Differences in measurements of hyperactivity between objective testing using infrared motion analysis (QbTest) and behavioural rating scales when comparing problems in alerting functions and response inhibition during the clinical assessment of ADHD

Abstract

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

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

“…In a large epidemiological study, Epstein et al (2006) found that unexpectedly, omission errors were associated with hyperactivity symptoms (and not with inattention symptoms), whereas commission errors were related to impulsivity symptoms, hyperactivity, and inattention symptoms. Likewise, a recent study demonstrated that the levels of hyperactivity or impulsivity during CPT performance might be associated with basic attentional rather than inhibition processes (Vogt et al, 2018). It has been suggested that excessive motoric activity, such as fidgeting during a cognitive performance, reflects efforts to modulate attention and alertness (Hartanto et al, 2016).…”

Clinical Conundrums When Integrating the QbTest into a Standard ADHD Assessment of Children and Young People

“…9,10 Cases with impairment in response inhibition manifest themselves by increased commission errors with normal reaction time and reaction time variation and reflect impulsivity during the QbTest. 5 The behavior is characterized by an inability to suppress irrelevant behaviors and acting before thinking. Deficits in inhibitory control functions are also supported by extensive research evidence in relation to a clinical presentation of ADHD-combined type, 11,12 with an estimated 35 to 50% of cases of ADHD-combined type having response inhibition deficits.…”

“…4 The aforementioned differences in activity during the test between the neuropsychological domains of arousal/alerting functions and response inhibition are displayed in quantitative rather than qualitative distinctions. 5 It is hypothesized that increased motor activity in the arousal/alerting domain reflects an attempt to increase cortical arousal, 18 and that excessive motoric activity such as fidgeting during cognitive performance reflects efforts to modulate attention and alertness. 19 However, the difficulties in response inhibition appear to respond to mitigating environmental factors from the laboratory conditions (low perceptual load with few distractions), thus suggesting that certain types of ADHD, normally regarded as prevalent independent of changing environmental or cognitive demands, 20 may in fact be more susceptible to mitigating environmental factors than previously thought.…”

“…4 Yet certain neurocognitive domains that are captured by the QbTest make important contributions in distinguishing ADHD from control youth and highlight the heterogeneity among children with ADHD. 5,6 The process in which during the QbTest clinicians are able to more accurately elicit known neurocognitive domains Keywords ► ADHD ► assessment ► QbTest ► continuous performance test (CPT) ► neurodevelopmental…”

“…4 The quantitative differences in activity levels measured between neurocognitive domains in a laboratory setting require particularly careful consideration during the clinical assessment. 5,7 This article aims to assist clinicians in clarifying these clinical conundrums that arise with the use of the QbTest and attempts to initiate the process of developing a consistent approach for the application of the QbTest in standard clinical practice. For this purpose, information has been drawn from evidence-based literature, clinical audit, case presentations, and 14 years of clinical experience with using the QbTest.…”