ADHD Testing: Beyond Brain Diagnosis

by Dr Charles Parker on January 31, 2011 · 17 comments

If You Think ADHD is Limited To 3 Basic Subsets – Think Again

ilus13 ADHD Testing: Beyond Brain Diagnosis

ADHD Complexity Evolves

For years those with ADHD have suffered with the downstream effects of significantly shallow perception of the real underlying contributory  issues. From “bad mothers,” to “insufficient corporal punishment” the limited psychological implications of both ADHD diagnosis and treatment often prove woefully insufficient to provide consistent treatment results.

ADHD Ignorance Abounds

The unhappy result of this medical and public confusion is a profusion of anti-biologic reverie, persistent abundant speculation, ubiquitous polymorphous “expertise” in a paradoxical sea of beliefs, dogma, and remarkably limited scientific review – all this in spite of the fact that psychopharmacologic interventions for ADHD are some of the most studied and peer-reviewed of childhood disorders.

This superficial penetration of the facts has led to considerable confusion, missed diagnosis, failed treatments, unexplained dangerous impulsivity for self and others, and an overall disillusion with both the ADHD diagnosis and the medical process used to treat ADHD. The public is justifiably unhappy and suspicious. A too frequent question: is ADHD make-believe or real brain science?

Does Suicide Matter?

Noteworthy in this regard, repeatedly reported here at CorePsych Blog [and in my book on the subject: ADHD Medication Rules - Paying Attention To The Meds For Paying Attention] is the confluence of cognitive anxiety and subsequent depression,  almost routinely associated with undiagnosed ADHD. ADHD leaves the suffering soul with the self-perception that the mind cannot be turned off and life is therefore arrested and meaningless.

No way out, trapped below with executive function gone, thought-squirrels running amok in the brain, years of uncontrollable thinking, – these symptoms herald a far too common interpersonal mind-hell, with no elevator shaft to the sunshine. Suicidal thoughts, suicidal plans, suicidal acts, self injurious behaviors, and suicidal death become paradoxical opportunities for relief when no one understands – even the medical profession. This is a major problem, a profound oversight for thousands of misunderstood people.

Biomedical Testing Matters

Reported recently here at CorePsych Blog is the fact that the new mind biology, from SPECT brain imaging to urinary neurotransmitter testing do provide ADHD biomedical markers, functional scientific answers that completely support these prefrontal cortical, executive function observations. ADHD is a process that predictably occurs under certain contextual circumstances, and is not a 24 x 7 diagnosis, as academia and institutional thinking would have you believe. Moreover, ADHD is associated with many associated biomedical conditions, a greater complexity of presentations than is commonly appreciated, and is far more treatable if we simply identify the comorbid ADHD targets correctly through modern diagnostic tools to completely understand multiple contributory factors.

Weigh In With Your Add-on ADHD Comorbid Diagnoses Below
Full Attribution For Additions! If Anonymous Let Me Know

Not 3, Not 6 – How About 161 ADHD Subsets – Updated Here To 171 ADHD Subsets
Let’s take a moment to join together in working here on a new project, begun in these ethers by a distant colleague, Tess Messer PA on a recent blog post detailing a list of 161 ADHD subtypes. I am listing her excellent summary once again here, and asking you, faithful readers, to add your biomedical subsets to this list in the comments below. Please ReTweet and forward this posting to your colleagues, your friends, your family and let’s all think about this excellent start from Tess.

This is Tess’s list, look it over, and add your thoughts in the comments below. At this writing a comment over at Tess’s blog has already added mold. Let’s get serious, take a moment to add your two cents to the evolving biomedical review, the new mind-science for ADHD treatment. ADHD medications don’t work if we’re not treating primary ADHD, but secondary biomedical issues. [Tess placed an asterisk beside those conditions most commonly confused with primary ADHD from her perspective.]

I added a few more of my own thoughts at the bottom…

__________________________________

*Academic/Learning Problems:
1.  Dyslexia
2.  Cognitive impairment
3.   Specific learning disability
4.   Giftedness
5.   Memory discrimination problems
6.   Mismatch of behavioral style and environmental expectations
7.    Inappropriate educational setting

*Allergy Problems:
8.  Allergy induced Asthma
9.  Allergic bronchitis
10.  Allergic rhinitis, allergic sinusitis, allergic otitis
11.  Wheat, lactose, peanut and other food allergies
12.  Allergies to food dyes or preservatives
13.  Chronic antihistamine use

Autoimmune disorders:
14.  AIDS
15.  Pandas, Pediatric autoimmune neuropsychiatric disorders
16.  Disorders or Carbohydrate metabolism
17.  Autoimmune neurological disorders and encephalopathy

*Anemias:
18.  B vitamin deficiency anemia
19.  Iron Deficiency
20.  Sickle Cell Anemia

Biomedical Problems:
21.  Lead poisoning
22.  Arsenic exposure during development
23.  Toluene exposure during development
24.  Mercury poisoning
25.  PCBs exposure
26.  Manganese Poisoning
27.  Carbon Monoxide Poisoning
28.  Prenatal Cocaine Exposure
29.  Fetal Alcohol Syndrome
30.  Organophosphates intoxication
31.  Asthma medication reactions
32.  Seizure medication reactions

Chronic Illness:
33.  Viral Infections
34.  Bacterial Infections
35.  Parasitic Infection
36.  Sequelae (symptoms resulting from) of  acute infection/trauma
37.  Chronic Asthma
38.  Chronic Infections
39.  Seizure Disorders
40.  Sickle Cell Disease
41.  Multiple Sclerosis

*Developmental Problems:
42.  Perceptual/processing disorders
43.  Pervasive Normal developmental variation
44.  Developmental disorders
45.  Development Disorders, not otherwise classified

Ear/Nose/Throat Problems:
46.  Tonsil and adenoid hyperplasia
47.  Chronic Ear Infection
48.  Chronic Sinusitis
49.  Chronic Upper Respiratory Infections

*Emotional Problems:
50.  Separation anxiety
51.  Social Anxiety
52.  Generalized Anxiety
53.  Attachment disorders
54.  Social Skills Problems

*Psychosocial:
55.  Traumatic Events (house fires, major motor vehicle accidents)
56.  Abuse (sexual, physical or emotional)
57.  Loss by separation or death of a loved one
58.  Mismatch of behavioral style and expectations

Genetic and or Chromosomal Problems:
59.  Fragile X syndrome
60.  Williams Syndrome
61.  Mental retardation
62.  Neurofibromatosis
63.  XXY syndrome
64.  Klinefelter Syndrome
65.  XYY Disorder
66.  Porphyria

*Hearing Problems:
67.  Hearing deficits and Hearing loss
68.  Auditory Processing problems
69.  Auditory Discrimination problems

Infections:
70.  Parasitic Infections (pinworms, roundworms, tapeworms and hookworm)
71.  Untreated or partially treated bacterial infections
72.  Viral infections
73.  Lingering symptoms of infections

*Lifestyle
74.  Lack of exercise
75.  Lack of Green space exposure
76.  Poor diet
77.  Major life transition (move, change of school)

Metabolic or Endocrine Problems:
78.  Hypothyroidism
79.  Hyperthyroidism
80.  Diabetes
81.  Hypoglycemia
82.  Menopause
83.  Hyperbilirubinimia (Gilbert’s Disease, mildly high bilirubin, inattention?)
84.  PMS
85.  Post Partum Depression

*Neurological Medical Problems:
86.  Tourette’s Syndrome
87.  Autism Spectrum Disorder
88.  Neurodegenerative disorders such as Alzheimer’s disease
89.  Temporal Lobe seizures
90.  Absence Seizures
91.  Post traumatic sub-clinical seizure disorder
92.  Other seizure disorders
93.  Neurodegenerative conditions
94.  Choreiform disorder
95.  Neurological infections
96.  Central Nervous System or Brain trauma
97.  Sensory Integration Disorders, Sensory defensiveness
98.  Migraine Headaches of all varieties
99.  Brain Tumors
100. Brain Cyst
101. ALS (amyotrophic lateral sclerosis)
102. Disorders of the Spine (infection, tumors, trauma)

Nutritional Problems:
103. Iron Deficiencies
104. Zinc Deficiencias
105.  Protein Deficiencies
106.  B vitamin Deficiency
107.  Omega-3 Fatty Acid deficiency
108.  Diets  high if food colorings, flavorings and preservatives
109.  Malnutrition

*Parenting Problems:
110. Inadequate Parenting
111. Child abuse or neglect
112.  Inconsistent expectations
113. Developmentally inappropriate parenting
114. Chaotic home environment
115. Stressful home environment
116. Cultural factors
117. Parental psychopathology
118. Parental chemical dependency
119. Parental Substance abuse
120. Exposure to Domestic Violence

Prescription Medication Problems:
121.  Asthma Medication
122.  Allergies Medication
123.  Headache Medication
124.  Seizure Disorder Medication
125.  Other Medication

*Psychiatric Problems [More Details In ADHD Med Rules]:
126. Depression
127.  Anxiety [ed. note: Do these sound familiar?]
128.  Post Traumatic Stress Disorder
129.  Bipolar Disorder
130.  Conduct Disorder
131.   Oppositional Defiance Disorder
132.   Childhood Mania-Juvenile Bipolar Disorder
133.   Dysthymia
134.   Psychosis
135.   Adjustment Disorder

*Psychosocial Problems:
136.  Abuse (sexual, physical or emotional)
137.  Exposure to Traumatic Events (house fires, major motor vehicle accidents)
138.  Domestic Violence
139.  Loss by separation or death of a loved one

*Speech and Language Problems:
140.  Expressive/Receptive language disorder
141.  Phonological disorder
142.  Dyslexia
143.  Dysfluency
144.  Apraxia
145.  Central auditory processing disorder

*Sleep Disorders:
146.  Insomnia
147.  Breathing related sleep disorders and Sleep Apnea
148.  Night Terrors
149.  Delayed sleep Onset
150.  Sleep Motor Restlessness (Restless Leg Syndrome, Sleep Leg Discomfort)
151.   Sleep walking
152.  Confusional arousals
153.  Snoring

Substance Abuse Disorders:
154. Illegal drug  use
155.  Inadvertent drug intoxication (glue sniffing)
156.  Prescription drug abuse
157.  Ethanol abuse

*Vision Problems:
158.  All Vision Impairments
159.  Near sightedness
160.  Convergence Insufficiency
161.   Visual discrimination problems

Added on Tess’s blog:
162. Mold Neurotoxins

My Additions:
163. Lyme Disease
164. Ciguatera Neurotoxins
165. Adrenal Fatigue
166. Estrogen Dominance [PCOS, etc.]
167. IBS – Constipation, Diarrhea [Transit Time under 18 hr or over 24 hr]
168. Hashimoto’s Autoimmune Thyroiditis

Tess Additions:
169: Parasitic Lung Disease
170: Primary antiphospholipid antibody syndrome
171: Argininosuccinate Lyase Deficiency . The non-neonatal form – see comment below

_______________________________


Now It’s Your Turn – Chime In Below!
Let’s get on this list gang and drop your comments below. Do recirculate this list to your list, it’s a great beginning to a significantly improved, more scientific ADHD dialogue. Thanks again, Tess!
cp


Related articles
ADHD Testing: Beyond Brain Diagnosis

Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop  
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version


Tagged as: ADD and ADHD, ADD/ADHD diagnosis and treatment, ADHD, ADHD Biomedical Assessments, ADHD Medication, ADHD Medication Rules, ADHD Rules, ADHD testing, ADHD treatment, Adult ADHD, Adult attention deficit hyperactivity disorder, Attention-deficit hyperactivity disorder, autoimmune disorders, Brain Evidence, Child and Adolescent, childhood disorders, childhood psychiatric disorders, comorbid adhd, disability, educational psychology, Executive functions, Health, Major depressive disorder, Medicine, Mental health, Neurological Disorders, PANDAS, Psychology, seizure disorder, SPECT & Brain Imaging, tess messer, Tourette syndrome

Post comment as
twitter logo facebook logo
Sort: Newest | Oldest
drcharlesparker

Thanks Tina, good contribution, need to get them added! cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
drcharlesparker

Maggie, Don't think your guy is bipolar, sounds like he is a mercurial slow burner. The meds are unpredictable because he has a moving therapeutic window, then a narrow therapeutic window, both of which are covered extensively here if you SEARCH them. As you know from *Rules* these metabolic vagaries are quite easily measured, and my favorite next step for your H would be Transit Time, and IgG testing asap. cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
drcharlesparker

Well said Don - this OCD, cognitive abundance presentation has been on my radar for many years, and I'm so pleased that others join me in thinking about surface symptoms of OCD from a functional point of view - involving PFC function - vs phenotypic analysis of appearances. Thanks for this excellent reference and big thanks for stepping up to the plate and weighing in on this much overlooked subset of ADHD presentations... OCD is clearly on my list! You might enjoy this brief video if you haven't seen it yet on this interesting Cognitive Anxiety/OCD appearing presentation: http://youtu.be/fu0mN68rkEs Thanks, cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Don Haupt, MD

I think obsessive compulsive disorder belongs on this list as a frequently comorbid condition to ADHD, I see only adults, and many with ADHD, and also a number with OCD. Almost every adult OCD person I've treated has a clear childhood history of ADHD. I heard a lecture by Paul Wender, MD, the "father" of Adult ADHD, who said that in his experience, 70% of those with Adult ADHD had at least some OCD symptoms as well. There is some success reported in open label trials of adding dextroamphetamine for OCD patients who are resistant to SSRIs.  And a reference: An Epidemiological Study of Obsessive-Compulsive Disorder and Related Disorders in Israeli Adolescents ADA H. ZOHAR, GIDI RATZONI, DAVID L. PAULS, ALAN APTER, AVI BLEICH, SHMUEL KRON, MICHAL RAPPAPORT, AVI WEIZMAN, DONALD J. COHEN Journal of the American Academy of Child and Adolescent Psychiatry 1 November 1992 (volume 31 issue 6 Pages 1057-1061 DOI: 10.1097/00004583-199211000-00010) For a well known example, read Howie Mandel's recently published autobiographyDon Haupt, MDCo-author, The Complete Idiot's Guide to Adult ADHD (Alpha/Penguin, 2010)

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
drcharlesparker

Don, Very sorry to be so late in replying here - and an emphatic yes is in order! Appreciate also the links and paper. Not trying to one up, but am kicking myself for not including it, as OCD subsets have been on my radar for years, back into 1996 when I first came across the fact that Adderall corrected the cognitive anxiety. This video and notes address your observation in some more detail - http://www.corepsychblog.com/2009/05/adhd-and-anxiety-adhd-looks-like-ocd/ - Thanks so much! Actually just saw that I did respond some time ago, ah well... cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Lisa

I'm curious. I have schizophrenia and ADHD. The negative symptoms of schizophrenia overlap those of ADHD, but there are subtle differences, I feel, in the area of motivation. When I'm having problems due to schizophrenia, my motivational issue is very "deep" for lack of a better word. I have problems getting out of bed, though I'm not depressed. I don't start my day until 2 or 3pm. I don't even eat or shower. I just don't do anything ...not for a particular reason...I just don't do anything. The motivational problems I have with ADHD are different. I don't have problems getting out of bed. I do have problems initiating tasks, in particular tasks I percieve as boring, too long or that I just plain don't like. I know that in general I have little motivation and drive and I have a hard time doing tasks for which there are no really exciting end goals. The medication I take does help with that. I still don't have as much motivation and drive as most people, but at least I can get stuff done now.

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Dr Charles Parker

Lisa, I got the 'deep' part from where ever you are! What you describe is a significant negative energy and an exhaustion. Without building false hope, only trying to offer an alternative, I can tell you I have many in my practice that had clear schizophrenic symptoms secondary to gluten or casein and the cytokine challenges downstream from flaming food allergies. My suggestion: Get an adrenal test for cortisol and DHEA, saliva preferred, and see what is going on with you adrenal cortex. NeuroScience NeuroAdrenal is paid by most insurances and would definitely be worth a shot. cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Tess Messer

1Argininosuccinate Lyase Deficiency . The non-neonatal form Excerpt Disease characteristics. Deficiency of argininosuccinate lyase (ASL), the enzyme that cleaves argininosuccinic acid to produce arginine and fumarate in the fourth step of the urea cycle, is characterized by a severe neonatal onset form and a late onset form. The severe neonatal onset form, which is indistinguishable from that of other urea cycle disorders, is characterized by hyperammonemia within the first few days after birth accompanied by vomiting, lethargy, hypothermia, and poor feeding. In the absence of treatment, lethargy, seizures, and coma worsen, resulting in death. In contrast, the late onset form ranges from episodic hyperammonemia triggered by acute infection or stress to cognitive impairment, behavioral abnormalities, and/or learning disabilities in the absence of any documented episodes of hyperammonemia. Manifestations of ASL deficiency that appear to be unrelated to the severity or duration of hyperammonemic episodes include: (1) neurocognitive deficiencies (attention deficit hyperactivity disorder [ADHD], developmental disability, seizures, and learning disability); (2) liver disease (hepatitis, cirrhosis); (3) trichorrhexis nodosa (coarse brittle hair that breaks easily); and (4) systemic hypertension. Diagnosis/testing. Elevated plasma ammonia concentration (>150 µmol/L, sometimes up to ≥2000-3000 µmol/L), elevated plasma citrulline concentration (usually 200-300 µmol/L), and elevated argininosuccinic acid in the plasma or urine establish the diagnosis of ASL deficiency. Molecular genetic testing of ASL (the only gene in which mutations are known to be causative) and assay of ASL enzyme activity may be helpful when the biochemical findings are equivocal. Note: All 50 states in the US include ASL deficiency in their newborn screening programs. Management. Treatment of manifestations: Treatment of acute metabolic decompensation with hyperammonemia involves rapid control of hyperammonemia by discontinuing oral protein intake, supplementing oral intake with intravenous lipids and/or glucose, and use of intravenous arginine and nitrogen scavenging therapy. If ammonia levels do not normalize, hemodialysis is the next step. Prevention of primary manifestations: Dietary restriction of protein and dietary supplementation with arginine are the mainstays in long-term management; for those not responsive to these measures, oral nitrogen scavenging therapy can be considered. Orthotopic liver transplantation (OLT) is considered only in patients with recurrent hyperammonemia or metabolic decompensations resistant to conventional medical therapy. Surveillance: Monitoring the concentration of plasma amino acids to identify deficiency of essential amino acids and impending hyperammonemia at intervals depending on the clinical scenario. Agents/circumstances to avoid: excess protein intake; less than recommended intake of protein; prolonged fasting or starvation; obvious exposure to communicable diseases; valproic acid; intravenous steroids; hepatotoxic drugs (in those with hepatic involvement). Testing of relatives at risk: Testing of at-risk sibs (either by molecular genetic testing if the family-specific mutations are known or by biochemical testing) shortly after birth can reduce morbidity by early diagnosis and treatment in those who are affected. Genetic counseling. ASL deficiency is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk family members and prenatal testing for pregnancies at increased risk are possible if the disease-causing mutations in the family have been identified. Copyright © 1993-2011, University of Washington, Seattle. All rights reserved.

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Dr Charles Parker

Wow Tess, Heavy, thanks, will include... deep will do it! cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Tess Messer

We are up to 170 169. Parasitic Lung Diseases (See case study #1 below) and 170. Primary antiphospholipid antibody syndrome (see second case report) [Toxocariasis in a 5-year-old boy--manifesting as bronchial asthma and behavioral disorder]. [Article in German] Varga EM, Auer H, Zach M. Klinische Abteilung für Pulmonologie, Univ.-Klinik für Kinder- und Jugendheilkunde Graz. Abstract We report on a five year old boy who was admitted to hospital because of obstructive airway disease; initially, findings were interpreted to indicate bronchial asthma. In addition, the patient presented with a behavioural abnormality of aggressiveness and hyperactivity. Laboratory examinations showed an elevated IgE level and eosinophilia, chest x-ray revealed infiltrations in both lungs. After excluding a spectrum of chronic lung disorders by relevant investigations, serological testing for parasitosis revealed massively elevated toxocara IgG antibodies. The diagnosis of a "covert form" of toxocarosis was established and an antihelminthic therapy with albendazole was initiated. Chronic respiratory symptoms in childhood can also indicate the presence of a parasitic infestation. #2. Mov Disord. 2007 Sep 15;22(12):1813-5. Clinical and positron emission tomography findings of chorea associated with primary antiphospholipid antibody syndrome. Wu SW, Graham B, Gelfand MJ, Gruppo RE, Dinopolous A, Gilbert DL. Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. Steve.wu@cchmc.org Abstract A fourteen-year-old right-handed male with a history of attention deficit hyperactivity disorder (ADHD) presented with alternating hemichorea. Laboratory findings included elevated anticardiolipin IgG and anti-beta(2)-glycoprotein I IgG, which were consistent with primary antiphospholipid antibody syndrome. Positron emission tomography (PET) imaging revealed altered striatal metabolism in his left putamen while he was exhibiting right-sided hemichorea. His symptoms resolved on prednisone; however, his antiphospholipid antibody profile remained markedly abnormal despite being symptom-free for 26 months.

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Dr Charles Parker

Tess, Great job, love the refs! cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Neal

You are correct about vision problems as a marker for ADD and other mental, emotional and cognitive disorders, Dr. Parker. This is way over the heads of most psychiatrists. I learned about the work of Dr. William H. Bates in 1982, and although I have not been able to give up my glasses to correct for myopia entirely, because it would not be safe to drive without them, I reduced my prescription considerably. I have always felt that if I could just go six months without having to wear them at all, I could be free permanently. Simply knowing the true cause of myopia, and its relationship to stress has improved my quality of life greatly. You don't need to pay for an expensive better vision course. The Bates material has been open sourced here. http://www.seeing.org/

share
  • spam
  • offensive
  • disagree
  • off topic
 Like
Dr Charles Parker

Neal, Thanks once again for your deep contribution and thoughtful reflections for our readers - the details do count, and you, my friend, are on them. cp

share
  • spam
  • offensive
  • disagree
  • off topic
 Like

Trackbacks

  1. Autism Sayings | Autism Jobs says:
    March 30, 2012 at 8:33 PM

    [...] ADHD Diagnosis Requires More Than Casual Thinking [...]

  2. Check ADHD – online test of ADHD – CheckADHD – Online ADHD Test | HealthAndFitnessCure.com says:
    September 13, 2011 at 9:18 AM

    [...] Deficit Hyperactivity DisorderTest of Variables of Attention (T.O.V.A.) untuk Membantu Diagnosa ADHDADHD Diagnosis Requires More Than Casual Thinkingdiv.socialicons{float:left;display:block;margin-right: 10px;}div.socialicons p{margin-bottom: 0px [...]

  3. Tweets that mention ADHD Testing: Beyond Brain Diagnosis | CorePsych Blog -- Topsy.com says:
    January 31, 2011 at 7:02 AM

    [...] This post was mentioned on Twitter by Dr Charles Parker, Dr Charles Parker. Dr Charles Parker said: New post: ADHD Testing: Beyond Brain Diagnosis http://goo.gl/fb/GPMaJ [...]

Previous post:

Next post: