Robert L. Hendren, DO

New technology increasingly offers insights into how the brain functions or how genes affect behavior, but some parents may be putting too much faith in unproven tools, a dilemma that will examined during an NCE plenary session.

The scientific validity of diagnostic tests offered by freestanding laboratories and imaging centers will be discussed during the October 3 plenary presentation "Are Imaging and Other Technologies Helpful in the Diagnosis of Mental Disorders in Youth" (P2059).

"Clinicians in their search for how to make use of this promising technology announce that they have tests that could help in making a diagnosis or in planning treatment. What's disappointing is that many times when parents or families hear this, they may be misled in thinking that there is good research to back it up," said plenary presenter Robert L. Hendren, DO.

During his presentation, Dr. Hendren, professor and vice chair of the department of psychiatry, and director of child and adolescent psychiatry at the University of California, San Francisco, will review several types of tests and the evidence of their effectiveness as a diagnostic and treatment planning tool.

Among the tests he said he expects to examine are: magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), magnetoencephalography (MEG), computerized electroencephalogram (EEG), response potentials (ERPs), genetic testing, genomic microarrays, neurotransmitters and nutritional assays.

"There often is some research literature about using these technologies, but there often is little evidence that these approaches are helpful or not helpful," Dr. Hendren said. "It's not that the idea of using these tests has been proven false, it's just that there isn't evidence that they are valid for diagnosis and treatment planning.

"I will review what techniques are being proposed and what the evidence is for their validity as tool for medical practice. I'm not necessarily saying parents should not do testing unless there is something dangerous about it, but that they should go in fully aware of whether these are really good diagnostic tools."

Ideally, evidence about the success or failure of tests will be found in double-blind placebo control trials and through replication by more than one laboratory. Lack of evidence does not mean tests do not work, but it may mean it is too early in the process to make a sound decision, Dr. Hendren said.

"The direction people are going with this new technology is likely the right direction," he said. "I think some day some version of these tests will be useful to us. It may not be in diagnosing a DSM disorder like ADHD or depression because those diagnoses don't seem to map on to the genome or to a brain structure very well, but they may help us know that there is an acute process going on that we should target for treatment."

The plenary is not designed to expose shams, but to update attendees on evidence that is available, and to help them work with parents desperate for answers.

"It is important for pediatricians and primary care providers to have an open mind about these approaches so they can engage their patients in thoughtful discussions about how to make good decisions for their families," Dr. Hendren said. "Otherwise, the parents and patients have to make decisions themselves, and they often do it without as much information as they should have to reach the best conclusion for them.

"If the parents decide to do testing anyway, then maybe you can say, ‘Good, but bring me back the results so we can look at it together and see if we can learn something from that information.' My main goal is to make people think about how to make good decisions, and then how to keep a patient and the patient's family engaged in both cutting-edge research and best practices."