There is a lot more to a QbCheck test than Q-scores and parameters. Insights from behavioral observations during testing can offer unique insights to support diagnostic decision-making. The more information we have on our patients, the better.
Our US clinical advisor, Dr. Corina Weir, highlights one of the test's key aspects – The Behavior Observation Form.
This content reflects the author’s views and is not intended as clinical guidance or medical advice. Content does not necessarily reflect the views of Qbtech.
What is the QbCheck Behavioral Observation Form?
The Behavioral Observation Form (BOF) is completed by the person who administers the QbCheck test. The administrator is responsible for ensuring the equipment is set up correctly, the environment has been standardized, and the test taker understands the instructions and is able to execute the task.
These are essential aspects of their role, as they ensure test validity, but they will also closely observe the patient before, during, and after QbCheck, recording what they see and hear on the BOF. This information offers valuable insights that other ADHD assessment tools may not have picked up.
Can the Behavioral Observation Form provide contrasting information to other sources?
Yes, sometimes a QbCheck report doesn’t fit with the information they receive from other assessments, and in these cases the form may be able to unlock the clues to understanding this discrepancy.
For example, a patient has significant levels of inattention reported from home and school but goes on to perform well in all the attention parameters on QbCheck. On the BOF, it is documented that the patient required the instructions to be broken down and repeated in a way that would not be expected for their age. This suggests that there was an impairment in understanding, but not in attention, once understanding had been achieved, and it may be worth considering if hearing, language, or processing difficulties may be the root cause.
By completing the QbCheck ahead of the clinical interview, and through reviewing the QbCheck report and BOF, this would allow the clinician to collect any additional information prior to the clinical appointment, potentially saving time and reaching a diagnostic decision quicker.
Can the Behavioral Observation Form help with differential diagnoses?
Hyperactivity is one of the key symptoms of ADHD, but high levels of activity may occur for many different reasons, such as anxiety, tics, tiredness, stims, sensory needs, and skin disorders. QbCheck will indicate whether the amount of activity is clinically significant and will also show if this increases or decreases over time.
We can also see minute-by-minute fluctuations in activity and link these to notes from the test administrator, assessing if movement patterns look chaotic, or if they are predominantly moving back and forth or side to side.
The finer details that will help to attribute the cause and function of movements, and thereby help with differential diagnosis, will be in the detailed description that can be found on the BOF.
Behavioral observation and ADHD symptom masking
Poor sleep commonly co-occurs with ADHD. If a patient’s QbCheck report is suggestive of ADHD and they were tired when they performed the test, it would be important to retest the patient once sleep difficulties have been managed.
If a patient is tired at the end of the QbCheck but wasn’t at the beginning, this could indicate ADHD. Some patients will put in an extreme effort during the QbCheck and produce a report that doesn’t look supportive of an ADHD diagnosis; however, if the BOF reports that the patient was significantly more tired after the test than they were before, this suggests that they have learned to mask their symptoms.
“The shapes were coming too fast.” – Do they have a processing difficulty?
“I got confused and couldn’t remember which shape to press.” – Is their inability to remember the instructions due to an undiagnosed learning difficulty?
“I have to go now because I have an important test at school.” – Were they preoccupied and not giving their best performance?
Comments from the patient after the test can be real eureka moments. While most patients will describe the test as boring and may want to exit it, it is worth the time to try to find out a little bit more about their experience.