symptom based diagnostic models

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.

Posted by Dr. Richard Dowell Jr. PhD at 10:26 AM