Misdiagnosis of Attention Deficit Hyperactivity Disorder – WrongDiagnosis.com.

So much of my reading lately and connections to new users have to do with the misdiagnosis of ADHD. There seems to be no other “disability” that generates more difficulty in accurate diagnosis and more ways to address the symptoms than ADHD. For a rather good look at the topic, a doctor friend sent me the link attached here. The language may be a little loose but the point is that there are many paths to a misdiagnosis and it is something for all of us, therapists, teachers and parents to be aware of that I thought it would be a good share.

There have been a lot of articles on Sensory Processing Disorder (SPD) are out this week and I posted links via previous posts to a couple of good definitional articles. The article below is noteworthy because it goes into an even more useful discussion of how SPD relates to and is yet distinct from Autism (pointing out clearly that “although a sensory processing disorder is not considered a qualifying characteristic for a diagnosis of autism, I have yet to meet a person on the autism spectrum who does not have a challenge in this area.”)

What is Sensory Processing Disorder and How Is It Related to Autism? | Psychology Today.

The author also reminds us of the effort to have SPD included in the next Diagnostic and Statistical Manual of Mental Disorders, which is currently being drafted, and which we described as a really important step in our posting from March 4:

DSM-5 Being Updated.

The person leading that effort is Dr. Lucy Jane Miller, OTR and Founder of the SPD Foundation, who has recommended our program:

“The Learning Breakthrough Program is helpful to enhance clinical therapy for a wide range of sensory processing issues. The unique program lends itself to use with a variety of therapeutic approaches. Its ease of use allows your patients to follow through with therapeutic activities at home. I have integrated this program into my practice and encourage fellow OT’s to take advantage of the benefits this program has to offer.”

SPD is a difficult topic/diagnosis for people to get their heads around; parents, teachers, scientists, therapists…lots of people. But the awareness is growing that SPD it is a unique neurological disorder that impacts many people in important cognitive areas. Addressing SPD is an important part of any treatment program for those on the spectrum.

We strongly advocate a unique DSM classification for Sensory Processing Disorder. We have seen how the Learning Breakthrough Program has produced substantial results when used to treat sensory disorders and a is wonderful complement to other therapies. This goes well beyond addressing just SPD symptoms…the point is that improved sensory processing affects higher order cognitive processes and abstract reasoning well beyond the simple notion of a “traffic jam” in the senses – the simplified definition often associated with SPD.

The article Brain scans shed light on dyslexia, written By Health Day Reporter Amanda Gardner, sheds light on dyslexia causes with modern brain scanning technologies. The findings, published in the online issue of Current Biology, seem to be in line with previous research. The experiment laid the foundation for the neuro-anatomy of dyslexia versus the non-impaired reader.

Guinevere Eden, director of the Center for the Study of Learning at Georgetown University said, “A typical person has an augmented response in this part of the brain, and in dyslexics, they’re not seeing that augmentation, suggesting that there does not seem to be a system in place to show that there’s an association [between visual and sound] that’s going on.” Further work on vestibular remediation correlates remarkably well with the sensory model being described. The more sensory coordination that occurs in any reader, the more resolved the system of abstract language construction becomes. This is the heart of LBP’s design logic and why we found the article to be so relevant.

To those who have not spent time pouring over the wealth of academic studies discussing the relationship between balance and dyslexia (as well as a host of other reading and learning difficulties), it might seem strange to suggest that balance and dyslexia bear any relation. However, when we realize that balance is governed by the vestibular system—a vast network that spans across other neural and body systems—it begins to make sense that a lack of balance and calibration of the delicate but immense processes governing cognitive acts (like reading or writing) can be upset when the balance and sensory systems themselves are not performing properly.

Before getting into more details about the physiological relationship between balance and dyslexia, let’s put the issue into a simpler context via the “cake” analogy. Hypothetically, we are setting about to make a four-layer cake, which is not an easy task as it involves several elements that must be just right in order to make the whole thing come together and remain upright. The temperature of the over must be exact and even minor alterations in the amount of sugar, flour, or eggs can make the cake as hard as rock or too soft to be layered. Cognitive processes such as reading, which seem simple when you look on the surface and see the end result, require the fine-tuning of the process of making a cake. If there is one “misfiring” during the process, you’ll be left with something that is unusable; however if all elements are synched and balanced together accurately, the end result is smooth and flawless.

One of the reasons why learning disabilities like dyslexia are not uncommon is because the relationship between balance and sensory processing within the vestibular system is very complicated. The vestibular system, which is critical to balance (which in turn governs far more cognitive processes) relies on neural transmission and processes between many systems in the brain and the body. There are “interconnections with the inner-ear, superior temporal cortex, insula and the temporal-parietal junction within the cortex, and the postural and extraocular muscle systems, all of which contribute to balance and vestibular reflexes” (Solan, 2007).  In other words, with so many neural “shots” being fired in such a vast array, there is great opportunity for problems to occur—for shot to go haywire.

One expert on the vestibular system has remarked that, “each element of learning occurs as a function of the individual’s total developmental framework….Learning in the absence of suitable developmental structures may preclude assimilation” (Solan, 2007). In other words, without proper functioning of the entire system of networks that govern neural and other processes, learning cannot occur in full. Our potential is not reached due to inefficient neural processing that results in barriers that can be targeted for improvement. At some point, the gaps in this framework will manifest and the information processing event will be stunted. This is absolutely the case with dyslexia and other reading difficulties. Without suitable interaction between the vestibular system (balance) and the brain, learning and applying reading or writing skills can be nearly impossible for some people. It is only when this imbalance has been negotiated, when calibration occurs, that the framework can be made effective once more.

The expression, “our bodies are remarkably resilient” extends beyond our physical capacity to heal and recover. This can also apply to our cognitive processes and body systems. Like other major systems in the body, the vestibular system is also resilient and can be adapted to enhance the quality of life. Scientific research has confirmed that practice reforming the balance system can have a positive impact on the underlying brain processes of those who with dyslexia and other learning disabilities.

Source

Solan, H. A. (2007). Vestibular Function, Sensory Integration, and Balance Anomalies: A Brief Literature Review. Optometry & Vision Development, 38(1), 13-17.

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Publication of the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in May 2013. This is an important document, you might even call it hugely important, for a number of reasons. The manual’s effects are such that its revisions can have a rippling impact for decades to come and this extends far beyond the psychiatric community of professionals that oversees its publication.

The DSM-5 is a listing of ALL psychiatric disorders in the USA and effects treatment regimens, how doctors approach diagnoses, how insurance coverage is defined, how health care is delivered, how labels are meted out for those who suffer with a covered diagnosis, and for every constituency in the medical field and many educational fields. Organizations and industries that use the DSM as a basis for their operating guidelines include the Food and Drug Administration (FDA), National Institutes of Health (NIH), insurance companies, medical companies, pharmaceutical companies, doctors, pyschiatrists, psychologists, learning pathologists, researchers, developmental specialists, clinical administrators, lawyers, judges and any group that interacts with special education and psychiatric disorders in any fashion.

Some of the headlines that are coming out of the proposed changes in this iteration of the DSM are:
•    Asperger’s Syndrome is out – everyone’s going to have an “autistic spectrum disorder” identification instead
•    Personality Disorders are out – kind of. In their place, there’s five Personality Disorder types, each of which you can have to varying degrees, and also six Personality Traits, each of which you can have to varying degrees
•    Hyperactive Sexual Desire Disorder is out, and is to be replaced with a definition of Sexual Interest and Arousal Disorder
•    Binge Eating Disorder, Hypersexuality Disorder, and Gambling Addiction are in

There are more detailed and difficult to interpret things in the DSM that have to do with diagnostic approaches, classifications, assessment standards and structural frameworks for a range of clinical definitions; and many other things that go beyond our simple observations listed here.

There are a few “DSM revision petition” sites out there and the one we are watching is at the SPD Foundation which is working to have sensory processing and sensory integration topics formally included in the DSM for the first time.

Inclusion in the DSM means a lot of things. It would serve as validation of decades of work by skilled sensory development specialists (like Frank Belgau) and open the way for Sensory Processing Disorder (SPD) to become formally recognized as a DSM-qualified disorder treatment. This would impact regulation and open the doors for countless people to have their sensory challenges treated with a level of scrutiny and resources that has not existed previously. It means pediatricians and others will have standardized criteria for making a correct diagnosis of Sensory Processing Disorder. It means treatment opportunities, funding and research priorities will be identified and propelled forward. It also means that children with Sensory Processing Disorder will be more likely to receive school accommodations and public services.  In this context, “hugely important” is probably a very fair characterization.