As far as I understand, ADHD and ADD are a product of the inability to process dopamine or a deficiency of dopamine. So why are there not tests or screenings that can show with evidence the deficiency and the presence of ADHD?
I’m looking at a possibility that my son(4) could have ADHD and the possibility that a doctor will recommend medication. I am not against medication but I fear putting him on medication that will alter his brain chemistry at such a young age especially if he does not actually have ADHD and the phase that he is going through will be one he will naturally grow out of as his brain develops.
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For what it’s worth, if he does have ADHD, then the ADHD is altering his brain chemistry, and the medicine would help balance it out.
Why? Because our technology has not yet advanced to that level *yet.* It’s the same for diagnosing other psychiatric disorders. You are diagnosed based on reported and observed symptoms. We can use things like various rating scales to help with this and sometimes need labs to rule out various other potential causes. It works really well when done correctly and patients are truthful in reporting. I think that we will have some type of test like you are asking about sometime in the future.
I’m in the UK and my son has ADHD and ODD he is now 7 and has been on medication for a little over a year. He takes a non stimulant (Intuniv) as he cannot tolerate stimulants as he has medication sensitivity (like me!) he was only diagnosed at age 6 and that’s young for a formal diagnosis. In the UK we don’t diagnose much less medicate ADHD before age 6/7 generally as it’s not thought possible to confidently diagnose at that stage of immaturity.
>As far as I understand, ADHD and ADD are a product of the inability to process dopamine or a deficiency of dopamine.
This is just a general hypothesis. We don’t know exactly how ADHD does what it does. People don’t have a standard amount of dopamine, or any neurotransmitter, for us to measure. It’s constantly in flux, varies region to region, is constantly released and reabsorbed based on what you’re thinking about, doing, and the status of every system your body has, physical and mental (hunger, tiredness, boredness, etc.). And it’s not clear that people with ADHD have less dopamine in any significant way, just that their behaviors can be changed by adding more artificial dopamine or slowing reuptake.
If we could just get a measure of your dopamine levels though, the thing that is stopping us is we would have to collect a sample from your brain, or at least your cerebral fluid. The amount of dopamine in a blood draw has very little relation to the amount of dopamine you would find in the prefrontal cortex because of the blood-brain barrier.
The other option is trying to match up symptoms, and most of the symptoms of ADHD are behavioral, so we’ve largely based diagnosis on examining behavioral patterns, although there are more “scientific” things they’ll do in a comprehensive evaluation, like hand-eye reflex and verbal memory tests. The other correlated symptom you can see is underdevelopment of the prefrontal cortex in many untreated cases of ADHD, but it’s an expensive scan to do and you won’t know until it’s done developing, and the adolescent years are when treating ADHD has the most impact, when they’re in school.
What research does support is that therapeutic doses of ADHD medication are generally not harmful, ADHD or not. It doesn’t develop into a chemical dependency or permanently alter the body’s own regulation of neurotransmitters unless abused over long periods of time. So it’s fairly safe to try, under the care of a responsible doctor.
I don’t think it’s definitively known that ADHD is specifically a deficit in dopamine production or absorption. I think this is kind of assumed to be reasonable because the drugs that are most effective for treating some symptoms of ADHD are stimulants that interact with the dopamine system. This doesn’t necessarily mean that ADHD is a deficit related to dopamine. It just means that stimulants provide symptomatic relief for some ADHD patients.
There aren’t any known physical markers of ADHD that could be easily tested for. There’s no gene sequence, or a physical structure that would show up in an MRI scan. It’s really just not well understood.
I’m NOT an expert here… But it seems to me that everyone is on the spectrum somehow, we all procrastinate, we all have our moments. But with ADHD and Autism, whether you “have” it or not is all about the need for intervention or extra help, medication etc. IE if actual money and resources need to be allocated, if special education plans need to be drawn up or not. Thus the tests for these things (particularly in Canada) can be a really political matter to conduct because if the test is positive, the province is legally obliged to spend extra money, allocate resources it does not have to that child. There is a real reticence to call a child Autistic unless they are non-verbal or totally incapable of completing any kind of assignment without direction, because the child will now cost many times more to educate than a kid without an ADHD or Autism diagnosis.
School Psychologist here – personally I’d wait until he’s grade school age and if he’s really struggling at school with concerns associates with ADHD (trouble completing work, behavioral problems, social concerns, etc) before going forward with medication. A lot of kids I work with only use medication on school days because they really don’t need to be attentive at home. Unless his behaviors are out of control I don’t see a strong benefit to medicating this young. 4 is also really young for a diagnosis of ADHD, so again, waiting a couple years might he best.
Has he had a neuropsychological evaluation? There are rating scales we use to see if a child has symptoms of ADHD, and there are also computer programs that test ability to sustain attention. We can evaluate what executive functioning skills they have difficulty with as well, which can help us and you to support your child.
If you’re in the US, if you refer your child to be evaluated for special education services when he is in grade school, the school psychologist with have to evaluate him and will test for ADHD, for free. Or you can pay to have a neuropsychologist evaluate him, which may be more extensive. Either way, I wouldn’t go off a PCP for this – get a specialist opinion if you haven’t.
If you do choose medication, whether now or when he’s older (which is when he’ll benefit most from it) keep in mind that you may have to try different doses or medications before you find one that works. Sometimes the medication doesn’t work well enough, and other times it can make kids lose their personality and become zombie-like, but taking them off of it will fix that should it happen.
Hey, your kid is tiny and usually ADHD isn’t diagnosed until at least age 5. Does he sleep consistently through the night? If not consider checking him for sleep apnea. Many pediatric symptoms of sleep apnea overlap with ADHD.
Don’t think of ADHD as “just” a dopamine deficiency. It’s an issue with brain development on a structural level as well. People with ADHD have differences in their brain growth from the smallest level from nerves to larger regions of the brain being poorly developed and connected. Medication only helps with one small part of it, the ability to switch and sustain attention. That’s vital to success in other areas to help make up for the deficits it doesn’t help.
The child is 4? You can start think about this in 10 years
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