ADHD Misdiagnosed: Beyond Behaviors

ADHD Course Corrections Are Imperative

Whither ADHD? Old Maps Need Revision
You've heard this message here at CorePsych blog before: The old Maine farmer to the lost city slicker: “Come to think of it, you can't get there from here…” You can be sophisticated and smart, but if you don't know how to get where you want to go, you simply can't get there – no matter how smart you are.

In this case, ignorance is not bliss.

Nowhere is confusion and misdiagnosis more commonplace than with ADHD diagnosis and treatment. Mark this down: ADHD is the most commonly misunderstood malady on the entire psychiatric spectrum, is far more common in prevalence than recognized, is too often abysmally ignored, and has become a remarkably inspiring diagnostic metaphor for the entire Paleolithic DSM-IV Diagnostic Manual [and the forthcoming woefully inadequate DSM-V as well – the labelers have lost their way].

Lost in coastal fog of superficial assessments, far too many suffering children, adults and families are bound for ominous icebergs ahead. The proportions are indeed Titanic.

Diagnosis Without Science
If we can't get ADHD right with it's commonplace presentation, then just what, dear readers, are we doing everyday with depression, anxiety and bipolar disorder? ADHD confusion should send everyone off to the map room to look more carefully at the charts and the radar, but no, we're still stuck on superficial ADHD appearances… the sun rotates around the Earth, right? It does look that way doesn't it? But if you ask Copernicus or Galileo, who bear the burden of new information, hooked up with math and then new technology – our solar system is just that “solar” –  is heliocentric, not geocentric.

Every day, for too many years, I've see it in my office repeatedly – ADHD is misdiagnosed, mistreated, overlooked, mislabeled, poorly medicated and capriciously considered. Diagnostic labels are flipped like morning pancakes, with even less thought. The inevitable consequence: meds are written almost whimsically because the maps just don't cover the territory. ADHD in 2011 needs a considerable, a thoughtful, a deep course correction. We need improvements in navigational markers, improvements in mapping attitude, and serious improvements in conversations with those in the wheelhouses of direct office care.

Dreaming, Not Direction – Cognition, Affect, and Behavior
What then, you may ask, are we missing? Very simply we're missing at least one to two thirds of the ADHD diagnostic picture, an oversight of profound proportions. With ADHD the entire diagnostic code remains fixated on behavior, just as it was in 1937 when Dexedrine was used for, get this: “Behavior Disorders.” Hyperactive, Inattentive and Combined are diagnostic appearances. Even with significant computer testing [e.g. Conner's CPT], one often misses the Affective [feeling] aspect of ADHD, and, even more importantly, the Cognitive [thinking] presentation of ADHD – and that Cognitive disarray is most often the basis of ADHD symptoms.

Learned perspectives associated with most training programs encourage only partial views of the complexity of ADHD.  Adult psychiatrists often miss both the Cognitive and Behavioral symptoms, but get the Affective. Pediatricians often get the Behavioral, but miss both the Cognitive and Affective. Child psychiatrists get the Behavioral and Affective, but often miss the specific Cognitive. Thinking, the Cognitive problem, is almost universally overlooked, not only in the diagnostic process, but as a marker for treatment effectiveness. For more info on the functional interplay between Thinking, Feeling, and Acting take a look at my complimentary Special Report on Predictable Solutions For The 10 Biggest Problems With ADHD Medications.

And one other point on the functional, less reductionistic side of ADHD diagnostic matters: Context matters, – ADHD is not a 24X7 diagnosis .

We're Treating Thinking Without Thinking About Thinking
Thousands are treated everyday in these United States for ADHD thinking problems without remotely thinking about thinking problems… only looking at behavior. And let me quickly add: No Blame here, No Polemics, No Name Calling – the problem is quite simple: too few are looking at the brain function evidence. Too many judge it from afar, and rely on gossip as a means of justification for remaining asleep.

This observation reminds me of a presentation I gave in DC [about 2005] on functional SPECT imaging for ADHD to a group of ADHD professionals. Unexpectedly, one of the medical “professionals” jumped up in a rage from his chair near the end of the presentation, and with eye's bulging, disrespectfully shouted: “My colleague at the National Institutes of Mental Health thinks this SPECT assessment process is all hogwash!” It's interesting how passionate one can become on simple gossip in the context of no direct experience with SPECT technology, or even with functional biomarker measures.

Hearsay only works well if you wish to remain lost, because the new paths are too complex, and you don't want to take the extra time or effort to understand them. “I'm ignoring the facts, and prefer to look over my shoulder at what my colleagues are thinking.” OUCH, on several counts.

Comprehensive Evaluations Provide More Predictable Outcomes
Let's face it: Current ADHD diagnostic science is also way beyond the polemics of “functional” and “traditional” arguments – if you are anywhere near San Francisco April 30th, I'll be presenting more details on just how all these comprehensive diagnostic measures do fit together. The theme there, with multiple case presentations: Comprehensive Assessments that include both mind and body biomarkers will provide crucial new maps for any interested in ADHD biomedical assessments.

New ADHD maps herald a significant change in future diagnostic map making – initial diagnosis will change, and misdiagnosis will significantly diminish when we all pay attention to this new brain and biomedical data.

Do hope to see you there in San Fran!
cp

Related articles

• ADHD Medication Problems: Why They Don't Work (corepsychblog.com)
• ADHD And NeuroScience – San Francisco (corepsychblog.com)
• ADHD and Medication (mccswu.wordpress.com)
• A.D.H.D. Diagnosis, Medication and Demographics (drkevinemery.wordpress.com)