Objective: The Quantified Behavioral Test (QbTest) is a computerized diagnostic test for ADHD, used in clinical psychiatric care, but its validity may be questioned. We analyzed the QbTest’s diagnostic validity and its relation to cognitive ability and psychosocial factors in an adolescent population with a high occurrence of neurodevelopmental disorders. Method: In total, 340 participants aged 15 years, completed the QbTest, along with questionnaires, clinical and intelligence quotient (IQ) assessments. Results: The clinical assessment resulted in 89 (26%) participants with ADHD. Area under curve (AUC) scores indicated a random to poor validity of the QbTest (AUC range = 0.48-0.64). QbTest scores of inattention and impulsivity correlated with IQ. Conclusion: The QbTest was insufficient as a diagnostic test for ADHD, and was not able to differentiate ADHD from other neurodevelopmental conditions. Clinicians should be aware of the dubious discriminating power of the QbTest.
AhnR.WoodbridgeA.AbrahamA.SabaS.KorensteinD.MaddenE.. . . KeyhaniS. (2017). Financial ties of principal investigators and randomized controlled trial outcomes: Cross sectional study. BMJ, 356, Article i6770. doi:10.1136/bmj.i6770
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
3.
AnckarsaterH.LundstromS.KollbergL.KerekesN.PalmC.CarlstromE.. . . LichtensteinP. (2011). The Child and Adolescent Twin Study in Sweden (CATSS). Twin Research and Human Genetics, 14, 495-508.
4.
CuboE.Saez VelascoS.Delgado BenitoV.VillaverdeV. A.GabrielY. G. J. M.SantidrianA. M.. . . Benito-LeonJ. (2011). Validation of screening instruments for neuroepidemiological surveys of tic disorders. Movement Disorders, 26, 520-526. doi:10.1002/mds.23460
5.
EdebolH.HelldinL.NorlanderT. (2012). Objective measures of behavior manifestations in adult ADHD and differentiation from participants with bipolar II disorder, borderline personality disorder, participants with disconfirmed ADHD as well as normative participants. Clinical Practice and Epidemiology in Mental Health, 8, 134-143. doi:10.2174/1745017901208010134
6.
EdebolH.HelldinL.NorlanderT. (2013). Measuring adult attention deficit hyperactivity disorder using the quantified behavior test plus. PsyCh Journal, 2, 48-62. doi:10.1002/pchj.17
7.
Garcia MurilloL.CorteseS.AndersonD.Di MartinoA.CastellanosF. X. (2015). Locomotor activity measures in the diagnosis of attention deficit hyperactivity disorder: Meta-analyses and new findings. Journal of Neuroscience Methods, 252, 14-26. doi:10.1016/j.jneumeth.2015.03.001
8.
GoodmanR. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337-1345. doi:10.1097/00004583-200111000-00015
9.
GroomM. J.YoungZ.HallC. L.GillottA.HollisC. (2016). The incremental validity of a computerised assessment added to clinical rating scales to differentiate adult ADHD from autism spectrum disorder. Psychiatry Research, 243, 168-173. doi:10.1016/j.psychres.2016.06.042
10.
HanssonS. L.Svanstrom RojvallA.RastamM.GillbergC.GillbergC.AnckarsaterH. (2005). Psychiatric telephone interview with parents for screening of childhood autism—Tics, attention-deficit hyperactivity disorder and other comorbidities (A-TAC): Preliminary reliability and validity. The British Journal of Psychiatry, 187, 262-267. doi:10.1192/bjp.187.3.262
11.
HerveyA. S.EpsteinJ. N.CurryJ. F. (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: A meta-analytic review. Neuropsychology, 18, 485-503. doi:10.1037/0894-4105.18.3.485
12.
HirschO.ChristiansenH. (2017). Factorial structure and validity of the quantified behavior test plus, Qb+). Assessment, 28, 1037-1049. doi:10.1177/1073191116638426
13.
HultN.KadesjoJ.KadesjoB.GillbergC.BillstedtE. (2015). ADHD and the QbTest: Diagnostic validity of QbTest. Journal of Attention Disorders. doi:10.1177/1087054715595697
14.
KaufmanA. S.FlanaganD. P.AlfonsoV. C.MascoloJ. T. (2006). Test review: Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV). Journal of Psychoeducational Assessment, 24, 278-295. doi:10.1177/0734282906288389
15.
KaufmanJ.BirmaherB.BrentD.RaoU.FlynnC.MoreciP.. . . RyanN. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980-988. doi:10.1097/00004583-199707000-00021
16.
LarsonT.AnckarsaterH.GillbergC.StahlbergO.CarlstromE.KadesjoB.. . . GillbergC. (2010). The autism–tics, AD/HD and other comorbidities inventory (A-TAC): Further validation of a telephone interview for epidemiological research. BMC Psychiatry, 10, Article 1. doi:10.1186/1471-244X-10-1
17.
LarsonT.LundstromS.NilssonT.SelinusE. N.RastamM.LichtensteinP.. . . KerekesN. (2013). Predictive properties of the A-TAC inventory when screening for childhood-onset neurodevelopmental problems in a population-based sample. BMC Psychiatry, 13, Article 233. doi:10.1186/1471-244X-13-233
18.
LisS.BaerN.Stein-en-NosseC.GallhoferB.SammerG.KirschP. (2010). Objective measurement of motor activity during cognitive performance in adults with attention-deficit/hyperactivity disorder. Acta Psychiatrica Scandinavica, 122, 285-294. doi:10.1111/j.1600-0447.2010.01549.x
19.
LundhA.KowalskiJ.SundbergC. J.GumpertC.LandenM. (2010). Children’s Global Assessment Scale (CGAS) in a naturalistic clinical setting: Inter-rater reliability and comparison with expert ratings. Psychiatry Research, 177, 206-210. doi:10.1016/j.psychres.2010.02.006
20.
MilioniA. L.ChaimT. M.CavalletM.de OliveiraN. M.AnnesM.DosSantosB.. . . CunhaP. J. (2017). High IQ may “mask” the diagnosis of ADHD by compensating for deficits in executive functions in treatment-naive adults with ADHD. Journal of Attention Disorders, 21, 455-464. doi:10.1177/1087054714554933
21.
PolanczykG. V.SalumG. A.SugayaL. S.CayeA.RohdeL. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56, 345-365. doi:10.1111/jcpp.12381
22.
RehV.SchmidtM.LamL.SchimmelmannB. G.HebebrandJ.RiefW.ChristiansenH. (2015). Behavioral assessment of core ADHD symptoms using the QbTest. Journal of Attention Disorders, 19, 1034-1045. doi:10.1177/1087054712472981
23.
SelinusE. N.MoleroY.LichtensteinP.LarsonT.LundstromS.AnckarsaterH.GumpertC. H. (2015). Childhood symptoms of ADHD overrule comorbidity in relation to psychosocial outcome at age 15: A longitudinal study. PLoS ONE, 10(9), e0137475. doi:10.1371/journal.pone.0137475
24.
ShafferD.GouldM. S.BrasicJ.AmbrosiniP.FisherP.BirdH.AluwahliaS. (1983). A Children’s Global Assessment Scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.
25.
SöderströmS.PetterssonR.NilssonK. W. (2014). Quantitative and subjective behavioural aspects in the assessment of attention-deficit hyperactivity disorder (ADHD) in adults. Nordic Journal of Psychiatry, 68(1), 30-37. doi:10.3109/08039488.2012.762940
TeicherM. H.PolcariA.FourligasN.VitalianoG.NavaltaC. P. (2012). Hyperactivity persists in male and female adults with ADHD and remains a highly discriminative feature of the disorder: A case-control study. BMC Psychiatry, 12, Article 190. doi:10.1186/1471-244X-12-190
ThaparA.CooperM.RutterM. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4, 339-346. doi:10.1016/S2215-0366(16)30376-5
30.
UlberstadF. (2012a). Discriminant validity for the Quantified Behavioral Test (QbTest) in adolescents and adults. Internal document written by Qbtech AB info@qbtech.com, www.qbtech.com
31.
UlberstadF. (2012b). Discriminant validity for the Quantified Behavioral Test (QbTest) in children. Internal document written by Qbtech AB info@qbtech.com, www.qbtech.com
32.
UlberstadF. (2017). Clinical documentation for QbTest in patients with ADHD. Available from http://www.qbtech.com
33.
WillcuttE. G.DoyleA. E.NiggJ. T.FaraoneS. V.PenningtonB. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336-1346. doi:10.1016/j.biopsych.2005.02.006
34.
ZelnikN.Bennett-BackO.MiariW.GoezH. R.Fattal-ValevskiA. (2012). Is the test of variables of attention reliable for the diagnosis of attention-deficit hyperactivity disorder (ADHD)?Journal of Child Neurology, 27, 703-707. doi:10.1177/0883073811423821
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
