Achieving for Children
The Royal Borough of Kingston and the London Borough of Richmond created Achieving for Children (AfC), a not-for-profit social enterprise, in 2014. They provide children’s services like assessment of ADHD and autism, and promote children’s mental and emotional health as a tier 2 service. The Emotional Health Service (EHS) provides children’s mental health services locally, commissioned by the Integrated Care Board (ICB) to deliver a pathway for the assessment of autism or ADHD.
Associate Director, Emotional Health Service and Consultant Clinical Psychologist, Dr. Jo Steer, and Assistant Psychologist, Ciaran Harte, explore the many ways in which introducing digital ADHD testing positively impacted ADHD assessments within the service.
Key takeaways
The neurodevelopmental service at Achieving for Children introduced digital ADHD testing as a one-year pilot program to evaluate efficiencies. The clinical team collected quantitative data, comparing the number of appointments within the ADHD assessment pathway before and after the implementation of Qbtesting, as well as the number of school observations and additional data.
Results showed:
- 88% of clinicians reported increased confidence in giving a diagnosis
- 88% agreed that objective solutions should be used routinely as part of the ADHD assessment
- 82% reduction in school observations
- 66% reduction in the wait list from first appointment to diagnosis
- 34% reduction in the number of appointments needed to reach a diagnosis
How does digital ADHD testing improve the accuracy and reliability of assessments?
Before introducing objective solutions into their pathway, Ciaran explains that there were a large number of school observations that they would partake in. This often led to a long wait time between an assessment and diagnosis. The introduction of digital ADHD tests saw a reduction of 66% from the first appointment to diagnosis.
The diagnostic reports at AfC suggest that the integration of Qbtesting added an objective element to their assessments. 88% of clinicians said that having objective data increased their confidence in giving a diagnosis, and agreed it should be a routine part of the diagnostic assessment. Additionally, 100% of clinicians confirmed that Qbtesting was easy to incorporate into the assessment process.
“In an ideal world, it would be great if everyone coming for an ADHD assessment had [Qbtesting] integrated into [their] assessment process, as I think it makes the whole process much more robust. It increases clinician confidence, it gives us some really helpful data also at the same time, I see the value in using it further back up the pathway, particularly when school evidence is lacking or isn’t very strong.”
– Dr. Jo Steer, Associate Director Emotional Health Service
How are digital ADHD tests reducing the need for time-consuming school observations?
School observations are one of the most common ADHD assessment methods for children since they can be a critical adjunct to parent and teacher reports. Despite its benefits, organizing a school observation comes with some challenges.
“With school observations, [children] engage differently with different subjects which is a challenge. The [digital] assessments are more standardized [when compared to school observations] and I think it’s an extra piece of information that adds to the confidence of the clinician [owing to the] addition of objective evidence.”
– Ciaran Harte, Assistant Psychologist
The AfC team reported that they would have to conduct school observations, as school forms would frequently not report the presence of ADHD adequately. AfC described these visits as time-intensive, requiring coordination with the school and often taking a couple of months to coordinate, complete, and write up. In the six months before the introduction of Qbtesting, Ciaran completed 22 school observations.
Since the introduction of objective testing, this has been reduced to four school observations, a reduction of 82%.
“When we observe a child during [Qbtesting] it can be really helpful as it is a time and a setting which requires concentration and focus, because when we go into school to do an observation, children can be at play or be engaged in an activity that doesn’t demand too much concentration, or be engaged in an activity they’re really interested in. We might see a child with amazing concentration because perhaps they’re hyper focused and really doing well in such settings, creating a bigger challenge with school observations.”
– Dr. Jo Steer, Associate Director Emotional Health Service
How can digital ADHD tests uncover masked ADHD symptoms in girls?
ADHD presents itself differently in boys and girls. ADHD is thought to be under-recognized in girls and women, mainly due to symptom masking. Jo mentions that in younger girls, the school reports are less reliable, perhaps owing to the school not noticing symptoms. Girls typically go under the radar in cases where they do not present with hyperactivity but do with inattention.
An objective ADHD test can help see whether the girl meets the criteria for ADHD.
“In a school setting, it can be quite challenging to pick up on signs. We could go and sit in a classroom and observe a girl and not necessarily be picking up any difficulties, but may be able to pick up those better in a Qb[testing] setting. Girls work really hard to mask symptoms to fit in socially, so observing them in that social setting might not be helpful.”
– Dr. Jo Steer
What impact does objective ADHD testing have on clinician decision-making?
As part of their evaluation, AfC surveyed clinicians within the Emotional Health Service. Here’s what they found about the experience of using digital ADHD testing as part of the ADHD pathway:
- Qbtesting was easy to implement
- Results from objective testing were helpful in understanding patient symptoms
- Objective data facilitated improved communication with patients
Clinicians found the most benefit in cases where there was limited screening evidence available to put a young person forward for a full ADHD assessment. Situations where evidence was lacking, or where symptoms may be masked in the school environment. Here are a few examples:
“I used it as a way of gathering objective information for the intake process. When a [young person’s] current school offered no/limited evidence for ADHD but the previous school, young person, family feedback and my observations at the choice and choice plus [intake assessments] were contrary to this. The Qb[testing]when offered, felt very validating to the young person and parents, they talked about feeling heard and listened to.”
Another reported that our objective test had been particularly useful “in cases where there is no second setting and in cases where families report symptoms of ADHD but the school does not see those symptoms or vice versa.”
Reports by AfC indicated a reduction of 34% in the number of clinical appointments required to make an ADHD diagnosis after the pilot. This indicates that objective testing has provided data that allowed clinicians to come to decisions with greater efficacy. This will have contributed to a reduction in waiting and assessment times overall for families and CYP.
How does digital ADHD testing improve communication with patients and families?
Our digital ADHD test reports are visual and help facilitate communication with patients and families. The one thing that Jo says she likes about the Qbtesting report is its graphic element. The visual presentation of the hyperactivity graph and the comparison with age and sex-matched norm groups helps patient communications.
“Since results are broken down by quarter, you see potentially how hyperactivity is increasing the longer the test goes, and looking at the [omission and commission errors] helps us explain the diagnosis to families and schools.”
– Dr. Jo Steer
Previously, the team relied solely on subjective measures such as clinical interviews, rating scales, and school observations or feedback. Adding objective elements, backed by evidence, has helped elevate the ADHD assessment process.
Effective clinician-patient conversations around ADHD are essential to help patients understand and manage the condition. Our psychoeducation toolkit includes easy-read patient handouts for children, teens, and adults to help facilitate those conversations.
Disclaimer: Achieving for Children is commissioned to take single diagnosis cases that are indicated at screening as being ADHD or autism spectrum disorder. The sample for the evaluations above only included young people where a singular ADHD assessment took place.
Ready to add objective testing solutions to your clinic’s pathway?
Our digital ADHD test measures the three core symptoms of ADHD – hyperactivity, impulsivity, and inattention. It standardizes ADHD pathways by using normative data of the same sex and age. It improves clinical understanding of patient symptoms and aids clinical decision-making when used alongside other clinical measures.