Wednesday, June 2, 2010

Diagnosing Attention Difficulties

We read with concern the article in yesterday's New York Times about computerized devices designed to "test" for attention difficulties. This is the latest in a group of highly commercialized tools to "objectively diagnose" ADHD. The current research simply does not support these claims. They will be nice little profit centers for clinicians, because they require no labor--but won't replace clinical diagnosis as the gold standard.


  • Attention is complex. For example, we know that there are at least three different brain systems involved in regulating attention-one to regulate alertness, one to regulate incoming information, and the other to regulate how we behave and how we work. Research is showing that what we call ADHD is really a group of symptoms with multiple causes, that may involve each of these systems in different ways to different degrees in different people. Also, children with attention problems often have other problems, called "co-morbidities". So, it is not likely that there will ever be a single "objective diagnostic test."
  • When children have symptoms like inattention/hyperactivity/impulsivity, it is important to consider all of the possible causes, which consideration is called "differential diagnosis". That requires the kind of comprehensive assessment that we perform. Comprehensive clinical assessment remains the "gold standard" for diagnosing ADHD.
  • We look closely at attention and its impact on learning-"Is inattention leading to calculation errors in math? Is the child missing details when listening or reading which is affecting her ability to follow instructions or understand what she is reading? Is impulsivity leading to behavior problems, poor organization of writing, reading and math errors?
  • More often than not, children with attention problems have other things going on that might be affecting school and life even more (e.g. language problems, memory problems). They will not respond to medication. Frequently these other problems are causing more problems than the attention deficit. In fact, attention may improve once they are addressed.
So, it is our opinion that a comprehensive diagnostic assessment remains the "gold standard" for diagnosing "ADHD". Furthermore, even when ADHD is diagnosed, treatment will need to be individualized, since many, if not most, children with ADHD have other problems (co-morbidities) that need to be diagnosed.

With regard to Quotient, the tool mentioned in the Times article, we think more research is warranted to determine if there is a potential role for this kind of tool as an adjunct to the diagnosis of disorders of attention. We don't use Quotient in our practice and don't plan to in the near future. We don't believe, at the present time and based upon existing research, that it adds to or replaces a comprehensive assessment including data from home and school.

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