Innovations in Practice: an objective measure of attention, impulsivity and activity reduces time to confirm attention deficit/hyperactivity disorder diagnosis in children – a completed audit cycle

Abstract

Background Diagnosing attention deficit/hyperactivity disorder (ADHD) in children and young people typically relies on clinical observation and subjective parent, teacher and self‐reports. The subjective nature of reports combined with contradictory or missing data can result in diagnostic uncertainty and delay. The aim of this study was to assess whether the addition of an objective test of attention, impulsivity and activity (QbTest) as an adjunct to standard ADHD assessment could accelerate the diagnostic process in routine National Health Service (NHS) settings. Method In a pre vs. post‐test audit design, case records were examined in 40 cases diagnosed without the QbTest [pre‐QbTest group] and 40 cases diagnosed with the QbTest [QbTest group], recording the number of consultations until a confirmed ADHD diagnosis was reached. Results Using Poisson regression, significantly fewer clinician consultations (mean 2.18 vs. 3.05; p < .02) were required to confirm the diagnosis of ADHD when the QbTest was used to augment assessment in comparison to standard assessment as usual. Conclusions The findings suggest that the addition of the QbTest to standard clinical assessment may reduce time to diagnosis and potentially result in cost savings to the NHS. These preliminary data suggest that there is a potentially clinically meaningful benefit of adding the QbTest to routine clinical ADHD assessment and this should be examined next in the context of a randomised controlled trial.

FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison—a feasibility trial protocol

“…Current service provision for ADHD in the CYPSE is ad hoc and uncoordinated. There is growing evidence within community settings30 32–34 that QbTest has the potential to significantly improve the current assessment pathway having a direct impact on young people’s health, service delivery and criminal justice outcome.…”

“…QbTest demonstrates good psychometric properties28 29 and has the additional benefit over other computer tasks of measuring activity level, a core symptom of ADHD 30. There are several studies that demonstrate the clinical utility of QbTest in aiding diagnosis 31 32. A recent randomised controlled trial found clinicians with access to the QbTest report were more likely to reach a diagnostic decision about ADHD.…”

The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder

“…In particular, further evidence is needed to help clinicians and healthcare service managers decide whether adding QbTest to clinical assessment of ADHD is cost effective. A recent audit reported that adding QbTest to ADHD assessment in a child and adolescent service reduced time to diagnosis and resulted in cost savings (Hall et al, 2016). Although these results offer some promise, further research is needed to determine how best to implement the test to enhance diagnostic decision-making in a cost-effective way.…”

Optimising medication management in children and young people with ADHD using a computerised test (QbTest): a feasibility randomised controlled trial

“…Research has identified the potential utility of the QbTest as a clinical tool to aid ADHD assessment and management [16]. The test has been shown to: aid in the differentiation of ADHD from other conditions [17][18][19], increase clinician confidence in diagnostic decision-making [15], reduce the number of appointments to make a diagnosis [15], and result in cost-savings to health services [20].…”