The Right Way to Get the Right Diagnosis

An accurate diagnosis is essential to managing attention deficit — but it may not be easy to get one. You'll need a qualified clinician and a solid evaluation.

Secondary Conditions and High-Tech Diagnosis

Disorders That Come with ADHD

As Scarpiello is finding out, determining whether a child with ADHD has a secondary disorder isn’t straightforward. Evidence of a secondary disorder may become apparent during the screening interview, and can be explored with additional questions and standardized rating scales for depression, anxiety, or other conditions.

“The steps to address a secondary disorder are the same — pursue the possibility through a clinical interview and standardized rating scales,” says Nigg, “The biggest challenge is not mechanical but mental. The clinician should not prematurely exclude other conditions when he thinks he sees ADHD.”

Even if a secondary disorder is not apparent, a clinician should ask questions about its possibility, such as a family history of mental-health issues, anxiety over routine tasks, or a history of depression. If a clinician suspects a cognitive problem, he may check for a learning disability by testing intelligence, memory, and reading ability. “A good clinical interview and evaluation will consider these comorbid conditions routinely,” says Nigg.

High-Tech Tools to Diagnose ADHD

In July 2013, the U.S. Food and Drug Administration approved a new medical device, based on brain function, for the diagnosis of ADHD. The device, called the Neuropsychiatric EEG-Based Assessment Aid (NEBA), records electrical impulses that are given off by the brain.

In clinical trials, the NEBA system has shown that the ratios of particular brain waves are different in children with ADHD. The device has not been tested on adults, and many experts doubt the test’s utility. “The field has been through a number of these machines that purport to work, but anyone who’s been in this for a while will always be skeptical,” says Dodson.

If a NEBA test appears abnormal for a child, there is a high chance he or she has a problem that needs to be addressed, but “there are people with ADHD who won’t show up as abnormal,” says Barkley. And this new test is expensive. Most important, “it’s not going to diagnose ADHD,” says Dodson. “The test is just going to say that it’s a little more likely in a given child.”

Forms of brain imaging, such as SPECT imaging scans, may also be suggested as a way to look at the brain for evidence of ADHD, but they are also expensive, and many experts are pretty sure that they won’t help. “There is no imaging test that can make a diagnosis of ADHD,” says Brown. “They are just snapshots of the brain, showing just a second of brain activity. ADHD happens over time.”

Computer-Based Tests: Do They Help?

Computer-assessment tests for ADHD, such as TOVA and the Quotient ADHD Test, score children on their ability to follow along with simple computer games. While these tests are good at measuring attention to a particular game, Brown worries that some children with ADHD are good at playing games. “I’ve seen 1,000 children and adults with ADHD who have no difficulty playing video games, but they can’t sit still in math class,” he says.

Though their accuracy is doubtful, scores from these neuropsychological tests are sometimes required by school districts when a child applies for special education or assistance in the classroom. So, “if you take these tests, and you get a normal score, disregard it,” says Barkley. “And if you get an abnormal score, you still need the interview process to find out what’s really wrong.”

The Bottom Line

As Braga and Scarpiello found out, there is no quick test for ADHD, but a proper diagnosis is crucial. As Scarpiello continues to seek help for her son, she is hopeful that someone will be able to piece together all of the clues to get him a proper diagnosis. “It’s not getting any easier,” she says.

Finding the best ADHD expert in your area is the most important step toward getting an accurate diagnosis of ADHD. It may take several appointments, but the clinician should use all the information at his disposal to assess you or your child and to guide a treatment plan.

“Now that I understand what ADHD is, everything else makes sense,” says Braga.

KAREN BARROW is a freelance health and science writer based in New York City. She holds a master’s degree in biomedical journalism from New York University.

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