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  #46  
Old 02-14-13, 02:39 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by Amtram View Post
When my father in law had kidney cancer, one doctor diagnosed him with diabetes, another doctor diagnosed him with lingering side effects from meningitis.

Doctors are human. Biology is complex. Diseases can share symptoms. Misdiagnosis is always a possibility.
Quote:
Originally Posted by Tyler Durden View Post
That is because the doctors based their diagnosis on symptoms alone, highlighting issues with symptomatic diagnostics.

Had they found a malignant tumor there would be no such disagreement or misdiagnosis.
Yes, symptoms are the reason doctors call for tests to confirm a diagnosis.

My mother had abdominal cancer that was diagnosed as diverticulitis.
Over time, it spread to her brain and she was diagnosed with an inner ear
infection.She was in pain, clearly sick, and loosing weight steadily.

Tests were done, including MRIs and PET scans, but they were looking at
her brain rather than at the base of the brain where the tumor was located.

Eventually she experienced what looked like a stroke or bell's palsy,
a paralysis on one side of her face.

She could not close that eye so it was covered and she was sent a larger
diagnostic and teaching hospital.

Following many more tests, MRIs and PET scans, I don't remember if a
doctor actually looked at the base of the brain or if they were just lucky
enough that one scan caught the edge of the tumor.

Finally, a diagnosis more than a year after the malignant tumor had moved
to her brain. Too late to save her life.

But yeah, whatever, a malignant tumor is easy to find with these infallible tests. /sarcasm


added: not really so different from ADHD being misdiagnosed, actually.
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  #47  
Old 02-14-13, 03:35 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

There is no such thing as an unambiguous adhd diagnosis.

Is it just me who can see the difference?
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  #48  
Old 02-14-13, 03:56 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

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Originally Posted by Tyler Durden View Post
There is no such thing as an unambiguous adhd diagnosis.

Is it just me who can see the difference?
You may be the only one who cares.

If the symptoms describe the disorder and the treatment is effective,
that's enough for many of us.
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  #49  
Old 02-14-13, 04:01 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

All I know, is that I'm not paying through the nose for a test that just confirms what is obvious already. Wanna give it to me for free? Oh, I'm not filling out a bunch of paperwork either to qualify for "assistance". Give me that test for free, and I'll take it. Sure, it would be very interesting. Since I can't even afford to go to do cognitive behavioural therapy, I'm not paying for a neuro test.

You don't ask someone with depression for a neuro test. They list a set of symptoms, and the docs try some meds on them. They don't even know what will work for sure. But you can be sure, that nobody's going to use an expensive test that may or may not be worth the cost, when the person is obviously depressed.

And, if the symptoms of ADHD were sufficient to prompt the doctor to give a neuro test and waste all that money, they're probably sufficient to just get the dang diagnosis.

Right now, neuro tests IMO are only valuable for research, not for use in the doctor's office. Maybe that'll change in the future.

I would hate to think of what would happen if the doctors decided that you HAVE to have a neuro test for a diagnosis. There would be many who could never afford it, and go undiagnosed. Screw that.

I don't feel that the symptoms are all that ambiguous, anyway. I gave my doc my symptoms, and he ruled out other diagnoses like bipolar because I don't have those symptoms. I have mood swings, for example. They don't last long at all, so bipolar is out. (this is just one example, I don't feel like listing my diagnosis process here)
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  #50  
Old 02-14-13, 04:45 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by Lunacie View Post
You may be the only one who cares.
If I was the only one who cared then this would be a very lonely forum.

Quote:
If the symptoms describe the disorder and the treatment is effective,
that's enough for many of us.
This is where you have always been greatly mistaken, symptoms do not describe the disorder, if that were the case a headache would describe a brain tumor and painkillers would be an "effective treatment".
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  #51  
Old 02-14-13, 05:07 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by Tyler Durden View Post
If I was the only one who cared then this would be a very lonely forum.



This is where you have always been greatly mistaken, symptoms do not describe the disorder, if that were the case a headache would describe a brain tumor and painkillers would be an "effective treatment".
I was afraid I wasn't being clear enough.

I meant that you may be the only one who cares ... about the difference
that you mentioned ... whatever you think that may be.

Someday we'll have little machines like on Star Trek that can diagnose
medical issues.

But for now doctors do use symptoms to describe those issues and to
diagnose them. When tests are available they use those tests to confirm
or rule out the diagnosis.

If that bothers you so much, go to medical school and change it all.
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  #52  
Old 02-14-13, 05:12 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Reductio ad absurdam. Diagnoses are not rendered based on a single symptom alone, ever. Diagnoses are rendered based on a collection of symptoms manifesting simultaneously all the time. Diagnoses are rendered based on a collection of symptoms without serum testing or imaging all the time, too. ADHD is far from being alone in this.

In many diagnoses, tests are not needed except as confirmation that the diagnosis is this thing and not that other thing that looks a lot like it. If it works for all but the most complex and obscure cases, then there's no reason to dismiss its usefulness in diagnosing psychiatric conditions as well.

Barkley is actually hopeful that at some point there will be tests that will confirm diagnoses and help eliminate some of the trial-and-error aspect of treatment options. However, he is not endorsing expensive tests and treatments that currently show no significantly better results than current approaches. He is far from alone in this; most researchers in mental health fields agree that imaging tests are not sufficiently accurate or economical to justify being used for diagnostic purposes. In other words, Barkley is not the one calling the shots here and telling the world what to do, but passing on the information that's accepted knowledge among the scientific community.
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  #53  
Old 02-14-13, 05:54 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

A reminder for everyone, this is the topic:


Quote:
This DR barkley quote says that neurological tests have little to no value in making the diagnoses of adhd.


So please stay with it.
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  #54  
Old 02-14-13, 07:55 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by Amtram View Post
Right now, the value of these tests is to see if there's enough of a consistent, measurable difference in the ADHD brain that they can, eventually, be useful for diagnosis. As Dizfriz says, there's a lot of statistical data that shows significant differences. . .but if you look at the data graphs, you'll still see some outliers that don't fit in the majority (but they still have ADHD!)

If this were some simple problem that had its origins in a single area of the brain, then there'd be no problem using imaging of one kind or another to pin down the problem. Most people with ADHD show a difference in size and function of the frontal lobes, but in some it's only the right or only the left. . .and some have differences in the hippocampus, and some don't. Some have differences in the temporal lobes, some don't. Some show a decrease in bilateral functions in fMRIs, some don't.

The only thing they do share is a collection of symptoms that lead to similar problems in cognition and behaviors that negatively affect their lives. As long as that's the only thing that's certain, that's the only thing we can use for diagnosis.
Amtram,

Could you provide some research about the following part quoted below, from the quote above? (I think this is very important to clarify)

Quote:
Most people with ADHD show a difference in size and function of the frontal lobes, but in some it's only the right or only the left.
Specifically "only the left"? This is the first time I ever heard this? But in the past wondered if it was possible? (I have more to discuss specifically about this topic, but I will stop here for now, and wait for a reply)(I am familiar with the smaller size of the right prefrontal cortex areas, in people with ADD)



.

Side Note, (in regards to the OP), In a recent video ,Dr.Barkley states that ADD is a disorder of the frontal lobe, this seems like a use of neurological testing to me?
Why can't it be both psychological and neurological testing, why does it need to be either/or. This either/or, is a big problem in these discussions. When it always seems to actually be both. All the time. Solving this constant ,either/or, problem would benefit us all. Support the middle ground.

.

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Old 02-14-13, 08:28 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Peripheral not sure I understand what do you mean by psychological testing? The questionnaires? neurological testing is stuff like tests on cognition etc. I can't see how useful that would be, are you referring to scans or examinations of brain physiology? (which I believe is potentially far more promising from a diagnostic standpoint).
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Old 02-14-13, 09:03 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

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Originally Posted by Tyler Durden View Post
Peripheral not sure I understand what do you mean by psychological testing? The questionnaires? neurological testing is stuff like tests on cognition etc. I can't see how useful that would be, are you referring to scans or examinations of brain physiology? (which I believe is potentially far more promising from a diagnostic standpoint).
If physiology includes both psychology and neurology.(and anything else that helps). I am not focusing on one specific test, but what ever tests helps.(there may be tests/scans ,both neurological and psychological, that don't work) I often get into the discussion between genetic or environment, but it is parts of both, always.
If I say ADD is genetic only, I am lying, if I say ADD is environmental only, I am lying. Both genes and environment are involved in a relationship. This is a fact. Why is it one or the other, psychology or neurology, genetic or environment. It is not nature or nurture. Its nature and nurture. Side note: I don't have a back ground in neurology or psychology. And am learning the "newer" sciences for the first time. I am not on one side or the other. I am on both sides. What ever works, the division doesn't make sense to me? Tyler, I appreciate you asking for clarity, maybe there is something I need to learn? I am learning,I'm 0pen to discussion, or any clarification that would help progress.

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  #57  
Old 02-14-13, 10:25 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

The main reason that the frontal lobes get top billing in this case is that they are in charge of executive function, which is well-known and accepted in neuroscience. The frontal lobe functions were pretty much the first ones that were studied in Traumatic Brain Injury patients that showed a clear correlation between location and function.

That made it a natural decision to check them out when trying to find the origins of ADHD, since the primary symptoms lined up with the deficits experienced by patients with frontal lobe damage.

Still, though, for all the tests that show that a statistically significant number of test subjects with ADHD have smaller frontal lobe mass than control subjects do, it's not 100%, and some individuals show the opposite. So, back to the drawing board.

If the tests had shown that even if the difference was small, ALL ADHD test subjects had smaller frontal lobe mass relative to brain size, then the problem would be solved, and we'd be able to use an MRI for diagnosis with stellar accuracy. No such luck. Our brains are still too complex for a machine to figure out all on its own.
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  #58  
Old 02-15-13, 12:47 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

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Originally Posted by Amtram View Post
The main reason that the frontal lobes get top billing in this case is that they are in charge of executive function, which is well-known and accepted in neuroscience. The frontal lobe functions were pretty much the first ones that were studied in Traumatic Brain Injury patients that showed a clear correlation between location and function.

That made it a natural decision to check them out when trying to find the origins of ADHD, since the primary symptoms lined up with the deficits experienced by patients with frontal lobe damage.

Still, though, for all the tests that show that a statistically significant number of test subjects with ADHD have smaller frontal lobe mass than control subjects do, it's not 100%, and some individuals show the opposite. So, back to the drawing board.

If the tests had shown that even if the difference was small, ALL ADHD test subjects had smaller frontal lobe mass relative to brain size, then the problem would be solved, and we'd be able to use an MRI for diagnosis with stellar accuracy. No such luck. Our brains are still too complex for a machine to figure out all on its own.
I'll make my own conclusions thanks. These topics are no where near, "back to the drawing board", in my opinion. It is very important to be specific about what hemisphere you are saying is underdeveloped. I have never heard of the left prefrontal cortex being smaller than the right prefrontal cortex in people with ADD, (I do wonder if it is possible in about 3% of the ADD population?)? So far I have only heard of the right frontal lobe? There are reasons why knowning the difference is very important to understand, and makes a big difference in terms of understanding the development of ADD. I am not doubting you,yet, but I need to see where you got this information about the left frontal lobe being smaller than the right, in some people with ADD? It makes a big difference in the things I know about (in more than one way). I can explain more if anyone interested.

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Old 02-15-13, 02:13 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

.
Prefrontal Cortex (general)


Left Hemisphere More Executive related?(tools?not exactly sure) >----------< Right Hemisphere Side More Emotional related?

The emotional right effects the executive left in some research.

There are exceptions. But I think this is the general idea. Open for discussion.


Tyler, if Physiology is the goal of understanding, biology,neurology,psychology,etc...interacting in a natural environment? (as much as possible, not specifically sure)?

Then I agree, Physiology is the word.

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Old 02-15-13, 03:23 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

check out this link.

http://www.humanconnectomeproject.or...onship-viewer/

Click on the right medial orbitofrontal cortex (on the left about 47 minutes past the hour)(sorta pink)

Then compare with,

Click on the left medial orbitofrontal cortex (on the right about 18 minutes past the hour)(sorta pink)

Compare both, right and left orbitofrontal cortex. They don't both make the same connections with the same other areas of the brain.
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