anniversary (28 March), we want to re-share the great partners we’ve worked with over the past decade. We start today with Karen Young of Hey Sigmund.

Back in 2021, when we were still struggling with covid and lockdowns, Karen spoke as part of our online conference on ‘Strengthening the relationship between you & your teen’. It was a great talk and I’m delighted that you can still listen to it via the link in the bio.

Karen also blogged about our work for the Hey Sigmund website in 2018. ‘How to Strengthen Your Relationship With Your Children and Teens by Understanding Their Unique Brain Chemistry (by SCCR)’, which is still available to read - see link in bio.

#conflictresolution #conflict #families #family #mediation #earlyintervention #decade #anniversary #digital #scotland #scottish #cyrenians #psychology #relationships #children #teens #brain #brainchemistry #neuroscience
I often go into schools to talk to kids and teens about anxiety and big feelings. 

I always ask, ‘Who’s tried breathing through big feels and thinks it’s a load of rubbish?’ Most of them put their hand up. I put my hand up too, ‘Me too,’ I tell them, ‘I used to think the same as you. But now I know why it didn’t work, and what I needed to do to give me this powerful tool (and it’s so powerful!) that can calm anxiety, anger - all big feelings.’

The thing is though, all powertools need a little instruction and practice to use them well. Breathing is no different. Even though we’ve been breathing since we were born, we haven’t been strong breathing through big feelings. 

When the ‘feeling brain’ is upset, it drives short shallow breathing. This is instinctive. In the same ways we have to teach our bodies how to walk, ride a bike, talk, we also have to teach our brains how to breathe during big feelings. We do this by practising slow, strong breathing when we’re calm. 

We also have to make the ‘why’ clear. I talk about the ‘why’ for strong breathing in Hey Warrior, Dear You Love From Your Brain, and Ups and Downs. Our kids are hungry for the science, and they deserve the information that will make this all make sense. Breathing is like a lullaby for the amygdala - but only when it’s practised lots during calm.♥️
When it’s time to do brave, we can’t always be beside them, and we don’t need to be. What we can do is see them and help them feel us holding on, even in absence, while we also believe in their brave.♥️
Honestly isn’t this the way it is for all of us though?♥️

#childanxiety #parenting #separationanxiety

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