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.

Charlotte L Hall,Chris Hollis,Kim Selby,Boliang Guo,Althea Z Valentine,Gemma M Walker

doi:10.1111/camh.12140

Abstract

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. 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. 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. 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.

Highlights

The assessment of attention deficit/hyperactivity disorder (ADHD) in children typically relies on the clinician’s judgement and the integration of various forms of subjective information, such as parent, teacher and the young person’s report
The pre-QbTest group consisted of 32 boys (80%) and 8 girls (20%), with a mean age of 8.1 years (SD = 2.4 years range: 4.5–14.6 years); the QbTest group consisted of 28 boys (70%) and 12 girls (30%), with a mean age of 9.2 years (SD = 2.3 years, range: 6.2–13.10 years)
In the pre-QbTest group, 15 children received a secondary diagnosis: six children received a secondary diagnosis of autism spectrum disorder (ASD), 2 ASD and tic disorder, 2 ASD and dyspraxia, 1 ASD and obsessive compulsive disorder, 1 oppositional defiance disorder, 1 sensorineural deafness, 1 mild epilepsy, 1 Tourette’s syndrome

Summary

Introduction

The assessment of attention deficit/hyperactivity disorder (ADHD) in children typically relies on the clinician’s judgement and the integration of various forms of subjective information, such as parent, teacher and the young person’s report. This process is heavily reliant on subjective interpretation and can be hindered when reports are not completed or contain contradictory evidence. 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. 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 in the context of a randomised controlled trial

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Conclusion