Screening Tests Don't Diagnose People

A recent article over at NPR’s health blog, Shots, cautions that attention deficit hyperactivity disorder (ADHD) can’t be diagnosed with a simple screening test. Of course, it can’t.

The question I have to ask then is, who ever said any mental illness or mental health condition could be diagnosed by a screening measure alone?

The article, by Rebecca Hersher, seems to reflect a fundamental misunderstanding about the purpose of screening measures, such as the one published by the World Health Organization to screen for ADHD:

Which is why many people were excited when earlier this year a World Health Organization advisory group endorsed a six-question screening test that a study published in the Journal of the American Medical Association reported could reliably identify adults with ADHD.

Rather than argue the scientific data from the study of 637 adults that showed that a new six-item screening quiz could reliably identify those who might quality for a formal ADHD diagnosis, the author seems to sidetrack into a completely different, unasked question. That is, whether screening measures alone should be the basis for a person’s mental health diagnosis.

I don’t know of a single professional who would answer “yes” to such a question.

The Purpose of Screening Measures

Let’s take a quick dip into better understanding the purpose of screening measures. “Screening” generally means helping a non-mental health professional (such as an ordinary person or a physician) understand whether a person appears to meet the minimum symptom criteria for a given disorder. I know of no screening measures that claim they actually diagnose disorders or conditions. Screening measures are meant simply to let a person know, “Hey, this appears to be a concern for you — you should seek out further professional mental health advice and help if you want an actual diagnosis.”

Screening measures are generally designed on purpose to err on the side of an abundance of caution when it comes to helping the people who are screened. Wouldn’t you rather be told by a screening measure that if you have symptoms that are consistent with ADHD, you should go get it checked out by a professional? In most parts of the world, that’s all screening measures do.

However, some parts of the world — typically those targeted by the World Health Organization — are poor and have very limited access to healthcare. Screening measures help these under-served countries conduct population-based preventative care. If someone is at risk for ADHD, for instance, they can be given strategies for helping their symptoms before it has the chance¬†to become a full-blown disorder. Teachers and parents can pay special attention to their needs; accommodations may be made for them at work.

Arguing Against Information

When screening measures are misused — such as suggesting they can substitute for a professional diagnosis — that is a problem. However, most ethical physicians or mental health professionals would never rely solely on a screening measure as the basis of a diagnosis. That’s why mental health professionals, including¬†psychologists and psychiatrists, have years of experience and practice with diagnosis. They know the subtleties and art of diagnosis.

Ironically, those who berate screening measures seem to be suggesting that people can’t be trusted with the information such measures provide. Once again, it’s that old medical paternalism rearing its ugly head. “We can’t let ordinary people take diagnostic screening measures, they’ll mistake the advice for a diagnosis!”

So what if they do? They, like most people, would then be empowered to engage in self-help treatments to alleviate their symptoms on their own. And if they wanted or needed more treatment, professional treatment? The formal disorder would still have to be diagnosed by a mental health professional or physician. And believe me, no credible professional takes the results of a screening measure as the final word on a diagnosis.

To me, these kinds of articles seem like they were built as a straw man argument. Nobody seriously believes a screening measure is a substitute for a diagnosis. Yet the article portrays that perspective as a legitimate concern — yet not one not supported by any scientific data.

Yes, formal diagnosis of a mental disorder can be complex, nuanced, and sometimes difficult. That’s why people should always go right to a mental health professional — not their primary physician — for a consultation if they have any concerns about their mental health.

 

Read the original article: Adult ADHD Can’t Be Diagnosed With A Simple Screening Test, Doctors Warn

Take the WHO’s 6-question Quick Adult ADHD Screening Test or our longer ADHD screening test.