Background: The aim of this study was to evaluate stimulant medication response following a single dose of methylphenidate (MPH) in children and young people with hyperkinetic disorder using infrared motion analysis combined with a continuous performance task (QbTest system) as objective measures. The hypothesis was put forward that a moderate testdose of stimulant medication could determine a robust treatment response, partial response and non-response in relation to activity, attention and impulse control measures. Methods: The study included 44 children and young people between the ages of 7-18 years with a diagnosis of hyperkinetic disorder (F90 & F90.1). A single dose-protocol incorporated the time course effects of both immediate release MPH and extended-release MPH (Concerta XL, Equasym XL) to determine comparable peak efficacy periods post intake. Results: A robust treatment response with objective measures reverting to the population mean was found in 37 participants (84%). Three participants (7%) demonstrated a partial response to MPH and four participants (9%) were determined as non-responders due to deteriorating activity measures together with no improvements in attention and impulse control measures. Conclusion: Objective measures provide early into prescribing the opportunity to measure treatment response and monitor adverse reactions to stimulant medication. Most treatment responders demonstrated an effective response to MPH on a moderate testdose facilitating a swift and more optimal titration process. Key Practitioner Message:• Objective measures are effective in the early identification of treatment response to stimulant medication.• Treatment response measures are available for children and adolescents from 6-18 years.• Single dose testing with objective measures facilitates swift and optimal titration at minimal exposure to medication.• A moderate test dose resulted in a robust treatment response in the majority (84%) of participants.• Both, short acting as well as extended-release stimulant medications can be used to measure treatment response with objective measures.

Aims and methodTo appraise the value of additional information from objective measurements (QbTest system) in the clinical assessment of children and adolescents with attention-deficit hyperactivity disorder (ADHD). Two groups of ADHD assessments were compared. In the first group, assessments were undertaken without objective measures, whereas in the second group objective measures were added to the assessment. Practice outcomes were followed up over 1 year.ResultsObjective measures improve differentiating between ADHD and other conditions whose symptoms are known to overlap with ADHD. Objective measurements reduce the risk of unidentified ADHD (P < 0.0035) as measured by subsequent rates of revised diagnosis over a 12-month period.Clinical implicationsIntroducing objective measurements into the clinical assessment of ADHD provides an increased robustness of the clinical diagnosis strengthening clinical decisions for treatment interventions.

PurposeAttention deficit hyperactivity disorder (ADHD) is the most commonly studied and diagnosed psychiatric disorder in children. There is a need to engage service development, commissioning and service managers to address primary care involvement and define service models that will enable effective management of people with ADHD. The purpose of this project is to define recommendations through consensus that can be implemented to improve ADHD management in the UK.Design/methodology/approachA set of 40 consensus statements has been developed by a multidisciplinary group of ADHD professionals in the UK. These statements cover ten topics, ranging from commissioning of ADHD services to optimisation of the care pathway. The aim of the project was to define a set of standards that could be tested across a wider clinical population.FindingsA total of 122 respondents scored each statement on a questionnaire and levels of agreement were summated and analysed. Of 40 statements, only four scored less than 90 per cent agreement, with all statements achieving greater than 74.9 per cent agreement.Originality/valueRecommendations support the wider integration of ADHD services and the closer involvement of commissioners within the new GP consortia to ensure that the potentially negative societal and personal impacts of ADHD are managed effectively and with appropriate use of resources.

Background Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side‐effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side‐effects. While some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method In‐depth interviews were carried out. Child and Adolescent Mental Health Services practitioners (n = 8), General practitioners (n = 8), teachers (n = 5) and mothers of children with ADHD (n = 4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long term. Some families do practise short‐term drug holidays at weekends and longer term ones during school holidays. The decision to introduce drug holidays is influenced by the child's academic progress, the parents' ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self‐assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.

Introduction: Little is known how problems in alerting functions or response inhibition affect objective infrared activity measurements during a continuous performance test (QbTest) despite an increasing use of these tests for the clinical assessment of ADHD. Difficulties in alerting functions and response inhibition are both associated with the presence of behavioural features in all three core domains of ADHD, i.e. inattention, impulsivity and hyperactivity. We hypothesized that objective infrared activity measurements during CPT and behavioural ratings for hyperactivity from a commonly used questionnaire for ADHD (Conners rating scale) would be raised for both alerting functions and response inhibition. Method: 951 sequential referrals completed a QbTest and parent and teacher Conners rating scales followed by a clinical assessment with a CAMHS clinician. Two groups, one with exclusive difficulties in alerting functions (inattention) and the other with exclusive difficulties in response inhibition (impulsive) resulting from the QbTest performance were extracted from the pool and activity measurements, rating scales and diagnostic outcome were compared. Results: Contrary to our hypothesis, only the group with difficulties in alerting functions (inattentive) showed significantly raised activity measurements during CPT. However, both groups had raised scores for hyperactivity in the behavioural rating scales. A higher number of cases with difficulties in alerting functions (79.6%) were assigned a diagnosis of ADHD compared to the group with exclusively difficulties in response inhibition (61.8%). Discussion: A cautious evaluation of activity measurements during the QbTest with full consideration of the interplay between naturalistic and laboratory environmental effects on motor activity is recommended

The uptake of the QbTest in clinical practice is increasing and has recently been supported by research evidence proposing its effectiveness in relation to clinical decision-making. However, the exact underlying process leading to this clinical benefit is currently not well established and requires further clarification. For the clinician, certain challenges arise when adding the QbTest as a novel method to standard clinical practice, such as having the skills required to interpret neuropsychological test information and assess for diagnostically relevant neurocognitive domains that are related to attention-deficit hyperactivity disorder (ADHD), or how neurocognitive domains express themselves within the behavioral classifications of ADHD and how the quantitative measurement of activity in a laboratory setting compares with real-life (ecological validity) situations as well as the impact of comorbidity on test results. This article aims to address these clinical conundrums in aid of developing a consistent approach and future guidelines in clinical practice.

No abstract

Difficulties in sustaining posture can present with features associated with hyperactive behaviour listed in DSM-5 and ICD-10 classifications for ADHD. Information from a system measuring motor activity during a neurocognitive test (QbTest), occupational therapist reports and Conners rating scales are compared between cases with and without posture problems. Weakness in sustaining posture results in elevated activity measures during infrared motion analysis. Strong posture on the other hand appears to mitigate activity levels. Posture is an independent factor which requires consideration during the assessment of ADHD.