The new Qb test could speed up assessments for ADHD in the NHS by between 20-30 per cent. Here’s everything you need to know
By Laurel Ives31 July 2024 • 8:00am
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“I wasn’t looking for a diagnosis for myself,” says Pippa Simou, 50, a former teacher turned ADHD coach. “My son was diagnosed with ADHD at the age of 10 after a wait of a year on the NHS. A few years later I came across a digital ADHD test at a conference and decided to take it myself.”
The test Pippa took was the digital Qb test for attention deficit hyperactivity disorder (ADHD), which the National Institute for Health and Care Excellence (NICE) has just recommended for use in the NHS that will be shared with practitioners. Research has demonstrated that using the Qb test could speed up assessments for ADHD in the NHS by between 20-30 per cent.
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Could this be the breakthrough the NHS needs to make a much-needed dent in waitlists?
What it means for patients
If you’re a patient seeking an ADHD diagnosis, you might be offered the test following a GP referral to an ADHD clinic. Currently, only some trusts are offering it but it’s likely the test will be rolled out to more following this guidance. You can also pay to take it privately.
When Pippa took it herself, her symptoms suggested she had it. Pippa then went on to receive a full diagnosis privately. “A diagnosis has been transformational for me,” she says. “My life is not as hard and I’m more at peace and kinder to myself.”
The Qb test measures concentration, movement and impulsivity (three core signs of ADHD) in 15-20 minutes, using an infrared tracking system and computerised tasks where the individual responds to stimuli by pressing a button, to measure reaction time, consistency and accuracy.
“The test is useful because it helps people have the confidence to work out whether it is worth waiting for an NHS diagnosis – whether they’re in the right queue,” says Pippa. And that queue is getting increasingly longer. According to a 2022 survey by the Petitions Committee, the wait list to get seen for ADHD ranges between six months and three years. Anecdotally some people are waiting even longer.
While Pippa was diagnosed later in life, NICE has now made it clear that the test should only be used to diagnose children and young people between the ages of six to 17 years, and that the test in itself is not enough for a diagnosis, but should be used in conjunction with a robust clinician assessment.
The rising demand for diagnosis
Meanwhile, the demand for ADHD services is rocketing. Since 2020 the ADHD Foundation has reported a 400 per cent increase in the number of people seeking a diagnosis and between 2019/20 and 2022/23, there was a 51 per cent increase in the number of patients prescribed medication for ADHD.
“We’re drowning, we have six times the requests for diagnosis we used to have, so if it’s a 20 per cent improvement at best this would be marginal, not transformational,” says Prof Marios Adamou, a consultant psychiatrist and clinical lead at South West Yorkshire Partnership NHS Trust.
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Prof Adamou explains that the test has been in use for some years already, in his clinic he uses a similar but cheaper test, not to diagnose people as he treats adults, but to assess whether medication is working.
“It’s got a better evidence base in children. In adults it’s not so useful as they have more additional conditions that produce the same symptoms, so the test might suggest you have ADHD when you might have another disorder. We use it rarely, in about 2 per cent of cases, to assess whether medication is working,” he says.
Concerns about over-diagnosis
Prof Adamou was one of several doctors who came together to urge NICE to take a look at the Qb test. The worry was what he describes as “unscrupulous practitioners”. He was also part of the committee that developed the guidelines.
“We were concerned that some, perhaps in the private field, were using it incorrectly, and so yes, we made a bit of noise so that NICE could put some boundaries around its use,” he says.
“There are too many practitioners diagnosing people without knowing enough about the condition, there are online assessments and strange treatments going on. If you use this test to leap into a diagnosis, yes you may reduce waiting lists, but the consequences are you may be giving controlled drugs, which can arrest growth and increase cardiovascular health risks, to children who don’t need them, ” he says.
Prof Peter Hill, a consultant child and adult psychiatrist in private practice in London, used the test in his practice briefly but abandoned it because of the cost.
“It’s not that cost-effective in private practice as you have to buy the test and have somebody supervising the child while they’re taking it. You don’t use it instead of an assessment, you use it alongside an assessment, so it’s not essential,” he says.
He found it useful in some instances as it gives an “objective” assessment and helps resolve disputes between parents. “If a parent, usually the dad, thinks the child is fine, this can help resolve a dispute. It can also help track whether treatment is working, that said, you’re not trying to improve the child’s ability to get better scores in the test, but to have a better life,” says Prof Hill.
He also worries that the test is being used as a shortcut to diagnosis.
“I know of a psychologist who bought a test similar to Qb, and she would give the child the test, tell the parents it proves he or she has ADHD and then refer them to a clinic for medication. That’s shockingly bad practice. However presumably in the NHS, this won’t happen as the guidelines are clear; it is only part of the diagnosis,” he says.
A step forward for those seeking diagnosis
However other doctors, like Dr Helen Read, a consultant psychiatrist who founded the ADHD Consultancy, believe that the Qb test has an important role to play.
“It’s positive because the test is often helpful at picking up patterns of inattentiveness and hyperactivity which are often missed in schools. While I have certainly come across examples of fantastic ADHD-aware SENCOs [special educational needs coordinators] and teachers, too often parents’ concerns are dismissed and ADHD symptoms are labelled as ‘just not trying’ or ‘bad attitude’. They are also attributed to other factors in a child’s life such as illness or parents’ divorce,” she says.
In the case of her son, his diagnosis was dismissed when they finally got their NHS appointment after his teacher stated he had no symptoms.
“I was able to appeal to the consultant and they sent a team member to observe him and it was clear that he was zoned out all day and he got the diagnosis. A less ADHD-aware parent would never have got to the clinic in the first place,” she says.
Certainly, when Zizi Durrance’s daughter Clara was diagnosed at the age of 11, the school had not reported any problems. “The school were in denial, they couldn’t see anything wrong, but I always felt she was a square peg in a round hole. We were told we would have to wait a long time on the NHS so we were lucky in that we could afford to go private,” she says.
Zizi estimates she spent around £2-3,000 on Clara’s diagnosis and treatment, but what she hadn’t anticipated was the ongoing cost of private medication. “It’s not just the diagnosis, it’s the follow-ups and the cost of the medications,” she says. Eventually, she received a referral back to the NHS, where Clara was also diagnosed with ADHD, and is now in ongoing treatment.
“Her diagnosis was immediately transformational. She felt heard, and for us as parents it made us so much more tolerant and able to understand her behaviour, rather than being frustrated by it,” she says.
As with everything when it comes to ADHD, the picture is complex and it’s not entirely clear how much difference the Qb test will make, if any, to lengthy waiting lists on the NHS.
But if the test can reduce the number of children being missed and not diagnosed, that’s surely a step in the right direction.
“Every missed diagnosis is a child who did not achieve their potential,” says Dr Read. “This will reverberate through their later lives with educational, social, emotional, mental health and even possible substance misuse or law-breaking.”
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