Symptom-based diagnostic models

You enter your physician’s office holding your head from a throbbing headache. The nurse cordially smiles at you and takes you to an examining room. Minutes later (hey… this is my dream… I can keep the wait short)… the physician enters the office. You inform him or her that you have a headache. Your physician gives you a long look, sighs then pronounces the diagnosis “You have a headache disorder!” Nonplussed, huh? Thinking that perhaps its not too late to get your co-payment back?

Unfortunately, each day millions of parents take their child into offices of physicians, psychologists, therapists, etc. proclaiming that their child has a deficit in attention and is hyperactive and are told by well-meaning professionals, “Your children has an attention deficit hyperactivity disorder!” Nonplussed? I hope so. Attention deficit hyperactivity disorder is a symptom-based diagnosis much like a “headache disorder” would be a symptom-based diagnosis. The unfortunate aspect of this scenario is that labeling the symptom (ie., “headache disorder”) does not explain the underlying cause or etiology of the symptom. Headaches are non-specific symptoms and may be related to underlying etiologies ranging from muscle tension, cervical neck strain, migraines, cluster headaches, increased intracranial pressure, hemorrhagic strokes to brain to tumors. As a patient-consumer you (and your physician) want to know the underlying cause of the headache so that subsequent treatment may be directed towards the cause, not simply the symptom, of the headache. Similarly, inattention, distractibility, off-task behaviors, restlessness, etc. are non-specific symptoms. A review of the DSM-IV-TR (Diagnostic and Statistical Manual – IV Text Revision) and other diagnostic manuals reveals that this cluster of symptoms is consistent with multiple diagnoses ranging from anxiety, depression, Tourette’s Syndrome, post-traumatic stress disorder, neurologic disorders, pervasive developmental disorders to learning disabilities.

The unfortunate effects of this symptom-based diagnostic model of “ADHD” include: (a) the simplistic labeling of symptoms (ADHD) with resulting termination of the search for an underlying cause, (b) evaluations that are limited to symptom counting, (c) a delay in the development of effective intervention plans among children with more pervasive developmental disorders or other deficits, (d) utilization of the child’s response to medication as a tool for confirming the accuracy of the diagnosis and (e) the “mis-diagnosis” of children with resulting public perceptions that oftentimes effective medications (ie., psychostimulants) are of no value or counter-productive. The solution… hmmm…

See you next week.

Neuropsychological Services

During the past twenty years, Dr. Dowell has completed neuropsychological evaluations among over 5000 patients. Neuropsychological Services currently completes consultations among over 300 – 400 children/adolescents each year presenting with a variety of symptoms/problems including features of attention deficit hyperactivity disorders (ADHD), learning disabilities, behavioral disorders (ie., oppositional defiant disorder, conduct disorder, etc.), pervasive developmental disabilities (ie., autism, Asperger’s Syndrome), post-traumatic stress disorders, neglect/deprivation, reactive attachment disorders and other adjustment disorders. He has served as a forensic neuropsychological witness within the county and federal court systems throughout Pennsylvania and New Jersey and testified in front of the State Department of Education.

Here Dr. Richard Dowell will share insights to common issues seen within the clinical and forensic neuropsychological arenas. At times humorous, other times a bit sarcastic, examples given are taken from real world experience, with the any names being changed to protect the innocent, and the doctor of course. While certain matters may be shown in a lighthearted manor the illnesses and people suffering from any type of mental or physical pain is not taken lightly.

The intent of Inside Neuropsychology is to open a dialogue between patients and their loved ones and the medical staff serving them. It is also a means to uncover some of the lunacy often common in diagnosis and treatment.