A computer model could complement the cognitive tests currently used to diagnose Attention Deficit/Hyperactivity Disorder (ADHD) and help to better assess the presence and severity of the problems of the patients concerned.
- Cognitive Tests Cannot Identify All ADHD Symptoms
- An enlightening mathematical model on decision-making could improve the care of children affected by this disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder. It is manifested by inattention, impulsiveness and hyperactivity. Thus, patients or often find it difficult to concentrate, stay in their place or wait their turn, which can lead to great difficulty in learning. As with most mental disorders, this affliction is diagnosed and treated based on clinical interviews and questionnaires. In the case of this disease, cognitive tests are used to identify the symptoms. But more often than not, these tests do not capture the complexity of the latter. According to a new American study published in the Psychological Bulletin, the advent of computational psychiatry which compares a computer-simulated model of normal brain processes to dysfunctional processes observed in tests could successfully complete the diagnostic process. Ultimately, this could help to better assess the presence and severity of behavioral problems in the children concerned, hope researchers from Ohio State University (USA).
To come to this conclusion, they looked at 50 studies of cognitive testing for ADHD. The latter assumed that children with this condition take longer than others to make decisions when performing tasks and relied on the average response time to explain the difference.
“In our study, we show that this method has multiple problems that prevent us from understanding the underlying characteristics of a mental health disorder such as ADHD, and also prevent us from finding the best treatment for different individuals” , comments Nadja Ging-Jehli, lead author of the study and a graduate student in psychology at Ohio State.
“Symptoms are difficult to measure with existing tools”
“The aim of our analysis was to show that there is a lack of standardization and a great complexity, and that the symptoms are difficult to measure with existing tools”, she continues, insisting: “we need to better understand ADHD so that children and adults have a better quality of life and receive the most appropriate treatment”.
“ADHD is not just the child who fidgets in a chair. It’s also the child who is inattentive because of daydreaming. Even if this child is more introverted and does not express as many symptoms than a hyperactive child, that does not mean that he does not suffer”. Little girls, for example, are particularly prone to daydreaming and less often enrolled in ADHD studies than boys, laments the researcher.
A computer model could, however, go further by providing information that doctors or relatives could use to facilitate the daily lives of sick children, the study suggests.
Broaden understanding of the disorder
“We can use models to simulate the decision-making process and see how decision-making happens over time – and better understand why children with ADHD take longer to make decisions,” suggests Nadja Ging-Jehli .
“We can use computer modeling to think about the factors that generate the observed behavior. These factors will broaden our understanding of a disorder, recognizing that there are different types of individuals who exhibit different deficits that also call for different treatments. We propose to use the entire distribution of reaction times, taking into consideration the slowest and fastest reaction times to distinguish between different types of ADHD”.
“However, cognitive testing and computer modeling should not be seen as an attempt to replace clinical interviews and existing questionnaire-based procedures, but as supplements that provide new information,” the study authors emphasize. .
This is why, according to them, a battery of tasks assessing social and cognitive characteristics should be assigned to establish a diagnosis rather than just one. In addition, greater consistency is needed between studies to ensure that the same cognitive tasks are used, the scientists insist.
Finally, combining cognitive tests with physiological tests, such as eye-tracking and EEGs that record electrical activity in the brain, could help provide important objective and quantifiable information for making a more reliable diagnosis. It would also allow clinicians to better predict which drugs would be most appropriate. Ultimately, the objective would therefore be to better characterize ADHD and what accompanies it, such as anxiety or depression, to improve the results of treatments and possibly to predict which children will no longer suffer from this disorder as adults.
What solutions are possible today?
Currently, a diagnosis can only be made if the disorder has lasted for at least six months. Several consultations with the doctor treating the child and then with a doctor specializing in ADHD are necessary. The experts will rely on an analysis of the child’s behavior, his school work and his family environment. They will also ask questions of parents and teachers. Then, a speech therapist and a neuropsychologist will carry out evaluation tests.
As for the treatment, if there is no drug to treat ADHD, it is however possible to reduce the symptoms, most often with methylphenidate which stimulates the cognitive activity of patients. It is best to supplement this treatment with cognitive-behavioral therapy (CCT) or family therapy. The first will give parents tools to better manage their child while the second will help to work on all dimensions of the disorder.
The psychologist will lead the child to identify the behaviors that pose problems and will help the entourage to react to them in a positive way. The goal is to gradually guide the child towards good habits. On a daily basis, an adaptation can be put in place in the school setting to facilitate the patient’s learning. Support groups and patient associations also exist so that parents can share their experience with other families.
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