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A clinician’s view: life before and after QbTest

Published: 22 Jul 2021 | QbTest , Opinion , ADHD , Objective Testing

Michael Walsh is a Clinical Nurse Specialist for HSE South and South Wexford Child and Adolescent Mental Health Service with extensive experience working with patients being assessed and treated for a range of mental health and neurodevelopmental conditions including ADHD.

Like many healthcare services globally, they are under pressure to support as many patients as possible whilst consistently delivering the highest standards of care. As Michael goes on to explain, tools like QbTest support his team to look beyond the information collected during clinical interviews and from rating scales. Here is a glimpse of the typical ADHD pathway for Michael and his team before and after QbTest.

 

Before and after QbTest

Michael Walsh: "Before QbTest, we had to consult more with schools and patients. It was often a long, drawn out process, taking up to six weeks to collect all the information. Now we can get to inform schools of the diagnosis faster and get supports for the children set up faster ie movement breaks, one to one work, psychoeducation for teachers.

Now, with QbTest, we can collect all the evidence and data we need on the day of the clinical interview for ADHD with both the patient and the parents or guardians. Patients will undergo a QbTest as part of their clinical assessment. At the end of the assessment, we feedback to the parents/guardians, and to the child, the findings from the clinical interview, rating scales and QbTest. It's great to be able to share the QbTest report with patients and parents/guardians and show on the chart in the report where their difficulties are, highlighting evidence of inattention, impulsivity or hyperactivity and discussing how it affects them.

If there is supporting evidence of an ADHD diagnosis, considering all the clinical measures, the patient can start treatment that day if necessary. In most cases, the QbTest reduces the number of appointments by 2-3 appointments in our care pathway. The net result is that it frees up more time to see more patients while continuing to provide quality care during the assessment process".

 

Enhanced communication with patients

"The QbTest report has been useful, especially with teens. Some patients are convinced that they are not hyperactive or impulsive. When I show them their performance on the QbTest compared to the norm group they can clearly see the difference. Sometimes the extent of their symptoms is clear cut, showing significant deviation from the norm group. For the patients it can be a learning curve and the first real, objective insight into their symptoms.

When patients who do receive an ADHD diagnosis come back after starting medication, we repeat the QbTest and we can assess whether the treatment is working effectively. You can see impact of the treatment by the changes in the output of the QbTest report and it further supports the patient to be an active participant, to see how their treatment is helping to improve their symptoms, which in many cases it is. Often, I find the report helps stimulate a conversation with the patients, with them giving feedback on whether they feel the treatment is working or that they notice the difference in school. The graph on the report is often a true reflection of what they feedback".

 

Using the data from QbTest for better understanding of symptoms for patients, parents/guardians and schools

"We often have cases referred to us where one symptom is the primary concern. If, for example, we have a patient who comes to us with mostly inattentive symptoms which are affecting their performance at school, you can focus on the attention measures displayed on the report to understand their symptoms better. This can give us, the clinicians, the patients and the parents/guardians an objective glimpse of what is happening.

For some patients, when they're in class, they may look like they're paying attention, when in fact they're not taking in any information. In these types of cases there is an extra effort on behalf of the school, to get that student the extra help, to show them where the difficulties are. So, QbTest is useful in being able to show schools and parents where best to focus their support, based on what is displayed on the report. If attention is the primary symptom, then schools can use that information to adapt the classroom for that student".

 

Enhancing psychoeducation for ADHD

"There is no way I'd bring out a summary of a rating scale we use to discuss with patients, families or the school.

The QbTest is very handy. It's one page and I think, once you can explain what you're looking at on the sheet in front of you, it makes sense. The rating scales we use are subjective insofar as the answers can depend on the day or how the teacher or parent/guardian was feeling when it was filled in. Whereas QbTest is taken at a particular time and this is the way the child is. Objectively it's direct feed back to the patient /parents there and then, not depending on others' point of view.

The report itself is easy to understand with a dedicated patient report. The graphs on their own help us communicate with parents and the teachers. I am able to explain their ADHD symptoms in the context of their challenges at this particular time. The report shows you exactly what the difficulties are and when they occur during the task".