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Computerised test may help improve ADHD diagnoses, our study finds

Adding a computerised test of attention and activity (QbTest) to standard care can reduce the time needed to make a diagnostic decision on attention deficit hyperactivity disorder (ADHD), a  study funded by NIHR CLAHRC East Midlands has demonstrated.

It also can increase the likelihood of excluding ADHD when it is not present and improve clinicians’ confidence in their decision-making, without compromising diagnostic accuracy, the clinical trial published in the Journal of Child Psychology and Psychiatry showed.

The prevalence of ADHD diagnoses in children and young people has increased, but diagnostic practice among clinicians remains variable, with significant diagnostic delays and reliance on subjective assessments.

In the Assessing QbTest Utility in ADHD (AQUA) trial in mental health and community paediatric clinics in England, 267 participants aged 6-17 years-old and their clinicians were randomised to either receive the QbTest report or not as part of their standard diagnostic assessment for ADHD. In the study, 132 of the 267 participants and their clinicians received the QbTest report. 

Clinicians with access to the QbTest report were more likely to reach a diagnostic decision about ADHD. At 6 months, 76 per cent of those with a QbTest report had received a diagnostic decision, compared with 50 per cent without. The QbTest reduced appointment length by 15 per cent, increased clinicians’ confidence in their diagnostic decisions, and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. 

Lead author Professor Chris Hollis, of the University of Nottingham, said: "The assessment of ADHD remains largely subjective, and children and young people in the UK, compared with other European counties, experience some of the longest delays for a diagnostic decision and initiation of appropriate treatment. 

"The AQUA trial is ground-breaking because it is the first independent randomised-controlled study to demonstrate that an objective assessment technology—QbTest—can increase the speed and efficiency of diagnostic decision-making in ADHD. The results suggest that QbTest is ready for implementation within the ADHD assessment pathway in the UK, and in other countries with similarly long delays to diagnosis, where it is likely to lead to earlier diagnostic decisions and significant healthcare system efficiencies."

The AQUA trial was supported by NIHR MindTech HealthTech Co-operative.