I LOVE that the video title is "Are There Tests for Diagnosing ADHD" and in the first few seconds "There are NO Tests for Diagnosing ADHD" is up on the screen. 😆
SUCH A RELIEF! And he doesn't hold the clip-on microphone in his hand, use a thumbnail of him holding up three fingers, mention "the algorithm" or any of the other stupid youtube trends that people think will make them famous.
Inappropriate use of tests was part of the reason my diagnosis was delayed by a decade. I thought they were administered and interpreted incorrectly at the time, but now I feel like I was scammed out of my money and time by people who used cognitive tests as a substitute for knowledge of and experience with patients with ADHD. I managed to get through undergraduate education alright, but struggled immensely with the transition to solitary, self-directed nature of postgraduate work in my field. I was literally falling asleep from boredom, and struggling to get started, to focus, and organise my work. I sought help, and my psychologist told me I was undermining myself subconsciously. I insisted on a cognitive assessment, so he put me through a barrage of cognitive tests. He concluded that since I did ok on parts of the TEA, I must not have ADHD. But I did abysmally on some, and he excused it , saying that it must have been an issue with how the test was administered. My scores on the WAIS-IV subtests were wildly inconsistent, so I didn't get an IQ score provided to me at the end . My processing speed was much lower than my other scores, 93rd percentile in mental arithmetic but below average in other working memory tasks (I am good at mental arithmetic because I do it instantly and without thinking, not because I can hold or manipulate numbers in my head!). But he concluded it wasn't ADHD, it was just poor processing speed and low self-esteem. I then took the test results to a psychiatrist, a low cost one who specialised in criminal psychiatry. He treated me like a drug seeker, glanced at the test results, and concluded that I don't have ADHD. I left feeling defeated. Over the years, I kept running into walls with finding people who took me seriously. One psychologist even suggested that with my low processing speed, I could have some specific brain abnormality she read about recently, and need to contact an academic team specialising in an obscure neurological disorder! I didn't see her again. Eventually, a psychologist with experience with ADHD patients took me seriously, as did my wonderful GP. So, a decade after the cognitive tests, I finally managed to see a psychiatrist who has a lot of experience treating adult women with ADHD. She interviewed me informally for an hour, confirmed details with someone who knew me for a long time, and administered a DIVA questionnaire. She diagnosed me with ADHD, for a lot less money than the psychologists took from me for tests and talk therapy. I am medicated now, with stimulants as well as medications to help me with my sleep problems. I can focus better, my emotions are regulated, and I can actually get started with tasks instead of internally screaming at myself to just do it. My working memory still causes me difficulties, but I am doing much better.
Dam i feel bad for your experience... and kinda have a similar one.... I just failed at my PHD because i could not FOR THE LIFE OF ME summon the power to write my memoirs. So 4 years of works/suffering not fully materializing... Despite doing all the technical parts (some of the work was still pure suffering over 3 years) A whole year of trying to force myself to do something i could not do... the feelings of shame and calling myself lazy and self punishment... It was so bad i was sent to the work doctor My work doctor said "i was the stereotype of gifted but troubled" she was old school she probably did not know the definition of ADHD. But saw the pattern forming in her career. The pattern of phd students intelligent enough to self mask ADHD... An online psychiatrist i talked to supported my OWN THEORY that i had undiagnosed adult ADHD. (I was the one reluctant to use medication at first) Now i am in the process of talking to a psychologist and she knows her stuff. From the first informal hour long talk she concluded that i had it and to a degree that IT NEEDED to be medicated. She even offered to talk to my general doctor (before we even finish the battery of tests) So i can have a head start at getting my medications. That is how sure we both are. He is the one who can order medication but he needs helps with dosage and things like that. Now it is a waiting game... with the CONSTANT non stop rumination and feeling of restless... As i wait for 3 more appointments. 2 weeks to a month is the duration i estimate. I think it is thanks to people like you telling their stories that i am finally ready for stimulant medication. I do also suffer from sleep problems But i am equally afraid of sleep medication... Some of the research shows they can be very dangerous for certain people.
@@aziouss2863 Hey, thank you for sharing, our experiences sound very similar. I am glad that there is not too long left for you to be seen. I was scared of stimulants too because I saw what abusing them did to other people. However, I realised that stimulants for ADHD are dosed carefully and for purpose, and gradually the fear went away. I had some side-effects at the start, but they settled now. As for sleep medications, I don't take anything scary - just melatonin extended release (it's prescription here) and clonidine (off-label, not extended release) before bed. They don't knock me out, they help me fall asleep and then stay asleep. I still sometimes wake up in the middle of the night, or wake up super early, but it's getting better. Maybe there's something gentle and safe that your doctor can recommend?
(did write it before i saw the end of the video ^^") we have the same exact "issue" with autism diagnostics, the defining characteristics for what is considered autism, are actually too vague and too much about comparing to the average of society, this is also why it's so easy to get missdiagnosed or falsely getting certain difficulties attributed to something when the traits of a person are not presenting obviously (aka the extremely visibly cases of someone being non verbal and not able to communicate in any way) , because the differences we can perceive are mostly within the person as long as we don't have any way to determine it "physically". It has been a big pet peeve of mine, because I have been trying to figure out my own mental health issues and life struggles and had been attributing most of it to trauma, then depression and anxiety and so did everyone else (if they didn't declare me as just lazy that is). And it has been a tremendous amount of effort to try to figure out where it's all coming from and when I dived deep into learning everything I could about all kinds of conditions and possibilities, I noticed how much the diagnostics for adhd and autism, can be so easily missinterpreted and missrepresented by both professionals, laymen and the general influence of how other people might perceive the person to be assessed (like friends and family being asked about how that person is like and was like in their childhood which is and can be heavily biased) not to mention that this also makes me very afraid that I will be missunderstood and missdiagnosed when I get my full neuropsych evaluation, because I know how easy it would be for them to missunderstand my situation, especially considering I had been missunderstanding it myself for a big part of my life and all the people around me, including a therapist I had for 3 consecutive years. I wished there was a way to just get a brainscan that shows it unmistakenly whats going on, instead of having to "guess" what would be most probable. (also because it's kind of painful to go through the whole evaluation process in my situation atleast, because of the anxiety coming with it and how much I need to make myself vulnerable to a sort of judgement of who I am and what I am and how I'm supposed to be like etc.)
I would love to be stuck in an elevator with you for half an hour so I could pick your brains. Thank you for clearing this up and being very candid about it. For a lot of people, this isn’t the answer they want to hear. The lack of a definitive ADHD test, let alone a binary one, feeds into the “ADHD is a made-up illness” trope as well as everyone casually saying they have ADHD in a way that no one would do for other conditions. No one says “I think I have a bit of HIV” or “I think I’m on the epileptic spectrum” but that’s fair game for ADHD in the absence of a test. What I wish you did cover here is whether you think the absence of a test leads to over or under diagnosis, and what this means for clinical caseloads - should the role of diagnosing adult ADHD be limited to specialists (creating waiting lists) or be open for all psychiatrists (potentially more false positives and negatives)?
Not the person you're asking, but I believe all psychiatrists and clinical psychologists MUST get trained on diagnosing ADHD as soon as possible, because they have to be able to recognize it in their patients who come for other reasons (anxiety, depression, burnout...). The problem is currently most of them never learned anything past one lecture in university and are woefully uninformed. That's preposterous for a disorder more than 5% of the population lives with. Screening should be routine by now.
Dr Russell please make a separate video on MTHFR mutation Spectrum and it's relation to ADHD PI and CDS And Thank you for all the hardwork you're doing for people like us!!
Kaiser only perform diagnosis ADHD through hours of surveys and testing. Only at the end if youve "passed the test" do you get to be interviewed by a human. If you "fail" a single survey you are kicked back without a diagnosis. This whole process normally takes ~6 months. If you miss a single appointment, you go to the back of the line and must start over.
I had to do so many tests as a 35-year-old and undergrad and let me tell you those tests were painful. I end up crying halfway through and then I stopped and left the building. It instantly took me back to grade school now little bit older I really believe those are accurate and you just confirmed it. Thanks, Doctor !
I don't remember much of my childhood. How do i know if i had ADHD in my childhood? I feel like i have these symptoms from the childhood but I'm also sceptical that these are false memories or something related. I just can't decide and i can't afford a therapist either.
1. Ask a person older than you who knew you then (parent, sibling, relative, caregiver, teacher...) 2. Look up any written records: school reports, medical records, letters, journals...
Just to share some notes I made to work this whole thing out: So, what would we need to have in order to diagnose ADHD by tests other than clinical interviews, rating scales and observations by others? * A comprehensive list of genetic factors as well as epigenetic and environmental factors that contribute to ADHD, plus a comprehensive list of mitigating factors, and ways to measure that these are indeed present in a way that must by necessity have lead to ADHD. * Or a battery of behavioral or performance tests that reliably show the presence of ADHD signs and symptoms, measured in an adequate way. I imagine this must involve being constantly observed by a measuring device for weeks or months. * Or a battery of brain activity measurements that conclusively show the presence of ADHD cognitive patterns. And for people who acquire ADHD after a brain injury, we would need similar tests. As Dr. Barkley has shown (in this video and others about ADHD tests), we do not know nearly enough about the whole breadth of causal factors of ADHD, or the entirety of measurable cognitive patterns, to create tests that *reliably* diagnose ADHD. We know enough to have impressive results, but they cannot indicate presence or absence of ADHD in a high enough percentage of people to be useful in contributing to a positive or negative assessment. And for behavioral & performance tests, we would need to build automated systems that can observe people over an extended period of time, highly reliably, while not being intrusive - because people with ADHD tend to be able to suppress their signs and symptoms sufficiently for shorter time periods. And that technology does not seem to exist. So, why is the clinical interview, including rating scales and observations by others, the gold standard? Because it is the most reliable way to assess the signs and symptoms of ADHD: it looks at behaviors and impairments over long periods of time, and tries to collect as much evidence as possible for and against an ADHD diagnosis. If we compare this to other conditions, we can see parallels: * An infectious disease is usually identified by its acute signs and symptoms: sneezing, fever, rashes, swellings, pains, nausea, lack of energy etc. Doctors only occasionally need to check for the causing infective agents, viruses or bacteria. A diagnosis can usually be made by looking at signs and symptoms, and an adequate treatment can be found - even when testing for the presence of an infectious agent is possible. * A cancer diagnosis is made considering a host of signs and symptoms, including the presence of malignant tumors. The breadth of the causes that lead to a specific cancer in a specific patient is often not clearly understood, except for some cancers (like certain breast cancers). What counts for a diagnosis are the signs and symptoms, and additionally often a biopsy and a test for tumor malignancy. So, checking for signs and symptoms, rather than solely relying on tests, is nothing unusual in the diagnosis of health conditions. So, why do we want a test for ADHD so badly? I believe there are a number of reasons: * Mental conditions seem less well defined than “physical” health conditions. We are still learning so much more about them that diagnoses keep being adjusted, and our understanding of the conditions still changes considerably. And a reliable test would change that: it would make any mental condition very well defined. * Mental conditions seem to be more subjectively defined than physical conditions. For example, some children get diagnosed with ADHD, but they do not really have it. And another example is that people often still switch from one diagnosis to another. Although this is changing, to some extent, since the DSM-5: people can have more mental conditions at the same time, the diagnoses are less exclusive of each other and more dimensional. And for ADHD, comobidities are very common. Also, ADHD gets recognized by more and more clinicians. We know more about the real prevalence rates now. And people with an ADHD diagnosis rarely switch to another diagnosis; the diagnosis is very stable. (Except for a percentage of ADHD kids who lose their diagnosis as adults.) But all of this needs to be understood by doctors, patients, and the general public. A reliable test for ADHD would make ADHD easily discernible from other mental conditions, which would be particularly helpful when comorbidities are present. * A certain percentage of people who are diagnosed with ADHD did so by reporting symptoms that they do not actually have. They want the diagnosis, because ADHD medications promise them performance advantages (although I read mixed accounts about how much or not ADHD medications may improve performance in non-ADHD people). Some may even be addicted to stimulants. Having a reliable, objective test for ADHD would prevent this from happening. * A reliable ADHD test could supposedly be administered more rapidly, and by a wider range of people. This could dramatically cut down waiting times for a diagnosis, which are often many years in many countries. * Many people still doubt that ADHD exists, or that it is a valid mental condition. Having a reliable test for ADHD would support its legitimacy: some people have it, others don’t. And we would know exactly and objectively how to check for this difference. (Btw, several studies have been conducted that show how dramatically impaired people with ADHD are over their lifetimes. Some of these studies include a large number of people, with and without ADHD.) There is no doubt that a *reliable* test for ADHD would be useful.
In my experience, as a ADHD patient, a test is a tool in the diagnosis, but never THE tool of diagnosis. My Diagnosis took dozens of hours, and most of it was in dialogue with my psychiatrist. In a private clinic in southern Germany, usually it will be faster, but at least a few hours.
I appreciate you putting this out there. I can't tell you how many people have told me that their doctors refuse to diagnose because of their performance on a computerized test.
This is interesting Prof Barkley. Because the doctors used the Qbtest and they did the test before I take methylphenidate and after taking the medicine. Before my concentration levels were in the worst quantile and after taking medicine it was in line with general population. I think QBtest seems to be a good test to help on diagnosis and heavily used in the country I live in.
Is it possible that a multivariate analysis using results from a combination of existing tests could give a clearer separation of groups? Do you know of any studies which have looked at the accuracy (e.g. in terms of false positive / false negative rate) of something like linear discriminant analysis across multiple tests or modalities of testing?
Isn't the point of p values and the concept of "statistical significance" specifically to address the weaknesses of "comparing averages in groups" and "what if the ranges overlap"? You still have a point about the importance of good diagnostic practice and avoiding over-reliance on tests in psychiatry, but it seems like saying they have no value is overly dismissive of tools that could potentially increase diagnostic accuracy for clinicians.
Took one of these tests last year at age 28. I’m quite confident that I have ADHD based on my experiences, but all i got was an anxiety and depression diagnosis. How is an adult even supposed to get properly diagnosed for ADHD…
Wow, this is great and something I was thinking about the past few days. I recently took a lot of these tests in my ADHD evaluation over two days and about 5-6 hours total. I was wondering if they gave all of these to see if there were any other problems with my thinking or learning disabilities. To help rule those out when they determined I did in fact have ADHD. Now and most likely most of my 50some years. But I wonder if the lacking attention from ADHD affected my AGI score? Because in some of the test I could find my thoughts drifting to other things. Well anyways this explains a lot, thanks.
I'm confused if not terrified. Did I waste my time getting a neuropsych evaluation? Also, if there are no diagnostic tests for adhd, doesn't that give the naysayers grounds to dismiss the didorder? I had an intake for 2 to 3 hours followed by a neuropsych evaluation two months later which took about 3 to 4 hours. The neuropsych evaluation included a battery of tests measuring executive functions i.e Connors, Delis Kaplan, WASI-II to name a few. I was diagnosed as a combined type adhd.
ADHD assesement and differential diagnosis is globally a mess. The assessing psychologist came to the conclusion that I have atypical ADHD with no attention issues whatsoever, based on one of those computerized tests (I didn't make a "pathological" amount of mistakes, though my reaction time varied wildly) - she threw at me a report the software generated, stating there were no signs of ADHD. Now the fact that I had noticable issues following her spoken instructions to virtually every test we've done, didn't seem to be worthy of her attention. This also seems to be an issue with iq tests for those who perform well on them. So called spiky profiles are often not taken seriousely if none of the scores fall into the "disability" range. On the WAIS my VCI and PRI are above average, my WMI is borderline bellow average (84) and the PSI is about average. There's also significant scatter among subtest seemingly depending on their working memory load (Information lags behind the other two VCI subtest by around 1 SD). The PRI subtests scores were messier. We started with the dices. The psychometriciran noted that I completed the later, more difficult, tasks faster than some of the easier ones. This is my lifelong pattern. It seemed to have showed up in the other two subtests as well. I did answer correctly to the very last Matrix reasoning task but my score comes nowhere near reflecting that. I figured out It's easier for me to compensate in the verbal domain (where I still have issues verbalizing the answers smoothly and not getting distracted by the actual questions) than in the spacial reasoning one, where I'm more sensitive to how challenging I perceive a task to be. This is what my teachers used to be perplexed by - I exhibited superior reasoning skills but was brought down by "careless mistakes" and issues with memorizing/recall. The WAIS IV did confirm what has always been my cognitive profile but the psychologist didn't really bother with digging into it beyond a very basic interpretation. I think the test could tell a lot about the cognitive issues we face in our daily lives If there was better understanding about how to interpret it in the context of ADHD. These tests also pick up our coping strategies so It's unlikely a distinctive profile would emerge. One that I acquired with age is not getting frustrated if I make a mistake or can't focus. This allows me to better handle real life problem solving but I'm still not more efficient with the strategies I employ. The WAIS (and some other tests) seems to have reflected that but the psychologist barely picked it up.
For someone who is unsure if they have ADHD, what should they do? If there is no specific test, what kind of doctor should they see for the evaluations mentioned at the end and should they have any specific training or credentials to look out for? Thanks.
There aren't specific tests, but there are reputable rating scales normed on the general population. Dr Barkley has a video on this (Screening for ADHD in Yourself or Your Child) on his channel. Reputable clinics will generally give an overview of their diagnostic practice, and will hence state the rating scale they use + have clinicians trained to conduct them properly, but, unfortunately, finding a good clinic in your area will probably require relying on word-of-mouth and independent research.
Are you aware of any promising research in the area of ADHD diagnostics? Such as more advanced neuro imaging (I.e. fMRI) or any other promising methodologies that we may see down the road?
Things are a bit more nuanced, as each test has a specificity/sensitivity that needs to be taken into consideration by the clinician. This informs you about the overlap of the distributions. Tests do not compare only averages between groups, rather they also compare individual scores in relation to the average of groups. None of the tests are great where things overlap, but not every person tested has a score where the groups overlap. Indeed, not one test or any test for that mather should be considered as the final diagnostic, but the clinician is the final diagnostic. However the clinician can be informed by tests, and they should be informed by tests and by other sources of information.
I LOVE that the video title is "Are There Tests for Diagnosing ADHD" and in the first few seconds "There are NO Tests for Diagnosing ADHD" is up on the screen. 😆
SUCH A RELIEF! And he doesn't hold the clip-on microphone in his hand, use a thumbnail of him holding up three fingers, mention "the algorithm" or any of the other stupid youtube trends that people think will make them famous.
Inappropriate use of tests was part of the reason my diagnosis was delayed by a decade. I thought they were administered and interpreted incorrectly at the time, but now I feel like I was scammed out of my money and time by people who used cognitive tests as a substitute for knowledge of and experience with patients with ADHD.
I managed to get through undergraduate education alright, but struggled immensely with the transition to solitary, self-directed nature of postgraduate work in my field. I was literally falling asleep from boredom, and struggling to get started, to focus, and organise my work. I sought help, and my psychologist told me I was undermining myself subconsciously. I insisted on a cognitive assessment, so he put me through a barrage of cognitive tests. He concluded that since I did ok on parts of the TEA, I must not have ADHD. But I did abysmally on some, and he excused it , saying that it must have been an issue with how the test was administered. My scores on the WAIS-IV subtests were wildly inconsistent, so I didn't get an IQ score provided to me at the end . My processing speed was much lower than my other scores, 93rd percentile in mental arithmetic but below average in other working memory tasks (I am good at mental arithmetic because I do it instantly and without thinking, not because I can hold or manipulate numbers in my head!). But he concluded it wasn't ADHD, it was just poor processing speed and low self-esteem.
I then took the test results to a psychiatrist, a low cost one who specialised in criminal psychiatry. He treated me like a drug seeker, glanced at the test results, and concluded that I don't have ADHD. I left feeling defeated. Over the years, I kept running into walls with finding people who took me seriously. One psychologist even suggested that with my low processing speed, I could have some specific brain abnormality she read about recently, and need to contact an academic team specialising in an obscure neurological disorder! I didn't see her again.
Eventually, a psychologist with experience with ADHD patients took me seriously, as did my wonderful GP. So, a decade after the cognitive tests, I finally managed to see a psychiatrist who has a lot of experience treating adult women with ADHD. She interviewed me informally for an hour, confirmed details with someone who knew me for a long time, and administered a DIVA questionnaire. She diagnosed me with ADHD, for a lot less money than the psychologists took from me for tests and talk therapy. I am medicated now, with stimulants as well as medications to help me with my sleep problems. I can focus better, my emotions are regulated, and I can actually get started with tasks instead of internally screaming at myself to just do it. My working memory still causes me difficulties, but I am doing much better.
Dam i feel bad for your experience... and kinda have a similar one.... I just failed at my PHD because i could not FOR THE LIFE OF ME summon the power to write my memoirs. So 4 years of works/suffering not fully materializing...
Despite doing all the technical parts (some of the work was still pure suffering over 3 years)
A whole year of trying to force myself to do something i could not do... the feelings of shame and calling myself lazy and self punishment...
It was so bad i was sent to the work doctor
My work doctor said "i was the stereotype of gifted but troubled" she was old school she probably did not know the definition of ADHD. But saw the pattern forming in her career. The pattern of phd students intelligent enough to self mask ADHD...
An online psychiatrist i talked to supported my OWN THEORY that i had undiagnosed adult ADHD. (I was the one reluctant to use medication at first)
Now i am in the process of talking to a psychologist and she knows her stuff. From the first informal hour long talk she concluded that i had it and to a degree that IT NEEDED to be medicated.
She even offered to talk to my general doctor (before we even finish the battery of tests) So i can have a head start at getting my medications. That is how sure we both are. He is the one who can order medication but he needs helps with dosage and things like that.
Now it is a waiting game... with the CONSTANT non stop rumination and feeling of restless...
As i wait for 3 more appointments.
2 weeks to a month is the duration i estimate.
I think it is thanks to people like you telling their stories that i am finally ready for stimulant medication.
I do also suffer from sleep problems But i am equally afraid of sleep medication...
Some of the research shows they can be very dangerous for certain people.
@@aziouss2863 Hey, thank you for sharing, our experiences sound very similar. I am glad that there is not too long left for you to be seen. I was scared of stimulants too because I saw what abusing them did to other people. However, I realised that stimulants for ADHD are dosed carefully and for purpose, and gradually the fear went away. I had some side-effects at the start, but they settled now.
As for sleep medications, I don't take anything scary - just melatonin extended release (it's prescription here) and clonidine (off-label, not extended release) before bed. They don't knock me out, they help me fall asleep and then stay asleep. I still sometimes wake up in the middle of the night, or wake up super early, but it's getting better. Maybe there's something gentle and safe that your doctor can recommend?
(did write it before i saw the end of the video ^^") we have the same exact "issue" with autism diagnostics, the defining characteristics for what is considered autism, are actually too vague and too much about comparing to the average of society, this is also why it's so easy to get missdiagnosed or falsely getting certain difficulties attributed to something when the traits of a person are not presenting obviously (aka the extremely visibly cases of someone being non verbal and not able to communicate in any way) , because the differences we can perceive are mostly within the person as long as we don't have any way to determine it "physically". It has been a big pet peeve of mine, because I have been trying to figure out my own mental health issues and life struggles and had been attributing most of it to trauma, then depression and anxiety and so did everyone else (if they didn't declare me as just lazy that is).
And it has been a tremendous amount of effort to try to figure out where it's all coming from and when I dived deep into learning everything I could about all kinds of conditions and possibilities, I noticed how much the diagnostics for adhd and autism, can be so easily missinterpreted and missrepresented by both professionals, laymen and the general influence of how other people might perceive the person to be assessed (like friends and family being asked about how that person is like and was like in their childhood which is and can be heavily biased)
not to mention that this also makes me very afraid that I will be missunderstood and missdiagnosed when I get my full neuropsych evaluation, because I know how easy it would be for them to missunderstand my situation, especially considering I had been missunderstanding it myself for a big part of my life and all the people around me, including a therapist I had for 3 consecutive years.
I wished there was a way to just get a brainscan that shows it unmistakenly whats going on, instead of having to "guess" what would be most probable. (also because it's kind of painful to go through the whole evaluation process in my situation atleast, because of the anxiety coming with it and how much I need to make myself vulnerable to a sort of judgement of who I am and what I am and how I'm supposed to be like etc.)
I would love to be stuck in an elevator with you for half an hour so I could pick your brains.
Thank you for clearing this up and being very candid about it. For a lot of people, this isn’t the answer they want to hear. The lack of a definitive ADHD test, let alone a binary one, feeds into the “ADHD is a made-up illness” trope as well as everyone casually saying they have ADHD in a way that no one would do for other conditions. No one says “I think I have a bit of HIV” or “I think I’m on the epileptic spectrum” but that’s fair game for ADHD in the absence of a test.
What I wish you did cover here is whether you think the absence of a test leads to over or under diagnosis, and what this means for clinical caseloads - should the role of diagnosing adult ADHD be limited to specialists (creating waiting lists) or be open for all psychiatrists (potentially more false positives and negatives)?
Not the person you're asking, but I believe all psychiatrists and clinical psychologists MUST get trained on diagnosing ADHD as soon as possible, because they have to be able to recognize it in their patients who come for other reasons (anxiety, depression, burnout...). The problem is currently most of them never learned anything past one lecture in university and are woefully uninformed. That's preposterous for a disorder more than 5% of the population lives with. Screening should be routine by now.
Dr Russell please make a separate video on MTHFR mutation Spectrum and it's relation to ADHD PI and CDS
And Thank you for all the hardwork you're doing for people like us!!
Clear and precise as usual. This is an extremely useful commentary for so many people. Thanks, Dr.!
Kaiser only perform diagnosis ADHD through hours of surveys and testing. Only at the end if youve "passed the test" do you get to be interviewed by a human. If you "fail" a single survey you are kicked back without a diagnosis. This whole process normally takes ~6 months.
If you miss a single appointment, you go to the back of the line and must start over.
It's been about 8 months for me
I had to do so many tests as a 35-year-old and undergrad and let me tell you those tests were painful. I end up crying halfway through and then I stopped and left the building. It instantly took me back to grade school now little bit older I really believe those are accurate and you just confirmed it. Thanks, Doctor !
I don't remember much of my childhood. How do i know if i had ADHD in my childhood?
I feel like i have these symptoms from the childhood but I'm also sceptical that these are false memories or something related. I just can't decide and i can't afford a therapist either.
1. Ask a person older than you who knew you then (parent, sibling, relative, caregiver, teacher...)
2. Look up any written records: school reports, medical records, letters, journals...
Just to share some notes I made to work this whole thing out:
So, what would we need to have in order to diagnose ADHD by tests other than clinical interviews, rating scales and observations by others?
* A comprehensive list of genetic factors as well as epigenetic and environmental factors that contribute to ADHD, plus a comprehensive list of mitigating factors, and ways to measure that these are indeed present in a way that must by necessity have lead to ADHD.
* Or a battery of behavioral or performance tests that reliably show the presence of ADHD signs and symptoms, measured in an adequate way. I imagine this must involve being constantly observed by a measuring device for weeks or months.
* Or a battery of brain activity measurements that conclusively show the presence of ADHD cognitive patterns.
And for people who acquire ADHD after a brain injury, we would need similar tests.
As Dr. Barkley has shown (in this video and others about ADHD tests), we do not know nearly enough about the whole breadth of causal factors of ADHD, or the entirety of measurable cognitive patterns, to create tests that *reliably* diagnose ADHD. We know enough to have impressive results, but they cannot indicate presence or absence of ADHD in a high enough percentage of people to be useful in contributing to a positive or negative assessment. And for behavioral & performance tests, we would need to build automated systems that can observe people over an extended period of time, highly reliably, while not being intrusive - because people with ADHD tend to be able to suppress their signs and symptoms sufficiently for shorter time periods. And that technology does not seem to exist.
So, why is the clinical interview, including rating scales and observations by others, the gold standard? Because it is the most reliable way to assess the signs and symptoms of ADHD: it looks at behaviors and impairments over long periods of time, and tries to collect as much evidence as possible for and against an ADHD diagnosis.
If we compare this to other conditions, we can see parallels:
* An infectious disease is usually identified by its acute signs and symptoms: sneezing, fever, rashes, swellings, pains, nausea, lack of energy etc. Doctors only occasionally need to check for the causing infective agents, viruses or bacteria. A diagnosis can usually be made by looking at signs and symptoms, and an adequate treatment can be found - even when testing for the presence of an infectious agent is possible.
* A cancer diagnosis is made considering a host of signs and symptoms, including the presence of malignant tumors. The breadth of the causes that lead to a specific cancer in a specific patient is often not clearly understood, except for some cancers (like certain breast cancers). What counts for a diagnosis are the signs and symptoms, and additionally often a biopsy and a test for tumor malignancy.
So, checking for signs and symptoms, rather than solely relying on tests, is nothing unusual in the diagnosis of health conditions.
So, why do we want a test for ADHD so badly? I believe there are a number of reasons:
* Mental conditions seem less well defined than “physical” health conditions. We are still learning so much more about them that diagnoses keep being adjusted, and our understanding of the conditions still changes considerably. And a reliable test would change that: it would make any mental condition very well defined.
* Mental conditions seem to be more subjectively defined than physical conditions. For example, some children get diagnosed with ADHD, but they do not really have it. And another example is that people often still switch from one diagnosis to another. Although this is changing, to some extent, since the DSM-5: people can have more mental conditions at the same time, the diagnoses are less exclusive of each other and more dimensional. And for ADHD, comobidities are very common. Also, ADHD gets recognized by more and more clinicians. We know more about the real prevalence rates now. And people with an ADHD diagnosis rarely switch to another diagnosis; the diagnosis is very stable. (Except for a percentage of ADHD kids who lose their diagnosis as adults.) But all of this needs to be understood by doctors, patients, and the general public. A reliable test for ADHD would make ADHD easily discernible from other mental conditions, which would be particularly helpful when comorbidities are present.
* A certain percentage of people who are diagnosed with ADHD did so by reporting symptoms that they do not actually have. They want the diagnosis, because ADHD medications promise them performance advantages (although I read mixed accounts about how much or not ADHD medications may improve performance in non-ADHD people). Some may even be addicted to stimulants. Having a reliable, objective test for ADHD would prevent this from happening.
* A reliable ADHD test could supposedly be administered more rapidly, and by a wider range of people. This could dramatically cut down waiting times for a diagnosis, which are often many years in many countries.
* Many people still doubt that ADHD exists, or that it is a valid mental condition. Having a reliable test for ADHD would support its legitimacy: some people have it, others don’t. And we would know exactly and objectively how to check for this difference. (Btw, several studies have been conducted that show how dramatically impaired people with ADHD are over their lifetimes. Some of these studies include a large number of people, with and without ADHD.)
There is no doubt that a *reliable* test for ADHD would be useful.
Thank you for all you do.
Dr Russell will you be my second dad
In my experience, as a ADHD patient, a test is a tool in the diagnosis, but never THE tool of diagnosis.
My Diagnosis took dozens of hours, and most of it was in dialogue with my psychiatrist.
In a private clinic in southern Germany, usually it will be faster, but at least a few hours.
I was just looking up this topic in google scholar, then I go to youtube and see this in my feed! amazing timing.
Not really just the stalking google algorithms tracking your life
I appreciate you putting this out there. I can't tell you how many people have told me that their doctors refuse to diagnose because of their performance on a computerized test.
This is interesting Prof Barkley. Because the doctors used the Qbtest and they did the test before I take methylphenidate and after taking the medicine. Before my concentration levels were in the worst quantile and after taking medicine it was in line with general population.
I think QBtest seems to be a good test to help on diagnosis and heavily used in the country I live in.
Thank you! This kind of clarity in a short, shareable video is much needed, and will do good.
Is it possible that a multivariate analysis using results from a combination of existing tests could give a clearer separation of groups? Do you know of any studies which have looked at the accuracy (e.g. in terms of false positive / false negative rate) of something like linear discriminant analysis across multiple tests or modalities of testing?
Kaiser had me do a CPT, then referred me after i failed the test. I feel bad for those who are a false negative.
What about medication effects?
Isn't the point of p values and the concept of "statistical significance" specifically to address the weaknesses of "comparing averages in groups" and "what if the ranges overlap"? You still have a point about the importance of good diagnostic practice and avoiding over-reliance on tests in psychiatry, but it seems like saying they have no value is overly dismissive of tools that could potentially increase diagnostic accuracy for clinicians.
P values? Please explain?
Took one of these tests last year at age 28. I’m quite confident that I have ADHD based on my experiences, but all i got was an anxiety and depression diagnosis. How is an adult even supposed to get properly diagnosed for ADHD…
Wow, this is great and something I was thinking about the past few days. I recently took a lot of these tests in my ADHD evaluation over two days and about 5-6 hours total. I was wondering if they gave all of these to see if there were any other problems with my thinking or learning disabilities. To help rule those out when they determined I did in fact have ADHD. Now and most likely most of my 50some years.
But I wonder if the lacking attention from ADHD affected my AGI score? Because in some of the test I could find my thoughts drifting to other things.
Well anyways this explains a lot, thanks.
I'm confused if not terrified. Did I waste my time getting a neuropsych evaluation? Also, if there are no diagnostic tests for adhd, doesn't that give the naysayers grounds to dismiss the didorder? I had an intake for 2 to 3 hours followed by a neuropsych evaluation two months later which took about 3 to 4 hours. The neuropsych evaluation included a battery of tests measuring executive functions i.e Connors, Delis Kaplan, WASI-II to name a few. I was diagnosed as a combined type adhd.
ADHD assesement and differential diagnosis is globally a mess. The assessing psychologist came to the conclusion that I have atypical ADHD with no attention issues whatsoever, based on one of those computerized tests (I didn't make a "pathological" amount of mistakes, though my reaction time varied wildly) - she threw at me a report the software generated, stating there were no signs of ADHD. Now the fact that I had noticable issues following her spoken instructions to virtually every test we've done, didn't seem to be worthy of her attention.
This also seems to be an issue with iq tests for those who perform well on them. So called spiky profiles are often not taken seriousely if none of the scores fall into the "disability" range.
On the WAIS my VCI and PRI are above average, my WMI is borderline bellow average (84) and the PSI is about average. There's also significant scatter among subtest seemingly depending on their working memory load (Information lags behind the other two VCI subtest by around 1 SD). The PRI subtests scores were messier. We started with the dices. The psychometriciran noted that I completed the later, more difficult, tasks faster than some of the easier ones. This is my lifelong pattern. It seemed to have showed up in the other two subtests as well. I did answer correctly to the very last Matrix reasoning task but my score comes nowhere near reflecting that.
I figured out It's easier for me to compensate in the verbal domain (where I still have issues verbalizing the answers smoothly and not getting distracted by the actual questions) than in the spacial reasoning one, where I'm more sensitive to how challenging I perceive a task to be.
This is what my teachers used to be perplexed by - I exhibited superior reasoning skills but was brought down by "careless mistakes" and issues with memorizing/recall.
The WAIS IV did confirm what has always been my cognitive profile but the psychologist didn't really bother with digging into it beyond a very basic interpretation. I think the test could tell a lot about the cognitive issues we face in our daily lives If there was better understanding about how to interpret it in the context of ADHD. These tests also pick up our coping strategies so It's unlikely a distinctive profile would emerge. One that I acquired with age is not getting frustrated if I make a mistake or can't focus. This allows me to better handle real life problem solving but I'm still not more efficient with the strategies I employ. The WAIS (and some other tests) seems to have reflected that but the psychologist barely picked it up.
What’s your opinion on brain scans being used?
it's talked about at 4:40
For someone who is unsure if they have ADHD, what should they do? If there is no specific test, what kind of doctor should they see for the evaluations mentioned at the end and should they have any specific training or credentials to look out for? Thanks.
that is what I want to know.....
There aren't specific tests, but there are reputable rating scales normed on the general population. Dr Barkley has a video on this (Screening for ADHD in Yourself or Your Child) on his channel. Reputable clinics will generally give an overview of their diagnostic practice, and will hence state the rating scale they use + have clinicians trained to conduct them properly, but, unfortunately, finding a good clinic in your area will probably require relying on word-of-mouth and independent research.
Are you aware of any promising research in the area of ADHD diagnostics? Such as more advanced neuro imaging (I.e. fMRI) or any other promising methodologies that we may see down the road?
He made a video about this at some point.
Things are a bit more nuanced, as each test has a specificity/sensitivity that needs to be taken into consideration by the clinician. This informs you about the overlap of the distributions. Tests do not compare only averages between groups, rather they also compare individual scores in relation to the average of groups. None of the tests are great where things overlap, but not every person tested has a score where the groups overlap. Indeed, not one test or any test for that mather should be considered as the final diagnostic, but the clinician is the final diagnostic. However the clinician can be informed by tests, and they should be informed by tests and by other sources of information.
I expected dad jokes😮
⭐️⭐️⭐️⭐️⭐️
Yay, I *don't* have ADD or anything else in my head wrong! 🥳😁👍
😂haha
Does not Dr. D. Amen have an accurate testing procedure for both?
No
@@vans4lyf2013 Sure does - Back in the later 90's he had 40,000 brain scans to back him up. His testing and protocols still stand the test of time.
He mentions at 4:40 that he considers the tests of Daniel Amen not sufficient to establish an accurate diagnosis
@@ethimself5064dr. Amen's claims were thoroughly debunked by other neuroimaging experts, but his PR machine is so strong he just won't go away.
Amen is a quack