NICE has recommended a new digital tool which could speed up ADHD diagnoses and help clinicians rule out more cases.
In draft guidance published today, NICE approved NHS use of the computer-based QbTest, alongside a standard clinical assessment, for diagnosis of attention deficit hyperactivity disorder (ADHD) in children and young people.
QbTest tracks the movement of participants while measuring the three main symptoms – inattention, impulsivity, and hyperactivity – and the results are then compared to a control group.
A previous clinical trial showed that QbTest led to a larger proportion of patients receiving a diagnostic decision within six months of their first assessment appointment.
NICE has said that use of the test also resulted in ‘clinicians being able to rule out ADHD in more cases’ and that the technology provides a ‘quicker diagnosis’.
ADHD diagnoses are usually made by specialist psychiatrists or paediatricians, and the NHS has seen a large rise in GP referrals for diagnosis in recent years.
A report earlier this year argued that demand for ADHD assessments is increasing at such a rate it has surpassed the ability of the NHS to keep up.
GP leaders across the UK recently called for locally commissioned NHS ADHD services and for patients to be able to self-refer to those services, without the requirement to consult their GP.
NICE heard from patient experts that long waiting times for ADHD assessment – sometimes lasting ‘many years’ – are a ‘significant issue’, and that many patients are seeking private care instead.
The recommendation for the use of digital technologies is limited to children and young people aged six to 17 for now, while further research is carried out for adults.
NICE’s diagnostics advisory committee emphasised that the QbTest should ‘only be used to supplement professional judgement, and not replace it’.
Director of NICE’s HealthTech programme Mark Chapman said children ‘deserve to receive a diagnosis in a timely manner’ and that there are ‘challenges’ in the current NHS pathway.
He continued: ‘This technology has the potential to generate tangible benefits to the lives of those waiting for an ADHD diagnosis.
‘Evidence presented to our committee showed the QbTest could increase the number of children and young people who get a diagnostic decision within 6 months of starting assessment.’
Dr Jessica Eccles, chair of the Royal College of Psychiatrists’ neurodevelopmental special interest group, said people often have to wait ‘months or even years’ for an ADHD assessment, and that any new ‘evidence-based tools’ should be used to reduce these ‘unacceptable waiting times’.
She added: ‘It’s critical that these tests are administered by a fully trained and qualified professional who can accurately interpret the information they provide. They must not be used in isolation but as part of a broader assessment.
‘The challenges facing ADHD services will not be solved by new technology alone. There is still a clear need for targeted resources to help them meet rising demand and provide vital care.’
A consultation on NICE’s draft guidance, which applies to England and Wales, is now open until 6 August.
ADHD is estimated to affect between 1% and 2% of children and young people in the UK, when using the World Health Organisation’s diagnostic criteria.
The NHS recorded a large jump in the number of medicines prescribed for ADHD in 2023/24, which included a 28% rise for adults and a 9.9% increase for children.
Last year, an analysis of primary care records found that children and young people with ADHD see their GP twice as often as others of the same age in the two years leading up to the diagnosis.
The FDA approved this test for adhd in 2012.
And been widely used in Europe.
So its taken Nice 12 years, and resulted in children waiting 4 years to be given a diagnosis to get extra support at school..
Yes it does not fix the waiting, but helps in setting up a more streamlined diagnostic service.
I am not sure how allowing patients to self-refer for assessment to NHS consultants would help?
The delay is not due to GPs failing to refer rapidly, so this will not help. The delay is in secondary care.
Removing GP from the referral process could exacerbate the problem, since GP-diagnoseable ‘other’ causes of hyperactivity, such as thyrotoxicosis, will not be identified before assessment, causing poor and delayed management of those patients, and a delay to others through clogging up the assessment service.
Ability to get private diagnoses is a problem, because services are not quality-controlled, and then are difficult to correct wrong diagnoses – such as for example thyroid or other educational or developmental problems. They also do not communicate well, and cause additional unecesary work for GPs, detrating from our ability to care for the patients.
Given the tendency of NICE to dump secondary care work on General Practice how long will it take for them to suggest GPs should undertake QbTest prior to referral?
What are all these kids going to do with their diagnosis? Don’t tell me, book an appointment to discuss it with their GP because there isn’t anybody else to treat them and tell their school to employ a support worker. Don’t worry I hear you say, the GP will get a leaflet on prescribing amphetamine to children and a ten point list of when to seek further advice and guidance from a specialist service that doesn’t exist and the school will be advised to contact the GP when they cant manage
This is fine but how much of a bottleneck is the actual diagnostic process? These patients will still need to spend time on a specialist service waiting list for initiation and stabilisation on medication.
if the QbTest test is, as NICE recommends, to be used along with clinical assessment, it is not going to speed anything up for anyone. As others have rightly pointed, the bottle neck is the clinical assessment service, not GPs. I wander if it is going to be used as self- diagnositc tool by those keen to “self- identify” as having ADHD, with ensuing rights to demand different conditions of education or employment.