Process of Diagnosing ADHD

Ron2Ron Swatzyna, PhD, LCSW

In a recent online discussion in Child & Adolescent Neurology, Psychiatry & Neurodevelopment Dr. Louis Naude brought poignant attention to a critical deficit in the process of diagnosing ADHD. He states “As long as the underlying cause of attention difficulties are not investigated, the diagnosis of ADHD can be disputed.” I propose that using symptoms-based approach to diagnosis mental health issues is archaic, outdated and not valid. Last year, the director of the National Institute of Mental Health, Thomas Insel called for a shift away from symptoms-based diagnosis because of its lack of validity and asked for researchers to identify neurological abnormalities (neurobiomarkers) that account for the patient’s symptoms.

 Our recent study supports the lack of validity of symptoms-based diagnosis. Of the 386 clinical cases we found there was only a 6 percent association between diagnosis and the neurobiomarkers that accounted for medication failure (Swatzyna, et al. 2014, EEG/qEEG Technology Identifies Neurobiomarkers Critical to Medication Selection and Treatment: A Preliminary Study, submitted to Clinical EEG and Neuroscience).  This means that any refinement of diagnosis will not assist in medication selection or, in many cases, efficacious treatment planning. This is the first study I am aware of that suggests symptoms-based mental health diagnosis in general is invalid and that a neurobiomarker profiling model soon will be the norm.

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