Stay On Track

From lack of follow-through to‘I’m so proud of you!’

QUANTITATIVE DATA

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5 minutes 10 minutes 15 minutesScott’s test results indicate that all of his motion metrics were well within the range of boys without ADHD for his age cohort. Results indicate excellent motion control on this test.

ARE WE ON TRACK?

MOTION ANALYSIS

ATTENTION STATE ANALYSIS

MOTION ANALYSIS

ATTENTION STATE ANALYSIS

Day 1On medication. Difficulty concentrating at the end of the day.

Scott had 16 shifts and was Attentive for 66.7% of the test. He was in the Distracted 16.7% of the test, which is 16th percentile. Can we do better?

Day 1 Day 8 Day 15Results %ile Results %ile Results %ile

Immobility Duration 575 ms 97 146 ms 43 418 ms 91

Movements 525 98 2649 22 718 91

Displacement 0.57 m 99 3.59 m 25 0.78 m 94

Area 10 cm2 98 91 cm2 34 11 cm2 96

Spatial Complexity 1.442 94 1.147 38 1.413 91

Temporal Scaling 0.131 97 0.726 25 0.265 91

Day 1 Day 8 Day 15Results %ile Results %ile Results %ile

# Shifts 16 34 21 7 3 92

Attentive 66.7% 61 26.7% 28 90.0% 83

Impulsive 16.7% 69 40.0% 35 10.0% 79

Distracted 16.7% 16 20.0% 11 6.7% 56

Disengaged

Random 0.0% 99 6.7% 34 0.0% 99

Minimal 0.0% 99 6.7% 12 0.0% 99

Contrary 0.0% 99 0.0% 99 0.0% 99

The Quotient® ADHD Test helps to inform treatment decisions to keep kids on track as they grow.

KEEP KIDS ON TRACK AS THEY GROWScott: I don’t have ADHD any more. I don’t want to take meds. Mom: He can’t finish homework, even when he does take his medication.Dad: He’s just like me at his age. He’s like any other kid.Teacher: His behavior is pretty good. He doesn’t disrupt the class.Doctor: I need to make sure he’s getting the right medicine and the right dose. The family needs to SEE objective data and get on the same page.

Scott, age 12, believed that he outgrew his ADHD. His dad agreed. His mom was bothered by poor organization and forgetfulness on weekends when he did not take his medication.

AAP guidelines recommend an annual full assessment off medication to evaluate the current status and the presence of impairing symptoms that would justify the continuation of medication.

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SUMMARY

5 minutes 10 minutes 15 minutes

KEEP KIDS ON TRACK AS THEY GROW

Day 8BASELINE

The area starts tight, but motion control degrades throughout the test. Results indicate that Scott has moderate motion dyscontrol.

BASELINE BENCHMARK

MOTION ANALYSIS

5 minutes 10 minutes 15 minutes

ATTENTION STATE ANALYSIS

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Scott had 21 attention shifts and was Attentive for 26.7% of the test. He was Impulsive for 40%, Distracted 20% and Disengaged 13.4% of the test. The pattern is consistent with inattention.

Scott: I see that I still need medicine sometimes.Mom: I knew it! So, what do we do to get him to focus on homework?Dad: OK, so he really does have a problem. He’ll take his meds.Teacher: He can’t sit still! He constantly disrupts the class. Doctor: Let’s try a longer-acting medication to cover him in the late afternoon.

Scott: I finish homework and still have time to play Xbox®.Mom and Dad: He is confident and is making friends now. He’s actually nice to be around. We’re so proud of him!Doctor: It’s successes like Scott’s that remind me why I do this job. The medication change maintained motion control and improved sustained attention. We’re there.

The parents and patient can see his clinical status in a concrete way. That makes planning next steps more efficient and productive.

Stay On Track

ATTENTIVE

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DISENGAGED

SUMMARY

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5 minutes 10 minutes 15 minutesScott had excellent motion control on this test.

BACK ON TRACK!

MOTION ANALYSIS

ATTENTION STATE ANALYSIS

Day 15Medication change.

Scott was 90% Attentive and had 3 attention state shifts.

We’re there!

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5 minutes 10 minutes 15 minutes 5 minutes 10 minutes 15 minutes

AAP Action Statement Quotient Application ImpactAction Statement 1The primary care clinician should initiate an evaluation for ADHD for any child 4 through 18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity.

Quantitative baseline data can help the physician to diagnose unrecognized ADHD, or consider alternative diagnoses to ADHD.

Maximize efficiency of coordination of care. Reduce inappropriate medication.

Action Statement 2To make a diagnosis of ADHD, the clinician should determine that DSM-IV criteria have been met, and information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care. The primary care clinician should also rule out any alternative cause.

The DSM-IV system does not specifically address symptom variation as a function of developmental level and might lead to over-diagnosis of normal developmental variants as disorders.

The Quotient test includes age and gender norms. These comparisons could help to mitigate the risk of over-diagnosis, especially for children that do not meet full DSM-IV diagnosis criteria.

Action Statement 3In the evaluation of a child for ADHD, the primary care clinician should include assessment for other conditions that might coexist with ADHD, including emotional or behavioral (e.g., anxiety, depressive, oppositional defiant, and conduct disorders), developmental (e.g., learning and language disorders or other neurodevelopmental disorders), and physical (e.g., tics, sleep apnea) conditions.

The Quotient ADHD Test measures neural control functions associated with ADHD symptom areas. The report is reliable, even in the presence of comorbid conditions.

The Quotient ADHD Test can help rule out ADHD and direct the line of questioning to an alternative differential diagnosis.

Action Statement 4The primary care clinician should recognize ADHD as a chronic condition and, therefore, consider children and adolescents with ADHD as children and youth with special health care needs. Management of children and youth with special health care needs should follow the principles of the chronic care model and the Medical Home model.

Accepted Best Practices for managing chronic conditions require accurate and reliable information for longitudinal assessment.

Objective data from the Quotient Test can help to standardize measurements of progress toward treatment goals. Standardization will help integrate ADHD management into the Medical Home model.

Action Statement 5Recommendations for treatment vary by age. Quotient results are age and gender

normed. Quotient provides a reliable assessment of child’s performance relative to expectable performance for level of development.

Action Statement 6Primary care clinicians should titrate doses of medication for ADHD to achieve maximum benefit with minimum adverse effects.

Objective data can help inform treatment planning.

Optimal dosing is required to improve core deficits to the expectable developmental level of children without ADHD.

6a. Because stimulants might produce positive but sub-optimal effects at a low dose in some children, titration to maximum doses that control symptoms without adverse effects is recommended instead of titration strictly on a mg/kg basis.

The Quotient test has test/re-test reliability of ~90% and virtually no learning effect from test to test.

This allows reliable re-assessment at appropriate intervals to help ensure that the medication is titrated to the optimal dose for that individual patient.

6b. Education of parents is an important component in the chronic illness model to ensure their cooperation in efforts to reach appropriate titration.

Quantitative and graphical data help the parent to see the results and participate actively in the treatment plan.

Seeing progress as concrete data improves understanding and strengthens commitment.

6c. The primary care clinician should alert parents and children that changing medication dose and occasionally changing a medication might be necessary for optimal medication management, that the process might require a few months to achieve optimal success, and that medication efficacy should be systematically monitored at regular intervals.

The physician sets patient/parent expectations for which tests and rating scales are required and when. Most patients may need 1 or 2 repeat Quotient tests in the first few months as part of a process to optimize medication during this initiation phase.

Visualizing objective data enhances understanding of the treatment goals and reinforces the need for follow-up to individualize and optimize treatment for the patient.

6d. Because stimulant medication effects are seen immediately, trials of different doses of stimulants can be accomplished in a relatively short time period. Stimulant medications can be effectively titrated on a 3- to 7-day basis.

Titrating to efficacy quickly yields results that improve persistence in treatment. Some patients stop taking medication because “it stopped working,” but they were never dosed therapeutically.

Objective data may help to reduce inappropriate discontinuation of medication, which denies the patient all of the benefits of appropriate treatment.

1- AAP ADHD Clinical Practice Guideline. Pediatrics, 2011 128(5).

Application and Impact of the Quotient ADHD Test as part of a full assessment to fulfill AAP Guidelines

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