ADHD digital test approved for use by the NHS

After successful trials by the NIHR, the NHS is now using a digital test to speed up the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children.

In July 2024, the National Institute for Health and Care Excellence (NICE) issued draft guidance approving the use of the QbTest by psychiatrists and specialist children’s doctors to help diagnose ADHD in children and young people. The computerised test improves and speeds up assessments when used alongside existing methods, and could save the NHS money.

ADHD diagnosis

ADHD affects an estimated 3-5% of school-age children who show symptoms of inattention, impulsivity and hyperactivity. To make an ADHD diagnosis, information is gathered from 

• parents
• teachers
• young people

Diagnosis is complex because the feedback is subjective and can be contradictory. Children in the UK wait 18 months on average to get a diagnosis.

Professor Richard Morriss, NIHR ARC East Midlands Mental Health and Well-being Theme Lead, said: “There has been a fourfold increase in referrals for ADHD since the COVID-19 pandemic and this device can reduce time to an accurate diagnosis in children and young people by one third in terms of clinic time.

“NIHR ARC East Midlands worked with industry to help with this challenge. NICE has now recommended QbTest, which is now used in 70% of NHS services for ADHD in children and young people. NIHR ARC East Midlands is currently exploring how QbTest might also help with treating as well as diagnosing ADHD.”

What is the QbTest?

A QbTest is a computer-based test which measures 

• attention
• impulsivity
• activity 

Over 20 minutes the child responds to target stimuli while ignoring other stimuli. A camera tracks the movements of a marker attached to the patient’s head. The results are then compared to a group of children of the same age and gender who do not have ADHD. The results help clinicians reach a diagnosis. 

Made possible by NIHR infrastructure

The NIHR funded and supported the research, which NICE reviewed as part of the process of recommending the QbTest. The research was possible because of the people, infrastructure and facilities which benefit from underlying support from the NIHR.

The first independent randomised controlled trial AQUA Trial: Assessing QbTest Utility in ADHD was funded by the NIHR Applied Research Collaboration East Midlands (ARC East Midlands) and supported by the NIHR Mental Health MedTech Co-operative (Mind Tech).

The researchers found that the QbTest: 

• shortens the assessment cycle; patients are 44% more likely to receive a diagnostic decision within 6 months 
• doubles the likelihood of excluding ADHD in the first 6 months
• helped 85% of patients surveyed to better understand their symptoms

Building on the success of the ARC research, Health Innovation East Midlands (HIEM) piloted the technology within three East Midlands NHS mental health trusts, which showed the potential to both cut the time to diagnosis, and achieve significant cost savings by reducing the appointments needed to reach diagnosis and so freeing up clinician time.

The ARC and HIEM collaboration provided the evidence base for wider adoption and in 2020 the QbTest was rolled out across England via the network of 15 health innovation networks (formerly the AHSNs).

The technology rapidly gained traction and by March 2024 the outstanding national impacts included:

• 95,097 hours of healthcare capacity has been released across the NHS.
• 41,582 clinical appointments have been saved.
• 71,102 children and young people have benefited.
• 79 NHS trusts are now using the technology, three quarters of all English trusts that provide ADHD services.
• £38.5M estimated NHS cost savings have been achieved.

The AQUA Trial was undertaken by Professor Chris Hollis, Dr Maddie Groom and Dr Charlotte Hall from the NIHR Mental Health MedTech Co-operative (Mind Tech). Professor Hollis is part of NIHR Nottingham Biomedical Research Centre (NIHR Nottingham BRC). NIHR Nottingham BRC funded Dr Charlotte Hall.

NIHR funding independent research of new technology 

In October 2023 the NIHR’s Health Technology Assessment (HTA) programme funded a Technology Assessment Review for the QbTest for the assessment of attention deficit hyperactivity disorder. They also assessed whether it offered value for money for the NHS.

Mark Chapman, Director of HealthTech at NICE, said: “Evidence presented to our committee showed the QbTest could increase the number of children and young people who get a diagnostic decision within six months of starting assessment.”

Dr Julie Clarke, Consultant Paediatrician, said: “As a clinician with extensive experience in assessment, diagnosis and treatment of ADHD, I can honestly say that the addition of QbTest has revolutionised my clinical practice.”