Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence. It is the most common disorder among children and adolescents referred for mental health services. ADHD is characterized by:
- Developmentally inappropriate over-activity
- Inability to pay attention or focus on tasks
- Impulsive behavior
ADHD affects 3% to 8% of all children and is associated with cognitive, social, and academic deficiencies. Undiagnosed and untreated (or wrongly treated), those with ADHD often experience failure in school or on the job, depression, low self-esteem, problems forming and maintaining relationships, and substance abuse.
Distinguishing normal variations of attention from an ADHD diagnosis can, at times, be challenging. Common conditions such as anxiety, depression, and various disruptive behaviors may superficially look like and be mistaken for ADHD.
Misdiagnosis often leads to mistreatment or no treatment, either of which can result in negative consequences. Only a thorough clinical evaluation by a professional well-versed in the field of ADHD with the expertise to establish a differential diagnosis is qualified to assess and address all pieces of what may be a complex clinical puzzle.
Our ADHD Diagnostic Approach
Prior to recommending treatment, Dr. Shnaps collects and evaluates an extensive history from parents, teachers, and the patient, along with the patient’s medical history, and conducts a clinical evaluation that includes a thorough psychiatric/psychological assessment.
As an adjunct to the clinical assessment, we use a new state of the art technology: the Quotient ADHD System.
Quotient ADHD System
Adapted, with permission, from: Calvin Sumner, MD, The ADHD Report,The Guillford Press 2010
Accurate, objective information is the foundation of effective ADHD diagnosis and treatment. Doctors obtain this information through the patient’s history and observations from third-party informants, including parents and teachers. Some of this data may be more subjective than objective.
The Quotient ADHD System provides another source of reliable and objective data to clarify other information, confirm and refine the diagnosis, and assist with monitoring treatment response.
The Quotient ADHD System accurately measures motion and analyzes shifts in attention state to give a clear picture of ADHD symptoms, focusing on the core symptom areas of ADHD:
- Hyperactivity: Inability to control movement and sit still while working.
- Impulsivity: Inability to inhibit inappropriate responses.
- Inattention: Difficulty in staying focused and on task.
The Quotient ADHD Test takes 15 minutes for children under 13, or 20 minutes for adolescents and adults. The report analyzes motion, attention, and shifts in attention states. Integrated composite scores report the level and severity of inattention, hyperactivity, and impulsivity compared to other people of the same age and gender.
The Motion Analysis section of the report provides information gathered by an infrared motion tracking system, which measures the slightest movements. Individuals with ADHD tend to find it more difficult to inhibit their movement, resulting in movement patterns that are more expansive and less constrained over the duration of the test.
The robustness of the motion data is directly related to the sensitivity of the infrared motion tracking technology, which records movements as small as 0.4 mm, 50 times/ second. Movement expansiveness and patterns are used to identify potential symptoms of excessive motor activity characteristic of ADHD.
The Attention Analysis section of the report shows the patient’s responses to a computerized “go/ no-go” attention task. In the child test, two stimulus items are presented at an interval of two seconds: one target (8-point star) and one non-target (5-point star). The patient is instructed to hit the space bar whenever a target appears at random positions on the screen and is not to hit any key when the non-target appears. The unique attention state analysis uses proprietary analysis algorithms to provide a continuous summary of the patient attention response pattern in a 30-second period of assessment.
Attention State Summary
Because attention is a highly dynamic and fluctuating process, many shifts in attention and mental states may occur throughout the course of a 15-minute test. Responses to the attention task visual stimuli are analyzed in 30-second segments. By segmental analysis of response pattern and attention shifts as a dynamic temporal process, Quotient precisely identifies the nature of the attention disturbance and provides new means for revealing changes in neural control function.
Composite scores consist of two components:
- System Index integrates the motion and attention indices to summarize the probability of an ADHD diagnosis for an un-medicated patient, or the degree of agreement between the patient’s results and the database of Quotient ADHD Test results obtained from subjects with ADHD.
- Scaled Scores are normalized calculations on a 10-point scale. Higher Scaled Scores indicate deficit in control of motion and attention compared to age and gender matched subjects. The Global Scaled Score is an average of the motion and attention scores.
ADHD Treatment and Follow Up
Treatment and follow up vary according to the diagnosis and situation. Scientific evidence shows that the most effective treatment for ADHD is combined psychopharmacology and psychotherapy. If it is determined that ADHD is not involved, other approaches may be recommended.
In addition to ongoing treatment and clinical follow up for ADHD, we use the Quotient ADHD system to achieve the following objectives:
- Match treatment to patient.
- Monitor and evaluate treatment effectiveness.
- Treat refractory (non-responsive) symptoms more effectively.
- Monitor the course of ADHD, assessing and documenting symptom improvement over time.
More About the Quotient ADHD System
Accurate and objective assessments of the neurological control functions associated with ADHD symptoms domains and domains of functional impairment are essential to guide efficient and effective diagnosis and treatment management. Inconsistency in the diagnosis and management of ADHD, at least in part, is due to inconsistent, unavailable, and subjective information necessary for assessment (Mitsis, McKay, Schulz, Newcorn, and Halperin, 2000).
Accurate information is the foundation of diagnosis and treatment of ADHD, and without it, even the most efficacious treatment will prove less than effective. The Quotient ADHD System demonstrates excellent test-retest reliability (Teicher, Polcari, Anderson, Lowen, and Navalta, 2003). This allows for a reliable assessment of deficits in developmentally expectable neuronal control functions relevant to ADHD and open changes in patient condition in response to therapeutic interventions or maturation over time (Teicher, 2008).
The foundational technology for the Quotient ADHD System was developed as the McLean-Motion and Attention Tests (M-MAT) at McLean Hospital under the direction of Martin H. Teicher, MD, PhD. The technology received FDA clearance in 2002. The system is not designed or intended to serve as a stand-alone assessment test for ADHD; it provides reliable data to complement and clarify patient information obtained through history, physical examination and observations from third party informants.
Quotient measures of activity have demonstrated significant correlation with abnormalities in blood flow and dopamine D2 receptor density in components of the basal ganglia in children with ADHD (Jucaite, Fernell, Teicher, Anderson, Polcari, Glod, Maas, and Renshaw, 2000).
Standard continuous performance tests (CPT) have demonstrated limited utility in assessments of ADHD (Edwards et al., 2007). In contrast, Quotient measurements of the number of shifts between attention states and the percent of time fully on task were found to be better discriminatory of ADHD than standard CPT performance (Teicher et al., 2004).
Jucaite, A., Fernell, E., Halldin, A., Forssberg, H., and Fardle, L. (2005) Biological Psychiatry 57, 229-238.
Mitsis, E. M., McKay, K. E., Schulz, K. P., Newcorn, J. H., and Halperin, J. M. (2000). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 308-313.
Teicher, M. H., Polcari, A., Anderson, C. M., Andersen, S. L., Lowen, S. B., and Navalta, C. P. (2003). Journal of Child and Adolescent Psychopharmacology, 13, 41-52.
Teicher, M. H., Polcari, A., and McGreenery, C. E., (2008). Journal of Child and Adolescent Psychopharmacology, 18, 265-270.
Teicher, M. H., Anderson, C. M., Polcari, A., Glod, C. A., Maas, L. C., and Renshaw, P. F. (2000). Nature Medicine, 6, 470-473.
Edwards, M. C., Gardner, E. S., Chelonis, J. J., Schulz, E. G., Flake, R. A., and Diaz, P. F. (2007). Journal of Abnormal Child Psychology, 35, 393-404.
Teicher, M. H., Lowen, S. B., Polcari, A., Foley, M., and McGreenery, C. E. (2004). Journal of Child and Adolescent Psychopharmacology, 14, 219-232.