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Bellato A, Hall CL, Groom MJ, Simonoff E, Thapar A, Hollis C, Cortese S. Practitioner Review: Clinical utility of the QbTest for the assessment and diagnosis of attention-deficit/hyperactivity disorder - a systematic review and meta-analysis. J Child Psychol Psychiatry 2024; 65:845-861. [PMID: 37800347 DOI: 10.1111/jcpp.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Several computerised cognitive tests (e.g. continuous performance test) have been developed to support the clinical assessment of attention-deficit/hyperactivity disorder (ADHD). Here, we appraised the evidence-base underpinning the use of one of these tests - the QbTest - in clinical practice, by conducting a systematic review and meta-analysis investigating its accuracy and clinical utility. METHODS Based on a preregistered protocol (CRD42022377671), we searched PubMed, Medline, Ovid Embase, APA PsycINFO and Web of Science on 15th August 2022, with no language/type of document restrictions. We included studies reporting accuracy measures (e.g. sensitivity, specificity, or Area under the Receiver Operating Characteristics Curve, AUC) for QbTest in discriminating between people with and without DSM/ICD ADHD diagnosis. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A generic inverse variance meta-analysis was conducted on AUC scores. Pooled sensitivity and specificity were calculated using a random-effects bivariate model in R. RESULTS We included 15 studies (2,058 participants; 48.6% with ADHD). QbTest Total scores showed acceptable, rather than good, sensitivity (0.78 [95% confidence interval: 0.69; 0.85]) and specificity (0.70 [0.57; 0.81]), while subscales showed low-to-moderate sensitivity (ranging from 0.48 [0.35; 0.61] to 0.65 [0.52; 0.75]) and moderate-to-good specificity (from 0.65 [0.48; 0.78] to 0.83 [0.60; 0.94]). Pooled AUC scores suggested moderate-to-acceptable discriminative ability (Q-Total: 0.72 [0.57; 0.87]; Q-Activity: 0.67 [0.58; 0.77); Q-Inattention: 0.66 [0.59; 0.72]; Q-Impulsivity: 0.59 [0.53; 0.64]). CONCLUSIONS When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis.
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Affiliation(s)
- Alessio Bellato
- School of Psychology, University of Nottingham, Nottingham, Malaysia
- Mind & Neurodevelopment (MiND) Research Cluster, University of Nottingham, Nottingham, Malaysia
| | - Charlotte L Hall
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Cardiff University School of Medicine, Cardiff, UK
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samuele Cortese
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
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2
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Peterson BS, Trampush J, Brown M, Maglione M, Bolshakova M, Rozelle M, Miles J, Pakdaman S, Yagyu S, Motala A, Hempel S. Tools for the Diagnosis of ADHD in Children and Adolescents: A Systematic Review. Pediatrics 2024; 153:e2024065854. [PMID: 38523599 DOI: 10.1542/peds.2024-065854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
CONTEXT Correct diagnosis is essential for the appropriate clinical management of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. OBJECTIVE This systematic review provides an overview of the available diagnostic tools. DATA SOURCES We identified diagnostic accuracy studies in 12 databases published from 1980 through June 2023. STUDY SELECTION Any ADHD tool evaluation for the diagnosis of ADHD, requiring a reference standard of a clinical diagnosis by a mental health specialist. DATA EXTRACTION Data were abstracted and critically appraised by 1 reviewer and checked by a methodologist. Strength of evidence and applicability assessments followed Evidence-based Practice Center standards. RESULTS In total, 231 studies met eligibility criteria. Studies evaluated parental ratings, teacher ratings, youth self-reports, clinician tools, neuropsychological tests, biospecimen, EEG, and neuroimaging. Multiple tools showed promising diagnostic performance, but estimates varied considerably across studies, with a generally low strength of evidence. Performance depended on whether ADHD youth were being differentiated from neurotypically developing children or from clinically referred children. LIMITATIONS Studies used different components of available tools and did not report sufficient data for meta-analytic models. CONCLUSIONS A valid and reliable diagnosis of ADHD requires the judgment of a clinician who is experienced in the evaluation of youth with and without ADHD, along with the aid of standardized rating scales and input from multiple informants across multiple settings, including parents, teachers, and youth themselves.
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Affiliation(s)
- Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, California
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Joey Trampush
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Morah Brown
- Southern California Evidence Review Center, Los Angeles, California
| | | | - Maria Bolshakova
- Southern California Evidence Review Center, Los Angeles, California
| | - Mary Rozelle
- Southern California Evidence Review Center, Los Angeles, California
| | - Jeremy Miles
- Southern California Evidence Review Center, Los Angeles, California
| | - Sheila Pakdaman
- Southern California Evidence Review Center, Los Angeles, California
| | - Sachi Yagyu
- Southern California Evidence Review Center, Los Angeles, California
| | - Aneesa Motala
- Southern California Evidence Review Center, Los Angeles, California
| | - Susanne Hempel
- Southern California Evidence Review Center, Los Angeles, California
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Previously Marzena Szkodo MOR, Micai M, Caruso A, Fulceri F, Fazio M, Scattoni ML. Technologies to support the diagnosis and/or treatment of neurodevelopmental disorders: A systematic review. Neurosci Biobehav Rev 2023; 145:105021. [PMID: 36581169 DOI: 10.1016/j.neubiorev.2022.105021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
In recent years, there has been a great interest in utilizing technology in mental health research. The rapid technological development has encouraged researchers to apply technology as a part of a diagnostic process or treatment of Neurodevelopmental Disorders (NDDs). With the large number of studies being published comes an urgent need to inform clinicians and researchers about the latest advances in this field. Here, we methodically explore and summarize findings from studies published between August 2019 and February 2022. A search strategy led to the identification of 4108 records from PubMed and APA PsycInfo databases. 221 quantitative studies were included, covering a wide range of technologies used for diagnosis and/or treatment of NDDs, with the biggest focus on Autism Spectrum Disorder (ASD). The most popular technologies included machine learning, functional magnetic resonance imaging, electroencephalogram, magnetic resonance imaging, and neurofeedback. The results of the review indicate that technology-based diagnosis and intervention for NDD population is promising. However, given a high risk of bias of many studies, more high-quality research is needed.
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Affiliation(s)
| | - Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Angela Caruso
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Maria Fazio
- Department of Mathematics, Computer Science, Physics and Earth Sciences (MIFT), University of Messina, Viale F. Stagno d'Alcontres, 31, 98166 Messina, Italy.
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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Fioravante I, Lozano-Lozano JA, Martella D. Attention deficit hyperactivity disorder: A pilot study for symptom assessment and diagnosis in children in Chile. Front Psychol 2022; 13:946273. [PMID: 35992438 PMCID: PMC9387654 DOI: 10.3389/fpsyg.2022.946273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders among school-age children and is characterized by varying degrees of inattention, hyperactivity, and impulsivity. Diagnosis, which currently relies on the DSM-V criteria, is complex. This research proposes an integrated procedure for ADHD diagnosis in children, improving the diagnostic process and scientific research on etiopathology. Materials and methods We conducted a clinical report on ADHD diagnosis in children (n = 92) between the ages of 8 and 13, based on the results of the application of different scales to parents of school-age children in Chile. The children were divided into two groups, those with an ADHD diagnosis (n = 44) and those without (n = 48) (24% females). Results The results revealed statistically significant differences between groups for scales EDAH y SDQ-Cas, Conners Comprehensive Behavior Scale, Conners Parent Scale and the criteria according to the DSM-V and its dimensions, with the exception of inattention. Conclusion The findings indicate the importance of appropriate criteria and procedures to establish a diagnosis and implement effective interventions in ADHD.
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Affiliation(s)
- Isabella Fioravante
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Antonio Lozano-Lozano
- Instituto de Ciencias Biomédicas, Instituto Iberoamericano Desarrollo Sostenible, Claustro Académico del Doctorado en Ciencias Sociales, Universidad Autónoma de Chile, Santiago, Chile
| | - Diana Martella
- Departamento de Psicología, Universidad Loyola de Andalucía, Sevilla, Spain
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Lee S, Hill TR, Johnson B, Testa R, Priya V, Spencer-Smith M, Coghill D. Can Neurocognitive Outcomes Assist Measurement-Based Care for Children with Attention-Deficit/Hyperactivity Disorder? A Systematic Review and Meta-Analyses of the Relationships Among the Changes in Neurocognitive Functions and Clinical Outcomes of Attention-Deficit/Hyperactivity Disorder in Pharmacological and Cognitive Training Interventions. J Child Adolesc Psychopharmacol 2022; 32:250-277. [PMID: 35704876 DOI: 10.1089/cap.2022.0028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions among school-age children. Early intervention and ongoing evaluation of treatment effectiveness are essential to minimize the life-long negative impact of ADHD. Neurocognitive functions have been reported to improve with pharmacological and cognitive training interventions for children with ADHD. We evaluated the value of measuring change in neurocognitive functions following ADHD interventions as a treatment outcome. We systematically reviewed randomized control trials of two distinctive types of ADHD interventions-pharmacological treatments and cognitive training-and summarized the changes in neurocognitive and clinical outcomes using a series of meta-analyses. Both pharmacological and cognitive training interventions showed positive effects on some aspects of neurocognitive functions. However, there were no significant correlations between changes in neurocognitive function (e.g., inhibition) and changes in ADHD behavioral symptoms (e.g., impulsive behavior). Although the associations between changes in neurocognitive function and clinical outcomes are not well studied, based on current findings, it is not suitable to use change in neurocognitive outcomes as a proxy for change in ADHD clinical symptom-based outcomes. There is, however, notable value in monitoring changes in neurocognitive function associated with ADHD interventions to achieve the following aims: (1) understanding full treatment effect on children with ADHD, (2) identifying ancillary indicators of subclinical changes, and (3) provision of objective and less biased measures of treatment effects. These findings are important evidence that changes in neurocognitive function could be a co-occurring objective indication that parallels the clinical effects of ADHD treatments.
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Affiliation(s)
- Seungjae Lee
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Thomas R Hill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Beth Johnson
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Renee Testa
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Vishnu Priya
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Megan Spencer-Smith
- Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - David Coghill
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Nylander E, Sparding T, Floros O, Rydén E, Landén M, Hansen S. The Quantified Behavioural Test Plus (QbTest+) in adult ADHD. NORDIC PSYCHOLOGY 2022. [DOI: 10.1080/19012276.2022.2036628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elin Nylander
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Orestis Floros
- Stockholm Center for Dependency Disorders, Lifestyle Treatment Unit, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eleonore Rydén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Hansen
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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7
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Williams L, Hall CL, Brown S, Guo B, James M, Franceschini M, Clarke J, Selby K, Vijayan H, Kulkarni N, Brown N, Sayal K, Hollis C, Groom MJ. Optimising medication management in children and young people with ADHD using a computerised test (QbTest): a feasibility randomised controlled trial. Pilot Feasibility Stud 2021; 7:68. [PMID: 33726855 PMCID: PMC7962270 DOI: 10.1186/s40814-021-00788-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
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 ClinicalTrials.gov, NCT03368573 , prospectively registered, 11th December 2017, and ISRCTN, ISRCTN69461593 , retrospectively registered, 10th April 2018.
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Affiliation(s)
- Laura Williams
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Charlotte L Hall
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Susan Brown
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Boliang Guo
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Julie Clarke
- United Lincolnshire Hospitals NHS Trust, Grantham and District Hospital, Grantham, Lincolnshire, UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Hena Vijayan
- North East London NHS Foundation Trust, Havering CAMHS, Essex, UK
| | | | - Nikki Brown
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Kapil Sayal
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,Centre for ADHD and Neurodevelopmental Disorders (CANDAL), University of Nottingham, Nottingham, UK
| | - Chris Hollis
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Madeleine J Groom
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,Centre for ADHD and Neurodevelopmental Disorders (CANDAL), University of Nottingham, Nottingham, UK.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
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8
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Valentine AZ, Brown BJ, Groom MJ, Young E, Hollis C, Hall CL. A systematic review evaluating the implementation of technologies to assess, monitor and treat neurodevelopmental disorders: A map of the current evidence. Clin Psychol Rev 2020; 80:101870. [PMID: 32712216 DOI: 10.1016/j.cpr.2020.101870] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
Technology-based interventions provide an attractive option for improving service provision for neurodevelopmental disorders (NDD), for example, widening access to interventions, objective assessment, and monitoring; however, it is unclear whether there is sufficient evidence to support their use in clinical settings. This review provides an evidence map describing how technology is implemented in the assessment/diagnosis and monitoring/ treatment of NDD (Prospero CRD42018091156). Using predefined search terms in six databases, 7982 articles were identified, 808 full-texts were screened, resulting in 47 included papers. These studies were appraised and synthesised according to the following outcomes of interest: effectiveness (clinical effectiveness/ service delivery efficiencies), economic impact, and user impact (acceptability/ feasibility). The findings describe how technology is currently being utilised clinically, highlights gaps in knowledge, and discusses future research needs. Technology has been used to facilitate assessment and treatment across multiple NDD, especially Autism Spectrum (ASD) and attention-deficit/hyperactivity (ADHD) disorders. Technologies include mobile apps/tablets, robots, gaming, computerised tests, videos, and virtual reality. The outcomes presented largely focus on the clinical effectiveness of the technology, with approximately half the papers demonstrating some degree of effectiveness, however, the methodological quality of many studies is limited. Further research should focus on randomised controlled trial designs with longer follow-up periods, incorporating an economic evaluation, as well as qualitative studies including process evaluations and user impact.
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Affiliation(s)
- Althea Z Valentine
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
| | - Beverley J Brown
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Emma Young
- Nottinghamshire Healthcare NHS Foundation Trust, Library and Knowledge Services, Duncan Macmillan House Staff Library, Porchester Road, Nottingham, UK
| | - Chris Hollis
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; Department of Child and Adolescent Psychiatry, South Block E Floor, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Charlotte L Hall
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Lennox C, Hall CL, Carter LA, Beresford B, Young S, Kraam A, Brown N, Wilkinson-Cunningham L, Reeves M, Chitsabesan P. FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison-a feasibility trial protocol. BMJ Open 2020; 10:e035519. [PMID: 31964678 PMCID: PMC7044874 DOI: 10.1136/bmjopen-2019-035519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The prevalence of attention deficit hyperactivity disorder (ADHD) within the Children and Young People Secure Estate (CYPSE) is much higher than seen in the general population. To make a diagnosis of ADHD, clinicians draw on information from multiple sources, including parents and teachers. However, obtaining these is particularly difficult for young people in the secure estate. There is increasing evidence in the community that QbTest is able to assist in the accurate and earlier diagnosis of ADHD. The objective of this study is to assess the feasibility and acceptability of QbTest in the assessment of ADHD within the CYPSE. METHODS AND ANALYSIS A single-centre parallel group feasibility randomised controlled trial will be conducted. Sixty young people within the CYPSE identified as displaying possible symptoms of ADHD will be randomised to the intervention arm (n=30; QbTest plus usual care) or control arm (n=30; usual care). Primary analyses will be descriptive and a process evaluation will be conducted to assess the contexts involved in implementing the intervention. Interviews will be conducted to explore acceptability and thematic analysis will be used to analyse the data. ETHICS AND DISSEMINATION This study was approved by National Health Service Wales research ethics committee 3 (18/WA/0347) on 15 February 2019. The findings will be published in peer-reviewed journals, presented at relevant conferences and disseminated to the public via summaries cocreated with our patient and public involvement group. TRIAL REGISTRATION NUMBER ISRCTN17402196.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Charlotte Lucy Hall
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Bryony Beresford
- Social Policy Research Unit, University of York, York, North Yorkshire, UK
| | - Susan Young
- Department of Clinical and Forensic Psychology, Psychology Services Limited, London, UK
| | - Abdullah Kraam
- Child and Adolescent Mental Health Service, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Nikki Brown
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Mindy Reeves
- Medical School, The University of Manchester, Manchester, UK
| | - Prathiba Chitsabesan
- Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, Lancashire, UK
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10
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Hall CL, Brown S, James M, Martin JL, Brown N, Selby K, Clarke J, Williams L, Sayal K, Hollis C, Groom MJ. Consensus workshops on the development of an ADHD medication management protocol using QbTest: developing a clinical trial protocol with multidisciplinary stakeholders. BMC Med Res Methodol 2019; 19:126. [PMID: 31215440 PMCID: PMC6582552 DOI: 10.1186/s12874-019-0772-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/09/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The study design and protocol that underpin a randomised controlled trial (RCT) are critical for the ultimate success of the trial. Although RCTs are considered the gold standard for research, there are multiple threats to their validity such as participant recruitment and retention, identifying a meaningful change, and non-adherence to the protocol. For clinical RCTs, involving patients and clinicians in protocol design provides the opportunity to develop research protocols that are meaningful to their target audience and may help overcome some of the inherent threats in conducting RCTs. However, the majority of protocols do not describe the methodology underpinning their development, limiting the amount of learned experience shared between research groups. METHOD With the purpose of reporting a collaborative approach towards developing a protocol, we present the findings from three sequential workshops that were conducted with the aim of developing a protocol to investigate the feasibility of adding a computerised test of attention, impulsivity and activity (QbTest) to medication management of children and young people with Attention deficit hyperactivity disorder (ADHD). Based on previous qualitative interviews with clinicians and families, each workshop prioritised topics for focused discussion. Information from the workshops was fed back to the participants for reflection in advance of the next workshop. RESULTS The workshops involved 21 multi-disciplinary ADHD experts, including clinicians, patient and public involvement (PPI) members, parents of young people with ADHD and researchers. The consensus workshops addressed key research issues such as: the most relevant outcome measures/ resource drivers; methods and time points for data collection; and the clinical protocol for utilising the QbTest, including when best to use this within the medication management process. The resulting protocol details a feasibility RCT design describing these factors. CONCLUSION Protocols which are co-developed may help overcome some of the risks associated with RCT completion (e.g. recruitment, retention, protocol adherence) and help prioritise outcomes of greater relevance to the populations under study. The methodology has potential value for researchers and organisations developing clinical guidelines, and offers insights into the valuable impact of PPI upon trial design. TRIAL REGISTRATION Clinicaltrials.gov NCT03368573, 11th December 2017 (retrospectively registered).
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Affiliation(s)
- Charlotte L. Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Susan Brown
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Jennifer L. Martin
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Nikki Brown
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Julie Clarke
- Acting Consultant Community Paediatrics, Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
| | - Laura Williams
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Kapil Sayal
- Child and Adolescent, Developmental Psychiatry, School of Medicine, University of Nottingham and CANDAL (Centre for ADHD and Neuro-developmental Disorders across the Lifespan), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Chris Hollis
- Devlopmental Psychiatry Queens Medical Centre, School of Medicine, and MindTech, Institute of Mental, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Madeleine J. Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
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Hollis C, Hall CL, Guo B, James M, Boadu J, Groom MJ, Brown N, Kaylor-Hughes C, Moldavsky M, Valentine AZ, Walker GM, Daley D, Sayal K, Morriss R. The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial. J Child Psychol Psychiatry 2018; 59:1298-1308. [PMID: 29700813 PMCID: PMC6124643 DOI: 10.1111/jcpp.12921] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.
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Affiliation(s)
- Chris Hollis
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Janet Boadu
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Catherine Kaylor-Hughes
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Maria Moldavsky
- Nottinghamshire Healthcare NHS Foundation Trust, West Nottinghamshire Community Team, Mansfield, UK
| | - Althea Z Valentine
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Gemma M Walker
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - David Daley
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Hall CL, James M, Brown S, Martin JL, Brown N, Selby K, Clarke J, Vijayan H, Guo B, Sayal K, Hollis C, Groom MJ. Protocol investigating the clinical utility of an objective measure of attention, impulsivity and activity (QbTest) for optimising medication management in children and young people with ADHD 'QbTest Utility for Optimising Treatment in ADHD' (QUOTA): a feasibility randomised controlled trial. BMJ Open 2018; 8:e021104. [PMID: 29453304 PMCID: PMC5829926 DOI: 10.1136/bmjopen-2017-021104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/11/2022] Open
Abstract
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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Affiliation(s)
- Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sue Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer L Martin
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Julie Clarke
- Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
| | - Hena Vijayan
- North East London NHS Foundation Trust, Acorn Centre, Romford, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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Hall CL, Valentine AZ, Walker GM, Ball HM, Cogger H, Daley D, Groom MJ, Sayal K, Hollis C. Study of user experience of an objective test (QbTest) to aid ADHD assessment and medication management: a multi-methods approach. BMC Psychiatry 2017; 17:66. [PMID: 28183284 PMCID: PMC5301349 DOI: 10.1186/s12888-017-1222-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis and monitoring of Attention deficit hyperactivity disorder (ADHD) typically relies on subjective reports and observations. Objective continuous performance tests (CPTs) have been incorporated into some services to support clinical decision making. However, the feasibility and acceptability of adding such a test into routine practice is unknown. The study aimed to investigate the feasibility and acceptability of adding an objective computerised test to the routine assessment and monitoring of attention deficit hyperactivity disorder (ADHD). METHODS Semi-structured interviews were conducted with clinicians (n = 10) and families (parents/young people, n = 20) who participated in a randomised controlled trial. Additionally, the same clinicians (n = 10) and families (n = 76) completed a survey assessing their experience of the QbTest. The study took place in child and adolescent mental health and community paediatric clinics across the UK. Interview transcripts were thematically analysed. RESULTS Interviewed clinicians and families valued the QbTest for providing an objective, valid assessment of symptoms. The QbTest was noted to facilitate communication between clinicians, families and schools. However, whereas clinicians were more unanimous on the usefulness of the QbTest, survey findings showed that, although the majority of families found the test useful, less than half felt the QbTest helped them understand the clinician's decision making around diagnosis and medication. The QbTest was seen as a potentially valuable tool to use early in the assessment process to streamline the care pathway. Although clinicians were conscious of the additional costs, these could be offset by reductions in time to diagnosis and the delivery of the test by a Healthcare Assistant. CONCLUSIONS The findings indicate the QbTest is an acceptable and feasible tool to implement in routine clinical settings. Clinicians should be mindful to discuss the QbTest results with families to enable their understanding and engagement with the process. Further findings from definitive trials are required to understand the cost/benefit; however, the findings from this study support the feasibility and acceptability of integrating QbTest in the ADHD care pathway. TRIAL REGISTRATION The findings form the implementation component of the Assessing QbTest Utility in ADHD (AQUA) Trial which is registered with the ISRCTN registry ( ISRCTN11727351 , retrospectively registered 04 July 2016) and clinicaltrials.gov ( NCT02209116 , registered 04 August 2014).
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Affiliation(s)
- Charlotte L. Hall
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Althea Z. Valentine
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Gemma M. Walker
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Harriet M. Ball
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Heather Cogger
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - David Daley
- Division of Psychiatry and Applied Psychology, University of Nottingham & Centre for ADHD and Neurodevelopmental Disorders across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Madeleine J. Groom
- Division of Psychiatry and Applied Psychology, CLAHRC-EM, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, University of Nottingham & Centre for ADHD and Neurodevelopmental Disorders across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Chris Hollis
- Centre for ADHD and Neuro-developmental Disorders across the Lifespan (CANDAL), & MindTech, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
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14
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Groom MJ, Young Z, Hall CL, Gillott A, Hollis C. The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder. Psychiatry Res 2016; 243:168-73. [PMID: 27400220 DOI: 10.1016/j.psychres.2016.06.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
There is a clinical need for objective evidence-based measures that are sensitive and specific to ADHD when compared with other neurodevelopmental disorders. This study evaluated the incremental validity of adding an objective measure of activity and computerised cognitive assessment to clinical rating scales to differentiate adult ADHD from Autism spectrum disorders (ASD). Adults with ADHD (n=33) or ASD (n=25) performed the QbTest, comprising a Continuous Performance Test with motion-tracker to record physical activity. QbTest parameters measuring inattention, impulsivity and hyperactivity were combined to provide a summary score ('QbTotal'). Binary stepwise logistic regression measured the probability of assignment to the ADHD or ASD group based on scores on the Conners Adult ADHD Rating Scale-subscale E (CAARS-E) and Autism Quotient (AQ10) in the first step and then QbTotal added in the second step. The model fit was significant at step 1 (CAARS-E, AQ10) with good group classification accuracy. These predictors were retained and QbTotal was added, resulting in a significant improvement in model fit and group classification accuracy. All predictors were significant. ROC curves indicated superior specificity of QbTotal. The findings present preliminary evidence that adding QbTest to clinical rating scales may improve the differentiation of ADHD and ASD in adults.
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Affiliation(s)
- Madeleine J Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK
| | - Zoe Young
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK; NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health and Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Charlotte L Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK; CLAHRC-EM, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK.
| | - Alinda Gillott
- Intellectual and Developmental Disabilities Service, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK; CLAHRC-EM, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK; NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health and Nottinghamshire Healthcare NHS Trust, Nottingham, UK
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