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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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Bella-Fernández M, Martin-Moratinos M, Li C, Wang P, Blasco-Fontecilla H. Differences in Ex-Gaussian Parameters from Response Time Distributions Between Individuals with and Without Attention Deficit/Hyperactivity Disorder: A Meta-analysis. Neuropsychol Rev 2024; 34:320-337. [PMID: 36877328 PMCID: PMC10920450 DOI: 10.1007/s11065-023-09587-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood and adolescence. Differences in reaction times (RT) in cognitive tasks have been consistently observed between ADHD and typical participants. Instead of estimating means and standard deviations, fitting non-symmetrical distributions like the ex-Gaussian, characterized by three parameters (µ, σ, and τ), account for the whole RT distributions. A meta-analysis is performed with all the available literature using ex-Gaussian distributions for comparisons between individuals with ADHD and controls. Results show that τ and σ are generally greater for ADHD samples, while µ tends to be larger for typical groups but only for younger ages. Differences in τ are also moderated by ADHD subtypes. τ and σ show, respectively, quadratic and linear relationships with inter-stimulus intervals from Continuous Performance Test and Go/No Go tasks. Furthermore, tasks and cognitive domains influence the three parameters. Interpretations of ex-Gaussian parameters and clinical implications of these findings are also discussed. Fitting ex-Gaussian distributions to RT data is a useful way to explore differences between individuals with ADHD and healthy controls.
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Affiliation(s)
- Marcos Bella-Fernández
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Universidad Pontificia de Comillas, Madrid, Spain
| | - Marina Martin-Moratinos
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Chao Li
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Ping Wang
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
- Universidad Autónoma de Madrid, Madrid, Spain.
- CIBERSAM Madrid, Madrid, Spain.
- ITA Mental Health, Madrid, Spain.
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3
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Smith MCF, Mukherjee RAS, Müller-Sedgwick U, Hank D, Carpenter P, Adamou M. UK adult ADHD services in crisis. BJPsych Bull 2024; 48:1-5. [PMID: 38058161 PMCID: PMC10801359 DOI: 10.1192/bjb.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/26/2023] [Accepted: 10/12/2023] [Indexed: 12/08/2023] Open
Abstract
The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.
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Affiliation(s)
| | | | | | - Dietmar Hank
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Peter Carpenter
- University of Bristol, Bristol, UK
- Royal College of Psychiatrists, London, UK
| | - Marios Adamou
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
- University of Huddersfield, Huddersfield, UK
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Holland AA, Shamji JF, Clem MA, Perez R, Palka JM, Stavinoha PL. Parent ratings of executive functioning in pediatric survivors of medulloblastoma and pilocytic astrocytoma. APPLIED NEUROPSYCHOLOGY. CHILD 2024; 13:52-61. [PMID: 36111630 DOI: 10.1080/21622965.2022.2123707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The present study compared parent-rated executive functioning in pediatric medulloblastoma (MB) and pilocytic astrocytoma (PA) survivors. Although standard care for both includes surgical resection, children with MB additionally receive chemotherapy and craniospinal irradiation. Given well-documented neurocognitive late effects associated with the latter, we anticipated poor parent-reported executive functioning in MB survivors. Parents/guardians of 36 MB survivors and 20 PA survivors completed the Behavior Rating Inventory of Executive Functioning (BRIEF). PA survivors were younger at diagnosis (t[51.97] = 3.07, p < .001, d = 0.86) and demonstrated higher IQ (t[54] = -3.51, p < .001, d = 0.95). However, relative to the MB group, the PA group was rated as having significantly more problems on all BRIEF scales (all p ≤ .05; d = 0.30 - 1.10), except the Shift scale. Additionally, all mean BRIEF scores for MB survivors were within normal limits, whereas for PA survivors, all mean BRIEF scores except for Organization of Materials were significantly discrepant from normative means. Overall, PA survivors were rated as demonstrating poorer executive function than MB survivors. Five theories are discussed as possible explanations for these surprising findings: two related to group differences, two related to potential sources of parental bias, and one related to the nature of questionnaire-based assessment. All these theories represent directions for future research. Parent questionnaires such as the BRIEF may have real-world implications for pediatric brain tumor survivors. Future research should explore factors affecting parent ratings of executive functioning in these populations, along with comparison to performance-based measures.
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Affiliation(s)
- Alice Ann Holland
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Jabeen F Shamji
- Department of Psychiatry, Children's Medical Center Dallas, Dallas, Texas, USA
- University of North Texas, Denton, Texas, USA
| | - Matthew A Clem
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Private practice in Dallas, Texas, USA
| | - Roger Perez
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Private practice in Mission Viejo, California, USA
| | - Jayme M Palka
- Department of Psychiatry, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Peter L Stavinoha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Psychiatry, Children's Medical Center Dallas, Dallas, Texas, USA
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Selaskowski B, Asché LM, Wiebe A, Kannen K, Aslan B, Gerding TM, Sanchez D, Ettinger U, Kölle M, Lux S, Philipsen A, Braun N. Gaze-based attention refocusing training in virtual reality for adult attention-deficit/hyperactivity disorder. BMC Psychiatry 2023; 23:74. [PMID: 36703134 PMCID: PMC9879564 DOI: 10.1186/s12888-023-04551-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is characterized by substantial interindividual heterogeneity that challenges the systematic assessment and treatment. Considering mixed evidence from previous neurofeedback research, we present a novel feedback system that relies on gaze behavior to detect signs of inattention while performing a neuropsychological attention task in a virtual seminar room. More specifically, an audiovisual feedback was given whenever participants averted their gaze from the given task. METHODS Eighteen adults with ADHD and 18 healthy controls performed a continuous performance task (CPT) in virtual reality under three counterbalanced conditions in which either gaze-based feedback, sham feedback, or no feedback was provided. In all conditions, phases of high and low virtual distraction alternated. CPT errors and reaction times, proportions of gaze dwell times (e.g., task focus or distraction focus), saccade characteristics, EEG theta/beta ratios, head movements, and an experience sampling of ADHD symptoms were analyzed. RESULTS While patients can be discriminated well from healthy controls in that they showed more omission errors, higher reaction times, higher distraction-related dwell times, and more head movements, the feedback did not immediately improve task performance. It was also indicated that sham feedback was rather associated with an aggravation of symptoms in patients. CONCLUSIONS Our findings demonstrate sufficient suitability and specificity for this holistic ADHD symptom assessment. Regarding the feedback, a single-session training was insufficient to achieve learning effects based on the proposed metacognitive strategies. Future longitudinal, multi-session trials should conclusively examine the therapeutic efficacy of gaze-based virtual reality attention training in ADHD. TRIAL REGISTRATION drks.de (identifier: DRKS00022370).
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Affiliation(s)
- Benjamin Selaskowski
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Marie Asché
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Annika Wiebe
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Behrem Aslan
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Thiago Morano Gerding
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Dario Sanchez
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ulrich Ettinger
- grid.10388.320000 0001 2240 3300Department of Psychology, University of Bonn, Bonn, Germany
| | - Markus Kölle
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- grid.15090.3d0000 0000 8786 803XDepartment of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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Luderer M, Seidt J, Gerhardt S, Hoffmann S, Vollstädt-Klein S, Reif A, Sobanski E. Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder. Front Psychiatry 2023; 14:1112843. [PMID: 36950259 PMCID: PMC10025293 DOI: 10.3389/fpsyt.2023.1112843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Rationale Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD. Methods We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest®) that also measures motor activity objectively. Results Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups. Conclusion Questionnaires are more useful in assessing ADHD core symptoms than the QbTest®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- *Correspondence: Mathias Luderer,
| | - Johanna Seidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Machida K, Barry E, Mulligan A, Gill M, Robertson IH, Lewis FC, Green B, Kelly SP, Bellgrove MA, Johnson KA. Which Measures From a Sustained Attention Task Best Predict ADHD Group Membership? J Atten Disord 2022; 26:1471-1482. [PMID: 35253511 DOI: 10.1177/10870547221081266] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Difficulty with sustaining attention to a task is a hallmark of ADHD. It would be useful to know which measures of sustained attention best predict a diagnosis of ADHD. Participants were 129 children with a diagnosis of ADHD and 129 matched controls who completed the fixed Sustained Attention to Response Task (SART). The number of commission and omission errors, standard deviation of response time (SDRT), tau, fast and slow frequency variability, d-prime, and mu were able to successfully classify children with and without ADHD. The mean response time, criterion, and sigma were not able to classify participants. The best classifiers were d-prime (0.75 Area Under the Receiver Operated Characteristic), tau (.74), SDRT (0.74), omission errors (0.72), commission errors (0.71), and SFAUS (0.70). This list of the best classifier measures derived from the SART may prove useful for the planning of future studies.
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Affiliation(s)
| | | | | | | | | | | | - Benita Green
- The University of Melbourne, Parkville, VIC, Australia
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8
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Adamou M, Jones SL, Marks L, Lowe D. Efficacy of Continuous Performance Testing in Adult ADHD in a Clinical Sample Using QbTest. J Atten Disord 2022; 26:1483-1491. [PMID: 35255743 DOI: 10.1177/10870547221079798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continuous performance tests are widely used to aid diagnostic decision making and measure symptom reduction in adult ADHD clinical populations. The diagnostic accuracy of the Quantified Behavior Test plus (QbTest+), developed to identify ADHD populations as an objective measure of ADHD symptoms, was explored. METHODS The utility of the QbTest+ was investigated in a clinical cohort of 69 adult patients referred to a specialist ADHD clinic in the UK. RESULTS Scores from the QbTest+ failed to differentiate between patients diagnosed with ADHD and those who did not receive a diagnosis after full clinical assessment. CONCLUSIONS Based on our findings, we recommend clinicians are cautious when interpreting results of the QbTest+ in clinical populations. This study highlights the need for investigation into the lack of validation of commonly used objective measures in ADHD populations.
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Affiliation(s)
| | - Sarah L Jones
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | - Laura Marks
- University College London Hospitals NHS Foundation Trust, UK
| | - Deborah Lowe
- Greater Manchester Mental Health NHS Foundation Trust, Bolton, UK
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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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10
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Wang XQ, Albitos PJ, Hao YF, Zhang H, Yuan LX, Zang YF. A review of objective assessments for hyperactivity in attention deficit hyperactivity disorder. J Neurosci Methods 2022; 370:109479. [PMID: 35038458 DOI: 10.1016/j.jneumeth.2022.109479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
Hyperactivity is one of the three core symptoms of attention deficit hyperactivity disorder (ADHD) that is a common childhood mental disorder. Objective assessments of hyperactivity are seldom utilized compared with measures of inattention and impulsivity during clinical diagnosis and evaluation. Acceleration-sensitive devices (e.g., Actigraph) and motion tracking systems (e.g., QbTest) are two main groups of devices that can be used to objectively measure hyperactivity. The Actigraph and QbTest have good discriminant validity, convergent validity, and sensitivity to the effects of stimulants. Furthermore, the assessment setting (i.e., research laboratory, school, or home) can greatly influence the presence and severity of hyperactivity. Nevertheless, objective assessments for hyperactivity have poor ability to distinguish ADHD from other disorders, or among the three types of ADHD. Thus, further studies are needed to assess objective measurements of hyperactivity in terms of discriminant and convergent validity, test-retest reliability in different settings, and correlations with brain activity.
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Affiliation(s)
- Xiu-Qin Wang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Princess Jane Albitos
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yong-Fu Hao
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Hang Zhang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Li-Xia Yuan
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
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Camp A, Pastrano A, Gomez V, Stephenson K, Delatte W, Perez B, Syas H, Guiseppi-Elie A. Understanding ADHD: Toward an Innovative Therapeutic Intervention. Bioengineering (Basel) 2021; 8:56. [PMID: 34062853 PMCID: PMC8147268 DOI: 10.3390/bioengineering8050056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a pervasive condition affecting persons across all age groups, although it is primarily diagnosed in children. This neurological condition affects behavior, learning, and social adjustment and requires specific symptomatic criteria to be fulfilled for diagnosis. ADHD may be treated with a combination of psychological or psychiatric therapeutic interventions, but it often goes unattended. People with ADHD face societal bias challenges that impact how they manage the disorder and how they view themselves. This paper summarizes the present state of understanding of this disorder, with particular attention to early diagnosis and innovative therapeutic intervention. Contemporary understanding of the mind-brain duality allows for innovative therapeutic interventions based on neurological stimulation. This paper introduces the concept of neurostimulation as a therapeutic intervention for ADHD and poses the question of the relationship between patient adherence to self-administered therapy and the aesthetic design features of the neurostimulation device. By fabricating devices that go beyond safety and efficacy to embrace the aesthetic preferences of the patient, it is proposed that there will be improvements in patient adherence to a device intended to address ADHD.
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Affiliation(s)
- Allyson Camp
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Amanda Pastrano
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Valeria Gomez
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Kathleen Stephenson
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - William Delatte
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Brianna Perez
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Hunter Syas
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
| | - Anthony Guiseppi-Elie
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA; (A.C.); (A.P.); (V.G.); (K.S.); (W.D.); (B.P.); (H.S.)
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
- Department of Electrical and Computer Engineering, College of Engineering, Anderson University, Anderson, SC 29621, USA
- ABTECH Scientific, Inc., Biotechnology Research Park, 800 East Leigh Street, Richmond, VA 23219, USA
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12
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Planton M, Lemesle B, Cousineau M, Carlier J, Milongo-Rigal E, Carle-Toulemonde G, Salles J, Pariente J. The role of neuropsychological assessment in adults with attention deficit/hyperactivity disorders. Rev Neurol (Paris) 2021; 177:341-348. [PMID: 33618892 DOI: 10.1016/j.neurol.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 12/01/2022]
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and/or impulsivity. While ADHD was initially recognized as a childhood syndrome, scientific evidence accumulated to indicate that a significant proportion of ADHD children continue to experience symptoms of ADHD in adulthood. Moreover, the question of ADHD diagnosis can arise in adult patients who were not diagnosed in childhood. Currently, the diagnosis of ADHD in adulthood is based on the revised criteria described for children. However, their application for adults may be difficult for many reasons including compensation and comorbid disorders. To date, no clinical, neuropsychological, biological or imaging marker is available for the diagnosis of ADHD. Considering that ADHD is based on a neuropsychological model, in this article we will examine the usefulness of neuropsychological testing in the diagnosis in adults. We will first present diagnostic criteria of ADHD and the limits of their application in adults. We will then detail the neuropsychological data available in adult ADHD and the French and international clinical recommendations for neuropsychological assessment. Finally, we will explore the predictive value of neuropsychological scores in the diagnosis of ADHD and discuss key methodological points and perspectives for clinical research.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, Toulouse, France; Inserm UMR1214, UPS, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France.
| | - B Lemesle
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - M Cousineau
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - J Carlier
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - E Milongo-Rigal
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - G Carle-Toulemonde
- Department of Emergency Psychiatry and Consultation-Liaison Psychiatry, Toulouse University Hospital, Toulouse, France
| | - J Salles
- Department of Emergency Psychiatry and Consultation-Liaison Psychiatry, Toulouse University Hospital, Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France; Inserm UMR1214, UPS, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
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13
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Schiweck C, Arteaga-Henriquez G, Aichholzer M, Edwin Thanarajah S, Vargas-Cáceres S, Matura S, Grimm O, Haavik J, Kittel-Schneider S, Ramos-Quiroga JA, Faraone SV, Reif A. Comorbidity of ADHD and adult bipolar disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 124:100-123. [PMID: 33515607 DOI: 10.1016/j.neubiorev.2021.01.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/17/2022]
Abstract
Attention-deficit / hyperactivity disorder (ADHD) and Bipolar Disorder (BD) are common mental disorders with a high degree of comorbidity. However, no systematic review with meta-analysis has aimed to quantify the degree of comorbidity between both disorders. To this end we performed a systematic search of the literature in October 2020. In a meta-analysis of 71 studies with 646,766 participants from 18 countries, it was found that about one in thirteen adults with ADHD was also diagnosed with BD (7.95 %; 95 % CI: 5.31-11.06), and nearly one in six adults with BD had ADHD (17.11 %; 95 % CI: 13.05-21.59 %). Substantial heterogeneity of comorbidity rates was present, highlighting the importance of contextual factors: Heterogeneity could partially be explained by diagnostic system, sample size and geographical location. Age of BD onset occurred earlier in patients with comorbid ADHD (3.96 years; 95 % CI: 2.65-5.26, p < 0.001). Cultural and methodological differences deserve attention for evaluating diagnostic criteria and clinicians should be aware of the high comorbidity rates to prevent misdiagnosis and provide optimal care for both disorders.
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Affiliation(s)
- Carmen Schiweck
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany.
| | - Gara Arteaga-Henriquez
- Department for Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Mareike Aichholzer
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany
| | - Sharmili Edwin Thanarajah
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany; Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Sebastian Vargas-Cáceres
- Department for Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Silke Matura
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany
| | - Oliver Grimm
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Josep Antoni Ramos-Quiroga
- Department for Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Andreas Reif
- Department for Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt- Goethe University, Germany
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14
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Knez R, Stevanovic D, Nasic S, Doric A, Wentz E. The Impact of Methylphenidate on QbTest Performance of Children with ADHD: A Retrospective Clinical Study. Neuropsychiatr Dis Treat 2021; 17:19-32. [PMID: 33447036 PMCID: PMC7802589 DOI: 10.2147/ndt.s277490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Quantified behavior Test (QbTest), which combines a continuous performance task (CPT) and motion tracking, provides data for the core signs of attention-deficit/hyperactivity disorder (ADHD): attention, hyperactivity, and impulsivity. This study aimed to evaluate the performance of children and adolescents with ADHD on the QbTest before and after a single methylphenidate (MPH) dose. SUBJECTS AND METHODS This retrospective chart review study included data from 149 children and 215 adolescents who completed the QbTest. A summary index of the CPT and motion capture data on the QbTest is provided by three cardinal parameters: QbActivity, QbImpulsivity, and QbInattention. The test was performed twice on the same day, before and up to three hours after MPH intake. A decrease by ≥ 0.5 in a cardinal parameter score was considered an improvement, whereas an increase by ≥ 0.5 a deterioration. RESULTS QbActivity improvement after MPH intake was present in 71.7% and 76.2% of the children and adolescents, respectively. QbImpulsivity improvement was observed in 50.4% of the children and 44.7% of the adolescents, and QbInattention improvement in 85.1% and 91.1% of the children and adolescents, respectively. All three parameters improved simultaneously in 27.7% of the children and 28.7% of the adolescents. The likelihood that one parameter deteriorated after MPH use was greater if that parameter was within the normal range before medication. This was most pronounced for QbImpulsivity. Among male adolescents, QbInattention improvement was often accompanied by QbImpulsivity deterioration. CONCLUSION The QbTest inattention and motor activity parameters improved markedly after a single MPH dose in children and adolescents with ADHD, while less so for impulsivity. Improvement of one parameter is not necessarily associated with improvement of the other two, and deterioration, especially regarding impulsivity, may occur. If confirmed, these results highlight the need for optimization and individualization of MPH treatment, while monitoring all aspects of the ADHD symptomatology based on the QbTest performance.
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Affiliation(s)
- Rajna Knez
- Department of Pediatrics, Skaraborgs Hospital, Skövde, Sweden; Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Dejan Stevanovic
- Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Salmir Nasic
- Research & Development Centre, Skaraborgs Hospital, Skövde, Sweden
| | - Ana Doric
- Department of Psychology, Faculty of Humanity and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Elisabet Wentz
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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15
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A Within-Sample Comparison of Two Innovative Neuropsychological Tests for Assessing ADHD. Brain Sci 2020; 11:brainsci11010036. [PMID: 33396421 PMCID: PMC7824145 DOI: 10.3390/brainsci11010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/25/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
New innovative neuropsychological tests in attention deficit hyperactivity disorder ADHD have been proposed as objective measures for diagnosis and therapy. The current study aims to investigate two different commercial continuous performance tests (CPT) in a head-to-head comparison regarding their comparability and their link with clinical parameters. The CPTs were evaluated in a clinical sample of 29 adult patients presenting in an ADHD outpatient clinic. Correlational analyses were performed between neuropsychological data, clinical rating scales, and a personality-based measure. Though inattention was found to positively correlate between the two tests (r = 0.49, p = 0.01), no association with clinical measures and inattention was found for both tests. While hyperactivity did not correlate between both tests, current ADHD symptoms were positively associated with Nesplora Aquarium’s motor activity (r = 0.52 to 0.61, p < 0.05) and the Qb-Test’s hyperactivity (r = 0.52 to 0.71, p < 0.05). Conclusively, the overall comparability of the tests was limited and correlation with clinical parameters was low. While our study shows some interesting correlation between clinical symptoms and sub-scales of these tests, usage in clinical practice is not recommended.
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