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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Today was an ending and a beginning. My darling girl finished year 12. The final year at school is tough enough, but this year was seismic. Our teens have moved through this year with the most outstanding courage and grace and strength, and now it is time for them to rest and play. My gosh they deserve it. 

It is true that this is a time of celebration, but it can also be an intense time of self-reflection for our teens. (I can remember the same feelings when my gorgeous boy finished so many years ago!) My daughter has described it as, ‘I feel as though I’ve outgrown myself but my new self isn’t ready yet.’ This just makes so much sense. 

There is a beautifully fertile void that is waiting for whatever comes next for each of them, but that void is still a void. At different times it might feel exciting, overwhelming, or brutal in its emptiness.

We also have to remember that this is a time of letting go, and there might be grief that comes with that. Before they can grab on to their next big adventure, they have to let go of the guard rails. This means gently adjusting their hold on the world they have known for the last 12+ years, with its places and routines and people that have felt like home on so many days. There will be redirects and shiftings, and through it all the things that need to stay will stay, and the things that need to adjust will adjust. 

To my darling girl, your loved incredible friends, and the teens who make our world what it is - you are the beautiful  thinkers, the big feelers, the creators, the change makers, and the ones who will craft and grow a better world. However you might feel now, the lights are waiting to shine for you and because of you. The world beyond school is opening its arms to you. That opening might happen quickly, or gently, or smoothly or chaotically, but it will happen. This world needs every one of you - your voices, your spirits, your fire, your softness, your strength and your power. You are world-ready, and we are so glad you are here xxx
When our kids or teens are in high emotion, their words might sound anxious, angry, inconsolable, jealous, defiant. As messy as the words might be, they have a good reason for being there. Big feelings surge as a way to influence the environment to meet a need. Of course, sometimes the fallout from this can be nuclear.
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Wherever there is a big emotion, there will always be an important need behind it - safety, comfort, attention, food, rest, connection. The need will always be valid, even if the way they’re going about meeting it is a little rough. As with so many difficult parenting moments, there will be gold in the middle of the mess if we know where to look. 
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There will be times for shaping the behaviour into a healthier response, but in the middle of a big feeling is not one of those times. Big feelings are NOT a sign of dysfunction, bad kids or bad parenting. They are a part of being human, and they bring rich opportunities for wisdom, learning and growth. .
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Parenting isn’t about stopping the emotional storms, but about moving through the storm and reaching the other side in a way that preserves the opportunity for our kids and teens to learn and grow from the experience - and they will always learn best from experience. 
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To calm a big feeling, name what you see, ‘I can see you’re disappointed. I know how much you wanted that’, or, ‘I can see this feels big for you,’ or, ‘You’re angry at me about .. aren’t you. I understand that. I would be mad too if I had to […],’ or ‘It sounds like today has been a really hard day.’ 
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When we connect with the emotion, we help soothe the nervous system. The emotion has done its job, found support, and can start to ease. 
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When they ‘let go’ they’re letting us in on their deepest and most honest emotional selves. We don’t need to change that. What we need to do is meet them where they and gently guide them from there. When they feel seen and understood, their trust in us and their connection to us will deepen, opening the way for our influence.
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When they are at that line, deciding whether to retreat to safety or move forward into brave, there will be a part of them that will know they have what it takes to be brave. It might be pale, or quiet, or a little tumbled by the noise from anxiety, but it will be there. And it will be magical. Our job as their flight crew is to clear the way for this magical part of them to rise. ‘I can see this feels scary for you - and I know you can do this.’ 
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When our kids or teens are struggling, it can be hard to know what they need. It can also be hard for them to say. It can be this way for all of us - we don't always know what we need from the people around us. It might be space, or distraction, or silence, or maybe acknowledging and being there is enough. Sometimes we might need to know that the people we love aren't taking our need for space, or our confusion or anger or sadness personally, and that they are still there within reach.
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What can be easier is thinking about what other people might need. Asking this when they are calm can invite a different perspective and can give you some insight into what they need to hear when they are going through similar. Don't worry if you just get a shrug, or a disheartened, 'I don't know'. They don't need to know, and neither do we. The question in itself might be enough to open a new way through any sense of 'stuckness' or helplessness they might be feeling.
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Give them space to talk but you don’t need to fix anything. You’ll want to, but the answers are in them, not us. Sometimes the answer will be to feel it out, or push for change, or feel the futility of it all so the feeling can let go, knowing it’s done it’s job - it’s recruited support, or raised awareness that something isn’t right.

Sometimes the feelings might be seismic but the words might be gone for a while. That’s okay too. Do they want to start with whatever words are there? Or talk about something else? Or go for a walk with you? Watch a movie with you? Or do a spontaneous, unnecessary drive thru with you just because you can - no words, no need to explain - just you and them and car music for the next 20 minutes. 

The more you can validate what they’re feeling (maybe, ‘Today was big for you wasn’t it’) and give them space to feel, the more they can feel the feeling, understand the need that’s fuelling it, and experiment with ways to deal with it. Sometimes, ‘dealing with it’ might mean acknowledging that there is something that feels big or important and a little out of reach right now, and feeling the fullness and futility of that. 

Part of building resilience is recognising that some days are rubbish, and that sometimes those days last for longer than they should, but we get through. First we feel floored, then we feel stuck, then we shift because the only choices we have we have are to stay down or move, even when moving hurts. Then, eventually we adjust - either ourselves, the problem, or to a new ‘is’. But the learning comes from experience.

I wish our kids never felt pain, but we don’t get to decide that. We don’t get to decide how our children grow, but we do get to decide how much space and support we give them for this growth. We can love them through it but we can’t love them out of it. I wish we could but we can’t.

So instead of feeling the need to silence their pain, make space for it. In the end we have no choice. Sometimes all the love in the world won’t be enough to put the wrong things right, but it can help them feel held while they move through the pain enough to find their out breath, and the strength that comes with that.♥️

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