On a more objective test for ADD/ADHD using brain imaging

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Discussion Overview

The discussion revolves around the potential use of brain imaging as a more objective diagnostic tool for Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). Participants explore the reliability of current diagnostic methods, the implications of using brain scans, and the challenges associated with ensuring the integrity of such tests.

Discussion Character

  • Exploratory
  • Debate/contested
  • Technical explanation

Main Points Raised

  • Some participants suggest that existing studies on neural anatomy could support the development of objective tests for ADD/ADHD.
  • Others argue that brain scans may only confirm existing diagnostic assumptions and question their reliability as definitive proof of ADD/ADHD.
  • Concerns are raised about the potential for increased bureaucracy and costs associated with requiring brain scans for diagnosis.
  • Some participants propose that statistical tests could be used to compare neuro-anatomical findings with standard diagnostic methods.
  • There is a discussion about the limitations of questionnaire-based screening tests, with some expressing skepticism about their reliability and the potential for individuals to manipulate results.
  • Participants note that while brain imaging could correlate with neuro-anatomical findings, it may not necessarily align with the clinical understanding of ADD/ADHD.
  • Concerns are voiced about the possibility of students faking tests to obtain prescriptions, highlighting the need for reliable test design to mitigate this issue.
  • Some participants mention that test designers could incorporate irrelevant questions to detect attempts to fake the tests.

Areas of Agreement / Disagreement

Participants express a range of views on the reliability and implications of using brain imaging for diagnosing ADD/ADHD. There is no consensus on whether brain scans would provide a definitive solution or merely complicate the diagnostic process.

Contextual Notes

Participants acknowledge the need for a well-defined classification scheme for any proposed tests and highlight the importance of rigorous hypothesis testing in establishing correlations between neuro-anatomical findings and clinical diagnoses.

Nano-Passion
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There has been quite a few studies on the difference in the neuralanatomy pertaining to ADHD/ADD patients. Can we use this for a more objective test for ADD/ADHD on patients?

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=Am.%20J.%20Psychiatry[ta]%20AND%20168[vol]%20AND%201154[page]&doptcmdl=Abstract

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=J.%20Child%20Psychol.%20Psychiatry[ta]%20AND%2047[vol]%20AND%201051[page]&doptcmdl=Abstract

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=J.%20Child%20Psychol.%20Psychiatry[ta]%20AND%2047[vol]%20AND%201051[page]&doptcmdl=Abstract

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=Am.%20J.%20Psychiatry[ta]%20AND%20168[vol]%20AND%201154[page]&doptcmdl=Abstract

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=Arch.%20Gen.%20Psychiatry[ta]%20AND%2068[vol]%20AND%201122[page]&doptcmdl=Abstract

"www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Search&term=Neuropsychopharmacology[ta
 
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The subjects in these studies must have been diagnosed with the current methods. For these studies to mean anything that method of diagnosis must have been assumed to be reliable. Diagnosis by brain scan can only affirm the assumptions that have already been made without the brain scans.

Are you thinking a brain scan would settle the issue in a case where someone questions a specific diagnosis of ADD/ADHD? It might cast doubt, I'm sure. If it's taken as definitive, though, it would mostly increase red tape: government assistance agencies and insurance companies would start demanding the "objective" brain scan for proof of the condition.
 
zoobyshoe said:
The subjects in these studies must have been diagnosed with the current methods. For these studies to mean anything that method of diagnosis must have been assumed to be reliable. Diagnosis by brain scan can only affirm the assumptions that have already been made without the brain scans.

Are you thinking a brain scan would settle the issue in a case where someone questions a specific diagnosis of ADD/ADHD? It might cast doubt, I'm sure. If it's taken as definitive, though, it would mostly increase red tape: government assistance agencies and insurance companies would start demanding the "objective" brain scan for proof of the condition.

I'm thinking if we can use it to diagnose ADD/ADHD in patients instead of the questionares that are used (not always).

For the underlined part - Which would also be too expensive for the insurance companies, hmm.
 
Nano-Passion said:
I'm thinking if we can use it to diagnose ADD/ADHD in patients instead of the questionares that are used (not always).

For the underlined part - Which would also be too expensive for the insurance companies, hmm.

There are statistical tests that can compare patients with and without positive findings on standard testing and with or without positive neuro-anatomical findings. It's essentially a 2x2 contingency table. Whatever has been the standard instrument for diagnosing or not diagnosing ADD/ADHD in the case and control populations should be used.
 
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SW VandeCarr said:
There are statistical tests that can compare patients with and without positive findings on standard testing and with or without positive neuro-anatomical findings. It's essentially a 2x2 contingency table.

I just had my ADD screening test today, it was just a questionnaire essentially. Why do they still use that method? It strikes me a bit odd because it seems anyone can fake it (not that I was). Why don't more places use a more objective test like the one that you have mentioned.
 
Nano-Passion said:
I just had my ADD screening test today, it was just a questionnaire essentially. Why do they still use that method? It strikes me a bit odd because it seems anyone can fake it (not that I was). Why don't more places use a more objective test like the one that you have mentioned.

Whatever test you may choose can be compared to the neuroanatomical findings this way, That's all I can say about this. You could have test that correlates with the neuroanatomical finding but doesn't correlate with the current clinical picture of what ADD/ADHD is. I'm not a psychiatrist so I can't really speculate on that. All I can say is if you think you have a reliable test and believe that there is a correlation with a neuroanatomical finding you can test that hypothesis in a rigorous way assuming your classification scheme is well defined.
 
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SW VandeCarr said:
Whatever test you may choose can be compared to the neuroanatomical findings this way, That's all I can say about this. You could have test that correlates with the neuroanatomical finding but doesn't correlate with the current clinical picture of what ADD/ADHD is. I'm not a psychiatrist so I can't really speculate on that. All I can say is if you think you have a reliable test and believe that there is a correlation with a neuroanatomical finding you can test that hypothesis in a rigorous way assuming your classification scheme is well defined.

I think it is a reliable test, no doubt about that actually. However what I am worried about is that crafty students can fake the test to take the prescription.
 
Nano-Passion said:
I think it is a reliable test, no doubt about that actually. However what I am worried about is that crafty students can fake the test to take the prescription.

All I can say is, if that's the case, you don't have a reliable test. There are ways to design tests to catch that sort of thing. Again, it's not my field, but psychiatrists and their test designers deal with this or similar kinds of problems all the time.
 
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SW VandeCarr said:
All I can say is, if that's the case, you don't have a reliable test. There are ways to design tests to catch that sort of thing. Again, it's not my field, but psychiatrists and their test designers deal with this or similar kinds of problems all the time.

Ya i think the mechanism is that they throw in irrelevant questions to see if people try to fake the test, other than that people can fake it if they are clever and have done their research. I've seen the test myself today.
 

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