Improving diagnosis of ADHD

ADHD is a neurobiological disorder – a disorder of brain development that affects behaviour. The main symptoms of ADHD are:

• Inattention (e.g. being easily distracted, making careless mistakes, difficulty concentrating)
• Hyperactivity (e.g. being unable to sit still when needed, talking excessively, having trouble playing quietly)
• Impulsivity (e.g. acting inappropriately, such as acting without thinking, interrupting and intruding on others).

Around five per cent (one in 20) of school-aged children are affected by ADHD, a neurobiological disorder of brain development that impacts on behaviour. ADHD is a treatable disorder yet if left untreated, can have a significant impact on personal development, academic outcomes and family interaction.

There is no simple test to determine whether a child has ADHD. The process for diagnosing or ruling out ADHD is variable across England. It will often include multiple steps and is based on clinical judgement informed by subjective reports from parents, teachers and observation of the patient. As such, children in the UK wait 18 months (average) to obtain an accurate diagnosis, more than the European average of 11 months. Multiple clinic visits over this period result in significant costs to the NHS, estimated at £23 million.

Research has shown that the use of objective assessment tools alongside other clinical information, can provide a more rapid diagnosis (with reductions of around five months).

Including an objective test is evidenced to:

• Reduce time for assessment and decision making (from first referral to decision to diagnose/rule out)
• Reduce the number of outpatient appointments between referral and diagnosis
• Reduce the number of nurse observation visits in schools
• Improve patient / family satisfaction / experience
• Improve clinician satisfaction and confidence in diagnosing or excluding ADHD.

The QBTest is an objective testing system that simultaneously measures attention, impulsivity, and motor activity though a computer-based activity. It is the only objective test that measures all three components. The performance of each patient is then summarised in a report where it is compared to an age and gender matched normative control group.

What can QBTest do?

• Provide quality/unbiased information, a clearer picture.
• Cut through ambiguous information.
• Standardise clinical practice.
• Highlight the impairments for each patient.
• Measure treatment effect for individuals and populations.

QBTest is not a stand-alone diagnostic tool and is not an instrument to replace clinical judgement.
Watch the video below from Oxleas NHS Foundation Trust demonstrating QBTest is action.

There is strong evidence for use of objective assessment tools in the initial assessment of children and young people with ADHD with over 20 publications including a systematic review. QBTest is also supported by a robust evidence base including multiple independent publications. A randomised, parallel, single-blind controlled trial at the University of Nottingham, known as the AQUA-Trial, demonstrated that when all participants undertook the test, and results were withheld in the control group, the participants in the open QBTest group were 44 per cent more likely to receive a diagnostic decision in six months. Please get in touch to learn more about the extensive evidence base for QB test and Objective testing more broadly.

Real world demonstrator

In 2017 East Midlands AHSN supported a 12-month, real-world demonstrator of QBTest across three NHS Trusts and seven sites. In 12 months over 1,200 children underwent a QBTest. Through pre and post audits the study demonstrated:

• Five months reduction from assessment to diagnosis time (median).
• One appointment fewer to make a diagnostic decision.
• 20-33 per cent clinical time released.
• 94 per cent of clinicians reported greater understanding of patients' symptoms.
• 85 per cent of patients found the QbTest results helpful.
• £84,460 return on investment. That’s £3.37 saving on every £1 spent.

Evaluation also suggests that the greatest effectiveness and efficiencies are gained when the objective assessment is embedded as early as possible within the ADHD assessment pathway as this maximises the opportunity to reduce the number of appointments required to confirm or rule out ADHD.

Our role is to support NHS providers of ADHD assessment to consider and adopt QB Test as part their pathway. We would really welcome a conversation to understand more about your service or your role in the system. This can be purely explorative. We can also support in helping to understand the budget impact of using QBTest, think through service changes, connect you with experienced clinicians, and support with building business cases.

In November 2021, the HIN collaborated with UCLP and ICHP to deliver a London wide webinar – ADHD: Reducing time to diagnosis for children and young people – sharing the experiences of using QBTest.

You can watch the webinar below.

You can check out the slidedeck here and read the questions and answers here.

We heard National Clinical Lead for Focus ADHD, Dr Julie Clarke, and the HIN’s Deputy Clinical Director for Mental Health, Dr Nicola Reynolds, share their experiences of implementing and using QBTest in practice as well as a young man and mother discuss their perspective of going through the assessment process.

Wider AHSN Network

This project is part of a national programme known as Focus ADHD, commissioned by NHS England. You can learn about the great strides the programme is making here -

Watch a video about some of national successes the programme has delivered below.