Diagnosis of ADHD in children and adolescents

Clinicians should take a cautious approach when considering use of the first medical device approved by the FDA to help diagnose ADHD in children.

The FDA recently approved an EEG-based technology for the diagnosis of this condition in children. The device calculates the theta-to-beta wave ratios, and some studies suggest this ratio is higher in a subset of children and adolescents with ADHD than in children without the disorder. However, these findings are not consistent in the literature.

Some clinicians also use computerized continuous performance tests as a diagnostic aid, such as T.O.V.A. (Test of Variables of Attention), but according to the American Academy of Pediatrics ADHD guidelines, these standardized psychological tests, compared with clinical interviews, do not reliably differentiate between children with and without ADHD.

The DSM-5, which was updated in May 2013, lists symptoms that children and adolescents must have to be diagnosed with this disorder. The only changes to diagnostic criteria, over those used in DSM-IV, were to include symptoms that are present prior to age 12 years, rather than just before age 7 years, and to not exclude people with autism spectrum disorder.

No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment.

Standardized rating scales, such as Vanderbilt Scales, are readily available and provide information required to make a diagnosis on the basis of the DSM criteria.

ADHD is a heterogeneous condition. Many pathways can result in the same behavioral findings. The DSM criteria for ADHD do not conform to unified biological or psychological constructs. This is one reason why laboratory tests often are not helpful.

Michael Vovakes, MD

 

REFERENCES

Little Research Supports Utility of new ADHD Diagnostic Test, AAP News, September 2013.

ADHD: Clinical Practice Guideline for Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents, Pediatrics 2011;128:5 1007-1022; doi:10.1542/peds.2011-2654.

Vanderbilt Scales download free: http://www.psychiatrictimes.com/clinical-scales-adhd-vadrs/clinical-scales-adhd-vadrs/vadprs-vanderbilt-adhd-diagnostic-parent-rating-scale-and-vadtrs-vanderbilt-adhd-diagnostic-teacher

ADHD (pamphlet), National Institute of Mental Health, 2012.

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