Gill Wales, a clinical advisor here at Qbtech, first came across QbTest when she worked as a nurse in a Paediatric Neurodevelopmental Service in Sheffield, and soon realised that there was a lot more to QbTest than Q-Scores and parameters.
What is the QbTest Behavioural Observation Form?
The Behavioural Observation Form (BOF) is completed by the clinician who administers the QbTest. The administrator is responsible for ensuring the equipment is set up correctly, the environment has been standardised, and the test taker understands the instructions and is able to execute the task on the QbTest laptop.
These are essential aspects of their role, as they ensure test validity, but they will also closely observe the patient before, during, and after QbTest, recording what they see and hear on the BOF. This information offers valuable insights which other ADHD assessment tools may not have picked up.
Can the Behavioural Observation Form provide contrasting information to other sources?
Yes, sometimes a QbTest report doesn’t fit with the information they receive from other assessments, and in these cases the form may be able to unlock the clues to understanding this discrepancy.
For example, a patient has significant levels of inattention reported from home and school but goes on to perform well in all the attention parameters on QbTest. On the BOF, it is documented that the patient required the instructions to be broken down and repeated in a way that would not be expected for their age. This suggests that there was impairment in understanding, but not in attention once understanding had been achieved, and it may be worth considering if hearing, language, or processing difficulties may be the root cause.
By completing the QbTest ahead of clinical interview, reviewing the QbTest report and BOF, this would allow the clinician to collect any additional information prior to the clinical appointment and potentially saving time and reaching a diagnostic conclusion more quickly.
The form can help with differential diagnoses
Hyperactivity is one of the key symptoms of ADHD, but high levels of activity may occur for many different reasons, such as anxiety, tics, tiredness, stims, sensory needs, and skin disorders. QbTest will accurately indicate whether the amount of activity is clinically significant and will also show if this increases or decreases over time.
We can also see minute by minute fluctuations in activity and link these to notes from the test administrator, assessing if movement patterns look chaotic, or if they are predominantly moving back and forth or side to side.
The finer details that will help to attribute the cause and function of movements, and thereby help with differential diagnosis, will be in the detailed description that can be found on the BOF.
Behavioural observation and ADHD symptom masking
Poor sleep commonly co-occurs with ADHD. If a patient’s QbTest report is suggestive of ADHD and they were tired when they performed the test, it would be important to retest the patient once sleep difficulties have been managed.
If a patient is tired at the end of the QbTest but wasn’t at the beginning, this could indicate ADHD. Some patients will put in an extreme effort during the QbTest and produce a report that doesn’t look supportive of an ADHD diagnosis, however if the BOF reports that the patient was significantly more tired after the test than they were before, this suggests that they have learnt to mask their symptoms.
Comments from the patient after the test can be real eureka moments. While most patients will describe the test as boring and may want to exit it, it is worth the time to try and find out a little bit more about their experience.
“The shapes were coming too fast” – do they have a processing difficulty?
“I got confused and couldn’t remember which shape to press” – is their inability to remember the instructions due to an undiagnosed learning difficulty?
“I have to go now because I have an important test at school” – were they preoccupied and not giving their best performance?
Get in touch to find out more about our ADHD testing technology
Complete the form below and a member of our team will get in contact with you about our ADHD tests.
If you’re an existing customer, you can use our clinical support calls to build up your confidence with understanding and interpreting QbTest and QbCheck reports. Discover our guides on interpreting our ADHD tests and using objective testing for treatment monitoring.