Post by Amtram on Jul 21, 2014 9:46:41 GMT -5
In my newsfeed this morning: Cutting edge ADHD test arrives in Central Texas
Well, it's new to them. In 2010, the New York Times reported it
Time wrote about it in 2011.
Now, all of this sounds mighty promising - and, indeed, components of this are used in a neuropsych workup - but does it work? I couldn't find insurance companies that cover it. Aetna classifies it thusly - "Aetna considers the following experimental and investigational for the assessment and treatment of ADHD because the peer-reviewed medical literature does not support the use of these procedures/services for this indication." (Of course, insurance companies cover some other dubious treatments, so this isn't a yardstick for evidence. But if you have to pay out of pocket, it's not as useful as a covered evaluation.) As well, Dr. Teicher has an impressive CV and 12 publications on ADHD, so he's clearly better informed about it than your average internet commenter (I posted this yesterday.)
Yes, it's been approved by the FDA, but reactions are mixed.
In fact, I wasn't able to find mention of it at all on the APA or NIMH websites, which isn't promising. So I'm wondering if the claims are just hype - like Amen's SPECT imaging (total hype) or NEBA system (not adequate for a complex condition.) Does it live up to its promises? From what I'm reading, it may be a foot in the door, but an accurate diagnosis still has to be done the old-fashioned way.
AUSTIN (KXAN) — More Americans than ever are being diagnosed with Attention Deficit Hyperactivity Disorder, also known as ADHD. A new test is helping Central Texas doctors provide an accurate diagnosis.
9% of people under age 18 and 4% of adults have it. Medications can offer dramatic improvement.
Instead of the standard questionnaires asking about your function, behavior and sleep patterns, a new cutting edge computer diagnostic tool has arrived in Central Texas.
Scott & White’s Cedar Park West Clinic began using it three months ago. Doctors say the results have been remarkable.
Designed for patients ages six to 55, the Quotient Test measures your attentive acuity and head movement, which can be an indicator of difficulty focusing. The test has a 94% accuracy rate for ruling out the disorder.
The test for adolescents lasts 15 minutes. The adult test runs 20. With a series of symbols flashing on the screen, the patient is instructed to click specific symbols, but not for others.
Colorful graphs and charts then instantly display the results. Patients scoring 70 and above are cleared. There is a gray area in between, and patients who score in the 30s or less are likely to have the disorder.
Continued ability to focus is measured in five minute increments.
9% of people under age 18 and 4% of adults have it. Medications can offer dramatic improvement.
Instead of the standard questionnaires asking about your function, behavior and sleep patterns, a new cutting edge computer diagnostic tool has arrived in Central Texas.
Scott & White’s Cedar Park West Clinic began using it three months ago. Doctors say the results have been remarkable.
Designed for patients ages six to 55, the Quotient Test measures your attentive acuity and head movement, which can be an indicator of difficulty focusing. The test has a 94% accuracy rate for ruling out the disorder.
The test for adolescents lasts 15 minutes. The adult test runs 20. With a series of symbols flashing on the screen, the patient is instructed to click specific symbols, but not for others.
Colorful graphs and charts then instantly display the results. Patients scoring 70 and above are cleared. There is a gray area in between, and patients who score in the 30s or less are likely to have the disorder.
Continued ability to focus is measured in five minute increments.
Well, it's new to them. In 2010, the New York Times reported it
Dr. Teicher’s invention, the Quotient A.D.H.D. System, is only one of several continuing efforts to find a biomarker — i.e., distinctive biological evidence — for this elusive disorder.
Most mainstream researchers consider A.D.H.D. to be an authentic neurological deficit that, left untreated, can ruin not only school report cards, but lives. Nonetheless the quest for objective evidence has gained new urgency in recent years.
Many critics say the disorder is being rampantly overdiagnosed by pill-pushing doctors in league with the drug industry, abetted by a culture of overanxious parents and compliant educators.
These critics say that the standard treatment — stimulant medications like Ritalin and Adderall — carries a high risk for side effects and abuse in children whose attention problems might have no biological cause.
Yet despite the perils of faulty diagnosis, the most common way of detecting the disorder has nothing directly to do with biology. Instead, patients — along with their parents and teachers, in the case of children — are asked to respond to a checklist of questions about symptoms that most mortals suffer at one time or another. Do you (or your child) often make careless mistakes? Do you often seem not to listen when spoken to directly? Do you often not follow through on instructions?
This method, similar to the way doctors diagnose most mental illnesses, is so subjective that the answers, and the diagnosis, may depend on how distressed a patient, a parent or a teacher is feeling on a given day. Moreover, parents and teachers, and indeed mothers and fathers, can disagree, obliging a doctor to choose whom to believe.
All this helps explain why an objective test has become “the holy grail” for many researchers, said Stephen Hinshaw, chairman of the psychology department at the University of California, Berkeley. Still, he and other experts are not convinced that any one test developed so far has proved better than the prevailing checklist method.
Most mainstream researchers consider A.D.H.D. to be an authentic neurological deficit that, left untreated, can ruin not only school report cards, but lives. Nonetheless the quest for objective evidence has gained new urgency in recent years.
Many critics say the disorder is being rampantly overdiagnosed by pill-pushing doctors in league with the drug industry, abetted by a culture of overanxious parents and compliant educators.
These critics say that the standard treatment — stimulant medications like Ritalin and Adderall — carries a high risk for side effects and abuse in children whose attention problems might have no biological cause.
Yet despite the perils of faulty diagnosis, the most common way of detecting the disorder has nothing directly to do with biology. Instead, patients — along with their parents and teachers, in the case of children — are asked to respond to a checklist of questions about symptoms that most mortals suffer at one time or another. Do you (or your child) often make careless mistakes? Do you often seem not to listen when spoken to directly? Do you often not follow through on instructions?
This method, similar to the way doctors diagnose most mental illnesses, is so subjective that the answers, and the diagnosis, may depend on how distressed a patient, a parent or a teacher is feeling on a given day. Moreover, parents and teachers, and indeed mothers and fathers, can disagree, obliging a doctor to choose whom to believe.
All this helps explain why an objective test has become “the holy grail” for many researchers, said Stephen Hinshaw, chairman of the psychology department at the University of California, Berkeley. Still, he and other experts are not convinced that any one test developed so far has proved better than the prevailing checklist method.
Time wrote about it in 2011.
Diagnosing any mental illness is difficult. Except in rare cases, specific gene mutations causing mental disorders haven’t been discovered (and may not exist). And while physical injuries and illnesses sometimes trigger mental problems, most of the time psychiatrists play guesswork. They use questionnaires and rating scales to try to determine whether symptoms add up to illness.
Most of these questionnaires have been vetted through psychometric analysis to ensure test-retest reliability, meaning your score on one day is about the same as your score two months later. But any questionnaire is only as reliable as the clinician administering it. In one typical diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime (K-SADS-PL), the clinician is asked to pose the following set of questions to a child:
Do your teachers complain that you don’t follow instructions?
When your parents or your teacher tell you to do something, is it sometimes hard to remember what they said to do? Does it get you into trouble?
Do you lose points on your assignments for not following directions or not completing the work?
Do you forget to do your homework or forget to turn it in?
Do you get into trouble at home for not finishing your chores or other things your parents ask you to do? How often?
Believe it or not, that’s just one of 29 sets of questions on the K-SADS-PL that can be used to diagnose ADHD. Although not every set of questions is asked of every child, the diagnostic interview can take up to three hours, according to Dr. Martin Teicher, director of the developmental biopsychiatry research program at McLean and a leading ADHD researcher. Never mind that a typical 10-year-old has a difficult time focusing on anything for more than 10 min. except, say, Toy Story 3. (More on TIME.com: Is ADHD a Global Epidemic or Just a Bunch of Fidgety Kids?)
And even if the child can manage to remember with accuracy all the answers, the clinician might be biased before the interview begins by parent or teacher reports that the child is hyperactive, inattentive or impulsive (the three main signs of ADHD). Past studies have shown that parents sometimes over-predict diagnosis of ADHD in their kids because the parents misremember their own childhoods as times of attentive and tranquil learning. Teachers also sometimes over-predict ADHD diagnosis because they expect ADHD treatment to result in quieter classrooms. And children often under-predict ADHD diagnosis because the kids have no reference point beyond their own behavior, which — even if wildly hyperactive — they see as normal. In any given case, the parents, the teacher, and the child rarely agree on whether the kid has ADHD.
Because of these diagnostic shortcomings, Teicher began experimenting 20 years ago with a test that could more objectively diagnose ADHD. At the time, many researchers were already using continuous-performance tests (CPTs) to help diagnose the disorder. CPTs require test subjects to focus on a boring task — say, pressing the space bar when a random shape appears on-screen but not when another random shape appears — for approximately 15 to 20 min.
CPTs accurately capture whether a student is inattentive (meaning he doesn’t focus on the task) or impulsive (meaning he presses the space bar too often). But they don’t measure how much kids fidget when they take the test, and restlessness (a.k.a. hyperactivity) is a key component of an accurate ADHD diagnosis. An older tool called the actigraph was widely used in the 1990s to measure body movements during tests. Actigraphs use sensors attached to body parts (usually wrists and ankles) to quantify movements.
Most of these questionnaires have been vetted through psychometric analysis to ensure test-retest reliability, meaning your score on one day is about the same as your score two months later. But any questionnaire is only as reliable as the clinician administering it. In one typical diagnostic interview, the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime (K-SADS-PL), the clinician is asked to pose the following set of questions to a child:
Do your teachers complain that you don’t follow instructions?
When your parents or your teacher tell you to do something, is it sometimes hard to remember what they said to do? Does it get you into trouble?
Do you lose points on your assignments for not following directions or not completing the work?
Do you forget to do your homework or forget to turn it in?
Do you get into trouble at home for not finishing your chores or other things your parents ask you to do? How often?
Believe it or not, that’s just one of 29 sets of questions on the K-SADS-PL that can be used to diagnose ADHD. Although not every set of questions is asked of every child, the diagnostic interview can take up to three hours, according to Dr. Martin Teicher, director of the developmental biopsychiatry research program at McLean and a leading ADHD researcher. Never mind that a typical 10-year-old has a difficult time focusing on anything for more than 10 min. except, say, Toy Story 3. (More on TIME.com: Is ADHD a Global Epidemic or Just a Bunch of Fidgety Kids?)
And even if the child can manage to remember with accuracy all the answers, the clinician might be biased before the interview begins by parent or teacher reports that the child is hyperactive, inattentive or impulsive (the three main signs of ADHD). Past studies have shown that parents sometimes over-predict diagnosis of ADHD in their kids because the parents misremember their own childhoods as times of attentive and tranquil learning. Teachers also sometimes over-predict ADHD diagnosis because they expect ADHD treatment to result in quieter classrooms. And children often under-predict ADHD diagnosis because the kids have no reference point beyond their own behavior, which — even if wildly hyperactive — they see as normal. In any given case, the parents, the teacher, and the child rarely agree on whether the kid has ADHD.
Because of these diagnostic shortcomings, Teicher began experimenting 20 years ago with a test that could more objectively diagnose ADHD. At the time, many researchers were already using continuous-performance tests (CPTs) to help diagnose the disorder. CPTs require test subjects to focus on a boring task — say, pressing the space bar when a random shape appears on-screen but not when another random shape appears — for approximately 15 to 20 min.
CPTs accurately capture whether a student is inattentive (meaning he doesn’t focus on the task) or impulsive (meaning he presses the space bar too often). But they don’t measure how much kids fidget when they take the test, and restlessness (a.k.a. hyperactivity) is a key component of an accurate ADHD diagnosis. An older tool called the actigraph was widely used in the 1990s to measure body movements during tests. Actigraphs use sensors attached to body parts (usually wrists and ankles) to quantify movements.
Now, all of this sounds mighty promising - and, indeed, components of this are used in a neuropsych workup - but does it work? I couldn't find insurance companies that cover it. Aetna classifies it thusly - "Aetna considers the following experimental and investigational for the assessment and treatment of ADHD because the peer-reviewed medical literature does not support the use of these procedures/services for this indication." (Of course, insurance companies cover some other dubious treatments, so this isn't a yardstick for evidence. But if you have to pay out of pocket, it's not as useful as a covered evaluation.) As well, Dr. Teicher has an impressive CV and 12 publications on ADHD, so he's clearly better informed about it than your average internet commenter (I posted this yesterday.)
Yes, it's been approved by the FDA, but reactions are mixed.
Still, no organization, such as the American Academy of Pediatrics or the American Psychiatric Association (APA), has yet included motion tracking into its clinical best practice guidelines. For neuropsychiatrist F. Xavier Castellanos, director of research at the New York University Child Study Center and a member of the ADHD subcommittee behind the 2013 update of the APA's Diagnostic and Statistical Manual (DSM), the evidence base is simply too weak for these types of motion analysis systems to be included yet in any psychiatric handbooks.
“With enough validation it might be possible for this type of approach to be incorporated into future versions of the DSM,” Castellanos says. “The real question over the next few years will be whether it assists the clinical process in meaningful ways.”
“With enough validation it might be possible for this type of approach to be incorporated into future versions of the DSM,” Castellanos says. “The real question over the next few years will be whether it assists the clinical process in meaningful ways.”
In fact, I wasn't able to find mention of it at all on the APA or NIMH websites, which isn't promising. So I'm wondering if the claims are just hype - like Amen's SPECT imaging (total hype) or NEBA system (not adequate for a complex condition.) Does it live up to its promises? From what I'm reading, it may be a foot in the door, but an accurate diagnosis still has to be done the old-fashioned way.