ADHD Assessment and treatment – can you quantify activity?

How can you tell if a patient is more hyperactive than their peers? Face-to-face, it is sometimes the most noticeable symptom in younger individuals, particularly males.

However, measuring all activity including much subtler movements like foot tapping and fidgeting for example, and having something to compare it to is more challenging.

Measuring activity is important; numerous studies pinpoint activity as a key differentiator from other clinical conditions in both children and adults [1], [2], [3].

Michael Walsh is a Clinical Nurse Specialist for HSE South and South Wexford Child and Adolescent Mental Health Service, and has extensive experience working with patients being assessed and treated for ADHD. He explains how using QbTest helps his team incorporate objective data on activity, to add context to other clinical measures for both the assessment and treatment of ADHD.

Objectively measuring activity

Michael Walsh: “The measure of activity in the QbTest report clearly shows hyperactivity in the vast majority cases where we feel that there is a likelihood that the patient has ADHD.

There have been some cases where we have believed that the patient only presents inattentive symptoms based on face-to-face interaction and observation. However, when they take a QbTest, the camera picks up more movement than we expected, beyond the norm range. In such cases, we are often surprised that when we have spoken or observed the patient face-to-face it was difficult to spot their hyperactivity, particularly the more subtle movements such as fidgeting; foot tapping, squirming in their seat for example. The QbTest is effective in the way it picks it up activity levels throughout the duration of the task.

Being able to record these subtler movements is clinically relevant information. In cases where a patient’s hyperactive traits are significant, we have to consider whether this impacts on their ability to concentrate. If they are unable to maintain their levels of concentration, we have to support that otherwise they may struggle to keep up with their peers”.

Objective data also supports decision making for borderline cases

“In any assessment for ADHD, we ask all the usual questions related to ADHD as part of our clinical interview. Girls, who often present differently to boys, aren’t usually as hyperactive or as aggressive. Instead, they suffer more with inattention. As a result, their symptoms are more likely to go unnoticed in school and by parents/guardians. Girls typically suffer more internally, and you don’t always get any clues from them in a clinical interview.

However, when they take a QbTest it highlights the inattentive symptoms. Inattentive symptoms, like hyperactivity, are not always obvious to the eye but they are picked up by QbTest. You have to be very skilled in ADHD assessments to identify ADHD in girls in the first place – QbTest really helps support clinicians to be able to do that more effectively, with these symptoms clearly marked on the report when they deviate from the normative group.

Often there are times when I feel that the patient was attentive and engaged during the clinical interview and then you find, after running a QbTest, that in actual fact their attention fluctuates, or is inconsistent compared with the normative group. It’s very useful in that respect”.

[1] Edebol, H., Helldin, L. & Norlander, T. (2013). Objective Measures of Behavior Manifestations in Adult ADHD and Differentiation from Participants with Bipolar II Disorder, Borderline Personality Disorder, Participants with Disconfirmed ADHD as Well as Normative Participants. Clinical Practice & Epidemiology in Mental Health, 8, 134-143.

[2] Groom, M., Young, Z.,Hall, C., Hollis, C., & Gillott, A. (2016). The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder. Psychiatry Research, 243, 168-173. doi: 10.1016/j. psychres.2016

[3] Vogt, C., & Shameli, A. (2011). Assessments for attention-deficit hyperactivity disorder: use of objective measurements. The Psychiatrist, 35(10), 380-383.