Clinical Conundrums When Integrating the QbTest into a Standard ADHD Assessment of Children and Young People

Abstract

The uptake of the QbTest in clinical practice is increasing and has recently been supported by research evidence proposing its effectiveness in relation to clinical decision-making. However, the exact underlying process leading to this clinical benefit is currently not well established and requires further clarification. For the clinician, certain challenges arise when adding the QbTest as a novel method to standard clinical practice, such as having the skills required to interpret neuropsychological test information and assess for diagnostically relevant neurocognitive domains that are related to attention-deficit hyperactivity disorder (ADHD), or how neurocognitive domains express themselves within the behavioral classifications of ADHD and how the quantitative measurement of activity in a laboratory setting compares with real-life (ecological validity) situations as well as the impact of comorbidity on test results. This article aims to address these clinical conundrums in aid of developing a consistent approach and future guidelines in clinical practice.

Keywords

ADHD - assessment - QbTest - continuous performance test (CPT) - neurodevelopmental

Compliance with Ethical Standards

Informed consent was obtained to publish anonymized individual QbTest results.

Publikationsverlauf

Eingereicht: 24. August 2020

Angenommen: 25. November 2020

Artikel online veröffentlicht:
14. Januar 2021

• References

• 1 Hollis C, Hall CL, Guo B. et al; the AQUA Trial Group. 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 (12) 1298-1308
• 2 Hult N, Kadesjö J, Kadesjö B, Gillberg C, Billstedt E. ADHD and the QbTest: diagnostic validity of QbTest. J Atten Disord 2018; 22 (11) 1074-1080
• 3 Tallberg P, Råstam M, Wenhov L, Eliasson G, Gustafsson P. Incremental clinical utility of continuous performance tests in childhood ADHD - an evidence-based assessment approach. Scand J Psychol 2019; 60 (01) 26-35
• 4 Reh V, Schmidt M, Lam L. et al. Behavioral assessment of core ADHD symptoms using the QbTest. J Atten Disord 2015; 19 (12) 1034-1045
• 5 Vogt C, Williams T, Susi K, Harrison S. Differences in measurements of hyperactivity between objective testing using infrared motion analysis (QbTest) and behavioural rating scales when comparing problems in alerting functions and response inhibition during the clinical assessment of ADHD. Psychol Disord Res 2018; 1 (02) 3-6
• 6 Nikolas MA, Nigg JT. Neuropsychological performance and attention-deficit hyperactivity disorder subtypes and symptom dimensions. Neuropsychology 2013; 27 (01) 107-120
• 7 Alderson RM, Rapport MD, Kasper LJ, Sarver DE, Kofler MJ. Hyperactivity in boys with attention deficit/hyperactivity disorder (ADHD): the association between deficient behavioral inhibition, attentional processes, and objectively measured activity. Child Neuropsychol 2012; 18 (05) 487-505
• 8 Hall CL, Walker GM, Valentine AZ. et al. 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 2014; 4 (12) e006838
• 9 Mefford IN, Potter WZ. A neuroanatomical and biochemical basis for attention deficit disorder with hyperactivity in children: a defect in tonic adrenaline mediated inhibition of locus coeruleus stimulation. Med Hypotheses 1989; 29 (01) 33-42
• 10 Nigg JT. What causes ADHD? Understanding What Goes Wrong and Why. New York: The Guildford Press; 2006: 74-141
• 11 Oosterlaan J, Logan GD, Sergeant JA. Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the stop task. J Child Psychol Psychiatry 1998; 39 (03) 411-425
• 12 Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997; 121 (01) 65-94
• 13 Nigg JT, Willcutt EG, Doyle AE, Sonuga-Barke EJ. Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes?. Biol Psychiatry 2005; 57 (11) 1224-1230
• 14 Westerberg H, Hirvikoski T, Forssberg H, Klingberg T. Visuo-spatial working memory span: a sensitive measure of cognitive deficits in children with ADHD. Child Neuropsychol 2004; 10 (03) 155-161
• 15 Littman R, Takács Á. Do all inhibitions act alike? A study of go/no-go and stop-signal paradigms. PLoS One 2017; 12 (10) e0186774
• 16 Rubia K. Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation. Front Hum Neurosci 2018; 12: 100
• 17 Vogt C, Williams T. Early identification of stimulant treatment responders, partial responders and non-responders using objective measures in children and adolescents with hyperkinetic disorder. Child Adolesc Ment Health 2011; 16 (03) 144-149
• 18 Rapport MD, Bolden J, Kofler MJ, Sarver DE, Raiker JS, Alderson RM. Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits?. J Abnorm Child Psychol 2009; 37 (04) 521-534
• 19 Hartanto TA, Krafft CE, Iosif AM, Schweitzer JB. A trial-by-trial analysis reveals more intense physical activity is associated with better cognitive control performance in attention-deficit/hyperactivity disorder. Child Neuropsychol 2016; 22 (05) 618-626
• 20 Porrino LJ, Rapoport JL, Behar D, Sceery W, Ismond DR, Bunney Jr WE. A naturalistic assessment of the motor activity of hyperactive boys. I. Comparison with normal controls. Arch Gen Psychiatry 1983; 40 (06) 681-687
• 21 Miller LJ, Nielsen DM, Schoen SA. Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology. Res Dev Disabil 2012; 33 (03) 804-818
• 22 Halperin JM, Trampush JW, Miller CJ, Marks DJ, Newcorn JH. Neuropsychological outcome in adolescents/young adults with childhood ADHD: profiles of persisters, remitters and controls. J Child Psychol Psychiatry 2008; 49 (09) 958-966
• 23 Vogt C. The risk of misdiagnosing posture weakness as hyperactivity in ADHD: a case study. Atten Defic Hyperact Disord 2017; 9 (04) 239-251
• 24 Banaschewski T, Jennen-Steinmetz C, Brandeis D. et al. Neuropsychological correlates of emotional lability in children with ADHD. J Child Psychol Psychiatry 2012; 53 (11) 1139-1148
• 25 Karalunas SL, Fair D, Musser ED, Aykes K, Iyer SP, Nigg JT. Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria. JAMA Psychiatry 2014; 71 (09) 1015-1024
• 26 Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 2014; 171 (03) 276-293
• 27 Molina BSG, Hinshaw SP, Swanson JM. et al; MTA Cooperative Group. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009; 48 (05) 484-500
• 28 Advokat C, Martino L, Hill BD, Gouvier W. Continuous Performance Test (CPT) of college students with ADHD, psychiatric disorders, cognitive deficits, or no diagnosis. J Atten Disord 2007; 10 (03) 253-256
• 29 Johansson V, Norén Selinus E, Kuja-Halkola R. et al. The quantified behavioral test failed to differentiate ADHD in adolescents with neurodevelopmental problems. J Atten Disord 2018; 1087054718787034: 1087054718787034
• 30 Gentile JP, Atiq R, Gillig PM. Adult ADHD: diagnosis, differential diagnosis, and medication management. Psychiatry (Edgmont Pa) 2006; 3 (08) 25-30
• 31 Karalunas SL, Geurts HM, Konrad K, Bender S, Nigg JT. Annual research review: reaction time variability in ADHD and autism spectrum disorders: measurement and mechanisms of a proposed trans-diagnostic phenotype. J Child Psychol Psychiatry 2014; 55 (06) 685-710
• 32 Tye C, Johnson KA, Kelly SP. et al. Response time variability under slow and fast-incentive conditions in children with ASD, ADHD and ASD+ADHD. J Child Psychol Psychiatry 2016; 57 (12) 1414-1423
• 33 Van der Meere J. State regulation and attention deficit hyperactivity disorder. In: Gozal D, Molfese DL. eds. Attention Deficit Hyperactivity Disorder: From Genes to Patients. Totowa, NJ: Humana Press Inc.; 2005. chapter 18: 413-433
• 34 Raymaekers R, van der Meere J, Roeyers H. Event-rate manipulation and its effect on arousal modulation and response inhibition in adults with high functioning autism. J Clin Exp Neuropsychol 2004; 26 (01) 74-82
• 35 Epstein JN, Goldberg CK, Conners JS, March SJ. The effects of anxiety on continuous performance test functioning in an ADHD clinic sample. J Atten Disord 1997; 2 (01) 45-52
• 36 Abramovitch A, Abramowitz JS, Mittelman A, Stark A, Ramsey K, Geller DA. Research review: neuropsychological test performance in pediatric obsessive-compulsive disorder--a meta-analysis. J Child Psychol Psychiatry 2015; 56 (08) 837-847
• 37 Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 1991; 148 (05) 564-577
• 38 Van der Meere J, Marzocchi GM, De Meo T. Response inhibition and attention deficit hyperactivity disorder with and without oppositional defiant disorder screened from a community sample. Dev Neuropsychol 2005; 28 (01) 459-472
• 39 Barry CT, Lindsey RA, Neumann AA. 22 - Assessment of Childhood Disruptive Behavior Disorders and Attention-Deficit/Hyperactivity Disorder. In: Sellbom M, Suhr JA. eds. The Cambridge Handbook of Clinical Assessment and Diagnosis Part III - Assessment and Diagnosis of Specific Mental Disorders. Cambridge University Press; 2019: 308-316 https://doi.org/10.1017/9781108235433.022 Online publication date: December 2019
• 40 Lewandowska M, Milner R, Ganc M, Włodarczyk E, Skarżyński H. Attention dysfunction subtypes of developmental dyslexia. Med Sci Monit 2014; 20: 2256-2268