Tales from the heart: Fixing flawed ADHD testing
MindTension has developed a direct-to-brain test to precisely diagnose ADHD, removing variables and the fear of imposter syndrome.
In Israel, a critical point in the ADHD diagnosis process is the MOXO test: a computerized assessment tool that measures attention, hyperactivity and impulsivity through interactive tasks on a computer or tablet.
I took the MOXO a few years ago, and I believe that it is flawed.
The test’s outcome was largely based on my ability to focus and maintain self-control for a relatively short time (about 20 minutes) on a task intentionally designed to be mind-numbingly boring.
I was told to stare at a slowly cycling procession of playing cards and click once every time an ace appeared. Clicking gives no kind of feedback, and as the test slugs on, visual and auditory distractions are drip-fed into the digital environment, making concentration on the cards into a Herculean — but still remarkably boring — effort.
I took the test once without medication (which I assume was a control), and once with medication (as a way of proving that Ritalin does what it says on the back of the box).
Afterward I was awarded a printout featuring numbers and graphs that could mean a lot to my psychiatrist but didn’t mean anything to me.
As I puzzled over my results, I was overwhelmed by questions and concerns about my impending diagnosis based on the test, largely because I felt as though there were a lot of variables both in and out of my control that could have changed its outcome.
Variables lead to uncertainty
What if my scores indicated ADHD, but I had actually focused poorly for some other reason besides the way my brain was wired?
What if I hadn’t slept well the night before? What if I was feeling anxious about other stressful factors in my life during the time of the test? What if I was subconsciously faking it so that I could get pills that I didn’t need but merely wanted so that I could make doing my job easier?
Was I an imposter trying to weasel in on a quick fix? One of the misdiagnoses that countless popular psychology authors claim are leading to the downfall of the human attention span and an overdependence on corrective medication?
On the other hand, what if I “played” the test too well, not giving an accurate representation of my attention issues?
I felt that this could be possible, considering that I love playing games and taking challenges — I could very well have convinced myself that the 20-minute test was an opportunity to hyperfocus on success and prove that I was the best card clicker they had ever seen.
After all, that was the same mentality that somehow got me through university among those at the top of my (admittedly small) class.
Worse still, what if good test results meant that those “attention issues” didn’t even exist? If my scores were in line with a normal person’s, had I just been fooling myself this entire time, using “I probably have ADHD” as an excuse for laziness and lack of personal drive?
The seemingly endless variables that could have influenced my test performance — personal, environmental, unintentional and intentional — resulted in an endless stream of anxiety, self-doubt and imposter syndrome.
In the end, I was diagnosed with ADHD, and given access to attention-wrangling medication that I frequently forget to take on a daily basis; so, that’s a feather in MOXO’s cap, for sure — but for every story like mine, there’s likely another that didn’t end up in the test-taker’s favor.
Which left me wondering: what if there was a way to eliminate all those variables in the first place?
What if a bad night’s sleep, an obsession with high scores or a desire for frequently abused medication couldn’t impact your ADHD diagnosis?
What if the test could be completely objective?
Oh, turns out it can be
These questions were the driving force behind an objective test for ADHD developed at MindTension, an Israeli health-tech startup in Kibbutz Nir Am.
The company’s attention test eliminates external variables by using electromyography (EMG) sensors to measure your brainstem’s reflexive responses to auditory cues.
In doing so, the test effectively cuts out the annoying middleman (read: you) and gets the critical information right from your brain, prying everything it needs from that pink, squishy walnut without introducing unnecessary variables (read: your personality; your body; your annoying self-sabotaging mentality).
MindTension offered to give me the test when I came across the company last month at the MIXiii health-tech conference in Jerusalem,. Because I was curious about the process and because I need every form of validation humanly possible, I obliged, and the difference between MindTension’s test and the MOXO was night and day.
What MindTension’s ADHD test feels like
I sat on a chair with my eyes glazed over (easy to do considering I had to take my glasses off to make room for the EMG’s sticky sensor pads — one behind my ear, and two beneath my eye).
Wearing headphones, I sat for six minutes and listened to white noise periodically punctuated by some clicking sounds at random intervals.
The neuroscientist running the test removed the pads and told me I probably have ADHD. She emailed me my test results and that was all there was to it.
No wondering if I’d done anything wrong during the test. No concerns about whether I needed to pretend to focus or let my attention wander or think about anything in particular. I just sat there and hung out while a machine checked in directly with my brain.
What have we learned, kids?
To that end, the company is getting ready to seek FDA approval for the test and is on the verge of commencing clinical trials to assess its effectiveness.
Even if there are more iterations of the test to come following those trials, MindTension’s efforts show that there is still enormous potential for improvement in the future of diagnosing ADHD, and getting helpful resources into the hands of those who need them.
MindTension has proven that sometimes, the best way to identify a problem is by eliminating every possible variable — and that staring at a deck of cards for 20 minutes twice while taste-testing Ritalin may not actually be the best way to tell if you’ve got attention issues.
Go figure.
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