Can Computer Tests Help Monitor ADHD Medication Response in Children?

What you need to know

• Both computer-based tests and rating scales showed improvements in ADHD symptoms after 1 month and 12 months of medication treatment in children and adolescents.
• The computer test and rating scale results were only weakly correlated, suggesting they may measure different aspects of ADHD symptoms.
• Children who dropped out of the study had less severe inattention symptoms on the computer test at baseline, which may help predict who will continue long-term medication.

Background on ADHD and treatment monitoring

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting about 5% of children worldwide. It is characterized by persistent difficulties with attention, hyperactivity, and impulsivity that interfere with daily functioning. Proper diagnosis and treatment of ADHD is important, as it can significantly impact a child’s academic performance, social relationships, and quality of life.

Medication is often prescribed to help manage ADHD symptoms. However, monitoring how well the medication is working can be challenging. Traditionally, clinicians have relied on rating scales completed by parents, teachers, or the patients themselves to assess symptom improvement. While these scales provide valuable information about real-world functioning, they are subjective and may miss subtle changes in attention or activity levels.

To complement rating scales, some clinicians use computerized tests called continuous performance tests (CPTs) to measure attention, impulsivity, and activity more objectively. This study aimed to compare how well a rating scale and a CPT with motion tracking captured medication effects in children with ADHD over the course of one year.

How the study was conducted

The researchers recruited 78 children and adolescents (ages 6-18) with ADHD who were starting medication treatment. Participants completed assessments at three time points:

1. Baseline (before starting medication)
2. Visit 1 (1 month after starting medication)
3. Visit 5 (12 months after starting medication)

At each visit, participants completed:

1. The QbTest - A computerized CPT that measures inattention, impulsivity, and hyperactivity. It includes a motion tracking system to capture physical activity during the test.

2. The ADHD Rating Scale (ADHD-RS) - A questionnaire assessing ADHD symptoms, completed based on clinician interviews with parents and children.

The researchers compared scores on these measures across the three time points to see how they changed with medication treatment. They also looked at whether baseline scores predicted which participants would drop out of the study before the 12-month visit.

Key findings

Both measures showed symptom improvement with medication

On average, participants showed significant reductions in ADHD symptoms on both the QbTest and ADHD-RS after 1 month and 12 months of medication treatment compared to baseline. This was true for all the main symptom areas measured:

• Inattention
• Hyperactivity
• Impulsivity

The improvements were seen quickly (by 1 month) and maintained over the full year of treatment.

Computer test and rating scale results were only weakly correlated

Although both measures showed overall symptom improvement, the researchers found only weak correlations between changes on the QbTest and ADHD-RS. This suggests the two types of measures may be capturing different aspects of ADHD symptoms:

• The QbTest provides an objective snapshot of attention, impulse control, and activity level during a structured task.
• The ADHD-RS reflects subjective ratings of real-world functioning across different situations.

The strongest correlation was between improvements in QbTest impulsivity scores and ADHD-RS hyperactivity/impulsivity scores. There was no significant correlation for the inattention or activity measures.

Computer test results may help predict medication adherence

Of the 78 participants who started the study, 18 dropped out before the 12-month visit. The researchers compared baseline scores between those who completed the study and those who dropped out to see if any factors predicted long-term adherence.

Interestingly, the group who dropped out had significantly better scores on the inattention measures of the QbTest at baseline:

• Faster reaction times
• Less variation in reaction times
• Lower overall inattention scores

This suggests they may have had less severe inattention symptoms to begin with. There were no differences in baseline ADHD-RS scores or other characteristics like age, gender, or IQ between the groups.

Most of the participants who dropped out (14 out of 18) also discontinued their ADHD medication. The QbTest results may therefore help identify patients who are less likely to perceive benefits from or adhere to long-term medication treatment.

What do these findings mean?

This study provides several important insights for clinicians and families managing ADHD treatment:

1. Medication effects can be detected quickly and maintained long-term

Both the computerized test and rating scale showed significant symptom improvements after just 1 month of treatment that were sustained over a full year. This reinforces that medication can be an effective long-term treatment option for many children with ADHD.

2. Computer tests and rating scales provide complementary information

The weak correlation between QbTest and ADHD-RS scores suggests these measures capture different aspects of ADHD symptoms. Using both types of assessments may provide a more comprehensive picture of treatment response:

• QbTest: Gives an objective measure of attention, impulse control, and activity during a structured task
• ADHD-RS: Reflects real-world functioning across different situations

3. Baseline computer test scores may help predict treatment adherence

Children with less severe inattention symptoms on the QbTest at baseline were more likely to drop out of treatment. Clinicians may want to follow up more closely with these patients to address any barriers to long-term adherence.

4. Regular monitoring is important for optimizing treatment

The study reinforces the value of systematically tracking ADHD symptoms over time using standardized measures. This can help clinicians and families make informed decisions about continuing, adjusting, or changing treatment approaches.

Limitations and future directions

While this study provides valuable insights, there are some limitations to keep in mind:

• The study did not include a control group of untreated ADHD patients, so we can’t be certain all the improvements were due to medication effects.
• The sample size was relatively small, particularly for the group that dropped out. Larger studies are needed to confirm the predictive value of baseline QbTest scores.
• The study only looked at one type of computerized test (QbTest). Results may differ for other CPTs or objective measures.

Future research could address these limitations and further explore:

• How different types of ADHD medications compare in their effects on computerized test performance
• Whether combining computer tests and rating scales improves treatment decision-making and outcomes
• Factors that influence long-term medication adherence in ADHD

Conclusions

• Both computerized tests and rating scales can capture ADHD medication effects over 1 year of treatment.
• These measures likely provide complementary information about different aspects of ADHD symptoms.
• Baseline performance on computerized attention tests may help predict which patients are more likely to discontinue long-term medication treatment.
• Using both objective tests and symptom ratings to monitor ADHD treatment response may provide the most comprehensive picture of medication effects.