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Improving diagnosis of ADHD

Programme(s):
Mental Health
National Programmes

Since April 2020, a number of AHSNs have been working with mental health trusts and community paediatric services to improve the assessment process for Attention Deficit Hyperactivity Disorder (ADHD) using computer-based tests (measuring attention, impulsivity and activity).

What is the problem we’re addressing?

ADHD is neurobiological – a disorder of brain development that impacts on behaviour, affecting around 5% (1 in 20) of school aged children. ADHD is a treatable disorder yet if left untreated, can have significant impact on personal development, academic outcomes and family interaction.

There is no simple test to determine whether a child has ADHD. The process for diagnosing or ruling out ADHD is variable across England. It will often include multiple steps and is based on clinical judgement informed by subjective reports from parents, teachers and observation of the patient. As such, children in the UK wait 18 months (average) to obtain an accurate diagnosis, more than the European average of 11 months. Multiple clinic visits over this period result in significant costs to the NHS, estimated at £23 million.

What are the outcomes we're trying to achieve?

Increase in the number of children and young people who have an objectives assessment as part of the clinical assessment.
Reduction in time for assessment and decision making (from first referral to decision to diagnose/rule out).
Reduction in number of outpatient appointments between referral and diagnosis.
Reduction in nurse observation visits in schools.
Improved patient / family satisfaction / experience.
Improved clinician satisfaction and confidence in diagnosing or excluding ADHD.

How will we do this?

The core element of this programme will involve work with NHS trusts across England to improve the ADHD assessment offer to children and young people by implementing an objective assessment tool (measuring attention, impulsivity and activity) to supplement current clinical assessment processes.

Research has shown that the use of an objective assessment tool alongside other clinical information, can provide a more rapid diagnosis (with reductions of around five months) after fewer patient visits, improving patient, family and clinician experience. The assessment tool offers instant results that present a report comparing a child’s or young person’s results against a normative data-set, based on age and gender.

East Midlands AHSN supported a 12-month, real-world demonstrator project, where an objective assessment tool (QbTest) was used in different pathways across three East Midlands NHS trusts.

Evaluation of the East Midlands AHSN approach was conducted through a before and after audit at each clinic, which showed:

Time from assessment to diagnosis reduced by 153 days (median figure)
The number of appointments to make a diagnosis was reduced by one appointment
20% clinical workforce time was released
33% cost reduction
85% of patients found the results helpful
94% of clinicians reported greater understanding of patients’ symptoms
Return on investment (ROI) = £84,460.

All three trusts in the East Midlands have now approved funding for the provision of the Qbtest as part of their ADHD pathways, ensuring sustainability beyond the AHSN-funded demonstrator.

The AHSN Network started delivery of the as a national programme in April 2020. Each AHSN region worked to map the ADHD service profile and local needs within their area. Most AHSNs have at least one Child and Adolescent Mental Health Service (CAMHS) or paediatric service that currently offer an objective assessment as part of their assessment process.

To support improvements in the assessment pathway, AHSN teams have been working closely with trusts to help them consider the levels of inefficiencies and unmet need that will influence whether local stakeholders will have an appetite to deliver the programme.

Since the start of the AHSN Network national Focus ADHD programme in April 2020, over 24,000 children across England have received an objective assessment for ADHD using AHSN-supported technology

Innovating ADHD diagnosis in England

The AHSN Network’s Focus ADHD programme is in its final year of a three-year national programme. Almost 75,000 people (aged 6-18 years) have received an objective assessment for ADHD since Academic Health Science Networks began to support a digital innovation, QbTest in 2017.

QbTest is an approved computer-supported objective test which measures attention, motor activity and impulsivity – the core symptoms of ADHD. The results are instantly analysed and presented in a report which compares a patients’ results against a normative dataset based on age and gender.

ADHD practitioners then use information from the QbTest report alongside their clinical assessment to inform their decision whether the young person has ADHD or not.

A recent evaluation study by the Institute of Mental Health, Nottingham has shown the impact of using QbTest as part of an improved ADHD assessment pathway.

QbTest can supply important data to help inform a clinician’s diagnosis. To date, it is being used in 65 trusts across 131 sites - over half of the NHS providers of ADHD assessments for this age group.

Watch the video to see how it has impacted one family’s life.