Posts Tagged ‘ diagnosis ’

2013 and … ADHD

Wednesday, December 18th, 2013

Is ADHD underdiagnosed? Overdiagnosed? Overtreated? Undertreated?

These questions continue to get debated in 2013 with no resolution. On the one hand, we see statistics indicating how the rate of ADHD is going up – although many times these studies do not perform gold standard diagnoses of kids but rather report how many kids have been given a diagnosis. Yet talk to many practitioners and they will have stories of kids who clearly show evidence of ADHD yet do not receive a diagnosis.

How do we make sense of all this? One lens to apply is a simple one: we need to know how kids are getting diagnosed. I have contented that we have an ADHD paradox in this country – many kids get the label (and a pill) when they probably wouldn’t be diagnosed if they went through a comprehensive evaluation, yet many kids with ADHD are not properly diagnosed and treated (including behavioral and psychosocial interventions) because they don’t get a comprehensive evaluation. The common denominator here is a lack of a comprehensive evaluation. Ideally this is done by an experienced team that can apply a multidisciplinary perspective to fully examine cognitive, neuropsychological, behavioral, educational, and emotional functioning – and then offer an evidence-based plan of action.

That’s what is lacking. But it takes funding, insurance coverage, and a national commitment to mental health research and treatment.

ADHD Diagnosis via Shutterstock.com

 

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2013 and … Autism

Wednesday, December 18th, 2013

Two themes stand out when I reflect on autism research in 2013.

First, there was substantial debate about how we diagnose autism, primarily spurred by changes introduced in DSM-5 (which was published in May). The reformulation of the diagnostic criteria – which led to a discontinuation of the category of Asperger Syndrome in favor of a broad-based category of Autism Spectrum Disorder (ASD) – spurred concerns that many youth would no longer qualify for a diagnosis and hence have their intervention options limited. Others suggested that more precise diagnostic criteria are needed to ensure that ASD does not get overdiagnosed. While we await empirical resolution via publication of well-designed studies, it’s clear that the DSM-5 debate will stand out as an important time in which we wrestled (again) with the best way to be inclusive in diagnosis without expanding diagnostic criteria too broadly.

Second, we are seeing more research on the early diagnosis of ASD, or at least detection of early warning signs, using methods like tracking eye movements of babies when looking at a human face. While this line of work will need to continue to refine the validity and feasibility of the approach – particularly when studying infants – it is an intriguing approach that may eventually have important implications for delivering interventions in the first year of life. Given the proven utility of early intervention, the hope is that the earliest interventions may hold the most promise for promoting development.

Wherever these research directions take us, we know for sure that early detection and intervention is essential. That’s one message that has not changed in 2013.

AUTISM via Shutterstock.com

Early Signs of Autism
Early Signs of Autism
Early Signs of Autism

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Movement And Autism: Why The Link?

Tuesday, July 30th, 2013

Researchers are developing methods to analyze movement patterns in children with autism spectrum disorder (ASD), with the hope that these may be invaluable tools for aiding the diagnostic process and eventually designing interventions. While movement difficulties have long been recognized to be part of ASD, these newer approaches are embracing the idea that movement is a core process via which infants develop their way of interacting with the world – one that it is critically linked with the development of a number of brain areas that underlie social and cognitive development

Consider the ways in which babies use movement to learn about the world. Think about how a baby pulls themselves up, starts to crawl, and learns to walk – from the perspective of how these movement-based actions allow them to explore their world. Think about how they use their hands to experience and manipulate their physical and social environment. These processes have been appreciated by developmentalists for a very long time. But what’s new is understanding how important movement is for establishing brain development. Recent advances in neuroimaging are showing, for example, how  the cerebellum is not just specialized for movement – it also has subsections involved in processing cognitive and emotional stimuli. Movement isn’t just about movement – it’s a fundamental vessel for integrating information out in the world and then translating that information into action.

We will continue to see more and more evidence for movement-brain-cognition links in the future. But the bottom line is that encouraging movement as a way of exploring the physical and social world in infancy and toddlerhood is a very good thing for the brain. And it may turn out that it will also be one avenue to help improve both diagnostics and generate potential interventions early in life for children with ASD.

Baby Crawling With Determined Look via Shutterstock.com

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Can ADHD Be Diagnosed With Brain Waves?

Monday, July 29th, 2013

The FDA recently approved a technique for evaluating brain waves (using electrical recordings or EEG) that may be used to help diagnose ADHD. Does this mean we are moving closer to a more “objective” biological approach to diagnosis? 

Maybe. Maybe not.

It’s clear that ADHD has a biological component. There’s certainly evidence that we can see differences in brain functioning in kids with ADHD when compared to kids without ADHD. But that’s where the fuzziness comes in.

Complex disorders like ADHD don’t easily yield to “either/or” diagnostic approaches. ADHD symptoms are varied, change with age, and are heavily influenced by environmental context. If you were to evaluate a large group of children, using the symptoms of ADHD, you wouldn’t get two clear-cut groups (one with ADHD, one without ADHD). You’d see a range of symptoms, with some kids having many, some having none, and many having some.

It makes sense to try to cut through this “noise” using biological technology. But it is unrealistic to think that it will provide a magical approach to diagnosis. Skilled clinicians will still need to collect all the information they now collect, and use their judgments to decide if intervention is required. Evaluating brain waves may add some good information to this diagnostic process, but it is unlikely that it will become the gold standard for diagnosing ADHD. ADHD is just too complex of a developmental construct to reduce it only to brain activity.

So while this approach is certainly worth pursuing, it’s wise to not promise – or expect – too much from it in the near (or far) future.

EEG via Shutterstock.com

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ADHD: 2012 In A Snapshot

Sunday, December 30th, 2012

Two themes stand out for me this year with respect to research on ADHD: 

Diagnosis: We continued to observe a potential paradox – ADHD may be overdiagnosed, yet many kids do not receive proper diagnosis and care. Here’s why. The overdiagnosis aspect comes about because kids are given a label of ADHD without going through a rigorous interdisciplinary evaluation. And that’s where some kids slip through the cracks – some kids with severe symptoms do not get evaluated properly and struggle for years without appropriate intervention. So even though studies suggest that the rate of ADHD is very high (like some of the data reported by the Centers for Disease Control and Prevention), that does not translate into saying that all kids who may suffer from high levels of severity and impairment are getting the clinical services they need.

Treatment: The debate about using medications to treat ADHD got more extreme this year. A controversial opinion piece by a leading developmental researcher essentially negated the role of biology as a root cause of ADHD. On the other side of the issue, there were suggestions that kids as young as 4 years of age should start receiving medications to control their symptoms – and there were reports that in some (economically disadvantaged) areas of the country doctors are giving kids ADHD medication (without assessment and diagnosis) to try to improve their behavior and performance in school. Lost in the debate is the very real need for behavioral treatments that focus on parental strategies to help kids with ADHD function better both at home and in school. My viewpoint on all this continues to be that behavioral approaches should be tried first and should always be in place – and that once those effects are established clinicians and parents can have a more meaningful dialogue about the possible additional advantages of medication.

Time For Review via Shutterstock.com

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