Practitioner Review: Clinical utility of the QbTest for the assessment and diagnosis of ADHD: a systematic review and meta-analysis

Bellato, Alessio; Hall, Charlotte L.; Groom, Madeleine J.; Simonoff, Emily; Thapar, Anita; Hollis, Chris; Cortese, Samuele

Abstract

Background
Several computerised cognitive tests (e.g. continuous performance test) have been developed to support the clinical assessment of attention-deficit/hyperactivity disorder (ADHD). Here, we appraised the evidence-base underpinning the use of one of these tests – the QbTest – in clinical practice, by conducting a systematic review and meta-analysis investigating its accuracy and clinical utility.

Methods
Based on a preregistered protocol (CRD42022377671), we searched PubMed, Medline, Ovid Embase, APA PsycINFO and Web of Science on 15th August 2022, with no language/type of document restrictions. We included studies reporting accuracy measures (e.g. sensitivity, specificity, or Area under the Receiver Operating Characteristics Curve, AUC) for QbTest in discriminating between people with and without DSM/ICD ADHD diagnosis. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A generic inverse variance meta-analysis was conducted on AUC scores. Pooled sensitivity and specificity were calculated using a random-effects bivariate model in R.

Results
We included 15 studies (2,058 participants; 48.6% with ADHD). QbTest Total scores showed acceptable, rather than good, sensitivity (0.78 [95% confidence interval: 0.69; 0.85]) and specificity (0.70 [0.57; 0.81]), while subscales showed low-to-moderate sensitivity (ranging from 0.48 [0.35; 0.61] to 0.65 [0.52; 0.75]) and moderate-to-good specificity (from 0.65 [0.48; 0.78] to 0.83 [0.60; 0.94]). Pooled AUC scores suggested moderate-to-acceptable discriminative ability (Q-Total: 0.72 [0.57; 0.87]; Q-Activity: 0.67 [0.58; 0.77); Q-Inattention: 0.66 [0.59; 0.72]; Q-Impulsivity: 0.59 [0.53; 0.64]).

Conclusions
When used on their own, QbTest scores available to clinicians are not sufficiently accurate in discriminating between ADHD and non-ADHD clinical cases. Therefore, the QbTest should not be used as stand-alone screening or diagnostic tool, or as a triage system for accepting individuals on the waiting-list for clinical services. However, when used as an adjunct to support a full clinical assessment, QbTest can produce efficiencies in the assessment pathway and reduce the time to diagnosis.

Citation

Bellato, A., Hall, C. L., Groom, M. J., Simonoff, E., Thapar, A., Hollis, C., & Cortese, S. (2024). Practitioner Review: Clinical utility of the QbTest for the assessment and diagnosis of ADHD: a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry, 65(6), 845-861. https://doi.org/10.1111/jcpp.13901

• Journal Article Type: Review
• Acceptance Date: Aug 4, 2023
• Online Publication Date: Oct 6, 2023
• Publication Date: 2024-06
• Deposit Date: Aug 16, 2023
• Publicly Available Date: Oct 6, 2023
• Journal: Journal of Child Psychology and Psychiatry
• Print ISSN: 0021-9630
• Electronic ISSN: 1469-7610
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 65
• Issue: 6
• Pages: 845-861
• DOI: https://doi.org/10.1111/jcpp.13901
• Keywords: QbTest; ADHD; validity; sensitivity; specificity; AUC
• Public URL: https://nottingham-repository.worktribe.com/output/24417573
• Publisher URL: https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13901