A study has shown that ADHD sufferers may have altered brain function and structure that can be picked up by scans and appropriately diagnosed. It could mean the prevention of countless misdiagnoses and earlier intervention.
The number of children diagnosed with ADHD globally has been rapidly increasing, particularly in Europe and North America. In England alone, the use of drugs such as Ritalin in the battle against the behavioural disorder has increased by 50 percent in six years, causing many to speculate that we are overdiagnosing.
In the US, the American Psychiatric Association estimates that five percent of children have ADHD and other estimates suggest that figure might be as high as 11 percent among four to 17-year-olds. Meanwhile, an article published last year in theBritish Medical Journal argued that changes in the guidelines doctors use to diagnose ADHD have significantly broadened the definition, which has led to the spike in drug use. This is despite the fact the World Health Organisation recommends: "Non-specialised health care providers at the secondary level should consider initiating parent education/training before starting medication for a child who has been diagnosed as suffering from attention-deficit hyperactivity disorder. Initial interventions may include cognitive-behavioural therapy and social skills training if feasible." We know, however, that CBT is a far more costly pursuit than drugs.
The paper also suggested that the fact 78 percent of those advisors consulted when formulating the diagnosis guidelines for the "psychiatrist's bible", the Diagnostic and Statistical manual of Mental Disorders (DSM-5), disclosed links to drug companies, means commercial reasons may be behind the spike in drug prescriptions. Overall, it argued for more caution, saying it may lead to "unnecessary and possibly harmful medical treatment" for some.
The problem is that diagnosis is not a cut and dry process. Parents will be asked about their child's symptoms -- hyperactivity and poor attention etc -- how long they have persisted and when they occur. If it's affecting their daily lives -- preventing them from learning or making social connections -- and a consultant verifies it's ADHD by ticking off definitions from the DSM-5, intervention will be suggested.
The latest clinical study, published in the journal Radiology, demonstrates how resting-state functional magnetic resonance imaging (rfMRI) -- a fairly new technique that attempts to study the brain while it is not being tasked to do something specific (though it's hardly possible to get a patient to "think of nothing") -- has the potential to be used as a diagnostic tool in the future.
The team, from the West China Hospital of Sichuan University in China, wanted to investigate the regional and network-level function of those with ADHD, knowing that normal MRI trials that ask ADHD subjects to focus on specific tasks had already shown the brain's frontostriatal circuit to be somewhat involved in the disorder. Thirty-three boys diagnosed as having ADHD but not yet receiving medication, and 32 healthy individuals took part.
Those with ADHD exhibited impairments in executive function that controls planning, organising, time management and regulation of emotion. In total, there was altered structure and function across the left orbitofrontal cortex, the left ventral superior frontal gyrus, the right globus pallidus, the right dorsal superior frontal gyrus and the frontoparietal and frontocerebellar networks.
"These findings of focal spontaneous hyper- and hypofunction, together with altered brain connectivity in the large-scale resting-state networks, which correlates with executive dysfunction, point to a connectivity-based pathophysiologic process in ADHD," conclude the authors. It shows the differences in brain function of those suffering from ADHD is more markedly different than previously thought, they argue.
"Our results suggest the potential clinical utility of the rfMRI changes as a useful marker, which may help in diagnosis and in monitoring disease progression and, consequently, may inform timely clinical intervention in the future," said Qiyong Gong, author on the study and neuroradiologist at the hospital. Gong and his team plan on following up by exploring the differences in connectivity further to see if degrees of difference correlate with degrees of ADHD.
The number of children diagnosed with ADHD globally has been rapidly increasing, particularly in Europe and North America. In England alone, the use of drugs such as Ritalin in the battle against the behavioural disorder has increased by 50 percent in six years, causing many to speculate that we are overdiagnosing.
In the US, the American Psychiatric Association estimates that five percent of children have ADHD and other estimates suggest that figure might be as high as 11 percent among four to 17-year-olds. Meanwhile, an article published last year in theBritish Medical Journal argued that changes in the guidelines doctors use to diagnose ADHD have significantly broadened the definition, which has led to the spike in drug use. This is despite the fact the World Health Organisation recommends: "Non-specialised health care providers at the secondary level should consider initiating parent education/training before starting medication for a child who has been diagnosed as suffering from attention-deficit hyperactivity disorder. Initial interventions may include cognitive-behavioural therapy and social skills training if feasible." We know, however, that CBT is a far more costly pursuit than drugs.
The paper also suggested that the fact 78 percent of those advisors consulted when formulating the diagnosis guidelines for the "psychiatrist's bible", the Diagnostic and Statistical manual of Mental Disorders (DSM-5), disclosed links to drug companies, means commercial reasons may be behind the spike in drug prescriptions. Overall, it argued for more caution, saying it may lead to "unnecessary and possibly harmful medical treatment" for some.
The problem is that diagnosis is not a cut and dry process. Parents will be asked about their child's symptoms -- hyperactivity and poor attention etc -- how long they have persisted and when they occur. If it's affecting their daily lives -- preventing them from learning or making social connections -- and a consultant verifies it's ADHD by ticking off definitions from the DSM-5, intervention will be suggested.
The latest clinical study, published in the journal Radiology, demonstrates how resting-state functional magnetic resonance imaging (rfMRI) -- a fairly new technique that attempts to study the brain while it is not being tasked to do something specific (though it's hardly possible to get a patient to "think of nothing") -- has the potential to be used as a diagnostic tool in the future.
The team, from the West China Hospital of Sichuan University in China, wanted to investigate the regional and network-level function of those with ADHD, knowing that normal MRI trials that ask ADHD subjects to focus on specific tasks had already shown the brain's frontostriatal circuit to be somewhat involved in the disorder. Thirty-three boys diagnosed as having ADHD but not yet receiving medication, and 32 healthy individuals took part.
Those with ADHD exhibited impairments in executive function that controls planning, organising, time management and regulation of emotion. In total, there was altered structure and function across the left orbitofrontal cortex, the left ventral superior frontal gyrus, the right globus pallidus, the right dorsal superior frontal gyrus and the frontoparietal and frontocerebellar networks.
"These findings of focal spontaneous hyper- and hypofunction, together with altered brain connectivity in the large-scale resting-state networks, which correlates with executive dysfunction, point to a connectivity-based pathophysiologic process in ADHD," conclude the authors. It shows the differences in brain function of those suffering from ADHD is more markedly different than previously thought, they argue.
"Our results suggest the potential clinical utility of the rfMRI changes as a useful marker, which may help in diagnosis and in monitoring disease progression and, consequently, may inform timely clinical intervention in the future," said Qiyong Gong, author on the study and neuroradiologist at the hospital. Gong and his team plan on following up by exploring the differences in connectivity further to see if degrees of difference correlate with degrees of ADHD.
Courtesy: Wired
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