How ADHD Is Diagnosed

Could High-Tech Brain Scans Help Diagnose ADHD?

The jury is still out regarding brain scans used to diagnose ADHD. Learn why some experts say neuroimaging, like a SPECT test, might offer a clearer picture, while others question the results.

Doctor with stethoscope and white lab coat writing diagnosis on clipboard after conducting brain scan on patient with ADHD

Most of the time, doctors can diagnose a child or adult with attention deficit hyperactivity disorder (ADHD) simply by observing his behavior in the office, and asking parents or spouses to describe his attention or behavior problems – when they started, where they occur, and so on.

But sometimes doctors have trouble making a definitive ADHD diagnosis. Maybe the symptoms don’t precisely fit the profile of ADHD. Maybe mood swings and anxiety muddy the picture. Or perhaps the patient has been taking ADHD medication for a while and things have gotten worse instead of better. What now?

When the diagnosis is iffy, the usual approach is to order one or more additional standard diagnostic tests (see Diagnosing Difficult Cases). But, in part because these tests have their own limitations, a handful of ADHD docs have begun offering high-tech (and high-cost) diagnostic tests – notably a technique known as single photon emission computed tomography (SPECT) and quantitative electroencephalography (qEEG), which measures brain wave activity.

Can these brain scans for ADHD really pinpoint the cause of a patient’s behavioral and emotional problems, as their proponents claim? Can the tests predict the most effective treatment? Or are they, as many mainstream ADHD docs insist, a useful tool for research, but unproven as a means of diagnosing individual cases of ADHD?

SPECT and speculation

The neuroimaging technique that has aroused the most interest among those suspected of having ADHD is SPECT. This 20-minute test measures blood flow within the brain; it shows which brain regions are metabolically active (“hot”) and which are quiescent (“cold”) when an individual completes various tasks.

[How Brain Imaging Changes Everything — Or Not]

The procedure entails an injection of a radioactive isotope that is then picked up by the brain. This means exposure to a small amount of radiation – about the equivalent of an X ray. The patient lies motionless as a camera rotates around his head. Several scans may be required, at a cost that can top $1,000.

SPECT has an outspoken advocate in psychiatrist Daniel Amen, M.D., of Newport Beach, California. Dr. Amen heads a group of four clinics, which, he says, have performed a total of 31,000 SPECT scans of people with various psychiatric problems.

“Neuroimaging doesn’t give you a diagnosis,” says Dr. Amen. “It’s one part of a full evaluation that you have to put in the context of what goes on in a patient’s life.” Low activity in the prefrontal cortex is typical of ADHD, he says, but it can also occur with dementia or head injury. “You can’t read these things blindly.”

By providing information that is impossible to obtain from a simple clinical examination, Dr. Amen claims, “SPECT adds to the richness of the diagnosis and helps target treatment.” The images are useful in a range of psychiatric and neurological disorders, not just ADHD, he says.

[Free Download: 3 Essential (and 4 Frivolous) Components of an ADHD Diagnosis]


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1 Comments & Reviews

  1. It is totally irresponsible of you to be re-publishing an article that was written over 14 years ago. You noted that it was updated on October 6, 202 but there are some facts in there that are dated. The article includes the opinion of some doctors discounting the benefits of SPECT and qEEG technologies in helping to better diagnose ADHD and other mental health disorders. The experience of the doctors that use them and the results from these tests speak volumes as to their benefit in providing the correct medication to those suffering with ADHD symptoms. Too often stimulants are prescribed to those that shouldn’t be taking them and in some instances has made things far worse.

    After many years of playing the guessing game with my son’s ADHD, anxiety and depression, I took him to one of eight (yes, it’s up to eight now) Amen clinics. The SPECT imaging helped his psychiatrist determine the right medication for him. He is finally able to function and think without distraction and emotional breakdown.

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