New breakthrough in diagnosis of ADHD
18 February 2010
The accuracy and efficiency of identifying Attention Deficit Hyperactivity Disorder (ADHD) in young people could improve by close to 30 per cent thanks to a new testing method developed by a consortium of researchers, with principal investigators at the University of Sydney.
With their consortium partners, the University of Sydney researchers based at the Brain Dynamics Centre at Westmead Millennium Institute trialed the efficacy of specific brain function related tests in detecting ADHD in 175 children/adolescents with ADHD, and 175 unaffected children/adolescents.
They found they could pinpoint young people with ADHD with 96 per cent accuracy through the tests, which detected variations in sustained attention, impulsivity, inhibition, intrusions and response variability. This accuracy also means that unaffected children/adolescents are not detected falsely. Previously tests that focus only on attention have only been able to identify ADHD with around 70 per cent accuracy.
The tests were conducted using a computer tool (called 'IntegNeuro'), which has been developed by Brain Resource, based on evidence from a global database. The tool helps identify patients through game-like tasks that challenge the brain, putting it under increasing load to see how it performs.
With computerization, the variations in ADHD can be detected with much greater efficiency, making this information a lot more accessible to the clinician for their decision-making.
University of Sydney Professor of Cognitive Neuropsychiatry Leanne Williams said the research- which appears in the February edition of Pediatric Neurology and is supported by an ARC linkage grant - showed for the first time that accurate and efficient assessment of ADHD could be achieved through cognitive testing in a way that can be translated into clinical practice.
"ADHD is of immense concern with at least one child affected in every classroom worldwide," Professor Williams said.
"Our study has shown for the first time that there is a biological basis to ADHD which can be reliably tested to diagnose it.
"There is currently no consensus on objective medical tests to help doctors and families make diagnostic and treatment decisions for ADHD, which is in stark contrast to many other areas of medical health, such as the oral glucose test for diabetes, and skin biopsies for skin cancer."
"The success of this research means there could be value in examining whether other mental health issues could be diagnosed through brain-based testing such as anxiety and conduct and learning disorders."
Professor Williams said she hoped her team's research would provide an effective tool to support doctors in making their clinical decisions.
"Many of the concerns we hear about ADHD are around the rights and wrongs of medicating a child. For clinicians and parents there is great peace of mind knowing that there is evidence that a child has some physical or biological change that makes it necessary to be medicated." That's what we had in mind as we tried to find a highly accurate but still efficient test that could be used," Professor Williams said. "Testing hasn't been prevalent until now because of the question of accuracy and the lack of tests that can be easily done in the clinic."
Professor Williams said tests that are currently available for ADHD focus on problems of attention alone.
The new testing her team developed also focuses on how variable or 'scattered' young people are, as well as how impulsive they are. By examining all these elements, you improve the overall accuracy of the assessment. Young people simply disinterested in the testing are not wrongly detected as having ADHD.
Professor Williams said the testing method and computer tool was in use in Sydney and Adelaide and extensively in Israel and could be adopted by GPs around Australia in the future.
Brain Resource was the industry partner on the ARC linkage grant supporting this study.
The research has been expanded to include another 500 young people, and medication trials with NHMRC support.
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