Brain Scans, Part 3
Some mainstream doctors give SPECT only qualified approval. Barton Blinder, M.D., clinical professor of psychiatry and director of the eating disorders program at the University of California, Irvine, has referred some patients with apparent ADHD for SPECT studies. But he has only referred "about 1 percent to 2 percent of the people I see," he says, usually in cases involving a head injury, a prior seizure disorder, or an infectious disease that may have damaged the brain.
The scan "may supply some clues," says Dr. Blinder. "On rare occasions," he says, "it has been of some help." But on the whole, he sees SPECT and other neuroimaging technologies as tools of the future: "They hold a great deal of promise, which will one day have diagnostic and treatment implications."
qEEG seems to have a bit more mainstream support than SPECT. Patricia Quinn, M.D., a developmental pediatrician, member of the ADDitude scientific advisory board, and co-founder/director of the National Center for Gender Issues and ADHD, is not currently in clinical practice, but she says that if she were, "I would be using qEEG for confirmation of diagnosis, to determine whether medication treatment is effective, and to help sort out coexisting conditions that look like ADHD."
Robert Chabot, Ph.D., associate professor of psychiatry and a researcher at the Brain Research Laboratories at New York University School of Medicine, agrees that qEEG is clinically useful. Patients "with ADHD have very specific EEG patterns — it's a much more definitive way of making the diagnosis than just looking at symptoms." Its application in choosing medication and in following response, on the other hand, "needs more research," he says.
Most of the medical profession would apply that phrase to any use of qEEG in ADHD diagnosis and treatment. Although EEG is used to investigate seizure disorders and other neurological conditions, most experts, as well as professional bodies, such as the American Psychiatric Association and the American Neurological Association, maintain that information obtained through EEG isn't reliable enough to detect the more subtle changes of psychiatric disorders.
More generally, the American Academy of Pediatrics doesn't recommend any lab tests for ADHD - making specific reference to neuroimaging techniques, including SPECT, and qEEG. The American Academy of Child and Adolescent Psychiatry is similarly skeptical: ADHD is "a clinical diagnosis," and brain imaging and the like provide "insufficient data."
Larry Silver, M.D., the Washington, D.C., child and adolescent psychiatrist who chairs ADDitude's scientific advisory board, is strongly opposed to the use of these high-tech tools in the diagnosis and treatment of ADHD. His advice to parents: "Don't put yourself or your child through these expensive procedures with the hope that they will clarify the diagnosis or the treatment plan. Would you put your child on medication that someone claimed would help when no studies had been done to validate this claim?" The bottom line, he says, is that neither SPECT nor qEEG has been proven useful for diagnosing or treating ADHD.
"Twenty years from now, [the proponents of high-tech diagnosis] may be vindicated," says Andrew Adesman, M.D., chief of developmental and behavioral pediatrics at Schneider Children's Hospital in Glen Oaks, New York. "Right now, they're on the fringe."