Dataset Information

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.

ABSTRACT:

Introduction

The National Institute for Health and Care Excellence (NICE) guidelines for attention deficit/hyperactivity disorder (ADHD) state that young people need to have access to the best evidence-based care to improve outcome. The current 'gold standard' ADHD diagnostic assessment combines clinical observation with subjective parent, teacher and self-reports. In routine practice, reports from multiple informants may be unavailable or contradictory, leading to diagnostic uncertainty and delay. The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes. This trial investigates whether providing clinicians with an objective report of levels of attention, impulsivity and activity can lead to an earlier, and more accurate, clinical diagnosis and improved patient outcome.

Methods and analysis

This multisite randomised controlled trial will recruit young people (aged 6-17 years old) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services (CAMHS) and Community Paediatric clinics across England. Routine clinical assessment will be augmented by the QbTest, incorporating a continuous performance test (CPT) and infrared motion tracking of activity. The participant will be randomised into one of two study arms: QbOpen (clinician has immediate access to a QbTest report): QbBlind (report is withheld until the study end). Primary outcomes are time to diagnosis and diagnostic accuracy. Secondary outcomes include clinician's diagnostic confidence and routine clinical outcome measures. Cost-effective analysis will be conducted, alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice.

Ethics and dissemination

The findings from the study will inform commissioners, clinicians and managers about the feasibility, acceptability, clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval.

Trial registration number

NCT02209116.

SUBMITTER: Hall CL

PROVIDER: S-EPMC4256543 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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.

Hall Charlotte L CL Walker Gemma M GM Valentine Althea Z AZ Guo Boliang B Kaylor-Hughes Catherine C James Marilyn M Daley David D Sayal Kapil K Hollis Chris C

BMJ open 20141201 12

<h4>Introduction</h4>The National Institute for Health and Care Excellence (NICE) guidelines for attention deficit/hyperactivity disorder (ADHD) state that young people need to have access to the best evidence-based care to improve outcome. The current 'gold standard' ADHD diagnostic assessment combines clinical observation with subjective parent, teacher and self-reports. In routine practice, reports from multiple informants may be unavailable or contradictory, leading to diagnostic uncertainty ...[more]

PMID: 25448628

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Project description:INTRODUCTION:Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. METHOD AND ANALYSIS:This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6-17?years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. ETHICS AND DISSEMINATION:The findings will be used to inform the development of a fully powered RCT. The results will be submitted for publication in peer-reviewed journals. The study has ethical approval. TRIAL REGISTRATION NUMBER:NCT03368573; Pre-results.

Project description:The diagnosis and monitoring of Attention deficit hyperactivity disorder (ADHD) typically relies on subjective reports and observations. Objective continuous performance tests (CPTs) have been incorporated into some services to support clinical decision making. However, the feasibility and acceptability of adding such a test into routine practice is unknown. The study aimed to investigate the feasibility and acceptability of adding an objective computerised test to the routine assessment and monitoring of attention deficit hyperactivity disorder (ADHD).Semi-structured interviews were conducted with clinicians (n?=?10) and families (parents/young people, n?=?20) who participated in a randomised controlled trial. Additionally, the same clinicians (n?=?10) and families (n?=?76) completed a survey assessing their experience of the QbTest. The study took place in child and adolescent mental health and community paediatric clinics across the UK. Interview transcripts were thematically analysed.Interviewed clinicians and families valued the QbTest for providing an objective, valid assessment of symptoms. The QbTest was noted to facilitate communication between clinicians, families and schools. However, whereas clinicians were more unanimous on the usefulness of the QbTest, survey findings showed that, although the majority of families found the test useful, less than half felt the QbTest helped them understand the clinician's decision making around diagnosis and medication. The QbTest was seen as a potentially valuable tool to use early in the assessment process to streamline the care pathway. Although clinicians were conscious of the additional costs, these could be offset by reductions in time to diagnosis and the delivery of the test by a Healthcare Assistant.The findings indicate the QbTest is an acceptable and feasible tool to implement in routine clinical settings. Clinicians should be mindful to discuss the QbTest results with families to enable their understanding and engagement with the process. Further findings from definitive trials are required to understand the cost/benefit; however, the findings from this study support the feasibility and acceptability of integrating QbTest in the ADHD care pathway.The findings form the implementation component of the Assessing QbTest Utility in ADHD (AQUA) Trial which is registered with the ISRCTN registry ( ISRCTN11727351 , retrospectively registered 04 July 2016) and clinicaltrials.gov ( NCT02209116 , registered 04 August 2014).

Project description:ObjectivesQbTest has been shown to improve time to decision/diagnosis for young people with attention deficit hyperactivity disorder (ADHD). The aim was to assess the feasibility of QbTest for young people in prison.DesignSingle-centre feasibility randomised controlled trial (RCT), with 1:1 allocation. Concealed random allocation using an online pseudorandom list with random permuted blocks of varying sizes.SettingOne Young Offenders Institution in England.Participants355 young people aged 15-18 years displaying possible symptoms of ADHD were assessed for eligibility, 69 were eligible to take part and 60 were randomised.InterventionQbTest-a computer task measuring attention, activity and impulsivity.Main outcome measuresEligibility, recruitment and retention rates and acceptability of randomisation and trial participation.ResultsOf the 355 young people assessed for eligibility, 69 were eligible and 60 were randomised (n=30 QbTest plus usual care; n=30 usual care alone). The study achieved the specified recruitment target. Trial participation and randomisation were deemed acceptable by the majority of participants. 78% of young people were followed up at 3 months, but only 32% at 6 months, although this was also affected by COVID-19 restrictions. Secondary outcomes were mixed. Participants including clinical staff were mostly supportive of the study and QbTest; however, some young people found QbTest hard and there were issues with implementation of the ADHD care pathway. There were no serious adverse events secondary to the study or intervention and no one was withdrawn from the study due to an adverse event.ConclusionsWith adaptations, a fully powered RCT may be achievable to evaluate the effectiveness of QbTest in the assessment of ADHD in the Children and Young People Secure Estate, with time to decision (days) as the primary outcome measure. However, further programme developmental work is required to address some of the challenges highlighted prior to a larger trial.Trial registration numberISRCTN17402196.

Project description:BACKGROUND:Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS:Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS:One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS:QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.

Project description:It has widely been accepted that aggregating group-level decisions is superior to individual decisions. As compared to individuals, groups tend to show a decision advantage in their response accuracy. However, there has been a lack of research exploring whether group decisions are more efficient than individual decisions with a faster information-processing speed. To investigate the relationship between accuracy and response time (RT) in group decision-making, we applied systems' factorial technology, developed by Townsend and Nozawa (Journal of Mathematical Psychology 39, 321-359, 1995) and regarded as a theory-driven methodology, to study the information-processing properties. More specifically, we measured the workload capacity CAND(t), which only considers the correct responses, and the assessment function of capacity AAND(t), which considers the speed-accuracy trade-off, to make a strong inference about the system-level processing efficiency. A two-interval, forced-choice oddball detection task, where participants had to detect which interval contains an odd target, was conducted in Experiment 1. Then, in Experiment 2, a yes/no Gabor detection task was adopted, where participants had to detect the presence of a Gabor patch. Our results replicated previous findings using the accuracy-based measure: Group detection sensitivity was better than the detection sensitivity of the best individual, especially when the two individuals had similar detection sensitivities. On the other hand, both workload capacity measures, CAND(t) and AAND(t), showed evidence of supercapacity processing, thus suggesting a collective benefit. The ordered relationship between accuracy-based and RT-based collective benefit was limited to the AAND(t) of the correct and fast responses, which may help uncover the processing mechanism behind collective benefits. Our results suggested that AAND(t), which combines both accuracy and RT into inferences, can be regarded as a novel and diagnostic tool for studying the group decision-making process.

Project description:When researchers complete a manuscript, they need to choose a journal to which they will submit the study. This decision requires to navigate trade-offs between multiple objectives. One objective is to share the new knowledge as widely as possible. Citation counts can serve as a proxy to quantify this objective. A second objective is to minimize the time commitment put into sharing the research, which may be estimated by the total time from initial submission to final decision. A third objective is to minimize the number of rejections and resubmissions. Thus, researchers often consider the trade-offs between the objectives of (i) maximizing citations, (ii) minimizing time-to-decision, and (iii) minimizing the number of resubmissions. To complicate matters further, this is a decision with multiple, potentially conflicting, decision-maker rationalities. Co-authors might have different preferences, for example about publishing fast versus maximizing citations. These diverging preferences can lead to conflicting trade-offs between objectives. Here, we apply a multi-objective decision analytical framework to identify the Pareto-front between these objectives and determine the set of journal submission pathways that balance these objectives for three stages of a researcher's career. We find multiple strategies that researchers might pursue, depending on how they value minimizing risk and effort relative to maximizing citations. The sequences that maximize expected citations within each strategy are generally similar, regardless of time horizon. We find that the "conditional impact factor"-impact factor times acceptance rate-is a suitable heuristic method for ranking journals, to strike a balance between minimizing effort objectives and maximizing citation count. Finally, we examine potential co-author tension resulting from differing rationalities by mapping out each researcher's preferred Pareto front and identifying compromise submission strategies. The explicit representation of trade-offs, especially when multiple decision-makers (co-authors) have different preferences, facilitates negotiations and can support the decision process.

Dataset Information

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.

Introduction

Methods and analysis

Ethics and dissemination

Trial registration number

Publications

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.

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