BeepNo evidence ADHD is being over-diagnosed, say experts
yucanduMy cousin was diagnosed by a brain scan. She signed up to be part of a clinical trial for something else, got kicked out of the trial because her fMRI showed she had ADHD.
So if we can literally scan someone’s brain and diagnose them from a picture instead of all these vague “describe your symptom” guessing… why don’t we?
It’s quite costly to run an fMRI. Not needed if you can get the same results more or less from a questionnaire.
ickplantIn my professional experience, it can be hard to tell between ADHD symptoms and CPTSD symptoms. The checklist is not a great way to diagnose people. We usually do a lot more assessments, I also use a computerized test to measure reaction time and error commission.
I wish we (therapists) at least had the option to order an MRI or recommend a doctor orders one in difficult cases (I can do the latter but they will just laugh at me).
Ya, it could be better. Maybe a compromise would be to go with EEG machines which are less costly and can probably still differentiate fairly well (maybe).
Wait, is there an actual chance to “see” ADHD in an MRI image? I was under the impression that we can’t do that (yet) and the only way to diagnose was through questionnaires, attention testing and such. That’s what I was told by the doctor who ultimately diagnosed me two years ago
Like @[email protected] said, it would need to be an fMRI, which is primarily used in research as far as I know. And while it alone could not tell you definitively “this person has ADHD,” it could help rule out other conditions (like TBI, which can also present similar to ADHD). Ultimately, your doctor is right that a standard MRI cannot diagnose it.
I like to combine the checklist with interviews (like DIVA, Diagnostic Interview for ADHD in Adults) and computerized continuous performance tests, like QBTest. Of course, there is also a lot of observation and sometimes even asking humorous questions, like “Do you have The Chair^TM^ at home?”
The Chair^TM^
Yes except the chair is the floor 😭
Thank you very much for the insight! I have had The Chair for as long as I can remember :)
Do you know if there any studies on whether the effects of the medicine used for ADHD could have similar positive effects on people with CPTSD?
Great question! To my knowledge, they are just starting to look into it, but with PTSD specifically, not CPTSD. There is this case study (n=1) and this pilot study (n=32) that show promise. They are recruiting people for more testing.
Preliminary evidence shows that it does help - and it makes sense. If cognitive deficits from PTSD are a result of an impaired executive function, then stimulants would help with those particular symptoms, much like in ADHD.
Here’s the thing though - the US healthcare system still doesn’t even have CPTSD as a diagnosis, so there is not too much research happening on the topic here. Considering how ADHD (especially in women) is also very understudied, there are so many variables we just don’t know or understand.
If you are interested in novel treatments of PTSD, I also recommend looking into blue light therapy. There is some promising results showing a reduction in symptom severity within 6 weeks of daily 30-min blue light exposure in the morning. Here is a systematic review that looks at 4 studies.
A new player in the field: Methylphenidate in post-traumatic stress disorder treatment
Currently available psychotherapies and psychotropic drugs for post-traumatic stress disorder (PTSD) are poorly effective in a substantial proportion of patients. Dopaminergic dysfunction plays a prominent role in the pathophysiology of PTSD: ...
I wish we (therapists) at least had the option to order an MRI or recommend a doctor orders one in difficult cases (I can do the latter but they will just laugh at me).
God, that’s awful. The most common sense thing to do there is is to use what’s availiable (fMRI) when it is, and if availability is the problem, fill the gaps with questionnaires - those who you’re sure about might not need an fMRI, but others might. Which you, as a person who’s supposed to sign off on the diagnosis, should be able to order.
I prefer objective, unqestionable evidence, since I tend to self-sabotage I guess.
It’s also worth noting that ADHD, as a condition, is mostly a Gordian knot of maladaptations. Built up over childhood (and beyond). While there are a lot of commonalities, you need to do a detailed investigation to pick out what bits are a problem to the individual.
If you’re going to go through that process, then you might as well not tie up an MRI machine for no reason.
Drugs can treat the base problem, but don’t work well without the follow-up care to repair the behavioural damage.
Ricky RigatoniAn mri would kill me because my diet includes a tablespoon of 2mm iron pellets daily.
Is this for your shotgun arm
You can’t get diagnosed with an fmri alone. It’s just one sign, a weak one, so you’d need the professional doing questionnaires anyways. They are way cheaper and faster (in terms of waiting times) than fmris too. Might as well skip it.