Dara Coppel, Head of Innovation Delivery at East Midlands AHSN reflects on some of the progress that has been made in ADHD assessment pathways for children during the pandemic, and the potential there is to make.

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness and affects around 5% of school-aged children worldwide.

As you can imagine, ADHD can have a marked impact on a child’s personal, academic and family life. In the UK children can wait on average 18 months from their first appointment to receiving a formal ADHD diagnosis. These 18 months can be a pivotal time for their development and the impact that must have on a child and the wider family is considerable.

National Focus ADHD programme

Recognising that ADHD diagnosis is often a lengthy and costly process, we undertook a 12-month real-world demonstrator across the East Midlands to evaluate the use of technology within ADHD assessment pathways. The demonstrator used technology called QbTest, which measures a patient’s attention, impulsivity and motor activity all at the same time. These indicators are core symptoms of ADHD and the test, when used alongside current clinical assessment processes, aimed to add objectivity to what is mainly a subjective assessment and decision.

Three trusts took part in the demonstrator across seven sites, providing data to evaluate the impacts of introducing the technology to their ADHD diagnosis pathway. Through this demonstrator, the intervention findings mirrored previously published research, demonstrating  that QbTest increases the efficiency of ADHD assessment pathways allowing clinicians to reach a diagnostic decision faster – in this case by approximately five months. This in turn increased staff capacity by reducing the number of appointments needed for diagnosis and by ruling out ADHD sooner for ambiguous cases. Releasing capacity of clinicians can help reduce waiting lists and allow clinicians more time to concentrate on complex cases.

Following the successful demonstrator, we have formed the Focus ADHD programme, which has been selected as a national adoption and spread programme by the AHSN Network. All 15 AHSNs will be working with clinicians in their local region to implement the programme and spread the intervention at pace and scale.

I am extremely proud that the results of the East Midlands demonstrator are being used to evidence the impacts that this programme can have. I have witnessed first-hand the pressures that clinicians are under and hearing their feedback about how the intervention helps them with their caseload on a day-to-day basis is so rewarding.

Reinstating ADHD diagnosis pathways following COVID-19

Like many NHS services, ADHD assessments were paused at the height of the COVID-19 pandemic. We are now seeing trusts reinstating these appointments. Trusts that were previously using QbTest are increasingly adding these back into their assessment process whilst other trusts are looking to implement QbTest for the first time in their pathway, to increase efficiencies by using an objective assessment as part of NHS service reset, restoration and recovery plans.

As an example, Leicestershire Partnership NHS Trust (LPT) is one of our early adopter sites in the East Midlands having participated in the demonstrator project. Following the demonstrator, QbTest became part of the standard ADHD assessment pathway for the Trust. Prior to the pandemic, LPT had a busy facility, running three clinics a week with around seven to eight appointment slots per day. When lockdown occurred, they closed the face-to-face clinics for three months. They restarted their clinics in late June 2020 introducing new safety measures such as screening phone calls before appointments, restricting the number of people in the room during the appointment and sanitisation measures.

Having used the QbTest intervention for some time, the Trust were able to recognise the efficiencies it can bring, which colleagues from the service have said is so important to their way of working, now more than ever. This approach will significantly help the Trust address the increased waiting times that there have been seen since COVID-19 restrictions were introduced nationally.

Like many NHS services, it is so important to patients and their families that these appointments are able to be safely reinstated, as the time waiting for a diagnosis can be extremely stressful.

An opportunity to improve ADHD assessment pathways

COVID-19 and the related physical distancing measures are presenting many challenges for everyone, yet these challenges are likely to be considerably greater for those with ADHD.

It is even more important to think creatively about how best to release capacity to catch up on those ever-increasing waiting lists.

This is the time to do things differently. All clinics should consider the use of an objective assessment tool as part of the re-establishment of their services. The results are impressive and those that use this approach rarely look back.

If you are a clinician interested in the QbTest intervention, please email Dara: Dara.Coppel@nottingham.ac.uk

Follow Dara on Twitter: @daracoppel

Find out more about the AHSN Network Focus ADHD national programme.