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McLean Motion and Attention Test (M-MAT)

A new test to diagnose a troubling disorder

A 10-year-old boy fidgets as he tries to complete a computer task. He is wearing a headband outfitted with an infrared light that allows a video camera to track his every movement. He is taking the McLean Motion and Attention Test (M-MAT), a new objective diagnostic evaluation for attention deficit hyperactivity disorder (ADHD), one of the most commonly diagnosed-and misdiagnosed-psychiatric disorders in children.

Martin Teicher

Martin Teicher, MD, PhD
Director of the Developmental Biopsychiatry Research Program

"Many children have the capacity to sit still but do not utilize that capacity. They move three to four times more than normal."

Martin Teicher, MD, PhD, director of McLean's Developmental Biopsychiatry Research Program, developed the M-MAT.

"Over the course of the 15-minute test, we are able to quantify the precise number of movements a child makes, as well as his or her whole movement pattern, thus helping us to detect whether a child truly has ADHD," he says.

"Many children have the capacity to sit still but do not utilize that capacity. Children with ADHD do not have that capacity. They move three or four times more than normal."

Chris Dell'Erba, 14, took part in one of the first studies of the M-MAT. Within five minutes of beginning the test, he moved 4,333 times; over the average for ADHD and far above the 1,000 movements children without ADHD make. His mother Cathy was relieved to see the results of the test, which confirmed her belief that her son had ADHD.

"It validated everything I had been thinking all along."

The M-MAT also can rule out other disorders, which, in Chris' case, reassured him he did not have Tourette's syndrome, a disorder marked by repetitive tics. "It made me feel better because I knew what was wrong, and my mom and dad and school teachers knew what was going on too."

Further evaluation using the M-MAT also confirms whether drugs for ADHD are effective."Instead of spending months trying to figure out whether a child is taking an effective medication, you can know in a day," says Teicher.

Chris Dell'Erba

With proper diagnosis and treatment Chris Dell'Erbe is now able to concentrate on his studies and his grades have improved.

Given the controversy surrounding treating children with Ritalin and other drugs, such objective ADHD testing raises the confidence level for doctors and parents.

In addition to the M-MAT, McLean researchers are incorporating a special brain imaging method in studies to help children with ADHD. Using this new technique, which looks at blood flow in tiny portions of the brain, McLean investigator Carl Anderson, PhD, says he and Teicher found that the vermis, a part of the brain's cerebellum that controls coordination of movement and thinking, may be linked to ADHD.

"This region is also the most responsive to Ritalin so there seems to be a connection there," says Anderson.

Both lines of research point to major advances in the diagnosis and treatment of ADHD. "I think it would be wonderful to have the M-MAT widely available," says Teicher, noting that children with ADHD are 12 times more likely to die in childhood due to accidents, and 25 times more likely to wind up with problems of juvenile delinquency, than children without ADHD.

"Thousands of kids have been tested, but there are hundreds of thousands more who could benefit from testing," he adds.

Exploring new research fronts

Using the McLean Motion and Attention Test (M-MAT) as one of their measures, hospital researchers made an important discovery in 2002 that could help clinicians identify children with attention deficit hyperactivity disorder (ADHD) who will most benefit from Ritalin, a common yet controversial medication.

Carl Anderson, PhD, Perry Renshaw, MD, PhD, and Martin Teicher, MD, PhD, monitored the effects of Ritalin on two forms of activity: overall body movement and nerve cell activity in an area toward the back of the brain known as the vermis, a new area of study in ADHD. Out of 10 boys who were treated with Ritalin for four weeks, only those who displayed high levels of both forms of activity at the start of the study were likely to benefit from Ritalin.

"This study shows that a child's rate of movement and his response to Ritalin is reflected in the activity of the vermis," Anderson said.

He believes the results, though preliminary, could be used to enhance Ritalin's effect and possibly, to design better treatments for ADHD. "Up until now, research has focused on the brain's frontal lobes," said Anderson. "The vermis is a completely new frontier in ADHD research."