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Evaluation of the role of Qb testing in attention deficit hyperactivity disorder



2. Evaluation of the role of Qb testing in attention deficit hyperactivity disorder
George Still forum
A Sharma,
B Singh.
Southampton University Hospitals, Southampton, UK;
Hospital, Torquay, UK
Introduction: The diagnosis of attention deficit hyperactivity
disorder (ADHD) hinges on history of core signs of inattention,
hyperactivity and impulsivity, and being able to demonstrate
pervasiveness of the disorder through ADHD questionnaires, which
are quite subjective. The Qb test is a computerised combined
continuous performance test and activity test. It helps us
objectively measure performance related impulsivity, attention as
well as activity.
Aims of this audit: This project was done as an audit to assess
whether the Qb test results correlate with the diagnosis of ADHD
as made by using an assessment of disruptive behaviour pathway
used locally as the standard.
Methods: 50 cases were selected from the Qb test database semi-
randomly, which were evaluated for ADHD as per local protocol or
as diagnosed by child and family guidance. The cases were analysed
based on a pre-prepared data sheet to look for the symptoms of
behavioural disorders and the Connor’s scores were also recorded.
Comorbid conditions were recorded alongside as well as the child’s
medication and response to medication. Qb tests for the cases were
analysed and compared with the diagnosis made as per protocol.
Predrug and postdrug Qb tests were also analysed where available.
Results: A total of 50 cases were reviewed (age range 5–15 years).
The Qb test correlated with clinical diagnosis in 90% of cases. The
test was 96% sensitive in making a diagnosis of ADHD and the
specificity was 81%. The positive predictive value of the test was
87% and negative predictive value was 94%.
Conclusions: The Qb test offers an objective way to aid diagnoses
of ADHD but has to be interpreted carefully and in relation to
comorbidities. Children who are suspected to have ADHD should
undergo Qb testing, which has been incorporated as a diagnostic
adjunct along with clinical review and ADHD questionnaires in
diagnosis of ADHD in our care pathway. Predrug and postdrug Qb
tests help to monitor drug effect and performance and may help in
dose optimisation of medication.
G Bhusari, S Howard, K Lehner. South West Essex NHS Trust, Basildon, UK
Aims: To review post-transition care of young people from a
behaviour assessment and management (BAM) service.
Method: All children who were discharged from BAM (a joint clinic
between community paediatricians and child and family consulta-
tion service professional) clinics after their 17th birthday during a
12-month period ending December 2006 were selected. A total of 30
young adults met the criteria. A structured form was devised for
telephone interview. The families with unobtainable telephone
numbers were posted the questionnaires along with an SAE.
Contact was made for a total of 20 parents and young adults (66%).
The information was obtained from 17 parents and from three
young adults.
Results: 10 of 20 (50%) were in education at the time of interview.
Five of 20 (25%) were on medication. For the remaining 15 young
adults the medication had been stopped at 15 years for four, at
16 years for two, at 17 years for six, at 18 years for two and at
19 years for one. Nine of 20 were referred and had been seen by an
adult psychiatrist. One young person on medication was not sure if
they had been seen by an adult team. Eight families had met
psychiatrists and two found the advice somewhat helpful, others
commented that no practical advice was given. One young adult
had seen a key worker and was offered help for stopping drugs and
found consultation very helpful. 11 of 20 (55%) in employment,
seven in full time and four in part-time employment. 10 of 20 (50%)
were in receipt of Disability Living Allowance; four of these were
young adults in full-time employment. Nine of 20 (45%) were
involved with the police for, eg, driving offences, RTA, theft and a
drink-related offence. One young person was arrested three times
for theft. 13 of 20 young adults smoked—55% were smoking by
16 years of age and six (30%) smoked more than 10 cigarettes per
day. Five of 20 (25%) had used street drugs such as cannabis,
cocaine and poppers: 16 of 20 (80%) drank alcohol—most drinking
occasionally but one young person drinks daily since the age of
16 years. Most parents commented they felt well supported when
under the care of the child development centre but felt forgotten,
lost and isolated after discharge.
Conclusions: This study demonstrates the need for the establish-
ment of a robust transitional care plan for these young adults
involving paediatricians, child and adolescent mental health
services professionals and adult psychiatrists; close working with
drug and alcohol service, smoking prevention service and the
police; and need to develop a post-discharge parent support
G Koshy,
A Delpisheh,
BJ Brabin.
Royal Liverpool Children’s Hospital, Alder Hey,
Liverpool, UK;
Liverpool School of Tropical Medicine, Liverpool University,
Liverpool, UK
Introduction: Attention deficit hyperactivity disorder (ADHD) is a
common behavioural disorder affecting children in the UK.
Objective: To determine the magnitude of the epidemiological
association of childhood obesity and smoking during pregnancy
with childhood ADHD.
Methods: A retrospective cross-sectional survey was conducted in
2006 using a standardised respiratory health survey instrument to
determine the association of ADHD risk with childhood obesity
prevalence and maternal smoking during pregnancy. A total of
1074 school children aged 5–11 years in Merseyside were enrolled
using a parent-completed questionnaire and ADHD was defined
by the question ‘‘does your child have Attention Deficit
Hyperactivity Disorder (ADHD), which has been diagnosed by a
Results: The prevalence of childhood obesity, maternal smoking
during pregnancy and childhood ADHD was 9.1% (145 of 1602),
28.0% (267 of 955) and 3.4% (32 of 945) respectively. Prevalence of
ADHD was 10.1% (11 of 109) in children with obesity(RR; 4.80,
95% CI 2.2 to 10.4, p,0.001) and 5.6% (14 of 251) in children born
to mothers who smoked during pregnancy (RR; 2.44, 95% CI 1.1 to
4.9, p = 0.02) and. Regression analysis adjusting for household
socio-economic status, low birth weight, single parent, gender,
maternal and child age showed a significant association of risk of
ADHD with obesity (AOR; 4.39, 95% CI 1.48 to 13.03, p = 0.008)
and pregnancy smoking (AOR; 3.18, 95% CI 1.07 to 9.47, p = 0.04).
Conclusions: Childhood obesity and maternal smoking during
pregnancy were associated with the development of ADHD in
childhood. Measures taken to reduce smoking among pregnant
women and obesity among children could help to reduce
consequences of childhood ADHD.
RCPCH abstracts
A72 Arch Dis Child 2009;94(Suppl I):A72 on July 22, 2014 - Published by adc.bmj.comDownloaded from
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George Still forum
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... The QbTest has good psychometric characteristics, with good test-retest scores and reported classification sensitivity ranging from 47% − 85% and a specificity ranging from 72% to 92% (Hult et al., 2018;Sharma & Singh, 2009;Ulberstad, 2012, unpublished data). The Qbtest correlated with clinical diagnosis in 90% of cases (Sharma & Singh, 2009) and has the ability to differentiate between children with and without ADHD (Hult et al., 2018;Oades, Myint, Dauvermann, Schimmelmann, & Schwarz, 2010). ...
... The QbTest has good psychometric characteristics, with good test-retest scores and reported classification sensitivity ranging from 47% − 85% and a specificity ranging from 72% to 92% (Hult et al., 2018;Sharma & Singh, 2009;Ulberstad, 2012, unpublished data). The Qbtest correlated with clinical diagnosis in 90% of cases (Sharma & Singh, 2009) and has the ability to differentiate between children with and without ADHD (Hult et al., 2018;Oades, Myint, Dauvermann, Schimmelmann, & Schwarz, 2010). ...
Background The assessment of Attention Deficit Hyperactivity Disorder (ADHD) requires the integration of many different sources of information. These sources of information are often subjective, so objective measures like the QbTest can be an asset to healthcare teams that diagnose ADHD. Method The present study used a mixed-methods design to examine the impact of the introduction of the QbTest in Irish Child and Adolescent Mental Health Services (CAMHS). The main analysis consisted of three focus groups with clinicians (n = 19) working in CAMHS. A concurrent pilot was run that consisted of the administration of 50 questionnaires to CAMHS clinicians (n = 17), young people (n = 15) and their families (n = 18). Results Thematic analysis of focus group transcripts highlighted that clinicians considered the QbTest a valued addition to ADHD assessment as it was efficient, objective and clear. Survey data suggested that young people and their families found the QbTest helpful and acceptable. Conclusions The findings indicated that participants in the present study (clinicians, young people, parents and guardians) all had positive reactions to their experience with the QbTest. Recommendations for future research are discussed.
... Its naturalistic design meant that we, as is usual in ordinary clinical settings, relied on the test manufacturer's cut-off proposals to judge whether a particular patient's performance deviated from normal or not (see Methods). Based on previous studies, we expected a robust impairment of QbTestþ performance (see Edebol et al., 2013b;Sharma & Singh, 2009). ADHD-medication has been shown to affect QbTest performance (Bijlenga et al., 2015;Ginsberg et al., 2012;Edebol et al., 2013a). ...
Full-text available
The Quantified Behavioural Test Plus (QbTest+) is widely used in clinical practice to assess patients with attention-deficit hyperactivity disorder (ADHD). This study mapped its behaviour in a group of adults with ADHD. Does it signal problems with impulsivity, attention and/or activity? To what extent are patients’ self-reported problems reflected in QbTest performance? Does Qb testing foretell the future, as reflected in the patients’ and clinicians’ judgements 4 years later? We here recorded the three QbTest+ cardinals–QbActivity, QbImpulsivity and QbInattention – in 67 consecutive ADHD patients diagnosed in adulthood. Among the 54 patients who medicated as usual on the day of testing, 35 (65%) scored above the clinical cut-off (Q-score ≥ 1.25) on at least one of the QbTest+ cardinals. Out of the 13 patients who suspended medication prior to the test, 11 (85%) scored above the clinical cut-off on at least one of the Qb-variables. There were modest associations between QbTest+ cardinals and symptom self-ratings [Brown ADD scale (BADDS); Adult Self-Report Scale (ASRS)]. Forty-one patients completed a second QbTest+ approximately 4 years after the first. Performance was improved on the follow-up test and fewer patients scored in the clinical range (34%). The scores on the QbInattention cardinal at baseline correlated positively with BADDS and ASRS self-ratings at the 4-year follow-up.
... Research has identified the potential utility of the QbTest as a clinical tool to aid ADHD assessment and management [21]. The test has been shown to aid in the differentiation of ADHD from other conditions [22][23][24], increase clinician confidence in diagnostic decision-making [20], reduce the number of appointments to make a diagnosis [20], and result in cost-savings to health services [25]. 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 [26,27]. ...
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Background Medication for attention deficit hyperactivity disorder (ADHD) should be closely monitored to ensure optimisation. There is growing interest in using computerised assessments of ADHD symptoms to support medication monitoring. The aim of this study was to assess the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate the efficacy of one such computerised assessment, the Quantified Behavior (Qb) Test, as part of medication management for ADHD. Methods This feasibility multi-site RCT conducted in child and adolescent mental health and community paediatric settings recruited participants aged 6–15 years diagnosed with ADHD starting stimulant medication. Participants were randomised into one of two arms: experimental (QbTest protocol) where participants completed a QbTest at baseline and two follow-up QbTests on medication (2–4 weeks and 8–10 weeks later) and control where participants received treatment as usual, including at least two follow-up consultations. Measures of parent, teacher, and clinician-rated symptoms and global functioning were completed at each time point. Clinicians recorded treatment decision-making and health economic measures were obtained. Data were analysed using multi-level modelling and participants (children and parents) and clinicians were interviewed about their experiences, resulting data were thematically analysed. Results Forty-four children and young people were randomised. Completion of study outcome measures by care-givers and teachers ranged from 52 to 78% at baseline to 47–65% at follow-up. Participants reported the questionnaires to be useful to complete. SNAP-IV inattention scores showed greater reduction in the intervention than the control group (− 5.85, 95% CI − 10.33, − 1.36,). Engagement with the intervention ranged from 100% at baseline, to 78% follow-up 1 and 57% follow-up 2. However, only 37% of QbTests were conducted in the correct time period. Interview data highlighted that the objectivity of the QbTest was appreciated by clinicians and parents. Clinicians commented that the additional time and resources required meant that it is not feasible to use QbTest for all cases. Conclusion The trial design and protocol appear to be feasible and acceptable but could be improved by modifying QbTest time periods and the method of data collection. With these changes, the protocol may be appropriate for a full trial. Adding QbTest may improve symptom outcome as measured by SNAP-IV. Trial registration, NCT03368573 , prospectively registered, 11th December 2017, and ISRCTN, ISRCTN69461593 , retrospectively registered, 10th April 2018
Full-text available
Introduction: Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. Method and analysis: This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6-17 years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. Ethics and dissemination: The findings will be used to inform the development of a fully powered RCT. The results will be submitted for publication in peer-reviewed journals. The study has ethical approval. Trial registration number: NCT03368573; Pre-results.
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