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Chil­dren with the inat­ten­tive type of ADHD (ADHD-I) show high rates of atten­tion dif­fi­cul­ties with­out the hyper­ac­tive and impul­sive behav­ior shown by chil­dren with ADHD Com­bined Type (ADHD-C). The inat­ten­tive type of ADHD is quite com­mon and is asso­ci­at­ed with sig­nif­i­cant impair­ment with school work, plan­ning and orga­ni­za­tion­al skills, pro­cess­ing speed, and peer rela­tions. Even so, chil­dren with ADHD-I tend to be iden­ti­fied lat­er than Read the rest of this entry »

Is ADHD over­diag­nosed? Despite wide­spread con­cerns that this occurs, a study that specif­i­cal­ly address­es this issue has not been con­duct­ed in the US. Thus, although it is well estab­lished that many chil­dren with ADHD are nev­er iden­ti­fied or treat­ed, the extent to which chil­dren are incor­rect­ly diag­nosed with ADHD is not known. Read the rest of this entry »

The new Diag­nos­tic and Sta­tis­ti­cal Man­u­al of Men­tal Dis­or­ders (DSM-5) is sched­uled to be released in May 2013. This recent Dana Foun­da­tion arti­cle points out the need of a fun­da­men­tal­ly dif­fer­ent approach based on the new ways researchers use to study and under­stand men­tal ill­ness.

The prob­lem with the DSM-IV, our cur­rent shared diag­nos­tic lan­guage, is that a large and grow­ing body of evi­dence demon­strates that it does a poor job of cap­tur­ing either clin­i­cal and bio­log­i­cal real­i­ties. In the clin­ic, the lim­i­ta­tions of the cur­rent DSM-IV approach can be illus­trat­ed in three salient areas: (1) the prob­lem of comor­bid­i­ty, (2) the wide­spread need for “not oth­er­wise spe­cif­ic (NOS)” diag­noses, and (3) the arbi­trari­ness of diag­nos­tic thresh­olds.

What­ev­er the ulti­mate approach to the DSM-5, it is crit­i­cal that the sci­en­tif­ic com­mu­ni­ty escape the arti­fi­cial diag­nos­tic silos that con­trol so much research, ulti­mate­ly to our detri­ment.

Key ques­tions: How can we give the research com­mu­ni­ty not only per­mis­sion but also encour­age­ment to rethink the clas­si­fi­ca­tion of psy­chopathol­o­gy? How can we encour­age sci­en­tif­ic inno­va­tion while ensur­ing that clin­i­cians can still com­mu­ni­cate with patients and families—and also with insur­ance com­pa­nies, schools, and courts?

Like all psy­chi­atric dis­or­ders, ADHD is diag­nosed based on the pres­ence of par­tic­u­lar behav­ioral symp­toms that are judged to cause sig­nif­i­cant impair­ment in an individual’s func­tion­ing, and not on the results of a spe­cif­ic test. In fact, recent­ly pub­lished ADHD eval­u­a­tion guide­lines from the Amer­i­can Acad­e­my of Pedi­atrics (AAP) explic­it­ly state that no par­tic­u­lar diag­nos­tic test should be rou­tine­ly used when eval­u­at­ing a child for ADHD.

While most ADHD experts would agree that no sin­gle test could or should be used in iso­la­tion to diag­nose ADHD, there are sev­er­al impor­tant rea­sons why the avail­abil­i­ty of an accu­rate objec­tive test would be use­ful.

First, many chil­dren do not receive a care­ful and com­pre­hen­sive assess­ment for ADHD but are instead diag­nosed with based on eval­u­a­tion pro­ce­dures that are far from opti­mal.

Sec­ond, although AAP guide­lines indi­cate that spe­cif­ic diag­nos­tic tests should not be rou­tine­ly used, many par­ents are con­cerned about the lack of objec­tive pro­ce­dures in their child’s eval­u­a­tion. In fact, many fam­i­lies do not pur­sue treat­ment for ADHD because the the absence of objec­tive eval­u­a­tion pro­ce­dures leads them to ques­tion the diag­no­sis. You can read a review of an inter­est­ing study on this issue at www.helpforadd.com/2006/january.htm

For these rea­sons an accu­rate and objec­tive diag­nos­tic test for ADHD could be of val­ue in many clin­i­cal sit­u­a­tions. Two impor­tant con­di­tions would have to be met for such a test to be use­ful.

First, it would have to be high­ly sen­si­tive to Read the rest of this entry »