Quicker ADHD Diagnoses with Computer-Based Test

Chris Hollis, MBBS, PhD

A computer-based test that measures the attention and activity of children with suspected attention deficit hyperactivity disorder (ADHD) may help clinicians diagnose the condition more efficiently, a clinical trial suggests.

The QbTest, used along with customary ADHD assessment measures, allowed clinicians to reduce the time they needed to make a diagnosis without sacrificing accuracy, researchers at the University of Nottingham in the UK found.

The test also improved clinicians’ confidence in their assessment and increased the likelihood that they would correctly exclude ADHD when it was not present, results published in the Journal of Child Psychology and Psychiatry showed.

“Adoption of objective computerized assessment technology (QbTest) as an adjunct to clinical diagnostic decision-making in the assessment of ADHD appears to increase the speed and efficiency of decision-making without appearing to compromise diagnostic accuracy,” wrote the researchers led by Chris Hollis, MBBS, PhD, a professor at the University of Nottingham.

“The clinicians who had access to a QbTest report were faster in reaching diagnostic decisions with no overall loss of diagnostic accuracy,” Hollis said.

However, only small cost savings were gained by including the test report with the clinician’s customary assessment, an economic analysis found.

“The impact of providing the QbTest report within this trial can best we viewed as `cost neutral,’” the Nottingham research team wrote.

Currently, ADHD is diagnosed using subjective measures such as an interview with the child and family and a behavioral assessment, the researchers said.

The lack of objective measures to identify the disorder can reduce the reliability and consistency of diagnoses, hurting patients by increasing the time it takes to receive a diagnosis and treatment, the team said.

“Early diagnosis and timely interventions reduce the risk of adverse long-term outcomes that are associated with ADHD such as antisocial behavior, poor academic performance, and social functioning,” the authors wrote.

The QbTest, created by Stockholm-based Qbtech, was developed to assess the core symptoms of ADHD. The test tracks a patient’s motions while he performs a continuous 15- to 20-minute computer-based task. It then compares the result with a norm and creates a report for a clinician to review.

To assess whether such an objective assessment could improve the speed and accuracy of ADHD diagnoses, the researchers conducted a trial involving patients 6 to 17 years old who had been referred for assessment to pediatric clinics in England.

The patients were given the QbTest along with each facility’s customary evaluation. The participants and their clinicians were divided into two groups.

In the first group of 123 young people, the QbTest report was provided immediately to the clinician. In the second group of 127, the report was withheld.

The researchers considered how many consultations were required to either confirm or exclude an ADHD diagnosis. They found that the groups who were given the QbTest results were more likely to reach a decision.

“At six months, 76% of those with a QbTest report had received a diagnosis compared with 50% without,” the researchers found.

The QbTest also cut appointment length by 15%, increased clinicians’ confidence in their decisions, and doubled the likelihood of excluding ADHD in clinicians’ findings, the team reported.

“Overall, our results suggest that the greatest impact of QbTest on diagnostic decision-making may be in cases where diagnosis would typically be deferred, possibly due to missing or inconsistent information,” the authors wrote.

Qbtech had no role in the design, collection, analysis, and interpretation of data, or in the writing of the manuscript, the authors said.

As for whether the trial results are relevant to other countries, the authors noted that the UK has a long waiting time from a patient’s first doctor visit to a formal ADHD diagnosis. Patients there experience a mean duration of 18.3 months compared to 10.8 months for EU countries overall.

“There are some limitations in generalizing these findings beyond the United Kingdom to countries, including North America, where ADHD diagnostic decision-making is typically significantly faster than the United Kingdom,” they said.