Can MRI or other brain imaging diagnose ADHD?

Magnetic Resonance Imaging (MRI) is an important research area, and it’s also a “hot topic” with periodic excited claims in the media. I discuss this in the context of various new treatment claims for ADHD and try to separate the wheat from the chaff in my book,  Getting Ahead of ADHD. So far, the bottom line is that brain imaging can’t diagnose ADHD or its subtypes, despite frequent claims that it can (based on single, small studies).

My research team and others are now undertaking a new generation of studies using advanced nonlinear equations (called machine learning) to improve prediction. These are powerful methods and there is reason to be hopeful. However, results from existing studies do not yet offer clinical value. One limitation is that sample sizes tend to be extremely small (often less than 100 children)—such samples are prone to chance findings that will not generalize, not matter how clever the analysis is. Scientists attempt to overcome this with re-sampling methods within their study (one common method is called “k-folds” cross validation). That is of some help, however, the acid test is whether the prediction holds up in a completely new, independent sample of children. Typically, that check is not even done. When it has been done, results are generally disappointing. This generalizability problem is challenging and it will be some time before it is solved. However, many research groups, our own included, are trying hard to do this. I have high hopes that we will eventually succeed. So stay tuned, but for now, remain skeptical of claims for breakthrough brain imaging diagnostics for ADHD. I do not advise you to seek brain imaging for a clinical case of ADHD in the absence of other medical indication and nothing has changed with recent publications or press reports. Check back here or sign up for e-mail updates. We will be tracking this literature and I will share significant findings with you.

As always, let’s keep our eye on the science for reliable answers.

Are Computerized Attention Games Helpful for ADHD?

Are We There Yet?

The effectiveness of computerized attention games is a “hot topic” area and potentially exciting–but emphasis on “potentially.” The Science Says: It’s not there yet.

Researchers have been trying for decades to use computerized training programs to help people with cognitive skills, like reading, memory (particularly in older adults), as well as attention. I discuss new and developing treatment ideas, and sort fact from fiction, in Getting Ahead of ADHD (I discuss brain training at some length in Chapter 5 ).

What The Science Says

Computer training programs for some academic skills, like reading and math, are potentially helpful, and there is some promise in improving children’s academic skills and learning with attention training. But when it comes to ADHD itself, the data are underwhelming.

In “open label” tests (with no control group, and no “blinding” or disguising of the fact they are trying a special intervention), children’s attention (or other skill) improves somewhat. But those designs are only a first, minimal test—they do not rule out placebo or expectancy effects. Sometimes, even on well-controlled experiments a computer program can improve children’s scores on attention and other tests of cognitive skills. However, so far, the best summaries of controlled trials, using raters who are blind to the treatment condition (placebo or active), fail to see improvement in ADHD symptoms from computerized cognitive or attention training.

The Effectiveness Of Computerized Attention Games Is Still Under Study

Now, as computer games get more emotionally engaging and realistic, “next generation” training programs deserve to be studied—they may one day get there. If they do, then it will be important to discover whether the money and time spent on the computer training did more good for the ADHD (or learning, or other target problem) than an equal effort on physical exercise, counseling, skill based learning, or other intervention. It may be that in the future certain aspects of ADHD are helped, at least for some children, and that ultimately this can be identified and verified.  In the meantime, parents can expect to see periodic, excited press releases as first tests come out on new computerized programs. Remember, these are likely to be preliminary results. For now, be somewhat skeptical. Computerized training is not ready for prime time as an ADHD treatment quite yet.

ADHD is Related to Social Disadvantage

What does it mean?

A new article from my team was released this week, showing that ADHD is related to social disadvantage. That means that if a family is in poverty or low income, or is experiencing what social scientists call “low social status” due to lack of parental education or low paying job, that the chances of a child having ADHD are higher. We showed clearly that the effect is not explainable by the fact that social disadvantage and ADHD also both overlap with children’s general behavior problems, and also not explained by the fact that adults with ADHD (who also have kids with ADHD) tend to obtain less education and less well paying jobs. There seems to be an actual effect of social disadvantage on ADHD itself.

Why would this be?

My hunch is that these socio-economic challenges are associated with chronic stress for parents and for kids. Less resources, more stress. If you are in this situation, you already knew this! Chronic stress builds up physical inflammation and other cell damage in the body of the individual. This physical wear and tear has a fancy scientific term: allostatic load. Scientists are learning how to measure it in the body. It fits with an emerging idea that inflammation contributes to the development of ADHD. What should you do? Recognize that chronic stress can add to ADHD risk, and do what you can do build up your social supports and physical health (for you and your children) and also give permission to yourself to engage in your own self-care. Recognize that as you manage stress levels in your own life, you are also helping your child.

Read more here!