Though it appears that most people no longer deny ADHD as a real condition, there remains skepticism about the over- (or under-) diagnosis of the condition. Many still feel that ADHD medication is too readily handed out to children when parents have difficulty controlling their kids or when a grade-school student seems disinterested in studying.
The source of the problem is often the diagnostic process. Most often, ADHD is diagnosed in young people through an evaluation by a pediatrician, psychologist, psychiatrist or social worker. The evaluation can include a physical evaluation with a checklist for symptoms, an analysis of family history of the condition, a questionnaire to be filled out by parents and teachers and psychological tests (such as an IQ test or tests for co-existing conditions).
With this style of testing, though, there is room for error and discrepancy and the process is far from objective. To help create a more reliable, consistent test, technology company BioBDx created the Quotient ADHD Test. Though not widely distributed yet, the test has the potential to change the way ADHD is diagnosed and how the disorder is perceived.
The Quotient test is fairly simple. First, sensors are attached to the patient's head that track movement during the test. Different shapes are flashed at random on a screen in front of the patient, and the patient is directed to press a key to acknowledge when a specific shape appears. For example, the patient would press a key when a 5-point star appears, but not when a 16-point star appears. The system is designed to track three major symptoms of ADHD: hyperactivity (where the patient may be moving all around and not sitting still during the test), impulsivity (where the patient may have inappropriate responses to the test) and inattention (where the patient has difficulty focusing on the task at hand). The results of the test are then compared to results of both healthy test-subjects and test-subjects who have been diagnosed with ADD and ADHD.
I recently spoke with Tiffany Schaller, a physician's assistant at the Neurology and Headache Treatment Center in Alexandria, Virginia – which utilizes the Quotient Test.
How did the Neurology and Headache Treatment Center get involved with an ADHD testing system?
Many of our patients are chronic headache patients, primarily, but many also have ADD or ADHD. Some have a known history and we may find it beneficial to test their response both off and on the medication. Thisprovides insight into how to improve ADHD treatment as well.
What is the Quotient Test? What does it entail?
It is an objective computerized test that tracks head and leg movement, as well as individual's change in focus based on visual stimuli over a 20 minute period.
Written questionnaires can be subjective and answers may change from one day to the next. By administering an objective, computerized test, we can more accurately diagnose ADD or ADHD.
Does this test work for both children and adults?
Yes – the test can be administered to both children and adults, though the test format and scoring is slightly different between the child and adult populations. Anyone under the age of 14 is considered a child based on the scoring criteria. However, at our clinic we only see patients over the age of 14, so we have only tested adults.
Do the results of the test influence dosages of medication both for headaches and ADHD?
With respect to ADHD, test results do have an impact on treatment. If the patient has previously been diagnosed with ADHD and the results are moderate to severely position while on medication, then we will most likely increase the daily dose. The use of a stimulant may have an indirect effect on headache patients, if headaches are triggered by daytime fatigue. The stimulant will help to reduce headache frequency and severity, as the daytime fatigue is being treated.
How does working with neurologists differ from that of someone in another field (pediatrics, psychology, psychiatry, social work) who may be diagnosing ADHD?
If someone is being diagnosed with ADHD or ADD based on test results, then the situation is clear-cut regardless of whether the patient sees a neurologist or another type of specialist. However, when our patients start complaining of memory loss or fatigue (which are common neurological complaints), we are apt to test for ADD or ADHD because these patients can present those symptoms. With respect to headaches, a stimulant can reduce frequency and severity.
Do you think this is the future of ADHD diagnosis?
I hope so It's a more accurate way of diagnosing and treating ADHD, based on objective testing. It also helps to tease apart other neurological symptoms.
With so much controversy surrounding the over-diagnosis of ADHD, do you think this will help take a more scientific approach to diagnosing the condition? Will it add more legitimacy to ADHD?
I think so – people worry about misuse of medications, especially among college kids. Stimulants themselves are not generally addictive, but they may be abused for the convenience they offer. The test will ultimately prevent overprescribing of stimulants based on accurate diagnoses.