The impact of a computerised test of attention and activity (QbTest) on diagnostic decision‐making in children and young people with suspected attention deficit hyperactivity disorder: single‐blind randomised controlled trial

Abstract

Background: Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. Methods: Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/ NCT02209116). Results: One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. Conclusions: QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.

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

“…The completion and return of study outcome measures by primary care-givers and teachers was similar across measures, although returns by teachers were affected by the timing of school holidays, particularly the long (6-week) summer holidays. Our response rates were lower than we would anticipate based on similar trials [22] however, during interviews the primary care-givers acknowledged that although the trial included several questionnaires, they were not unduly burdened by completing them. Based on our previous experience of successful trials we would implement the following strategies to facilitate completion rates: conduct measures online with researcher telephone support where needed, including out-of-hours telephone appointments, and provide personalised thank you messages when measures are complete.…”

“…Although comparatively less researched than its use for diagnosis, qualitative findings from a recent randomised controlled trial (RCT) indicate the potential for QbTest to aid medication management [21,22]. Clinician interviews have identified that the QbTest is useful in supporting their confidence in starting medication, choosing suitable titration schedules, communicating to families/schools about medication efficacy, and promoting medication adherence [21].…”

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.…”

“…At 6 months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without a QbTest report. QbTest reduced appointment length, increased clinicians’ confidence in their diagnostic decisions and doubled the likelihood of excluding ADHD 33…”

“…The acceptability of the QbTest needs to be assessed to see if the same positive findings can be replicated. Primary outcomes in previous QbTest trials33 have been time to diagnosis, but given the comparative short stay in the CYPSE and difficulty obtaining these data once they leave, it is unclear how reliably these data can be collected and/or if other outcomes, such as in aggressive incidents, are more important in this population.…”