Verified by 
The Problem of ADHD Diagnosis
Like many Americans, I think ADHD is over-diagnosed. This over-diagnosis is not as a sign that ADHD doesn’t exist, just that clinicians aren’t being accurate enough in identifying when it is and isn’t present. The contention by some that over-diagnosis somehow proves the non-existence of ADHD is rubbish. Like Elvis sightings in Kalamazoo, it’s a tenuous position that ignores the bigger trend of evidence. ADHD’s over-diagnosis is a clinical practice problem.
Despite media reports, the science backing ADHD isn’t really controversial. The official criteria for diagnosing ADHD (DSM-5) are slightly vague but specific enough that ADHD is theoretically distinguishable from other conditions with similar symptoms. The biggest problem in diagnosing ADHD seems to be human. Too often it’s diagnosed with just two or three questions in a doctor’s office or using a brief screening device. That’s just not gonna cut it.
There is just no way that a clinician doing a two-minute screening of ADHD symptoms (without a detailed developmental history, cognitive test data, and an assessment of similarly presenting conditions) is going to get it right much of the time. Additionally, some clinicians have a bias toward seeing ADHD when it is not even present! Giving an ADHD diagnosis to every patient who walks through the door is not probable, accurate, or helpful. The best way to establish an ADHD diagnosis is with a detailed evaluation that incorporates the individual’s symptoms, developmental history, cognitive test performance, and feedback from others who know him/her well. All of this information is then carefully weighed to confirm a likely diagnosis of ADHD, while also showing that the symptoms aren’t due to another condition, like depression, anxiety, head trauma, or some other condition.
Brain Wave Data in ADHD Diagnosis
So ADHD diagnosis can improve. It’s a tricky disorder to accurately identify because other conditions can look like ADHD, and because it doesn’t have any tell-tale sign or biological marker that gives it away.
One promising tool to improve ADHD diagnosis uses brain waves measured on an electroencephalogram (EEG). You may know of EEG as a diagnostic measure used in epilepsy or other neurologic disorders. Approved in 2013 by the FDA, the product, called NEBA®, was mistakenly described by some media outlets as a replacement for clinicians diagnosing ADHD. A 2015 article by Steven Snyder and others however in the journal Brain and Behavior documented increased diagnostic accuracy for ADHD when combining NEBA® with other commonly tools to identify the condition, not as a stand-alone method. In particular, NEBA® seemed helpful in distinguishing ADHD from other similar appearing syndromes, an area of challenge for many clinicians. NEBA® is currently available only for children under 18 years of age, so it can’t be used with adult patients.
The relationship between ADHD and brain waves isn’t a new idea, nor is it only being studied in the US. In fact, a 1974 paper by Loring Burnett and Frederick Struve discussed the use of EEG results to diagnose Minimal Brain Dysfunction, a previous incarnation of ADHD. And a 2015 study by a group in Seoul, South Korea, showed that diagnostic accuracy of ADHD improved when combining EEG results with a computerized test of sustained attention.
Looking at EEG data may well help improve diagnostic accuracy for ADHD. Still, clinicians must be more thorough and meticulous in their clinical assessment of ADHD and other related disorders, to identify and treat individuals who have the actually disorder and to curb the persistent problems of over-diagnosis that remain.
