6 ms·

Which part of the disgnosis do you find objective measures? There isnt a single scientific one Take a look at studying looking at the consensus on diagnosis. E

Which part of the disgnosis do you find objective measures? There isnt a single scientific one Take a look at studying looking at the consensus on diagnosis. Even among psychatrists the same patient gets diagnosed with different things.

bruce343434 1y ago
QbTest [https://www.qbtech.com/adhd-tests/qbtest/ https://www.qbtech.com/adhd-tests/qbtest/] It measures your ability to focus your attention quite objectively and there's statistically significant differences between neurotypical and adhd performance. This test was used during my own diagnosis.
- andoando 1y ago
  There is no doubt some differences in people who experienced mental problems, and sought or were given a diagnosis, and the general population. QbTest was retroactively designed specifically to target this subjectively diagnosed ADHD group. This may be evidence that an ADHD diagnosis does differentiate populations based on some criteria, but it says nothing to this differentiation being caused by a singular disorder/pathology I'd like to see a study of this test done on other comorbidities. I found this for example which finds a weak relation in these tests https://pubmed.ncbi.nlm.nih.gov/38317541/ https://pubmed.ncbi.nlm.nih.gov/38317541/ differentiating between ADHD and depression, anxiety, OCD. Here is another study. https://pubmed.ncbi.nlm.nih.gov/37800347/ https://pubmed.ncbi.nlm.nih.gov/37800347/ >Conclusions: When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis. I'll also point out few things: 1. Attention/focus is not a simple single metric one can measure and varies entirely on the task/situation at hand. That is a computerized test with no actual risk/reward to a person is not a predictor of attention/focus in general life. Focus/attention is driven largely by the feelings, rewards, risks, outcomes someone sees, those with diagnosed ADHD are already entering this study with an entirely different mental perception/attitude. 2. There is inherent bias present in ADHD patients in they may intentionally fudge their performance to meet their diagnosis. Unlike most disorders, people actually seek an ADHD diagnosis for access to stimulants, and its incredibly easy to understand how to mimic that behavior for these tests. 3. Other computerized tests have existed aiding in diagnosis, so this becomes circular.
  - bruce343434 1y ago
    I think if you look hard enough there will always be fuzzy boundaries and overlaps in all the forms of neurodivergence. And yet, stereotypes and categories exist for a reason. Just because diagnosis is not perfect, doesn't mean it isn't good enough to do more good than harm in the world. To your point 1, that's true. When there's ample motivation/inspiration, which is fickle and as far as I can tell not really up for conscious mutation, hyperfocus can occur in people with ADHD. 2: The test was actually quite long. In my unmedicated graph my attention was pretty high at first, but then I apparently got slowly distracted or disengaged. During the test I didn't feel distracted or disengaged however, and yet it showed quite clearly. Might it be harder than you think for people to "fake" this in a convincing way? Anyway I do look forward to a better understanding of ADHD rather than "not enough dopamine" which seems to be the leading explanation. And I'm curious how much of a bimodal distribution that spectrum of dopamine deficiency is for humanity, or whether it is even bimodal at all.
    - andoando 1y ago
      What I am trying to say is that the brain is a VERY complex machine, I do not believe there is a singular cause for why people fail to be motivated/alert in their daily lives. I refuse to call it ADHD, as that implies some known pathology. It is imo a social construction. Categorization can be useful for assessment/treatment but it isnt science. Quite frankly I dont care if people were handed amphetamines simply because they wanted to see if it improved their lives. I will just say, I am disgnosed and take stims and the best and most motivatrd I ever felt was when I was doing some sort of physical activity almost daily, had a challenging rewarding job and friends. I was completely sober and happy, and completely depressed, ADHD like all the years prior. If youre not exercising regularly I highly suggest you try it
ttul 1y ago
You’re right that there isn’t a _single_ “scientific” or purely objective test for ADHD. The consensus statements on ADHD make this explicit: diagnosis is clinical, not biomarker-based [1][2], even though biomarker tests are being developed and this is a promising area of research. That said, there are structured and semi-objective tools that add quantifiable data to the process, even if they can’t stand alone; and, these tools in combination reveal a very real condition that is also highly treatable once diagnosed: 1. Rating scales (e.g. Vanderbilt, CBCL) use structured questionnaires to quantify symptom frequency. They’re subjective (based on parent/teacher/patient report) but standardized. Many mental health conditions are assessed using standardized rating scales [3]. 2. Continuous Performance Tests (CPTs) and objective activity measures can quantify attention lapses and hyperactivity. They’re more “objective,” but consensus statements say they’re insufficient for diagnosis _in isolation_ [4]. I did a CPT test and it lit up for ADHD, which was helpful in ruling out other conditions. 3. Multi-informant reports (parents, teachers, patients) are required in good clinical practice to triangulate symptoms across contexts [5]. As I wrote in my first comment, ADHD exists only when the symptoms affect functioning in many areas of life. 4. Experimental methods (like neuroimaging or computerized neurocognitive tests) show promise but aren’t yet validated for clinical use [6]. The core of diagnosis remains a comprehensive clinical interview and history guided by DSM/ICD criteria. This is where “inter-rater variability” arises: different psychiatrists may weigh the same evidence differently. Consensus statements acknowledge this diagnostic variability, which is a limitation of current psychiatric nosology in general (not just ADHD). So to answer directly: no, there isn’t a single objective test. But there are quantifiable tools that support diagnosis. The diagnosis itself is still fundamentally consensus- and criteria-driven, not biologically “proven.” But this limitation is minor and is common in psychiatry where many real conditions are diagnosed using a combination of approaches because no single test exists (and may never). [1] Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J., Tannock, R., & Franke, B. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022 https://doi.org/10.1016/j.neubiorev.2021.01.022 [2] Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., & Nunes Filipe, C. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001 https://doi.org/10.1016/j.eurpsy.2018.11.001 [3] Collett, B. R., Ohan, J. L., & Myers, K. M. (2003). Ten-Year Review of Rating Scales. V: Scales Assessing Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42(9), 1015–1037. https://doi.org/10.1097/01.CHI.0000070245.24125.B6 https://doi.org/10.1097/01.CHI.0000070245.24125.B6 [4] Hall, C. L., Valentine, A. Z., Groom, M. J., Walker, G. M., Sayal, K., Daley, D., & Hollis, C. (2016). The clinical utility of the Continuous Performance Test and Objective Measures of Activity for diagnosing and monitoring ADHD in children: A systematic review. European Child & Adolescent Psychiatry, 25(7), 677–699. https://doi.org/10.1007/s00787-015-0798-x https://doi.org/10.1007/s00787-015-0798-x [5] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [6] Cao, Q., Zang, Y., Sun, L., Sui, M., Long, X., Zou, Q., & Wang, Y. (2006). Abnormal neural activity in children with attention deficit hyperactivity disorder: A resting-state functional magnetic resonance imaging study. NeuroReport, 17(10), 1033–1036. https://doi.org/10.1097/01.wnr.0000224769.92454.5d https://doi.org/10.1097/01.wnr.0000224769.92454.5d

bruce343434 1y ago

QbTest [https://www.qbtech.com/adhd-tests/qbtest/ https://www.qbtech.com/adhd-tests/qbtest/] It measures your ability to focus your attention quite objectively and there's statistically significant differences between neurotypical and adhd performance. This test was used during my own diagnosis.

andoando 1y ago
There is no doubt some differences in people who experienced mental problems, and sought or were given a diagnosis, and the general population. QbTest was retroactively designed specifically to target this subjectively diagnosed ADHD group. This may be evidence that an ADHD diagnosis does differentiate populations based on some criteria, but it says nothing to this differentiation being caused by a singular disorder/pathology I'd like to see a study of this test done on other comorbidities. I found this for example which finds a weak relation in these tests https://pubmed.ncbi.nlm.nih.gov/38317541/ https://pubmed.ncbi.nlm.nih.gov/38317541/ differentiating between ADHD and depression, anxiety, OCD. Here is another study. https://pubmed.ncbi.nlm.nih.gov/37800347/ https://pubmed.ncbi.nlm.nih.gov/37800347/ >Conclusions: When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis. I'll also point out few things: 1. Attention/focus is not a simple single metric one can measure and varies entirely on the task/situation at hand. That is a computerized test with no actual risk/reward to a person is not a predictor of attention/focus in general life. Focus/attention is driven largely by the feelings, rewards, risks, outcomes someone sees, those with diagnosed ADHD are already entering this study with an entirely different mental perception/attitude. 2. There is inherent bias present in ADHD patients in they may intentionally fudge their performance to meet their diagnosis. Unlike most disorders, people actually seek an ADHD diagnosis for access to stimulants, and its incredibly easy to understand how to mimic that behavior for these tests. 3. Other computerized tests have existed aiding in diagnosis, so this becomes circular.
- bruce343434 1y ago
  I think if you look hard enough there will always be fuzzy boundaries and overlaps in all the forms of neurodivergence. And yet, stereotypes and categories exist for a reason. Just because diagnosis is not perfect, doesn't mean it isn't good enough to do more good than harm in the world. To your point 1, that's true. When there's ample motivation/inspiration, which is fickle and as far as I can tell not really up for conscious mutation, hyperfocus can occur in people with ADHD. 2: The test was actually quite long. In my unmedicated graph my attention was pretty high at first, but then I apparently got slowly distracted or disengaged. During the test I didn't feel distracted or disengaged however, and yet it showed quite clearly. Might it be harder than you think for people to "fake" this in a convincing way? Anyway I do look forward to a better understanding of ADHD rather than "not enough dopamine" which seems to be the leading explanation. And I'm curious how much of a bimodal distribution that spectrum of dopamine deficiency is for humanity, or whether it is even bimodal at all.
  - andoando 1y ago
    What I am trying to say is that the brain is a VERY complex machine, I do not believe there is a singular cause for why people fail to be motivated/alert in their daily lives. I refuse to call it ADHD, as that implies some known pathology. It is imo a social construction. Categorization can be useful for assessment/treatment but it isnt science. Quite frankly I dont care if people were handed amphetamines simply because they wanted to see if it improved their lives. I will just say, I am disgnosed and take stims and the best and most motivatrd I ever felt was when I was doing some sort of physical activity almost daily, had a challenging rewarding job and friends. I was completely sober and happy, and completely depressed, ADHD like all the years prior. If youre not exercising regularly I highly suggest you try it

ttul 1y ago

You’re right that there isn’t a _single_ “scientific” or purely objective test for ADHD. The consensus statements on ADHD make this explicit: diagnosis is clinical, not biomarker-based [1][2], even though biomarker tests are being developed and this is a promising area of research. That said, there are structured and semi-objective tools that add quantifiable data to the process, even if they can’t stand alone; and, these tools in combination reveal a very real condition that is also highly treatable once diagnosed: 1. Rating scales (e.g. Vanderbilt, CBCL) use structured questionnaires to quantify symptom frequency. They’re subjective (based on parent/teacher/patient report) but standardized. Many mental health conditions are assessed using standardized rating scales [3]. 2. Continuous Performance Tests (CPTs) and objective activity measures can quantify attention lapses and hyperactivity. They’re more “objective,” but consensus statements say they’re insufficient for diagnosis _in isolation_ [4]. I did a CPT test and it lit up for ADHD, which was helpful in ruling out other conditions. 3. Multi-informant reports (parents, teachers, patients) are required in good clinical practice to triangulate symptoms across contexts [5]. As I wrote in my first comment, ADHD exists only when the symptoms affect functioning in many areas of life. 4. Experimental methods (like neuroimaging or computerized neurocognitive tests) show promise but aren’t yet validated for clinical use [6]. The core of diagnosis remains a comprehensive clinical interview and history guided by DSM/ICD criteria. This is where “inter-rater variability” arises: different psychiatrists may weigh the same evidence differently. Consensus statements acknowledge this diagnostic variability, which is a limitation of current psychiatric nosology in general (not just ADHD). So to answer directly: no, there isn’t a single objective test. But there are quantifiable tools that support diagnosis. The diagnosis itself is still fundamentally consensus- and criteria-driven, not biologically “proven.” But this limitation is minor and is common in psychiatry where many real conditions are diagnosed using a combination of approaches because no single test exists (and may never). [1] Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J., Tannock, R., & Franke, B. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022 https://doi.org/10.1016/j.neubiorev.2021.01.022 [2] Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., & Nunes Filipe, C. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001 https://doi.org/10.1016/j.eurpsy.2018.11.001 [3] Collett, B. R., Ohan, J. L., & Myers, K. M. (2003). Ten-Year Review of Rating Scales. V: Scales Assessing Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 42(9), 1015–1037. https://doi.org/10.1097/01.CHI.0000070245.24125.B6 https://doi.org/10.1097/01.CHI.0000070245.24125.B6 [4] Hall, C. L., Valentine, A. Z., Groom, M. J., Walker, G. M., Sayal, K., Daley, D., & Hollis, C. (2016). The clinical utility of the Continuous Performance Test and Objective Measures of Activity for diagnosing and monitoring ADHD in children: A systematic review. European Child & Adolescent Psychiatry, 25(7), 677–699. https://doi.org/10.1007/s00787-015-0798-x https://doi.org/10.1007/s00787-015-0798-x [5] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. [6] Cao, Q., Zang, Y., Sun, L., Sui, M., Long, X., Zou, Q., & Wang, Y. (2006). Abnormal neural activity in children with attention deficit hyperactivity disorder: A resting-state functional magnetic resonance imaging study. NeuroReport, 17(10), 1033–1036. https://doi.org/10.1097/01.wnr.0000224769.92454.5d https://doi.org/10.1097/01.wnr.0000224769.92454.5d