McCall Letterle: Improving Care for ADHD Patients

There remains a need to improve diagnostics and treatment for patients with attention deficit/hyperactivity disorder (ADHD) of all ages.

Often times the disease can manifest differently in different people, making it a challenge for many to get diagnosed.

However, a new ADHD diagnostic and management tool called QbTest and QbCheck could help close some of these gaps.

These tools, developed by Qbtech, are aimed at providing clinicians with up to date data on the patient’s core ADHD symptoms. The system works by instantly analyzing and comparing the patient’s symptoms to the general population within the same age and gender group who do not have ADHD.

In an interview with HCPLive®, McCall Letterle, Head of Commercial Operations for Qbtech, explained how the program works and what is needed in the future to improve ADHD care.

HCPLive: Can you explain how these testing systems work?

Letterle: We have two different testing devices giving us the ability to test in clinic and from a remote location.

What we really try to address is that lack of rigor that we've seen across decades.

There's a lack of standardization in the ADHD care process, whether you're a child or an adult seeking an evaluation for ADHD, there's no real domain that owns the ADHD diagnosis. So it's shared across all these different providers – pediatricians, psychiatrists, and neurologists.

Because you can diagnose and assess treatment monitoring quite quickly, oftentimes, it's treated as a light disorder that doesn't need to have this high level of standard of care. The problem that we typically see is that you don't have the ability to identify patients early and have a substantial amount of robust data that informs the decision.

Then in turn, better informs the treatment process so you can fine tune. And, we typically see that across the board.

There's a lot of room for even more improvement in the treatment follow up process. We tend to see with ADHD, there is not often consistent data points that are used across specialties.

Yes, we use rating scales, but the rating scales that are utilized in the process are completely across the gamut, and very oftentimes are difficult to collect, especially during the pandemic.

There is a lot of areas for improvement in the standard assessment process, because it does not have the ability to give physicians hard concrete data that is highly quantitative and can be used in a repeated way to measure the patient's improvement for optimization earlier and faster.

We're trying to improve that lack of rigor. We think we can do this by better implementing a systematic form of collecting and using robust reliable data throughout assessments and treatments.

Qbtech uses an infrared tracking camera to monitor the patient's hyperactivity, while they take a 15 to 20 minutes under stimulating task.

HCPLive: How does this fill a need within the space of ADHD management and care?

Letterle: What we really saw during the pandemic was that it destabilized patients access to care across the gamut. And in this destabilization, we typically saw that half of the kids that needed services were actually receiving them.

Even worse, specialized service care is highly reduced even still to this day. We saw kind of a wave comeback in what we thought was the end of the pandemic, and then you know, as it continues to track on for the unforeseeable future, we've seen it increase again.

What we hope to do by using telehealth testing is issue a voucher code from the doctor to send to the patient to take in their home environment.

They can take the 15 to 20 minute test, standardized instructions are given to the patient, and the results are immediately transmitted back to the physician. So if a patient lives in a rural community, they have access to standardized care they wouldn't otherwise have.

If they live in an area where they just don't feel safe to go out or they're part of the vulnerable population. We can also accommodate work schedules. Being able to test the patient from home has completely expanded Qbtech's ability to improve access of care.

Increasing the rigor in evaluations and treatment follow up is our main goal. We’re improving access to care and equity across the course by offering telehealth in addition to in-clinic testing. The continuity of care is also really important.

Then the last is what we see in treatment follow up, which is oftentimes based on patient feedback.

There was a study that came out in March that showed QbTest not only identified treatment follow up earlier then the rating scales did in the same pathway. But it also identified 50% more treatment response than the rating scales alone.

We often find that individuals tend to have difficulty self-rating the improvement that they expect to see from medication. And, it makes it very hard for a doctor to fine tune and optimize the patient’s dosage quickly.

And that was at the six month mark, where QBTest saw 50% more treatment response than rating skills alone.

The combination of these elements, our ability to improve treatment follow up, is going to really help with a disorder that is highly responsive to treatment.

Good patient outcomes come when a patient is accurately and quickly identified and then treated relatively quickly, as well.

We can help give doctors an additional tool that is highly valid, highly reliable, and reproducible without using a lot of resources, cost or strain on the system.

HCPLive: Does this kind of system work for all the symptoms attached to ADHD, even something like hyperactivity which can fade as the individual ages?

Letterle: It's typically believed that the hyperactivity kind of dies off. Oftentimes, we think around 16, 17, 18 the hyperactivity dissipates significantly, and then the predominant symptoms are inattention and impulsivity.

What we've actually found is that when you use quantitative data that hyperactivity, while it reduces, it is still clinically significant compared to norms for the age group.

The really nice part about QbTest is that by capturing and quantifying the movement throughout the test, for a 32 year old, a 36 year old, a 45 year old, we're able to compare that level of hyperactivity against a normative database and say, “Is this clinically significant enough to warrant what we would call a hyperactivity diagnosis?”

What QbTest does is it measures all three core symptoms separately, so it does not combine them together. The nice part about this is that doctors are able to look at hyperactivity, inattention and impulsivity separate of each other and say, yes, hyperactivity symptoms exist for this patient, but we're not seeing impulsivity symptoms.

If somebody just has significant inattention issues and no hyperactivity, the doctor will be able to read that on the QbTest sheet as well.

HCPLive: How important is it for children as they age through adolescence into adulthood to have a system like this in place?

Letterle: It's a really important question because we find that compliance to medication is quite low.

And, oftentimes QbTest can be used as a psychoeducational tool to inform the patient and improve the conversation that happens between the doctor and patient about what those symptoms are and how they're evolving across your age span.

Having data that can track and follow your severity of symptoms, from age six, to age 12, to age 16, to age 25, and be able to monitor how it changes, really helps to improve the patient's understanding of their disorder. We hope to long term improve the compliance to medication.

HCPLive: Where are the current gaps in a system like this and what would you like to do with the technology in the future?

Letterle: At the macro level, there's so much more that can be done to say, how do systems look at their entire ADHD care pathway?

And, are we doing that in a standardized way that is improving outcomes on a group level, not just on an individual level?