Cited by 67Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchHealth Systems, Economic Evaluations, Quality of Life

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

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Hollis, Chris, Hall, Charlotte L., Guo, Boliang, James, Marilyn, Boadu, Janet, Groom, Madeleine J., Brown, Nikki, Kaylor‐Hughes, Catherine +7 more·2018·Journal of Child Psychology and Psychiatry

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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  • Preliminary evidence from a randomized, parallel, single-blind, controlled trial showed that the diagnosis of ADHD with the support of a computerized test of attention and activity (QbTest), compared to the standard clinical diagnosis, led to an appointment length reduced by 15% (time ratio: 0.85, 95% CI: 0.77-0.93) and an increased clinicians' confidence in their diagnostic decisions (odds ratio:

    “For instance, preliminary evidence from a randomized, parallel, single-blind, controlled trial showed that the diagnosis of ADHD with the support of a computerized test of attention and activity (QbTest), compared to the standard clinical diagnosis, led to an appointment length reduced by 15% (time ratio: 0.85, 95% CI: 0.77-0.93) and an increased clinicians' confidence in their diagnostic”

    From Candidate diagnostic biomarkers for neurodevelopmental disorders in children and adolescents: a systematic review (2023) · cites this paper as [49]

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  1. Goldstein H Multilevel statistical models John Wiley & Sons 2011 922
  2. Hall CL Walker GM Valentine AZ Guo B Kaylor-Hughes C James M Daley D Sayal K Hollis C Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—‘Assessing QbTest Utility in ADHD’(AQUA): a randomised controlled trial BMJ Open 2016 4 12 e006838 erratum PMC4256543 25448628
  3. NICE Methods for the development of NICE public health guidance 3rd Edition London 2012 27905711

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Authors
Hollis, C., Hall, C. L., Guo, B., James, M., Boadu, J., Groom, M. J., Brown, N., Kaylor‐Hughes, C., Moldavsky, M., Valentine, A. Z., Walker, G. M., Daley, D., Sayal, K., Morriss, R., & the AQUA Trial Group
Affiliations
  • University of Nottingham (GB)
  • Nottinghamshire Healthcare NHS Foundation Trust (GB)
Corresponding author
Hollis, Chris
Venue
Journal of Child Psychology and Psychiatry
Publisher
Wiley
Published
2018-04-26
Volume
59
Issue
12
Pages
1298-1308
ISSN
  • 0021-9630 (ISSN-L)
  • 1469-7610
OpenAlex
W2800244867
Cited by
67
References
40
Citations by year
2026: 7 · 2025: 11 · 2024: 9 · 2023: 10 · 2022: 13 · 2021: 6 · 2020: 8 · 2019: 3
FWCI
3.34
Type
journal article
Language
en
Open access
Locations
  • Journal of Child Psychology and Psychiatry (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by-nc)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc)
Funders
  • National Institute for Health Research
  • National Institute on Handicapped Research
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
attention deficit hyperactivity disorder, computer-based testing, diagnostic decision-making, ADHD diagnosis, children and young people, diagnostic accuracy, clinician confidence, appointment length, cost-effectiveness, patient throughput
MeSH terms
Adolescent, Attention, Attention Deficit Disorder with Hyperactivity, Child, Cost-Benefit Analysis, Decision Making, Computer-Assisted, Diagnosis, Computer-Assisted, Female, Humans, Male, Motor Activity, Sensitivity and Specificity, Reproducibility of Results, Single-Blind Method

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