Around 5% of children in the UK are estimated to have ADHD. Assessing ADHD in young people can be complex, with symptoms often presenting differently across home, school, and social settings.
Dr Richard T. Jones is a Principal Forensic Psychologist with the Greater Manchester Mental Health NHS Foundation Trust. He explains how introducing Qb testing at Barton Moss Secure Children’s Home has helped engage young people during assessment and treatment of their ADHD. Seeing visual test results of symptoms has increased understanding for young people and boosted clinician confidence in diagnoses.
The assessment process is also an important step towards patients understanding themselves and being able to access the right support. Alongside input from parents, carers, and teachers, it’s important that young people are fully engaged and can contribute to their care journey.
Key outcomes for Barton Moss Secure Children’s Home
- Young people now feel more engaged with their mental health care
- Qb testing results are helping children understand the effects of ADHD treatment
- Clinician confidence in diagnostic decision-making increased
- Assessments are more robust, and previous diagnoses were reviewed and, in many cases, retracted
The challenge
Subjective ADHD assessments introduce responder bias and limit young people’s engagement in care planning
Before objective testing was introduced at Barton Moss Secure Children's Home, clinicians undertaking ADHD assessments would have to rely more heavily on subjective measures, and young person involvement was limited to self-report measures.
Young people felt disengaged by the ADHD assessment process
Rating scales completed by parents, teachers, or children’s home staff, developmental history, and academic reports are all part of a comprehensive ADHD assessment. However, when the patient is a child or young person, this can mean much of the ADHD assessment process happens without their direct involvement.
Young people who received ADHD assessments in the community, before being at Barton Moss Secure Children’s Home, described meeting clinicians for as little as ten minutes in the assessment process. Engaging young people in their ADHD care journey is essential. Research suggests that children and adolescents can often feel under-involved in discussions about their own care, with their perspectives not always fully incorporated.
Subjective measures can introduce responder bias
While important, a reliance on only subjective measures during an ADHD assessment can introduce responder bias. Moreover, conflicting reports introduce diagnostic uncertainty. This can make it more difficult to build a clear picture of an individual's symptoms and how they affect day-to-day functioning.
Clinicians had to make difficult diagnostic decisions on borderline ADHD cases
Before Qb testing, diagnoses were significantly more challenging to make without the support of objective data. For example, hyperactivity and impulsivity may be present, but this may be better explained by trauma than ADHD.
The solution
Integrating Qb Testing to standardize ADHD assessment and improve patient engagement
Objective testing now forms part of the standardized ADHD assessment process at the children’s home. Here are some changes after integrating Qb testing:
Engaging young people in ADHD assessment and treatment decisions
Since introducing Qb testing, young people are now directly involved in a larger part of their assessment. Results from digital ADHD tests are shared with them, supporting better discussions between the clinician and young person.
“Showing them Qb testing results gives that objective evidence of improvements, rather than residential or educational staff opinion, which can be subject to bias.”
- Dr. Richard T Jones
The result
Standardized care model, improved clinician confidence, and empowered patients
The children's home remodeled their ADHD assessment and care workflow to incorporate objective testing with beneficial outcomes for both clinicians and young people.
Improving clinician confidence and reassessing previous diagnoses with objective data
Clinicians now have quantitative data about ADHD symptoms to complement subjective assessment measures. This has helped them to diagnose ADHD with increased confidence. Equally, this objective data can help clinicians to unpick differential diagnoses.
The availability of objective data has enabled clinicians at the children’s homes to review previous assessments and even retract some diagnoses.
“The quantitative data from Qb testing has supported us in retracting ADHD diagnoses as well, particularly where questionable diagnoses have been made or when the assessment processes have been less robust.”
- Dr Richard T. Jones, Greater Manchester Mental Health NHS Foundation Trust
Increased patient engagement in ADHD assessment
Incorporating digital technologies such as Qb testing can support a process which feels more child-led. Young people at Barton Moss have reported feeling more involved in ADHD assessment and care.
“Young people have been generally interested in the results from Qb testing, often preferring to see something visual as opposed to written or verbal information.”
- Dr Richard T. Jones, Greater Manchester Mental Health NHS Foundation Trust
Better clinician-patient conversations and shared decision-making
Being able to see visual reports helps young people understand their specific ADHD symptoms and the impact medication has on them. Clinicians have been able to use digital ADHD test results to support discussions around medication and involve the young people in shared decision-making on their treatment and care.
When a young person at the children’s home was shown pre-medication and post-medication objective test results, they commented: “So, the medication is working then.”
This has helped young people to see medication effects in a tangible way, when previously they may not have been aware of improvements, other than through anecdotal comments made by others.
The integration of digital technologies enhances the role young people have in the ADHD assessment procedure. After Qb testing was introduced, young people’s outcomes have improved in engagement, understanding, and involvement in shared care decisions. Clinicians have benefited from a more robust assessment process, giving them greater confidence in deciding whether a diagnosis of ADHD is supported.