ADHD Brain Scans

[Greg1982]

Hi Everyone,

I know I'm new here so please understand this post isn't meant to offend, only to share information. I've noticed throughout the board there is some information that may not be 100% accurate. I'm only posting this to help clear up any misconceptions or false information that might have been passed along erroneously.

While it is true that the procedure to diagnose ADHD is not 100% standardized across practitioners within the United States (I don't know about the rest of the world to comment), it is also 100% untrue that there aren't any diagnostic tests being done whether research based or not.

It's known that the brain functions differently for us than it does for people without ADHD, and it's also known that there are different types. What seems to be less known is that there are scans to assess brain function available that are accurate enough to show that certain parts of the brain are not functioning correctly. By pinpointing this scan to a portion of the brain, specifically the executive center, MD's or Psych Docs are quite able to assess whether or not it is functioning correctly. In our case, it does not.

However, there are other portions of the brain that are different for us with ADHD than it is for others. By evaluating the level of function of the executive center along with some other portions of the braing a diagnosis can be determined, as well as, a plan of treatment.

I'm absolutely not claiming to be an expert, and I still have so much to learn. Here are some videos to help explain some of the things I've written above though because if you're anything like me, you just clicked on the links and couldn't read/absorb any of what I just wrote .

http://www.youtube.com/watch?v=aXFyU...feature=relmfu

http://www.youtube.com/watch?v=2utqm...feature=g-vrec

Hoping for an engaging evidenced based discussion to follow.

Greg

[BluegrassBound]

Are there Highlight reels of each of these video's?? Something in shorter increments. Not 27 minutes and an hour and 20.

[Dizfriz]

I posted on this today.

http://www.addforums.com/forums/show...84&postcount=1

The problem with Amen is that no one has replicated his work and thus we have no way of knowing if he is right or not. It doesn't mean he is wrong it is just that we don't know and right now there seems to be no validated evidence that the scans are useful for diagnosis or treatment of ADHD.

Dizfriz

[Drewbacca]

Originally Posted by Greg1982

By pinpointing this scan to a portion of the brain, specifically the executive center, MD's or Psych Docs are quite able to assess whether or not it is functioning correctly. In our case, it does not.

Since we are clarifying things in this thread, it should be pointed out that the "executive center" is not a portion of the brain. It is a model of what we believe to take place in the frontal lobe, not an actual physical reality in of itself.
As such, it's a bit difficult to measure something that doesn't exist, even if various scans show a correlation with the deficits in question.

[JOHNCG]

Originally Posted by Greg1982

Hi Everyone,

I know I'm new here so please understand this post isn't meant to offend, only to share information. I've noticed throughout the board there is some information that may not be 100% accurate. I'm only posting this to help clear up any misconceptions or false information that might have been passed along erroneously.

While it is true that the procedure to diagnose ADHD is not 100% standardized across practitioners within the United States (I don't know about the rest of the world to comment), it is also 100% untrue that there aren't any diagnostic tests being done whether research based or not.

It's known that the brain functions differently for us than it does for people without ADHD, and it's also known that there are different types. What seems to be less known is that there are scans to assess brain function available that are accurate enough to show that certain parts of the brain are not functioning correctly. By pinpointing this scan to a portion of the brain, specifically the executive center, MD's or Psych Docs are quite able to assess whether or not it is functioning correctly. In our case, it does not.

However, there are other portions of the brain that are different for us with ADHD than it is for others. By evaluating the level of function of the executive center along with some other portions of the braing a diagnosis can be determined, as well as, a plan of treatment.

I'm absolutely not claiming to be an expert, and I still have so much to learn. Here are some videos to help explain some of the things I've written above though because if you're anything like me, you just clicked on the links and couldn't read/absorb any of what I just wrote .

Hoping for an engaging evidenced based discussion to follow.

Greg

Functional and structural neuroimaging data (from technologies like: fMRI , SPECT, etc are invaluable for research scientists investigating the neuroanatomy, neuropsychology on so on, of the ADHD brain, but at present they have no legitimate role to play in the clinical diagnostic process.

Daniel Amen, by the way, is a "gold-plated" , "evidence-based" quack. (You weren't to know that, of course, so don't sweat it)

[BluegrassBound]

Originally Posted by JOHNCG

Functional and structural neuroimaging data (from technologies like: fMRI , SPECT, etc are invaluable for research scientists investigating the neuroanatomy, neuropsychology on so on, of the ADHD brain, but at present they have no legitimate role to play in the clinical diagnostic process.

Daniel Amen, by the way, is a "gold-plated" , "evidence-based" quack. (You weren't to know that, of course, so don't sweat it)

I did a substantial amount of research and reading last night. I came to the same conclusion. A dead give away is you don't need pharmacueticals, just special vitamins. We happen to sell those vitamins. Snakeoil salesman.

I would be open to discussion on the further dissection of different types of ADHD.

[sarahsweets]

Dont know much about dr amen except his theory on not need ing drugs sends off my "nonsense" alert alarm. If HE did his research he would see they have ben studied for years and while his theory has merit it has noting to do with diagnosing a person with adhd.

[amiegrace]

Umm, what you're saying is sort of correct and sort of not. Researchers with credibility are definitely using brain scans to assess what the differences between ADHD brains and NT brains are, and there are differences. However, they are FAR from actually using a brain scan to definitively and accurately diagnose ADHD. You ARE correct, however, if you assume that they have DEFINITELY found that ADHD is a neurological difference, it is REAL and not "all in our heads," and not something we can fix. I've read the research and if I ever remember to I will post the links or some of the articles.

They have also identified some of the genetic differences between ADHDers and NTs, and they are real and identifiable. However, they can't do a genetic test and definitively diagnose you.

All in all, as it stands at this moment, ADHD is diagnosed almost exclusively via self-report, documentation of symptomatology, and assessment of functioning as a child. Hopefully, they'll find something "tangible" so all the dummies who tell us it's not real will shut up!

[tortilaman]

Oh please dear god do not go to Amen. He charges you $3000 for a scan and then throws you under the bus.

Here's the yelp reviews for the clinic in newport beach http://www.yelp.com/biz/amen-clinic-...Amen%20Clinics
Read the filtered reviews too, I guess amen got to them and filtered out most of the scathingly bad reviews. It's a horrible trick.

[LynneC]

Did anyone actually view Dr. Amen's video? (the first video; the 2nd video has nothing to do with him) He is definately not anti-medication. He shows side by side images of the same brain, untreated vs treated (2 different brains, one treated w/ Concerta, the other with Adderall).

In those two instances he is treating ADHD combined with no co-morbids, and ADHD -PI with no co-morbids, from what he describes as the patients' symptoms.

It appears that what he's saying is that one size does not fit all as far as treatment goes. Nothing false about that...

He also states that in some cases stimulant medication can make symptoms such as aggression and anxiety worse. This also is true...

Where it gets sketchy is that he claims to be able to pinpoint by looking at these images what type of ADHD a person has, as well as what that person's co-morbid symptoms might be. He claims to be able to tailor treatment based on what these images show him; the treatment may or may not include stimulant or other medication and may include supplements.

The idea is intriguing.(the brain imaging part) But here's the problem. The scan is expensive and not covered by insurance unless you've had a brain injury. In addition the supplements probably comprise a large part of the revenue of his clinics, so the incentive is there to recommend supplements before meds.

I don't have anything against supplements; I take a good many myself. But I am uncomfortable with the idea that someone who is paid to diagnose and treat a psychiatric condition has very little incentive to prescribe what may be the best course of treatment...

[sarahsweets]

stimulants are a first line of treatment. Very few supplements or natural rememdies havebeen studie long enough to prove effective.

[Drewbacca]

Originally Posted by LynneC

Did anyone actually view Dr. Amen's video?

When I have an hour free, I prefer to read peer-reviewed journals rather than watch videos...
Not that I wouldn't watch it; I just haven't had the time this week.

That said, I always watch/read posts before making assumptions and criticizing an author's work based on that assumption. I hope that we all share this quality. Thanks for going against the grain a bit.

[LynneC]

Originally Posted by sarahsweets

stimulants are a first line of treatment. Very few supplements or natural rememdies havebeen studie long enough to prove effective.

Sarah, I don't disagree, and it appears that in some cases, neither does Dr. Amen.
I'm not advocating for brain scans or using supplements when medication is likely to be more effective.
My point is, before dismissing EVERYTHING that Amen has to say it might be worthwhile to know what he's actually saying. Then you can dismiss him. (and I don't mean 'you' personally, btw...)

[Greg1982]

Thank you all for your responses. I'll try not to miss anything as I go through these.

Originally Posted by BluegrassBound

Are there Highlight reels of each of these video's?? Something in shorter increments. Not 27 minutes and an hour and 20.

Unfortunately, I haven't searched for any highlight reels.

Originally Posted by Dizfriz

I posted on this today.

http://www.addforums.com/forums/show...84&postcount=1

The problem with Amen is that no one has replicated his work and thus we have no way of knowing if he is right or not. It doesn't mean he is wrong it is just that we don't know and right now there seems to be no validated evidence that the scans are useful for diagnosis or treatment of ADHD.

Dizfriz

Replication, as you accurately suggested, is always the biggest issue in medical research. There is quite a bit of data out there that does support certain claims but nothing I've found with regards to Dr. Amen's specificity theory.

I apologize for being so vague earlier. Organizing my thoughts to reflect what I'm actually thinking is something I'm still working on and I should have clarified myself a little better. I haven't found anything to back up Dr. Amen's claims of using brain scans to diagnose specific types of ADHD. I have, however, found data that other people have gathered showing that it is possible to diagnose ADHD using brain scans(specifically EEG), but again, nothing to support the specificity theory of Dr. Amen.

I'd also like to point out the first sentence of the second abstract. I am certaintly not suggesting that brain scans are the only method that should be used for diagnosis. I am only suggesting that it could potentially confirm a diagnosis or catch a mis-diagnosis.

Increased EEG power density in alpha and theta bands
in adult ADHD patients

S. Koehler

Æ P. Lauer Æ T. Schreppel Æ C. Jacob Æ

M. Heine

Æ A. Boreatti-Hu¨mmer Æ A. J. Fallgatter Æ

M. J. Herrmann

Received: 10 July 2008 / Accepted: 31 October 2008 / Published online: 22 November 2008

Springer-Verlag 2008

Abstract

This study examined EEG abnormalities in

adults with attention deficit hyperactivity disorder (ADHD).

We investigated EEG frequencies in 34 adults with ADHD

and 34 control subjects. Two EEG readings were taken over

5 min intervals during an eyes-closed resting period with 21
electrodes placed in accordance with the international
10–20 system. Fourier transformation was performed to
obtain absolute power density in delta, theta, alpha and beta
frequency bands. The ADHD patients showed a significant
increase of absolute power density in alpha and theta bands.
No differences were found for beta activity. Our findings
indicate that abnormalities in the EEG power spectrum of
adults with ADHD are different than those described in
children. Reliable discriminators between patients and
healthy subjects in adulthood could be alpha and theta
power density. Based on our results, we suggest further
research involving longitudinal studies in ADHD patients to

investigate the changes of EEG abnormalities with age.

The EEG Consistency Index as a Measure of ADHD

and Responsiveness to Medication

R. Lawrence Merkel,

1;2 Daniel J. Cox,1 Boris Kovatchev,1 James Morris, Jr.,1

Rob Seward,

1 Rebecca Hill,1 and Ron Reeve1

The primary diagnostic procedure for Attention-Deficit/Hyperactivity Disorder (ADHD) is

the clinical interview, because psychological, neuropsychological, and neurological tests

to date have not had sufficient specificity. Currently, there is no objective means to measure

severity of ADHD, or the extent to which it is benefited by various dosages of medication.We
recently reported that a certain EEG profile, the Consistency Index, occurring during the
transition between two easy cognitive tasks clearly differentiated ADHD from non-ADHD
boys between the ages of 8 and 12. The current study replicated this with older males (19–25)
using different tasks, and a double blind, placebo versus Ritalin

® controlled crossover

design. Seven ADHD subjects were found to have a significantly lower Consistency Index
than 6 non-ADHD males while transitioning from 2 Simple tasks during placebo condition,
while only the ADHD subjects demonstrated a significant improvement in their Consistency

Index while on Ritalin

®.

Originally Posted by Drewbacca

Since we are clarifying things in this thread, it should be pointed out that the "executive center" is not a portion of the brain. It is a model of what we believe to take place in the frontal lobe, not an actual physical reality in of itself.

Originally Posted by Drewbacca

As such, it's a bit difficult to measure something that doesn't exist, even if various scans show a correlation with the deficits in question.

Thanks for clearing this up for me. Like mentioned above sometimes I get too detailed, and other times I'm too vague. I appreciate the help!

Originally Posted by JOHNCG

Functional and structural neuroimaging data (from technologies like: fMRI , SPECT, etc are invaluable for research scientists investigating the neuroanatomy, neuropsychology on so on, of the ADHD brain, but at present they have no legitimate role to play in the clinical diagnostic process.

Originally Posted by JOHNCG

Daniel Amen, by the way, is a "gold-plated" , "evidence-based" quack. (You weren't to know that, of course, so don't sweat it)

I agree with you on the functional analysis. EEG seems to be the most valuable.

Dr. Amen seems to be a pretty good salesman, but I don't know much about him.

Originally Posted by BluegrassBound

I did a substantial amount of research and reading last night. I came to the same conclusion. A dead give away is you don't need pharmacueticals, just special vitamins. We happen to sell those vitamins. Snakeoil salesman.

Just to play devils advocate, not every physician who sells what they recommend is motivated solely by profit. We recommend and sell specific supplements to our weight loss surgery patients at a very minimal profit because:

• We can sell them cheaper than retail stores to help save patients money
• "It's a business, it ain't Unicef." (Joe Dirt)
• We can be 100% certain that the supplements we supply will give the patient the nutritional value they need medically
• The majority of patients need supplements to be healthy nutritionally and medically

That said, we aren't selling St. John's Wart or other goofy stuff like that. It's calcium, B vitamins, D vitamins and protein supplements. Stuff the body actually needs and uses on a daily basis.

Originally Posted by sarahsweets

Dont know much about dr amen except his theory on not need ing drugs sends off my "nonsense" alert alarm. If HE did his research he would see they have ben studied for years and while his theory has merit it has noting to do with diagnosing a person with adhd.

I 100% agree here and included an abstract above showing a positive correlation with the use of Ritalin. Not to mention my personal experience so far with Concerta has been pretty good. Living 30 years without treatment thinking everyone else has the same problems was a huge awakening when I took the med for the first time. I never knew what it was like to be able to sit down and do something...to completion... before.

Originally Posted by amiegrace

Umm, what you're saying is sort of correct and sort of not. Researchers with credibility are definitely using brain scans to assess what the differences between ADHD brains and NT brains are, and there are differences. However, they are FAR from actually using a brain scan to definitively and accurately diagnose ADHD. You ARE correct, however, if you assume that they have DEFINITELY found that ADHD is a neurological difference, it is REAL and not "all in our heads," and not something we can fix. I've read the research and if I ever remember to I will post the links or some of the articles.

Originally Posted by amiegrace

They have also identified some of the genetic differences between ADHDers and NTs, and they are real and identifiable. However, they can't do a genetic test and definitively diagnose you.

All in all, as it stands at this moment, ADHD is diagnosed almost exclusively via self-report, documentation of symptomatology, and assessment of functioning as a child. Hopefully, they'll find something "tangible" so all the dummies who tell us it's not real will shut up!

Thank you for explaining this so well! This was the point I was going for in my original post but failed at miserably.

The fact that there are scans that exist, such as EEG, that can show a difference between a normal brain and an ADHD brain was what I was trying to get at.

On a side note, what does NT stand for? I've seen it written all over and I searched around for the meaning of that acronym but wasn't able to find it.

Originally Posted by LynneC

Did anyone actually view Dr. Amen's video? (the first video; the 2nd video has nothing to do with him) He is definately not anti-medication. He shows side by side images of the same brain, untreated vs treated (2 different brains, one treated w/ Concerta, the other with Adderall).

Originally Posted by LynneC

In those two instances he is treating ADHD combined with no co-morbids, and ADHD -PI with no co-morbids, from what he describes as the patients' symptoms.

It appears that what he's saying is that one size does not fit all as far as treatment goes. Nothing false about that...

He also states that in some cases stimulant medication can make symptoms such as aggression and anxiety worse. This also is true...

Where it gets sketchy is that he claims to be able to pinpoint by looking at these images what type of ADHD a person has, as well as what that person's co-morbid symptoms might be. He claims to be able to tailor treatment based on what these images show him; the treatment may or may not include stimulant or other medication and may include supplements.

The idea is intriguing.(the brain imaging part) But here's the problem. The scan is expensive and not covered by insurance unless you've had a brain injury. In addition the supplements probably comprise a large part of the revenue of his clinics, so the incentive is there to recommend supplements before meds.

I don't have anything against supplements; I take a good many myself. But I am uncomfortable with the idea that someone who is paid to diagnose and treat a psychiatric condition has very little incentive to prescribe what may be the best course of treatment...

The specificity theory does seem a little hard to replicate as mentioned above and I'm intrigued just like you. I'd love to see someone duplicate it but the cost doesn't really seem to justify it for many docs and they certainly aren't going to eat those high prices.

Originally Posted by sarahsweets

stimulants are a first line of treatment. Very few supplements or natural rememdies havebeen studie long enough to prove effective.

I don't know much about the difference between pharma and supplement so I can't comment here. Just wanted to say thanks for the info.

Originally Posted by Drewbacca

When I have an hour free, I prefer to read peer-reviewed journals rather than watch videos...

Originally Posted by Drewbacca

Not that I wouldn't watch it; I just haven't had the time this week.

That said, I always watch/read posts before making assumptions and criticizing an author's work based on that assumption. I hope that we all share this quality. Thanks for going against the grain a bit.

I agree, I'd also rather read journals. Less marketing and "media" involved in those.

Originally Posted by LynneC

Sarah, I don't disagree, and it appears that in some cases, neither does Dr. Amen.

Originally Posted by LynneC

I'm not advocating for brain scans or using supplements when medication is likely to be more effective.

My point is, before dismissing EVERYTHING that Amen has to say it might be worthwhile to know what he's actually saying. Then you can dismiss him. (and I don't mean 'you' personally, btw...)

Well put.

Thank you all again for your responses.

Greg

[LynneC]

Greg, NT=neurotypical