College students faking symptoms of attention-deficit hyperactivity disorder to get hold of pills may have met their match in an ADHD lie detector device.
People are acting fidgety and inattentive to try to dupe doctors into writing prescriptions for ADHD drugs, which can be used to get high, stay awake or concentrate while studying. The growing illicit use of the drugs on college campuses and a tripling in emergency-room visits linked to the pills have helped spur efforts to improve diagnosis.
That’s why Jeffrey Wishik, a neurologist and clinical neurophysiologist specializing in ADHD, is one of a growing number of doctors testing patients with Pearson Plc’s Quotient device. It’s not only to help root out fakers, but to improve diagnosis standards as well.
“There have always been a few people who misuse, abuse and divert medication,” said Wishik, a Providence, Rhode Island, physician who has been seeing ADHD patients for about 30 years. “It seems to have gotten much more prevalent in the last two to three years.”
ADHD diagnosis usually relies on patient interviews -- a subjective method that’s in part to blame for why prevalence varies substantially by region. While behavior management and counseling are treatment options, most patients receive prescription stimulants including Shire Plc’s Adderall XR and Vyvanse and Novartis AG’s Ritalin.
Quotient is a computer equipped with infrared motion-tracking equipment, because even ADHD patients who aren’t hyperactive tend to exhibit disorder-specific movements. It works by comparing a test taker’s answers against a database of responses from actual ADHD patients who aren’t taking medication. A Pearson-funded study shows Quotient helps experts predict with up to 92 percent accuracy whether someone is faking the symptoms of ADHD.
Feigning distraction or answering questions haphazardly raises red flags because responses don’t align with those of a real ADHD patient, said Theresa Cerulli, one of 300 doctors across the U.S. using the test on patients.
“When they’re performing no better than chance, you can see that they’re not putting in true effort,” said Cerulli, who practices in North Andover, Massachusetts. “They’re trying to throw the test.”
A surge in diagnosis rates since 2007 has helped U.S. sales of such medicines more than double to $8.97 billion last year. One survey found that more than a third of college students used stimulant ADHD pills illicitly. Among members of fraternities, that number soared to 55 percent.
Mirroring those trends is the 15,585 U.S. emergency-room visits linked to the medication in 2010, almost triple the number in 2005, the Drug Abuse Warning Network said in January. The drugs, known to act on the brain in the same way as cocaine, can raise blood pressure and heart rate and lead to feelings of hostility and paranoia.
Not everyone is convinced that Quotient and similar devices will have much impact on diagnosis standards or curbing unnecessary prescriptions.
“Diagnosis relies on histories and a variety of functions, not on how you do on a test at one certain time or in one domain,” said Rachel G. Klein, professor of child and adolescent psychiatry at New York University’s Langone Medical Center. “The notion that we can measure all this information with a test is wishful thinking.”
Still, the rise of overdoses and other “crisis points” suggest more must be done, says Travis Millman, who manages the Quotient unit at Pearson, a London-based publisher specializing in education materials. Pearson publishes the Financial Times, which competes with Bloomberg News parent Bloomberg LP in providing financial news and information.
Even experienced doctors can be fooled by those motivated enough to get their hands on the pills, Wishik said. A 2010 American Psychological Association study compared real ADHD patients off their medication against university students feigning ADHD symptoms. The fakers “readily produced ADHD-consistent profiles,” the researchers said.
“There is less vigor in this area then in other medical conditions,” Millman said. “We need more stringent measures.”
Pearson acquired the product after purchasing BioBehavioral Diagnostics Co. this year in a bid to gain entry in universities and high schools. Quotient may also be useful in ruling out ADHD for parents hoping medication will help their children’s school performance or help discern whether ADHD-like symptoms are better explained by stress, anxiety or sleep disorders.
“If the diagnosis is incorrect, the medication can make things worse,” Cerulli said. “It puts a great burden on the physician to know who is appropriately in need.”
Demand for Quotient is likely to rise among educators as some universities tighten rules for the use of ADHD pills on campus, Pearson said. Among doctors, the device went from virtually no users in 2008 to about 100 in 2010, to about 300 today.
Quotient isn’t the only device approved by the U.S. Food and Drug Administration for ADHD assessment. NEBA Health LLC in July won FDA approval for a test that calculates the ratio of two standard brain wave frequencies to help determine whether a child has ADHD. Such tools are gaining popularity as more doctors find it challenging to spot fakers.
“It’s not terribly difficult to walk in to my office and say, ‘Doc, I can’t sit still, I can’t focus, I’ve been this way since I was a child,’” Wishik said. “But with the Quotient, I actually have some data I can look at as well. The more information you have, the better.”