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I have no problem with imaging to see how the brain differs. This is not new technology but applying it to ADHD brains is relatively new and only recently have scientific peer reviewed papers really started to appear on the use of imaging as a tool for diagnosis.
My question is this: If you spend a small fortune having a scan that says you have ADHD then that’s great – but then what? It’s not a cure – just a diagnosis.
The diagnosis might be more accurate than the current methods for diagnosing, but there are caveats – e.g. studies have so far been on small groups of people and their medication status might influence those small numbers of studies AND then the diagnosis can only be given by someone who has sufficient knowledge to interpret the scan.
I looked up Dr. Amen in the scientific literature and he has published scientific papers in the field of SPECT scanning which suggests a legitimate scientific interest BUT I wouldn’t spend that money on a scan to tell me what I already know about my behaviour. In a field like this, usually scientists would be happy to have volunteers – better to try to find out if you can be a subject of analysis for free somewhere – although I did that for a different condition and they don’t tend to give you the results.
I also looked up papers on SPECT that were not written by Dr. Amen and found a review of the different techniques. It’s from 2005 though and I guess there will have been a lot of developments since then. However, if you’re interested there are snippets from it below. I think the sentence in bold which is also immediately below is probably still relevant to today.
I worry about Dr Amen and his definitions of the sub-types – personally I think that’s complete c**p and it’s that plus the hard sell that REALLY puts me off and makes me question his credibility. I personally would not spend my money on him or his techniques – but I am ready to be convinced otherwise.
The review authors mentioned one of Dr Amen’s papers in their review:
Amen DG, Carmichael BD (1997): High-resolution brain SPECT imaging in ADHD. Ann Clin Psychiatry 9:81– 86.
The study was of: Children/adolescents: 54 ADHD/ 18 control (psychiatric)
The interpretation/conclusion the review authors made of Amen’s study was: “Qualitative analysis concluded “hypofrontality,” but use of subjective analysis and inadequate description of methodology precludes meaningful comment.”
I have no wish to diss Amen – he might be totally legit and I’ll do some further digging but I need to go to work now – I just think we need to be like detectives and protect ourselves and do the research before we part with lots of money.
The sentence of note in the review paper I mentioned is:
On a final cautionary note, imaging research can carry great, often disproportionate weight in swaying minds. Its highly technical nature unfortunately carries with it the potential for misinterpretation, misuse, and exploitation—situations to be actively guarded against to protect the reputation of the field. Efforts to push forward the technology need to be matched with equal vigor in protecting patients and research subjects. In particular, we must clearly define the proper uses of imaging and ensure that these techniques are properly integrated with clinical evaluation.
Snippets from the review paper:
Functional Neuroimaging of Attention-Deficit/Hyperactivity Disorder: A Review and Suggested Future Directions
George Bush, Eve M. Valera, and Larry J. Seidman
BIOL PSYCHIATRY 2005;57:1273–1284
Some problems are specific to particular imaging modalities. For example, SPECT and PET offer inferior spatial resolution compared with fMRI, and their requirement for exposure to radiation makes it difficult to recruit the necessary healthy control subjects.
Functional imaging studies are relatively expensive, and as such have typically used small subject samples. Often the control group is either a homogeneous sample (matched to the patient group) or psychiatrically ill with only a single disorder. These factors 1) increase the likelihood of both type I and type II errors; and 2) make it impossible to generalize findings. Now that the imaging techniques are more mature and the cognitive neuro- science upon which they are based better established, future studies will benefit from larger patient samples and the use of statistical models (e.g., random effects models) that permit generalization to the larger population. This will require large- scale comparison studies across diagnostic groups using the same task(s) to be most useful. An added benefit, though, will be that these studies will be adequately powered to make even negative results meaningful and publishable. This does not mean that smaller-scale pilot studies cannot be valuable or that studies using fixed effects statistical models are invalid, but rather a new emphasis should be placed on using established tasks in larger groups and across diagnostic categories.
Imaging researchers investigating ADHD will continue to benefit from working collaboratively with cognitive neuroscientists, affective neuroscientists, developmental experts, neuropsychologists, and structural imaging colleagues to optimize paradigms and interpret data. Not surprisingly, a large number of factors that might influence imaging results are still under-studied and often ignored. Some examples would be the effects of age, gender, handedness, caffeine use, alcohol use, intelligence quotient, and practice on commonly used tasks, or the test–retest reliability of cognitive activation paradigms. Also, differential between-groups performance characteristics during cognitive tasks or differential thought processes during resting studies might confound imaging results and should be taken into account. Finally, a crucially important (yet often overlooked) issue is that of the proper correction for the large number of multiple comparisons that are inherently performed as part of functional imaging. Failing to account for multiple comparisons might make nonsignificant results erroneously seem to be significant.
There are some who have argued that much of the imaging work to this point has been too inconsistent (Baumeister and Hawkins, 2001) or confounded by prior medication exposure (Leo and Cohen 2003) to be meaningfully interpreted. In contrast to such harshly dismissive stances, we advocate taking a measured, conservative approach to interpreting the body of work that has already been produced, and importantly, listening to the valid criticisms of prior studies in the service of improving future studies.
On a final cautionary note, imaging research can carry great, often disproportionate weight in swaying minds. Its highly technical nature unfortunately carries with it the potential for misinterpretation, misuse, and exploitation—situations to be actively guarded against to protect the reputation of the field. Efforts to push forward the technology need to be matched with equal vigor in protecting patients and research subjects. In particular, we must clearly define the proper uses of imaging and ensure that these techniques are properly integrated with clinical evaluation. Last, we should not lose sight of the fact that not only can studies of normal healthy volunteers inform our studies of patients, but also studies of patients can increase our understanding of normal brain structure and function.
Functional imaging techniques represent new frontiers in ADHD research. Convergent data strongly suggest that frontostriatal abnormalities (DLPFC, VLPFC, dACC, caudate, and putamen) contribute to ADHD pathology. Suggestions for maximizing future progress include 1) placing an emphasis on larger-scale studies with validated tasks; 2) increasing the methodologic rigor of study designs; 3) renewing studies of therapeutic drug manipulations, using refined tasks and updated techniques; 4) refining neuroanatomic focus on the basis of advances in cognitive neuroscience and imaging technology; (5) interfacing more with genetics studies; 6) increasing the use of identical tasks and parameters to facilitate direct comparisons of ADHD imaging results with those of other psychiatric disorders; 7) making greater attempts to isolate effects and interactions due to common comorbidities; and 8) making greater use of combined modalities, such as fMRI and ERPs. Used wisely, functional imaging should continue to fulfill its promise as one of the strongest tools available for unraveling the mysteries of the neurobiology of ADHD.
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