However, the iffy parts of the brain-wave test has raised concerns, given the history and disparities of many African-Americans diagnosed with Attention Deficit Hyperactivity Disorder. Parents and educators also worry about the stigmatization of rambunctious, but misunderstood, schoolchildren who are sent for screening unnecessarily and don’t have ADHD.
“Even with futuristic tools and test, there will always need to be clinically-focused diagnoses,” said Rahn K. Bailey, M.D., president of the National Medical Association and chairman of the Department of Psychiatry and Behavioral Sciences at Meharry Medical College in Nashville, Tenn.
“We remain cautiously optimistic,” said Bailey, who has served on the Professional Advisory Board ofCHADD: Children and Adults With Attention Deficit Hyperactivity Disorder.
The U.S. Food and Drug Administration approved marketing of the device last week as just one component of a comprehensive medical and psychological examination, said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health.
“The device requires that the clinician do an evaluation first,” added
Peter Como, Ph.D., a neuropsychologist in the same FDA office. It could help confirm the evaluation, they said, or help the clinician determine that more assessment is needed.
A Welcome Addition?
Dr. Bailey said medical professionals would welcome an additional method to help them diagnose patients more accurately and quickly. “This one does sound encouraging.”
Shane Perrault, Ph.D., a psychologist in Washington, D.C., who has ADHD and specializes in treating it, agrees. “I think generally it’s helpful,” Perrault said of the brain-wave test. “Is it more helpful than the paper and pen method? Maybe; maybe not.”
“Diagnosing ADHD is only part of the battle,” he added. “What kind of treatment do you put together for the patient?”
And that’s what concerns Karran Harper Royal of New Orleans, who became an educational advocate for other parents after dealing with ADHD in her family.
“I know what a hot market ADHD can be, and I worry about exploitation, especially in communities of color,” Royal said. “My concerns are that we know our children don’t often receive the same amount of treatment as their white counterparts, and I worry that doctors will rely too heavily on this new device rather than a full comprehensive assessment and evaluation.”
“At a time when we have to fight the stigma of mental health diagnoses and fight for treatment when a proper diagnosis is made, we do not need to complicate the diagnosing of ADHD by trivializing the screening process.”
According to the Centers for Disease Control and Prevention (CDC) in Atlanta, 5.4 million children have ADHD with twice as many boys diagnosed than girls. The percentage of children whose parents said they had been diagnosed with the neurobehavioral disorder jumped 22 percent between 2003 and 2007.
While the prevalence is racially comparable, CHADD reports, black children are less likely to receive treatment but more likely to suffer negative consequences at school. This can include punitive placement in special education, disciplinary actions and disproportionate referrals for medical evaluation, said Leslie T. Fenwick, Ph.D., a renowned policy expert and dean of the School of Education at Howard University in Washington, D.C.
Fenwick, a former kindergarten through 12th-grade teacher, attributes some of these consequences to “under-prepared, under-credentialed and sometimes overwhelmed teachers.”
“Effective teachers tend to have fewer students acting out in their classes,” Fenwick explained, “because they have effective teaching practices.”
Fenwick said the clinical study for the device should have included more than the 275 children studied and had more diversity.
Como said the study met the FDA’s standards and was “fairly well geographically distributed” over 13 testing sites. “In order to be on market, the sponsor had to conduct a pretty rigorous clinical study,” he added.
Seventy-three percent of the 275 children studied were white, and 27 percent were non-white, including 46 African-Americans (17 percent). Yet, black children are diagnosed at nearly the same rate according to 2004-2006 CDC statistics.
In the study, boys accounted for 64 percent of the children studied, with girls making up 36 percent. The average age of the children studied was 10 years old.
How the Device Works
The study was sponsored by NEBA Health, which is based in Augusta, Ga., and developed the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System.
The NEBA System is a non-invasive test that lasts 15 to 20 minutes. It’s based on electroencephalogram (EEG) technology and involves the placement of electrodes and gel on a child’s head. “There’s no risk other than the need to wash your hair afterwards,” Como said.
The test calculates the ratio of the brain’s theta and beta waves, which is higher in children and adolescents with ADHD, according to NEBA and the FDA.
“Without adequate sampling of African-American children in the study population, how do we know that this statement is true of African-American children with ADHD?” Fenwick asked. The accuracy rate for African-American children in the study was 85 percent compared to 90 percent for whites.
Foreman said that the NEBA system “could help with reducing the amount of prescribed medication,” but cautioned that the FDA didn’t have supporting data.
The CDC notes that 66 percent of children diagnosed with ADHD are on medication, a notion that sends chills up the spines of some parents.
“Some people need medication, and some don’t,” Dr. Bailey says reassuringly. “Unrealistic fears block people from treatment.” However, he advocates second opinions if parents aren’t comfortable with their child’s diagnosis and treatment.
“The first thing that people have to be aware of is the normative criteria,” Dr. Bailey says. All five of the following must be present to begin establishing a diagnosis of ADHD and should be confirmed before using the brain-wave test:
- The patient must have at least one of the behavioral symptoms of ADHD — hyperactivity, inattention or impulsiveness
- “Symptoms must have existed prior to age seven,” Dr. Bailey says. “It’s a neurobiological disorder. It starts early. It doesn’t just show up later based on a stressor in life.”
- The individual has “functional impairment,” such as being retained in a grade or having difficulty keeping a job.
- “There must be difficulty in more than one domain in life — home and school for a child; home and work for an adult.” If problems exist in just one environment, it could be a “psycho-social problem between individuals.” This might include Fenwick’s example of a gifted but rambunctious boy and a teacher who doesn’t know how to challenge him intellectually.
- “It cannot be due to a medical problem,” Dr. Bailey explains. “It’s got to stand on its own feet.”
The important thing, Dr. Perrault says, is “what does the diagnosis mean?”
He then zeroes in on a child’s strengths to really tailor treatment and maximize his or her gifts.
In addition to appropriate medical treatment, a creative child might benefit from music lessons or art classes while a linguistically gifted child could learn a new language. The energy of a physically active child might be channeled into sports. “There’s a reason they have all that energy,” Dr. Perrault points out.
He also cited the example of a famous rapper who might have avoided dealing drugs and the ensuing legal issues if he had been properly diagnosed as a child and mentored by an entrepreneur or music producer. “I think ADHD is the entrepreneur gene,” he says.
The bottom line, he adds, is that “treatment should play to the strength of who you are.”
The ADHD Action List
- Trust your gut. To ease your mind about signs and symptoms and try an interactive checklistbased on the American Psychiatric Association’s test, and talk to your pediatrician.
- Join a support group. You can also find one in your area through CHADD.
- Know your rights. Learn about Section 504 of the Rehabilitation Act of 1973, and check out theCouncil of Educators for Students With Disabilities.
- Work with your school to set up an Individualized Education Plan (IEP) for your child.
- Consider tutors outside class and during the summer.
- Keep in mind that just because there are laws in place, your school might not know how to implement them. Many parents have had to educate educators. Karran Harper Royal said that she even drafted some of the plans that were implemented in New Orleans.
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