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Bellato A, Hall CL, Groom MJ, Simonoff E, Thapar A, Hollis C, Cortese S. Practitioner Review: Clinical utility of the QbTest for the assessment and diagnosis of attention-deficit/hyperactivity disorder - a systematic review and meta-analysis. J Child Psychol Psychiatry 2024; 65:845-861. [PMID: 37800347 DOI: 10.1111/jcpp.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
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.
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Affiliation(s)
- Alessio Bellato
- School of Psychology, University of Nottingham, Nottingham, Malaysia
- Mind & Neurodevelopment (MiND) Research Cluster, University of Nottingham, Nottingham, Malaysia
| | - Charlotte L Hall
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Wolfson Centre for Young People's Mental Health, Cardiff University School of Medicine, Cardiff, UK
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Samuele Cortese
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
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Gustafsson U, Hansen M. QbTest for Monitoring Medication Treatment Response in ADHD: A Systematic Review. Clin Pract Epidemiol Ment Health 2023; 19:e17450179276630. [PMID: 38164455 PMCID: PMC10758132 DOI: 10.2174/0117450179276630231030093814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024]
Abstract
Introduction Attention deficit hyperactivity disorder (ADHD) is considered one of the most common neurodevelopmental disorders in childhood and adolescence. Pharmacological treatment plays an important part in the therapy of the disorder and verifying the effectiveness of ADHD medication is essential throughout the course of treatment. QbTest is a computerized test, for which intended use is to provide healthcare professionals with objective measurements of hyperactivity, impulsivity, and inattention to aid in the clinical assessment of ADHD and the evaluation of treatment interventions. Methods A systematic review of relevant articles was conducted for which QbTest was used for monitoring medication treatment response in ADHD. Literature published between 2004 and 2023 was appraised. Results A total of 15 studies were included in the review. Thirteen articles involved subjects diagnosed with ADHD and two studies that were related to the disorder, which evaluated QbTest in medication treatment response. Changes in QbTest data such as Q-scores, effect size, or improvement/deterioration of QbTest variables were evaluated. A clinically relevant decrease in QbTest Q-scores was found in the majority of the studies when treated with any type of ADHD medication in therapeutic doses, both in comparison to placebo and when compared from baseline to endpoint treatment. Conclusion QbTest can distinguish pharmacological treatment effects within hours of pharmacological titration and can be used for monitoring of long-term treatment of ADHD. A need for optimization and individualization of medication treatment response could be addressed with access to objective measures in ADHD management.
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Affiliation(s)
- Urban Gustafsson
- Qbtech AB, Medical Department, Cardellgatan 1, 11436 Stockholm, Sweden
| | - Mikkel Hansen
- Qbtech AB, Medical Department, Cardellgatan 1, 11436 Stockholm, Sweden
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Löhman M, Domingo B, Östlund M, Jansson L. Contrasting expectancy effects with objective measures in adults with untreated ADHD during QbTest. Scand J Psychol 2023. [PMID: 36786078 DOI: 10.1111/sjop.12906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
Expectancy has been associated with neuropsychological assessments and cognitive performance. However, little is known about the effects of expectations in clinical assessments during drug trials with continuous performance tests (CPTs). In a randomized, double-blind study with cross-over design, we examined if the participants' self-reported expectations changed after one-single dose immediate release methylphenidate (MPH) and after one-single dose placebo during the QbTest. Forty adults between 19 and 64 years (72.5% women) with un treated ADHD were consecutively enrolled in the study and their assessments of expected performance, mental effort, perceived performance and help from the pill were analyzed. The study comprised two trial days with four days in between. The QbTest was performed twice on the same day, before and 80 minutes after a pill. Our study demonstrates that there were expectancy effects during CPTs. Participants reported lower mental effort and improved their performance in the coronary parameter QbInattention both after MPH and after placebo. No significant differences in expected performance were reported. The participants seemed to show some uncertainty when assessing their expected performance, however, they could evaluate their performance afterwards. In clinical practice, the focus should be on reinforcing patients' expectations in order to increase treatment effects.
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Affiliation(s)
- Monica Löhman
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Blanca Domingo
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Mona Östlund
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
| | - Lennart Jansson
- Psychiatric Clinic (in association with Centre for Clinical Research, Uppsala University, Sweden), Uppsala, Sweden
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Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2023; 32:921-935. [PMID: 36764972 PMCID: PMC9918404 DOI: 10.1007/s00787-023-02148-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023]
Abstract
The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.
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Chitsabesan P, Hall CL, Carter LA, Reeves M, Mohammed V, Beresford B, Young S, Kraam A, Trowse S, Wilkinson-Cunningham L, Lennox C. Using an objective computer task (QbTest) to aid the identification of attention deficit hyperactivity disorder (ADHD) in the Children and Young People Secure Estate (CYPSE): a feasibility randomised controlled trial. BMJ Open 2022; 12:e064951. [PMID: 36526320 PMCID: PMC9764651 DOI: 10.1136/bmjopen-2022-064951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES QbTest has been shown to improve time to decision/diagnosis for young people with attention deficit hyperactivity disorder (ADHD). The aim was to assess the feasibility of QbTest for young people in prison. DESIGN Single-centre feasibility randomised controlled trial (RCT), with 1:1 allocation. Concealed random allocation using an online pseudorandom list with random permuted blocks of varying sizes. SETTING One Young Offenders Institution in England. PARTICIPANTS 355 young people aged 15-18 years displaying possible symptoms of ADHD were assessed for eligibility, 69 were eligible to take part and 60 were randomised. INTERVENTION QbTest-a computer task measuring attention, activity and impulsivity. MAIN OUTCOME MEASURES Eligibility, recruitment and retention rates and acceptability of randomisation and trial participation. RESULTS Of the 355 young people assessed for eligibility, 69 were eligible and 60 were randomised (n=30 QbTest plus usual care; n=30 usual care alone). The study achieved the specified recruitment target. Trial participation and randomisation were deemed acceptable by the majority of participants. 78% of young people were followed up at 3 months, but only 32% at 6 months, although this was also affected by COVID-19 restrictions. Secondary outcomes were mixed. Participants including clinical staff were mostly supportive of the study and QbTest; however, some young people found QbTest hard and there were issues with implementation of the ADHD care pathway. There were no serious adverse events secondary to the study or intervention and no one was withdrawn from the study due to an adverse event. CONCLUSIONS With adaptations, a fully powered RCT may be achievable to evaluate the effectiveness of QbTest in the assessment of ADHD in the Children and Young People Secure Estate, with time to decision (days) as the primary outcome measure. However, further programme developmental work is required to address some of the challenges highlighted prior to a larger trial. TRIAL REGISTRATION NUMBER ISRCTN17402196.
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Affiliation(s)
- Prathiba Chitsabesan
- Children and Young People's Research Unit, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Charlotte Lucy Hall
- Psychiatry, Institute of Mental Health, NIHR CLAHRC-East Midlands, Nottingham, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Mindy Reeves
- Medical School, The University of Manchester, Manchester, UK
| | - Vaseem Mohammed
- Medical School, The University of Manchester, Manchester, UK
| | | | - Susan Young
- Department of Clinical and Forensic Psychology, Psychology ServicesLimited, London, UK
- Department of Psychology, University of Reykjavik, Reykjavik, Iceland
| | - Abdullah Kraam
- Children and Adolescent Mental Health, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Sally Trowse
- Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Charlotte Lennox
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Nylander E, Sparding T, Floros O, Rydén E, Landén M, Hansen S. The Quantified Behavioural Test Plus (QbTest+) in adult ADHD. NORDIC PSYCHOLOGY 2022. [DOI: 10.1080/19012276.2022.2036628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elin Nylander
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Timea Sparding
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Orestis Floros
- Stockholm Center for Dependency Disorders, Lifestyle Treatment Unit, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eleonore Rydén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Hansen
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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Lee WH, Kim JI, Kwon AM, Cha JH, Yim D, Lim YH, Cho SH, Cho SH, Park HK. Quantified assessment of hyperactivity in ADHD youth using IR-UWB radar. Sci Rep 2021; 11:9604. [PMID: 33953298 PMCID: PMC8100299 DOI: 10.1038/s41598-021-89024-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/20/2021] [Indexed: 11/09/2022] Open
Abstract
Research on the quantification of hyperactivity in youth with attention-deficit/hyperactivity disorder (ADHD) has been limited and inconsistent. The purpose of this study was to test the discriminative value of impulse-radio ultra-wideband (IR-UWB) radar for monitoring hyperactive individuals with ADHD and healthy controls (HCs). A total of 10 ADHD patients and 15 HCs underwent hyperactivity assessment using IR-UWB radar during a 22-min continuous performance test. We applied functional ANOVA to compare the mean functions of activity level between the 2 groups. We found that the mean function of activity over time was significantly different and that the activity level of the ADHD group slightly increased over time with high dispersion after approximately 7 min, which means that the difference in activity level between the two groups became evident at this period. Further studies with larger sample sizes and longer test times are warranted to investigate the effect of age, sex, and ADHD subtype on activity level function.
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Affiliation(s)
- Won Hyuk Lee
- Department of Electronics and Computer Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea
| | - Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Amy M Kwon
- Biostatistical Consulting and Research Laboratory, Medical Research Collaborating Center, Seoul, Republic of Korea
| | - Jong Ho Cha
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | | | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seok-Hyun Cho
- Department of Otorhinolaryngology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Ho Cho
- Department of Electronics and Computer Engineering, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Republic of Korea.
| | - Hyun-Kyung Park
- Division of Neonatology, Department of Pediatrics, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Williams L, Hall CL, Brown S, Guo B, James M, Franceschini M, Clarke J, Selby K, Vijayan H, Kulkarni N, Brown N, Sayal K, Hollis C, Groom MJ. Optimising medication management in children and young people with ADHD using a computerised test (QbTest): a feasibility randomised controlled trial. Pilot Feasibility Stud 2021; 7:68. [PMID: 33726855 PMCID: PMC7962270 DOI: 10.1186/s40814-021-00788-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication for attention deficit hyperactivity disorder (ADHD) should be closely monitored to ensure optimisation. There is growing interest in using computerised assessments of ADHD symptoms to support medication monitoring. The aim of this study was to assess the feasibility and acceptability of a randomised controlled trial (RCT) to evaluate the efficacy of one such computerised assessment, the Quantified Behavior (Qb) Test, as part of medication management for ADHD. METHODS This feasibility multi-site RCT conducted in child and adolescent mental health and community paediatric settings recruited participants aged 6-15 years diagnosed with ADHD starting stimulant medication. Participants were randomised into one of two arms: experimental (QbTest protocol) where participants completed a QbTest at baseline and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later) and control where participants received treatment as usual, including at least two follow-up consultations. Measures of parent, teacher, and clinician-rated symptoms and global functioning were completed at each time point. Clinicians recorded treatment decision-making and health economic measures were obtained. Data were analysed using multi-level modelling and participants (children and parents) and clinicians were interviewed about their experiences, resulting data were thematically analysed. RESULTS Forty-four children and young people were randomised. Completion of study outcome measures by care-givers and teachers ranged from 52 to 78% at baseline to 47-65% at follow-up. Participants reported the questionnaires to be useful to complete. SNAP-IV inattention scores showed greater reduction in the intervention than the control group (- 5.85, 95% CI - 10.33, - 1.36,). Engagement with the intervention ranged from 100% at baseline, to 78% follow-up 1 and 57% follow-up 2. However, only 37% of QbTests were conducted in the correct time period. Interview data highlighted that the objectivity of the QbTest was appreciated by clinicians and parents. Clinicians commented that the additional time and resources required meant that it is not feasible to use QbTest for all cases. CONCLUSION The trial design and protocol appear to be feasible and acceptable but could be improved by modifying QbTest time periods and the method of data collection. With these changes, the protocol may be appropriate for a full trial. Adding QbTest may improve symptom outcome as measured by SNAP-IV. TRIAL REGISTRATION ClinicalTrials.gov, NCT03368573 , prospectively registered, 11th December 2017, and ISRCTN, ISRCTN69461593 , retrospectively registered, 10th April 2018.
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Affiliation(s)
- Laura Williams
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Charlotte L Hall
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Susan Brown
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Boliang Guo
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Marilyn James
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Julie Clarke
- United Lincolnshire Hospitals NHS Trust, Grantham and District Hospital, Grantham, Lincolnshire, UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Hena Vijayan
- North East London NHS Foundation Trust, Havering CAMHS, Essex, UK
| | | | - Nikki Brown
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Kapil Sayal
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,Centre for ADHD and Neurodevelopmental Disorders (CANDAL), University of Nottingham, Nottingham, UK
| | - Chris Hollis
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
| | - Madeleine J Groom
- School of Medicine, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.,Centre for ADHD and Neurodevelopmental Disorders (CANDAL), University of Nottingham, Nottingham, UK.,NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, UK
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Knez R, Stevanovic D, Nasic S, Doric A, Wentz E. The Impact of Methylphenidate on QbTest Performance of Children with ADHD: A Retrospective Clinical Study. Neuropsychiatr Dis Treat 2021; 17:19-32. [PMID: 33447036 PMCID: PMC7802589 DOI: 10.2147/ndt.s277490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Quantified behavior Test (QbTest), which combines a continuous performance task (CPT) and motion tracking, provides data for the core signs of attention-deficit/hyperactivity disorder (ADHD): attention, hyperactivity, and impulsivity. This study aimed to evaluate the performance of children and adolescents with ADHD on the QbTest before and after a single methylphenidate (MPH) dose. SUBJECTS AND METHODS This retrospective chart review study included data from 149 children and 215 adolescents who completed the QbTest. A summary index of the CPT and motion capture data on the QbTest is provided by three cardinal parameters: QbActivity, QbImpulsivity, and QbInattention. The test was performed twice on the same day, before and up to three hours after MPH intake. A decrease by ≥ 0.5 in a cardinal parameter score was considered an improvement, whereas an increase by ≥ 0.5 a deterioration. RESULTS QbActivity improvement after MPH intake was present in 71.7% and 76.2% of the children and adolescents, respectively. QbImpulsivity improvement was observed in 50.4% of the children and 44.7% of the adolescents, and QbInattention improvement in 85.1% and 91.1% of the children and adolescents, respectively. All three parameters improved simultaneously in 27.7% of the children and 28.7% of the adolescents. The likelihood that one parameter deteriorated after MPH use was greater if that parameter was within the normal range before medication. This was most pronounced for QbImpulsivity. Among male adolescents, QbInattention improvement was often accompanied by QbImpulsivity deterioration. CONCLUSION The QbTest inattention and motor activity parameters improved markedly after a single MPH dose in children and adolescents with ADHD, while less so for impulsivity. Improvement of one parameter is not necessarily associated with improvement of the other two, and deterioration, especially regarding impulsivity, may occur. If confirmed, these results highlight the need for optimization and individualization of MPH treatment, while monitoring all aspects of the ADHD symptomatology based on the QbTest performance.
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Affiliation(s)
- Rajna Knez
- Department of Pediatrics, Skaraborgs Hospital, Skövde, Sweden; Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Dejan Stevanovic
- Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Salmir Nasic
- Research & Development Centre, Skaraborgs Hospital, Skövde, Sweden
| | - Ana Doric
- Department of Psychology, Faculty of Humanity and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Elisabet Wentz
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Slobodin O, Yahav I, Berger I. A Machine-Based Prediction Model of ADHD Using CPT Data. Front Hum Neurosci 2020; 14:560021. [PMID: 33093829 PMCID: PMC7528635 DOI: 10.3389/fnhum.2020.560021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Despite the popularity of the continuous performance test (CPT) in the diagnosis of attention-deficit/hyperactivity disorder (ADHD), its specificity, sensitivity, and ecological validity are still debated. To address some of the known shortcomings of traditional analysis and interpretation of CPT data, the present study applied a machine learning-based model (ML) using CPT indices for the Prediction of ADHD.Using a retrospective factorial fitting, followed by a bootstrap technique, we trained, cross-validated, and tested learning models on CPT performance data of 458 children aged 6–12 years (213 children with ADHD and 245 typically developed children). We used the MOXO-CPT version that included visual and auditory stimuli distractors. Results showed that the ML proposed model performed better and had a higher accuracy than the benchmark approach that used clinical data only. Using the CPT total score (that included all four indices: Attention, Timeliness, Hyperactivity, and Impulsiveness), as well as four control variables [age, gender, day of the week (DoW), time of day (ToD)], provided the most salient information for discriminating children with ADHD from their typically developed peers. This model had an accuracy rate of 87%, a sensitivity rate of 89%, and a specificity rate of 84%. This performance was 34% higher than the best-achieved accuracy of the benchmark model. The ML detection model could classify children with ADHD with high accuracy based on CPT performance. ML model of ADHD holds the promise of enhancing, perhaps complementing, behavioral assessment and may be used as a supportive measure in the evaluation of ADHD.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Israel
- *Correspondence: Ortal Slobodin
| | - Inbal Yahav
- Coller School of Management, Tel Aviv University, Tel Aviv, Israel
| | - Itai Berger
- Pediatric Neurology, Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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Ulberstad F, Boström H, Chavanon M, Knollmann M, Wiley J, Christiansen H, Thorell LB. Objective measurement of attention deficit hyperactivity disorder symptoms outside the clinic using the QbCheck: Reliability and validity. Int J Methods Psychiatr Res 2020; 29:e1822. [PMID: 32100383 PMCID: PMC7301281 DOI: 10.1002/mpr.1822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
Objective measurements of ADHD symptom levels can be a highly valuable complement to ratings. However, sometimes it is not feasible to bring patients into the clinic/lab for assessment. The aim of the present study was therefore to evaluate the psychometric properties of the QbCheck, an online computerized test that measures errors and reaction time as well as activity during testing using the computer's built-in web camera. Study I (n = 27 adolescents/adults) investigated test-retest reliability and concurrent validity of the QbCheck. Study II included 142 adolescents/adults (69 with ADHD/73 controls) and investigated convergent and diagnostic validity, as well as usability, of the QbCheck. In Study I, the QbCheck showed high test-retest reliability and high concurrent validity. In Study II, high convergent validity was observed when studying associations between the QbCheck performed in the home and the QbTest performed at the clinic. In addition, the QbCheck discriminated well between patients with ADHD and controls, with a sensitivity of 82.6 and a specificity of 79.5. The QbCheck appears to be a valuable test with good psychometric properties and will thereby enable assessment of ADHD symptom levels in adolescents and adults outside the clinic in the home setting.
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Affiliation(s)
- Fredrik Ulberstad
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Hans Boström
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Mira‐Lynn Chavanon
- Clinical Child and Adolescent Psychology, Department of PsychologyPhilipps University MarburgGermany
| | - Martin Knollmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and PsychotherapyUniversity Hospital Essen, University of Duisburg‐EssenEssenGermany
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of PsychologyPhilipps University MarburgGermany
| | - Lisa B. Thorell
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
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12
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Valentine AZ, Brown BJ, Groom MJ, Young E, Hollis C, Hall CL. A systematic review evaluating the implementation of technologies to assess, monitor and treat neurodevelopmental disorders: A map of the current evidence. Clin Psychol Rev 2020; 80:101870. [PMID: 32712216 DOI: 10.1016/j.cpr.2020.101870] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
Technology-based interventions provide an attractive option for improving service provision for neurodevelopmental disorders (NDD), for example, widening access to interventions, objective assessment, and monitoring; however, it is unclear whether there is sufficient evidence to support their use in clinical settings. This review provides an evidence map describing how technology is implemented in the assessment/diagnosis and monitoring/ treatment of NDD (Prospero CRD42018091156). Using predefined search terms in six databases, 7982 articles were identified, 808 full-texts were screened, resulting in 47 included papers. These studies were appraised and synthesised according to the following outcomes of interest: effectiveness (clinical effectiveness/ service delivery efficiencies), economic impact, and user impact (acceptability/ feasibility). The findings describe how technology is currently being utilised clinically, highlights gaps in knowledge, and discusses future research needs. Technology has been used to facilitate assessment and treatment across multiple NDD, especially Autism Spectrum (ASD) and attention-deficit/hyperactivity (ADHD) disorders. Technologies include mobile apps/tablets, robots, gaming, computerised tests, videos, and virtual reality. The outcomes presented largely focus on the clinical effectiveness of the technology, with approximately half the papers demonstrating some degree of effectiveness, however, the methodological quality of many studies is limited. Further research should focus on randomised controlled trial designs with longer follow-up periods, incorporating an economic evaluation, as well as qualitative studies including process evaluations and user impact.
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Affiliation(s)
- Althea Z Valentine
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
| | - Beverley J Brown
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Emma Young
- Nottinghamshire Healthcare NHS Foundation Trust, Library and Knowledge Services, Duncan Macmillan House Staff Library, Porchester Road, Nottingham, UK
| | - Chris Hollis
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK; Department of Child and Adolescent Psychiatry, South Block E Floor, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Charlotte L Hall
- Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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13
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Lennox C, Hall CL, Carter LA, Beresford B, Young S, Kraam A, Brown N, Wilkinson-Cunningham L, Reeves M, Chitsabesan P. FACT: a randomised controlled trial to assess the feasibility of QbTest in the assessment process of attention deficit hyperactivity disorder (ADHD) for young people in prison-a feasibility trial protocol. BMJ Open 2020; 10:e035519. [PMID: 31964678 PMCID: PMC7044874 DOI: 10.1136/bmjopen-2019-035519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The prevalence of attention deficit hyperactivity disorder (ADHD) within the Children and Young People Secure Estate (CYPSE) is much higher than seen in the general population. To make a diagnosis of ADHD, clinicians draw on information from multiple sources, including parents and teachers. However, obtaining these is particularly difficult for young people in the secure estate. There is increasing evidence in the community that QbTest is able to assist in the accurate and earlier diagnosis of ADHD. The objective of this study is to assess the feasibility and acceptability of QbTest in the assessment of ADHD within the CYPSE. METHODS AND ANALYSIS A single-centre parallel group feasibility randomised controlled trial will be conducted. Sixty young people within the CYPSE identified as displaying possible symptoms of ADHD will be randomised to the intervention arm (n=30; QbTest plus usual care) or control arm (n=30; usual care). Primary analyses will be descriptive and a process evaluation will be conducted to assess the contexts involved in implementing the intervention. Interviews will be conducted to explore acceptability and thematic analysis will be used to analyse the data. ETHICS AND DISSEMINATION This study was approved by National Health Service Wales research ethics committee 3 (18/WA/0347) on 15 February 2019. The findings will be published in peer-reviewed journals, presented at relevant conferences and disseminated to the public via summaries cocreated with our patient and public involvement group. TRIAL REGISTRATION NUMBER ISRCTN17402196.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Charlotte Lucy Hall
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Lesley-Anne Carter
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Bryony Beresford
- Social Policy Research Unit, University of York, York, North Yorkshire, UK
| | - Susan Young
- Department of Clinical and Forensic Psychology, Psychology Services Limited, London, UK
| | - Abdullah Kraam
- Child and Adolescent Mental Health Service, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
| | - Nikki Brown
- Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Mindy Reeves
- Medical School, The University of Manchester, Manchester, UK
| | - Prathiba Chitsabesan
- Child and Adolescent Mental Health Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, Lancashire, UK
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Stobernack T, de Vries SPW, Rodrigues Pereira R, Pelsser LM, Ter Braak CJF, Aarts E, van Baarlen P, Kleerebezem M, Frankena K, Hontelez S. Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) - study protocol of an open-label trial to investigate the mechanisms underlying the effects of a few-foods diet on ADHD symptoms in children. BMJ Open 2019; 9:e029422. [PMID: 31694844 PMCID: PMC6858247 DOI: 10.1136/bmjopen-2019-029422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common childhood behavioural disorder, causing significant impediment to a child's development. It is a complex disorder with numerous contributing (epi)genetic and environmental factors. Currently, treatment consists of behavioural and pharmacological therapy. However, ADHD medication is associated with several side effects, and concerns about long-term effects and efficacy exist. Therefore, there is considerable interest in the development of alternative treatment options. Double-blind research investigating the effects of a few-foods diet (FFD) has demonstrated a significant decrease in ADHD symptoms following an FFD. However, an FFD requires a considerable effort of both child and parents, limiting its applicability as a general ADHD treatment. To make FFD intervention less challenging or potentially obsolete, we need to understand how, and in which children, an FFD affects ADHD behaviour and, consequently, the child's well-being. We hypothesise that an FFD affects brain function, and that the nutritional impact on ADHD is effectuated by a complex interplay between the microbiota, gut and brain, that is, the microbiota-gut-brain axis. METHODS AND ANALYSIS The Biomarker Research in ADHD: the Impact of Nutrition (BRAIN) study is an open-label trial with researchers blinded to changes in ADHD symptoms during sample processing and initial data analyses. ETHICS AND DISSEMINATION The Medical Research and Ethics Committee of Wageningen University has approved this study (NL63851.081.17, application 17/24). Results will be disseminated through peer-reviewed journal publications, conference presentations, (social) media and the BRAIN study website. A summary of the findings will be provided to the participants. TRIAL REGISTRATION NUMBER NCT03440346. STUDY DATES Collection of primary outcome data started in March 2018 and will be ongoing until 100 children have participated in the study. Sample data analysis will start after all samples have been collected.
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Affiliation(s)
- Tim Stobernack
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Stefan P W de Vries
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | | | | | - Cajo J F Ter Braak
- Biometris, Wageningen University and Research, Wageningen, The Netherlands
| | - Esther Aarts
- Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
| | - Peter van Baarlen
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Michiel Kleerebezem
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
| | - Klaas Frankena
- Adaptation Physiology, Wageningen University and Research, Wageningen, The Netherlands
| | - Saartje Hontelez
- Host-Microbe Interactomics, Wageningen University and Research, Wageningen, The Netherlands
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15
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Bijlenga D, Ulberstad F, Thorell LB, Christiansen H, Hirsch O, Kooij JJS. Objective assessment of attention-deficit/hyperactivity disorder in older adults compared with controls using the QbTest. Int J Geriatr Psychiatry 2019; 34:1526-1533. [PMID: 31243809 DOI: 10.1002/gps.5163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/29/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Attention-deficit/hyperactivity disorder (ADHD) persists into old age, with prevalence rates of 2.8% to 3.3% in adults over 60 years of age. Most diagnostic assessment tools are not validated for older adults. The Quantified behavioral Test (QbTest) is an objective assessment for the core symptoms of ADHD and is validated for children and younger adults. We investigated whether the QbTest can be used to differentiate between older adults with ADHD and healthy controls. METHODS Older adults aged 55 to 79 years with (n = 97) or without (n = 112) ADHD were assessed with the QbTest. They also rated their ADHD symptom severity. QbTest raw scores were compared between groups. Factor scores were computed using factor loadings from a confirmatory factor analysis (CFA). Multilevel regressions were used to determine effects of background characteristics and comorbidity. Logistic regressions were performed to determine whether the QbTest differentiated between patients with ADHD and healthy controls. RESULTS The factor structure of the CFA was comparable with that of younger age groups. Older age was associated with higher Inattention score. Parameters comprising the factors Hyperactivity and Inattention, but not Impulsivity, were shown to contribute significantly in differentiating between the groups. The QbTest had a correct classification rate of 70%, which was increased to 91% when combining QbTest scores and self-reports of ADHD symptom severity. CONCLUSIONS The QbTest is feasible for older adults, and the factors Hyperactivity and Inattention are valid parameters for the diagnostic assessment of ADHD in older adults, when used in addition to self-reports.
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Affiliation(s)
- Denise Bijlenga
- Expertise Center Adult ADHD, PsyQ, The Hague, The Netherlands
| | - Fredrik Ulberstad
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Qbtech, Stockholm, Sweden
| | - Lisa B Thorell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University, Marburg, Germany
| | | | - J J Sandra Kooij
- Expertise Center Adult ADHD, PsyQ, The Hague, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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16
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Hall CL, Brown S, James M, Martin JL, Brown N, Selby K, Clarke J, Williams L, Sayal K, Hollis C, Groom MJ. Consensus workshops on the development of an ADHD medication management protocol using QbTest: developing a clinical trial protocol with multidisciplinary stakeholders. BMC Med Res Methodol 2019; 19:126. [PMID: 31215440 PMCID: PMC6582552 DOI: 10.1186/s12874-019-0772-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/09/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The study design and protocol that underpin a randomised controlled trial (RCT) are critical for the ultimate success of the trial. Although RCTs are considered the gold standard for research, there are multiple threats to their validity such as participant recruitment and retention, identifying a meaningful change, and non-adherence to the protocol. For clinical RCTs, involving patients and clinicians in protocol design provides the opportunity to develop research protocols that are meaningful to their target audience and may help overcome some of the inherent threats in conducting RCTs. However, the majority of protocols do not describe the methodology underpinning their development, limiting the amount of learned experience shared between research groups. METHOD With the purpose of reporting a collaborative approach towards developing a protocol, we present the findings from three sequential workshops that were conducted with the aim of developing a protocol to investigate the feasibility of adding a computerised test of attention, impulsivity and activity (QbTest) to medication management of children and young people with Attention deficit hyperactivity disorder (ADHD). Based on previous qualitative interviews with clinicians and families, each workshop prioritised topics for focused discussion. Information from the workshops was fed back to the participants for reflection in advance of the next workshop. RESULTS The workshops involved 21 multi-disciplinary ADHD experts, including clinicians, patient and public involvement (PPI) members, parents of young people with ADHD and researchers. The consensus workshops addressed key research issues such as: the most relevant outcome measures/ resource drivers; methods and time points for data collection; and the clinical protocol for utilising the QbTest, including when best to use this within the medication management process. The resulting protocol details a feasibility RCT design describing these factors. CONCLUSION Protocols which are co-developed may help overcome some of the risks associated with RCT completion (e.g. recruitment, retention, protocol adherence) and help prioritise outcomes of greater relevance to the populations under study. The methodology has potential value for researchers and organisations developing clinical guidelines, and offers insights into the valuable impact of PPI upon trial design. TRIAL REGISTRATION Clinicaltrials.gov NCT03368573, 11th December 2017 (retrospectively registered).
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Affiliation(s)
- Charlotte L. Hall
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Susan Brown
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Jennifer L. Martin
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Nikki Brown
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Julie Clarke
- Acting Consultant Community Paediatrics, Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
| | - Laura Williams
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Kapil Sayal
- Child and Adolescent, Developmental Psychiatry, School of Medicine, University of Nottingham and CANDAL (Centre for ADHD and Neuro-developmental Disorders across the Lifespan), Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Chris Hollis
- Devlopmental Psychiatry Queens Medical Centre, School of Medicine, and MindTech, Institute of Mental, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
| | - Madeleine J. Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU UK
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17
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Quantified Activity Measurement for Medical Use in Movement Disorders through IR-UWB Radar Sensor. SENSORS 2019; 19:s19030688. [PMID: 30744003 PMCID: PMC6387084 DOI: 10.3390/s19030688] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 11/16/2022]
Abstract
Movement disorders, such as Parkinson's disease, dystonia, tic disorder, and attention-deficit/hyperactivity disorder (ADHD) are clinical syndromes with either an excess of movement or a paucity of voluntary and involuntary movements. As the assessment of most movement disorders depends on subjective rating scales and clinical observations, the objective quantification of activity remains a challenging area. The purpose of our study was to verify whether an impulse radio ultra-wideband (IR-UWB) radar sensor technique is useful for an objective measurement of activity. Thus, we proposed an activity measurement algorithm and quantitative activity indicators for clinical assistance, based on IR-UWB radar sensors. The received signals of the sensor are sufficiently sensitive to measure heart rate, and multiple sensors can be used together to track the positions of people. To measure activity using these two features, we divided movement into two categories. For verification, we divided these into several scenarios, depending on the amount of activity, and compared with an actigraphy sensor to confirm the clinical feasibility of the proposed indicators. The experimental environment is similar to the environment of the comprehensive attention test (CAT), but with the inclusion of the IR-UWB radar. The experiment was carried out, according to a predefined scenario. Experiments demonstrate that the proposed indicators can measure movement quantitatively, and can be used as a quantified index to clinically record and compare patient activity. Therefore, this study suggests the possibility of clinical application of radar sensors for standardized diagnosis.
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18
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Hollis C, Hall CL, Guo B, James M, Boadu J, Groom MJ, Brown N, Kaylor-Hughes C, Moldavsky M, Valentine AZ, Walker GM, Daley D, Sayal K, Morriss R. The impact of a computerised test of attention and activity (QbTest) on diagnostic decision-making in children and young people with suspected attention deficit hyperactivity disorder: single-blind randomised controlled trial. J Child Psychol Psychiatry 2018; 59:1298-1308. [PMID: 29700813 PMCID: PMC6124643 DOI: 10.1111/jcpp.12921] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of attention deficit hyperactivity disorder (ADHD) relies on subjective methods which can lead to diagnostic uncertainty and delay. This trial evaluated the impact of providing a computerised test of attention and activity (QbTest) report on the speed and accuracy of diagnostic decision-making in children with suspected ADHD. METHODS Randomised, parallel, single-blind controlled trial in mental health and community paediatric clinics in England. Participants were 6-17 years-old and referred for ADHD diagnostic assessment; all underwent assessment-as-usual, plus QbTest. Participants and their clinician were randomised to either receive the QbTest report immediately (QbOpen group) or the report was withheld (QbBlind group). The primary outcome was number of consultations until a diagnostic decision confirming/excluding ADHD within 6-months from baseline. Health economic cost-effectiveness and cost utility analysis was conducted. Assessing QbTest Utility in ADHD: A Randomised Controlled Trial was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02209116). RESULTS One hundred and thirty-two participants were randomised to QbOpen group (123 analysed) and 135 to QbBlind group (127 analysed). Clinicians with access to the QbTest report (QbOpen) were more likely to reach a diagnostic decision about ADHD (hazard ratio 1.44, 95% CI 1.04-2.01). At 6-months, 76% of those with a QbTest report had received a diagnostic decision, compared with 50% without. QbTest reduced appointment length by 15% (time ratio 0.85, 95% CI 0.77-0.93), increased clinicians' confidence in their diagnostic decisions (odds ratio 1.77, 95% CI 1.09-2.89) and doubled the likelihood of excluding ADHD. There was no difference in diagnostic accuracy. Health economic analysis showed a position of strict dominance; however, cost savings were small suggesting that the impact of providing the QbTest report within this trial can best be viewed as 'cost neutral'. CONCLUSIONS QbTest may increase the efficiency of ADHD assessment pathway allowing greater patient throughput with clinicians reaching diagnostic decisions faster without compromising diagnostic accuracy.
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Affiliation(s)
- Chris Hollis
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Janet Boadu
- Division of Rehabilitation and Ageing, School of Medicine, B132 Queens Medical Centre, University Of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Catherine Kaylor-Hughes
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Maria Moldavsky
- Nottinghamshire Healthcare NHS Foundation Trust, West Nottinghamshire Community Team, Mansfield, UK
| | - Althea Z Valentine
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Gemma M Walker
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - David Daley
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Richard Morriss
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Handal N, LePage J, Dayley P, Baldwin B, Roeser A, Kay J, Theobald HA, Nellamattathil M, Drotar S, Weir C, Tindell N, Tice K. Validation, reliability, and specificity of CliniCom™ Psychiatric Assessment Software. Psychiatry Res 2018; 265:334-340. [PMID: 29778712 DOI: 10.1016/j.psychres.2018.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/11/2018] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to determine the specificity and reproducibility of CliniCom™ Psychiatric Assessment Software to appropriately diagnose five prevalent mental health disorders. This online assessment tool incorporates proprietary algorithms for its propensity assessment. Unlike other questionnaires, which require a survey per specific mental disorder, CliniCom can simultaneously assess multiple mental disorders for an individual. CliniCom was concordant with other commonly used assessment tools in diagnosing five prevalent disorders including: Attention Deficit and Hyperactivity Disorder, Generalized Anxiety Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder, and Social Phobia. The online tool was overall 78% concordant in diagnosing the same disorder during a test-retest analysis. When subjects exhibited two, three, or four disorders, the tool was less consistent in diagnosing the same set of disorders during the test-retest analysis (53% concordant). However, if evaluated as individual disorders within subjects, the more persistent disorders had a higher rate of concordance: MDD (83.3%), ADHD (81.0%), and OCD (68.4%). This study proposes CliniCom as an online assessment tool that demonstrates specificity in identifying specific psychiatric conditions and shows reproducibility over multiple administrations.
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Affiliation(s)
- Nelson Handal
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA.
| | - James LePage
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Philip Dayley
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Barbara Baldwin
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Amellia Roeser
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Joni Kay
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Heather Ann Theobald
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Michael Nellamattathil
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Scott Drotar
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Connor Weir
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Neil Tindell
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
| | - Kevin Tice
- Dothan Behavioral Medicine Clinic and Harmonex Neuroscience Research, 408 Healthwest Drive, Dothan, AL 36303, USA
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Courtabessis E, Pupier F, Surig L, Picot MC, Nogué E, Macioce V, Stein E, Purper-Ouakil D. Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France. Eur Child Adolesc Psychiatry 2018; 27:367-376. [PMID: 28983797 DOI: 10.1007/s00787-017-1061-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
Abstract
European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician's decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student's t test or Wilcoxon Mann-Whitney test and Chi-square or Fisher's test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23-16.55), p = 0.023], age [OR 1.46 (1.14-1.88), p = 0.003], ODD/CD [OR 5.53 (2.19-14.01), p < 0.001], DCD [OR 4.22 (1.70-10.48), p = 0.002], PRI [OR 0.97 (0.94-0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians' treatment decision-making complies with European guidelines and is furthermore associated with the type and severity of ADHD symptoms but also with co-occurring disorders.
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Affiliation(s)
- Elodie Courtabessis
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France.
| | - Florence Pupier
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Laurie Surig
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Marie-Christine Picot
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France.,INSERM, Centre d'Investigation Clinique 1411, Montpellier, France
| | - Erika Nogué
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France
| | - Valérie Macioce
- Unité de Recherche Clinique et Epidémiologie, Département Information Médicale, CHU Montpellier, 34295, Montpellier Cedex 5, France
| | - Elizabeth Stein
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
| | - Diane Purper-Ouakil
- Médecine Psychologique de l'Enfant et de l'Adolescent, CHRU Montpellier-Hopital Saint Eloi, Montpellier Cedex 5, France
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Hall CL, James M, Brown S, Martin JL, Brown N, Selby K, Clarke J, Vijayan H, Guo B, Sayal K, Hollis C, Groom MJ. Protocol investigating the clinical utility of an objective measure of attention, impulsivity and activity (QbTest) for optimising medication management in children and young people with ADHD 'QbTest Utility for Optimising Treatment in ADHD' (QUOTA): a feasibility randomised controlled trial. BMJ Open 2018; 8:e021104. [PMID: 29453304 PMCID: PMC5829926 DOI: 10.1136/bmjopen-2017-021104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. METHOD AND ANALYSIS This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6-17 years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. ETHICS AND DISSEMINATION The findings will be used to inform the development of a fully powered RCT. The results will be submitted for publication in peer-reviewed journals. The study has ethical approval. TRIAL REGISTRATION NUMBER NCT03368573; Pre-results.
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Affiliation(s)
- Charlotte L Hall
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Marilyn James
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sue Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Jennifer L Martin
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Nikki Brown
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kim Selby
- Department of Community Paediatrics, Medway NHS Foundation Trust, Kent, UK
| | - Julie Clarke
- Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
| | - Hena Vijayan
- North East London NHS Foundation Trust, Acorn Centre, Romford, UK
| | - Boliang Guo
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Madeleine J Groom
- Institute of Mental Health, Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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