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  #1  
Old 02-13-13, 07:09 AM
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this DR Barkley quote states that Neurological tests have no value in the diagnoses..

This DR barkley quote says that neurological tests have little to no value in making the diagnoses of adhd. So if you were to go in and get an evaluation for adhd and they make you do a lot of tasks that help indintify issues with attention, would this be of little value. Is this what DR barkley is reffering to?


"Neuropsychologists do thorough evaluations that can result in a diagnosis of A.D.H.D. with any of a combination of inattention, hyperactivity, impulsivity. There’s a lot more to a decent evaluation than questionnaires. And there can be a lot more going on with “attention” problems than garden-variety A.D.H.D.
GrammyofWanda, Maine
A.

Dr. Barkley responds:
While neuropsychological testing may have some value for other learning disabilities or evaluating the extent of cognitive impairment from brain injuries, it is of little or no value in making the diagnosis of A.D.H.D. Interviews with the patient and family, rating scales, the history of the patient and the use of diagnostic criteria from the Diagnostic and Statistical Manual, along with the professional’s expert knowledge of differential diagnosis of disorders, are all essential parts to an evaluation.
The only testing that may be needed in such cases is to rule out limited intelligence or learning disabilities as possible coexisting problems that could explain some of the performance difficulties the person may be having in school settings. Otherwise, there are no psychological, medical or neurological tests that are useful for diagnosing A.D.H.D."
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  #2  
Old 02-13-13, 09:23 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

I'm just going to directly quote Dr Barkley from his book-taking charge of ADHD.

Quote:
" A large number of studies have compared the electrical activity in the brains of those with ADHD to those of children without ADHD. A variety of such studies, done easily and painlessly using an electroencephalograph (EEG) while children with ADHD were sitting at rest and also while performing certain mental tasks, have found that the brain electrical activity of children with ADHD is less than that seen in children without ADHD, particularly over the frontal area.

In 1973 Drs. Monte Buchsbaum and Paul Wender, then at the National Institute of Mental Health, measured EEG activity in response to repeated stimulation to derive average evoked responses. When 24 children with ADHD and 24 normal children were compared, the children with ADHD responded as younger children without ADHD would: Their responses reflected a less mature pattern of brain electrical activity. These researchers also found that giving stimulant medication to the children with ADHD reduced these differences. Although children with ADHD show less activation in certain types of EEG activity, this does not automatically mean that training them to increase this activity is an effective therapy (see sidebar on p.68)."
EEG/fMRI are some of the tools that neuropsychologists use. Reading that seems to contradict

Quote:
"Otherwise, there are no psychological, medical or neurological tests that are useful for diagnosing A.D.H.D."
Based on what he's written before it stands to reason that EEG scans would be a useful tool in making a diagnosis of ADHD.
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Old 02-13-13, 09:32 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

That being said- those kids were not doubt diagnosed as being ADHD by the DSM criteria, which could be used as proof that its an effective way of diagnosing people with ADHD.
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Old 02-13-13, 09:33 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

I think the reason for this seeming contradiction is that while on a population level (on average), there are differences between groups of people with ADHD and groups of people without, these differences are not sufficiently reliable for diagnosis at the individual level.

So, if you take 100 people with ADHD, the average electrical activity might be lower than the average for a group of 100 people without. But if you take any 1 person with ADHD, their individual electrical activity may or may not be lower than 1 person without ADHD. And it may not even be lower than the average of people without ADHD.

There would likely be too many false negatives and too many false positives.

As imaging techniques and our understanding of the precise mechanisms behind ADHD (which may include several different pathways) improves, imaging-based diagnostics may become more reliable.

But for now, they don't seem to add much value (and they add cost and discomfort) to a diagnosis that can be made using interviews and a thorough medical, social, academic, developmental, and occupational history.
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  #5  
Old 02-13-13, 09:55 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
I think the reason for this seeming contradiction is that while on a population level (on average), there are differences between groups of people with ADHD and groups of people without, these differences are unreliable for diagnosis at the individual level.

So, if you take 100 people with ADHD, the average electrical activity might be lower than the average for a group of 100 people without. But if you take any 1 person with ADHD, their individual electrical activity may or may not be lower than 1 person without ADHD. And it may not even be lower than the average of people without ADHD.
I think these tests would add legitimacy to the condition. Given that there's much debate in society over whether ADHD exists or not, which is something that seems specific to ADHD and not other mental disorders. For people with ADHD its not just the problem of dealing with the disorder- its also dealing with other people who question whether it even exists.

thought about it for awhile, and I think you're right, If there is a large amount of variability in the electrical activity data of those who have ADHD, even if overall the average of brain activity was lower than the average population- it would not be able to be used as a useful individual diagnostic tool. So I guess someone has to look at that study & the variability in the data in order to determine- just how successful a diagnosis via EEG would be.
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  #6  
Old 02-13-13, 10:10 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by noradd View Post
Wow, a lot of replies in this thread. Seems like Barkley is a hot topic lol.

What I found a bit confusing about his speech is that I found myself in some of the stuff he said but not in the other things. Now what does this mean? I have been driving without meds for 10 years without accident does this mean I cant have ADD?
What he is saying is that statistically ADHDers , among other driving issues, have a much greater incident rate of accidents and those accidents tend to be more serious than non ADHDers. The research confirms this well and there is really no question. Keep in mind though, the statistics are mostly for untreated ADHD. ADHD is treatable.

We are talking about statistics involving groups of people, not single individuals. Many who are ADHD have safe driving records but on the whole, those who are ADHD have worse driving records than those who are not.

Quote:
Or my parents werent totally worried about me when I was a child and I also did my homework does this mean I cant have ADD?
No, again we are talking about statistics about groups. (A note, all statistics are about groups, not single individuals).

While difficulty staying focused enough to successfully do homework is very common among ADHD children, some do not have this. ADHD is a complex disorder with a number of genes involved and several parts of the brain. Each is a unique mix of those. It is the pattern of symptoms that define the disorder, not individual ones.

Quote:
What I dont like are these generalizations like all children who have ADD dont do homework and are a nightmare for their parents and all other children dont like them cause they have such a bad temper. Does this really have to be so? What if his ADHD definition is too narrow and excludes people who also have it?
The statistics involved address characteristics that most who are diagnosed as ADHD have but not all. If the majority of ADHD children have difficulty with staying focused on homework then it is relevant but some will not have this problem. Statements of "all" ADHD children are not made by professionals. Part of the training is learning to interpret statistics and "all" does not come into play.

What Barkley usually does in his lectures is to state that those who are ADHD exhibit these characteristics. This is to keep things simplified for educational purposes otherwise a lecture or workshop would be impossible and will bog down on fine details and exceptions.

If you want to get accurate information of what he is saying and what the research shows in fine detail, you would have to read his academic works. There he goes into these details.

When a doctor is discussing a medication, all of the possible side effects are usually not discussed, this is what data sheets given out with the prescription is for.


When he gives a lecture, a list of articles and books is given for those who want to go into greater depth.

Very interesting questions and good ones to bring up.

Dizfriz
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  #7  
Old 02-13-13, 10:20 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by ackblerg View Post

Based on what he's written before it stands to reason that EEG scans would be a useful tool in making a diagnosis of ADHD.
A much more accurate statement would be that EEG scans "could" be useful tool in making a diagnosis of ADHD and hopefully in time they will.

The EEG diagnostic tools show a good bit of promise but they are not there yet. I have seen some good reports on the Qeeg.

Right now, diagnosing ADHD is a clinical judgement issue. Keep in mind that according to Barkley, none of the DSM disorders have a valid test for diagnosing, they are all based on clinical judgement.

I have seen none of the DSM diagnosis to be otherwise but I have not looked at all of them (there are around 400 of them.) I pretty much suspect Barkley has and will take his word on this.


Good points to bring up. You are not the only one to have these questions.

Dizfriz
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  #8  
Old 02-13-13, 10:41 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Originally Posted by ackblerg View Post
I think these tests would add legitimacy to the condition. Given that there's much debate in society over whether ADHD exists or not, which is something that seems specific to ADHD and not other mental disorders. For people with ADHD its not just the problem of dealing with the disorder- its also dealing with other people who question whether it even exists.
While there is a debate in the general public about the reality of ADHD, there is not one among scientists and clinicians. The reality of ADHD is considered a scientific fact with fact being defined as confirmed to such a degree that it would be perverse to withhold provisional assent.

The problem is that the debate is being kept alive by groups of anti-psychiatry zealots who seem to have little interest in truth or accuracy.

So you are quite correct, dealing with people who do doubt or do not believe in the reality of ADHD is one of the battles we have to fight and yes a well validated test would be very useful with this but right now, we don't have one.



Good points that many reflect questions about ADHD that many have. Thanks for bringing them up.

Dizfriz
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  #9  
Old 02-13-13, 11:15 AM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

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.
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Old 02-13-13, 12:29 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Not to state the blindingly obvious but...

Until people figure out what adhd actually is then they will never find a reliable test for it.
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  #11  
Old 02-13-13, 12:34 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Going to quote Barkley again- this time from one of his papers.

Clinical utility of EEG in attention deficit hyperactivity disorder.
http://www.adhd.com.au/downloads/Loo2005ADHD.pdf

Quote:
Diagnostic Utility of EEG in ADHD
Sensitivity and specificity of EEG. To study the
diagnostic utility of any new instrument (in this case
EEG), one should compare its ability to correctly identify those with a diagnosis (made with the “gold standard”) and those with no diagnosis. Sensitivity tells you
what percent of ADHD children have an abnormal EEG
and specificity tells you what percent of non-ADHD
children have a normal EEG. In several studies, the
EEG has demonstrated good sensitivity (90%–97%)
and specificity (84%–94%; Chabot, Merkin, Wood,
Davenport, & Serfontein, 1996; Monastra et al., 2001;
Monastra et al., 1999). This means that, when you have
a group of children with ADHD, a high percentage of
kids will have a corresponding abnormal EEG
(increased theta or high theta/beta ratio); in a comparison group of children with no ADHD, a high percentage of those children will have a normal EEG (lower
levels of theta or lower theta–beta ratio). But more important from the standpoint of clinical diagnosis is positive (PPP) and negative predictive power (NPP). PPP
tells you whether an abnormal EEG can correctly predict which children will receive a diagnosis of ADHD
and NPP tells whether a normal EEG correctly predicts
who will be normal or non-ADHD. The PPP and NPP
for EEG have been reported to be 98% and 76%, respectively (Monastra et al., 2001), meaning that when
there is an abnormal EEG (high theta/beta ratio in this
case) it is highly likely that the child is ADHD. However, when the EEG is within the normal range, 24% of
those children go on to be diagnosed as ADHD using
other clinical methods. Most clinicians would consider
this to be an unacceptably high rate of misdiagnosis for
clinical purposes. Furthermore, a two-group comparison (ADHD vs. normal) of EEG diagnostic validity is
not the most appropriate way to examine predictive
power because most ADHD children referred to clinics
have at least one if not two other comorbid disorders.
Thus, the issue facing the clinician is not whether the
referred case is disordered or normal, but rather, which
disorder or set of disorders the case manifests among
the various possible disorders (e.g., learning, depression, anxiety, etc.) occurring in a clinical practice.

Sorry for bad formatting it was copied from a PDF, its probably easier to go to page 67 to read it.

main points being

Quote:
But more important from the standpoint of clinical diagnosis is positive (PPP) and negative predictive power (NPP). PPP
tells you whether an abnormal EEG can correctly predict which children will receive a diagnosis of ADHD
and NPP tells whether a normal EEG correctly predicts
who will be normal or non-ADHD. The PPP and NPP
for EEG have been reported to be 98% and 76%, respectively (Monastra et al., 2001), meaning that when
there is an abnormal EEG (high theta/beta ratio in this
case) it is highly likely that the child is ADHD. However, when the EEG is within the normal range, 24% of
those children go on to be diagnosed as ADHD using
other clinical methods. Most clinicians would consider
this to be an unacceptably high rate of misdiagnosis for
clinical purposes.
so if you have an EEG done & it comes back positive you can be 98% sure that you do have ADHD. Although if it turns out to be negative/normal- there's still a 24% chance based on the data that you may have ADHD.

I would take this test for my own peace of mind. Knowing that if It came back positive, then that would be all the proof I needed that I did have ADHD and I wouldn't have to doubt the diagnosis.

wanted to analyse that further- but I need sleep so will just leave it at that, and come back to it later/ look forward to reading your responses.
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Old 02-13-13, 01:04 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

ackblerg

Here is the summary from the article paragraphed for readability.


Quote:
Summary

Although the existing studies of EEG biofeedback claim promising results in the treatment of ADHD, the promise of EEG biofeedback as a legitimate treatment cannot be fulfilled without studies that are scientifically rigorous.

Undoubtedly, treatments for ADHD would benefit greatly from a non medication alternative that is efficacious and cost effective. But there is much work to be done to demonstrate that EEG biofeedback provides that alternative and that actually changing the EEG is the mechanism of change in ADHD symptoms (as op- posed to just more time with a therapist). Without such demonstrations, the changes in behavior cannot in fact be attributed to this specific treatment mechanism.

It must also be shown that treatment effects can generalize to non treatment settings and can persist over time. Even with such demonstrations it must also be shown that treatment is cost effective in managing the symptoms of ADHD relative to the prevailing empirically supported approaches.
Note that the article was from 2005. That is fairly old for a evidence review article.


It might be useful to look at the last part of the article.

From the last section: Future Directions for Research on the Clinical Utility of EEG in ADHD

Quote:
If EEG is to be used as a diagnostic tool for ADHD, there has to be much greater clarity on its ability to differentiate ADHD from normal children, ADHD subtypes from each other, and to assess for differential diagnoses as well as ADHD comorbidities. Work documenting correlations between EEG and ADHD symptoms and subtypes is needed.
This was true in 2005. I do not know what the status is currently but as far as I know it has not changed all that much. Since I only keep up with this in a general manner, my thoughts are hardly definitive.

Quote:
I would take this test for my own peace of mind. Knowing that if It came back positive, then that would be all the proof I needed that I did have ADHD and I wouldn't have to doubt the diagnosis.
You might get some degree of certainty but proof is a much higher level and is seldom reached in this kind of work.

You are perfectly free to take the test. I might suggest you look at the Qeeg as it, as far as I know, seems to be the best supported.


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  #13  
Old 02-13-13, 01:37 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
Not to state the blindingly obvious but...

Until people figure out what adhd actually is then they will never find a reliable test for it.
Yes. Well, the current test (the real current test, the inconvenient and difficult and clumsy one, namely the discussion of life history with a professional who knows the difference between ADHD and not) is now refined enough to be correct far more often, but it depends on the personality and education of the professional - which obviously leaves it wide open to error. So, we don't know the source of ADHD, and until we do, that clumsy and error-prone method is all we've got.

I think pretending that one of the convenient-but-wrong tests is worth anything is the greater problem right now though.
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Old 02-13-13, 02:33 PM
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Smile Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

Quote:
Not to state the blindingly obvious but...

Until people figure out what adhd actually is then they will never find a reliable test for it.
Not necessarily true.

Take epilepsy for example: it was understood what causes it about 50
years before a test was devised to reliably diagnose it.

Quote:
1859-1906:
Under the leadership of three English neurologists--John Hughlings Jackson, Russell Reynolds, and Sir William Richard Gowers--the modern medical era of epilepsy begins. In a study, Jackson defines a seizure as "an occasional, an excessive, and a disorderly discharge of nerve tissue on muscles." He also recognizes that seizures can alter consciousness, sensation, and behavior.

1929

A German psychiatrist named Hans Berger announced to the world that it was possible to record electric currents generated on the brain, without opening the skull, and to depict them graphically onto a strip of paper. Berger named this new form of recording as the electroencephalogram (EEG).
from: http://www.epilepsy.com/epilepsy/history
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  #15  
Old 02-13-13, 03:50 PM
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Re: this DR Barkley quote states that Neurological tests have no value in the diagnos

A misdiagnosis, not only in the case of ADHD but in many other conditions (testable, physical conditions can be misdiagnosed as well) is that the wrong treatment or even no treatment at all can be seriously detrimental. In some cases, even deadly.

Essentially, unless you have a test that demonstrates that it is significantly superior to current evaluation procedures, there's no justification for the extra cost. EEG and qEEG cost thousands of dollars, and you still have to have them interpreted by a human being - same as the diagnostic evaluations you get from a psychiatrist. Unless it has a much smaller margin of error and is more conclusive than what we have now, it's better at decreasing your bank balance than anything else.

OTOH, the continued use of imaging programs, genetic testing, and other clinical trials, even when they fail, improves our understanding and gets us closer to finding more reliable answers.

And if you really, really, really want to see your brain, but can't afford the cost, you can do what I did and fall down and hit your head. It might get you only a CT scan, though, just to warn you!
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