Is believing how objective data helps us better understand ADHD brains is our next segment. And the coming up section just tells you we're running a few minutes late. But otherwise, doing alright. This is important in multiple levels. But it's important because bringing data to ADHD, you know, we've just struggled with a channel four program, saying ADHD is just a social construct. One of the reasons saying, well, there's no... Like, what's the data? Like, where's the evidence? And obviously, there's a mountain of data matters.

Jess Brunet is the director of clinical operations at Qbtech. She's a registered mental health nurse and a non medical prescriber. She has a Master's in Neuroscience from King's College London and more than a decade in NHS services, including clinical leadership in child and adolescent mental health and pediatric ADHD teams and leading an NHS ADHD nursing team in Norfolk. She has a special interest in how ADHD shows up in girls and women. QbTech, which is what we're talking about, makes QbTest. It's a computer based test of attention impulsivity and activity. NICE recommends, and I was one of the main members of the committee that did this.

NICE recommends QbTest alongside clinical assessment to help diagnose ADHD in children and young people. And today Jess will show how objective data can help people see and understand their strengths and their needs through referral assessment and treatment. So without further ado, I welcome.

Jess. Jess, welcome. Hi, Henry. Thank you so much. I'm grateful to be here. Well, thank you for coming here. Qbtech.

Is very important and I know people have a lot of questions about it, I'm extremely pleased to have you here. So thank you so much for for doing that. Without further ado, I'll hand over to you. Do you have some slides? Because I just... They're not. They'll come... They'll appear in a second. Okay. Over to you, Jess.

Wonderful. Thank you so much. So let me just get my get my slides up and running. And just whilst we're doing that, there we go. Wonderful. So thank you for that introduction. As already said, my name is Jess. I'm an advanced nurse practitioner by background, and I'm here to discuss more about what we do at QbTech. So we're a medical device company, and we produce QbTest and QbCheck, which are class one medical devices. And as we've already heard from Ash, this is put under a lot of scrutiny, a lot of evidence based in order to bring this to market and support people in their everyday ADHD care. Next slide, if that's okay. Fabulous. Okay. So let's start with with the why. What why are we doing this? What is this about?

And so the mission here at Qbtech is to improve the lives of ADHD. We are incredibly fortunate to have an entire clinical team and a number of our team members on-site are either neurodivergent themselves or have individuals within their family who have been through UK, US systems and global ADHD systems. So this is all about improving lives and making the understanding of ADHD far more accessible. And how are we doing that? So at the moment, Qbtech is in 18 countries and we are so privileged that we have supported over one point five million individuals throughout their ADHD journey, and over 20,000 clinicians are already using these medical devices, which is absolutely fantastic. The technology has been in use since 2002.

And as part of the rigor behind it, we have go through certain clearances in order for this to be safe and effective within clinical setting. And so we are FDA cleared. We have a number of ISO's for anyone working in NHS. You'll know that we'll need to pass this in order to have medical devices within your clinical care. And as Henry has already mentioned, we are involved in the NICE guidance. We are recommended QbTest for ages six to 18 there. And we were so fortunate to work with the East Midlands HIM, the Health Innovation Network within The UK and we have run a study called the Focus ADHD program and across the time period shown, we were able to save the NHS £38,500,000.

Through saving time in appointments by adding in objective data. And that was over ninety five thousand hours of clinician time saved and it supported over 70,000 children and young people to better understand their ADHD symptomology. So this isn't something new. This is something that's been growing and growing and being supported by families and individuals with ADHD globally. So what what is it? What is it I'm talking to you about today? And I think to kind of start us off, we wanna think about what's the difference between objective data and subjective data. So when we are talking about objective data, we are talking about numbers. We're talking about quantitative information.

And we are thinking about how we can show with data how symptoms track. Subjective is our own experience. It's the way that we express our thoughts and feelings and it might be through questionnaires and it may be through our clinical interview. And this is incredibly important to get the scope of how our ADHD is experienced. But the objective data shows where our strengths and needs really lie and we all know that ADHD is different for different individuals. Some individuals are more prone to masking. There are comorbidities in the mix, which means that often clinicians may come back and say.

It's hard to understand if we can reach a diagnosis at at this moment in time. And so Qbtech tries to add an extra data in order to really understand symptoms, but crucially, it is visual as well. It's the starting point. It's so tough to be able to go into an appointment with a pediatrician, a psychiatrist, a specialist clinician, and know what it is that you're expected to say. So when you have got something visual in front of you, you've got a common starting point, a communication tool to really express and navigate your symptoms. So Henry has mentioned that we have QbTest, which is our original medical device and this is our in clinic solution.

And you'll see on the screen that we have a young woman and she's got like a band around her head, which has got a reflective marker and there's a camera on the wall and the camera tracks all of the movements from that reflective marker. This is where we started. And it is a fantastic solution. I've used it in my own clinic with children and young people and it really adds depth and observation. But the feedback that we have from individuals with ADHD and going through assessment as well as clinicians is what if I can't get into clinic or what if my sensory needs mean that I can't wear that headband or it feels too uncomfortable or.

What if coming into the clinic is so anxiety provoking that I'm just not gonna be able to do this properly. And so we have QbCheck, which is the exact same computer computer test. However, now you can do it either in clinic with your clinician or you can do it at home, at school, within the workplace, with... Within any quiet setting on a laptop. And instead of having the band around your head, you can use laptop camera. And what it does is it creates a digital map of your face, so it's not recording you and it tracks every one millimeter of movement with this digital mesh mesh, which is incredibly clever. So the task itself, it is purposely.

Boring. For anyone on the call who has done this, you'll know what I mean by this. So we have not gamified the test and that is intentional. There is no music. There is no pings or dings or well done or anything like that because we know that ADHD brains are looking for a bit of dopamine. And so by having no music, we're not kind of rewarding the task at all. What we see is that individuals with ADHD over time, the duration of the test, either fifteen minutes for the child's test or twenty minutes for the 12 and above test, things get worse over time. It's harder to concentrate. We might get a bit more wiggly and or we we may see a change in our response and that's that's what we're looking for with our data.

So we have two tests. The initial one is for six to 11 year olds and this is what we call a go no go task. And the individual has to watch the screen and they're gonna see 450 of these little circles and they need to click when they see the gray circle and try and inhibit not click when they see the circle with the cross. And out of those 450 stimuli, 50% of those are gonna be what we call target stimuli. That's when you need to click. And if you're between the ages of 12 and 60, we've got a slightly differentiated task which just takes a bit more of that that memory and what we call executive function. Can you remember the shape that has come before? So for this task, it's twenty minutes long and there is 600 stimuli.

And your job here is to click on the space bar or the responder button if you're doing a QbTest. For each time, the same shape and the same color repeats. So you're having to remember what comes before for the full twenty minutes. And these have been specially designed to take certain medical conditions into account to improve that accessibility for the test. So this grounds us in what it is that we're doing for for fifteen or twenty minute period. And then what you get as a result is you get a data point. So you get a numerical score around activity, impulsivity, and inattention which are core symptoms of ADHD as per the DSM five, the diagnostic and statistical manual. And what Qbtech does is it compares your results.

To an age and sex match norm group. So if a seven year old boy has taken the test, their results would be compared to other seven year old boys who have taken the test. And if you're a 35 year old woman, your results are compared to other 35 year old women. The point of that is to pick up on variation and we understand that ADHD changes through the lifespan. It changes when there are hormonal differences in place and it also changes as we begin to learn about our symptoms because maybe we get better at understanding or even inhibiting some of the symptoms for a period of time. And so we are picking up on all of this and quantifying it into something called a Q score. So how do we implement this?

So it can be used at any point in the process. So in The UK, we refer to pre assessment to the point at which you've been referred to an ADHD service. So it might be at this point you are being given some rating scales to complete some questionnaires. It can also be used within the assessment itself, so when you are going to see the clinician, or it can be used out at treatment response too, you can track over time if you're starting medication, how it's doing. The main thing is that this should not be used as a standalone tool. So whilst QbTest and QbCheck is a class one medical device, it should not be used in isolation. The whole point is to build up a picture of the individual individual strengths and needs.

So you've got your clinical interview, you've got your rating scales, and you've got your objective measure. And all of this comes together shows how over the lifespan and how today your symptoms impact you, where your strengths are, and where your areas of need are, and where you may need to work on in either your pharmacological or non pharmacological approaches to care. And again, with medication follow-up, you can do it at baseline. So when you are not on medication and then as you change doses or as you optimize as well, so you can compare, is this working for me? Are we seeing any measurable difference.

Or are there things that we're not seeing in the mix? Are things feeling like they're getting worse? And we've had so much feedback from individuals where there are other things in in the mix. And so we've had young people who have been informed by teachers that you need your medication changed and they're saying, no, I don't. My mental health is suffering at the moment. I need help from other avenues. There are other environmental factors going on. They've then done an objective measure. They have done a QbTest or a QbCheck, and it's showing that their medication is working extremely well.

But they were exactly right that there were other things in their world that needed at that point in time response to trauma which hadn't been fully resolved which was an impact to them in other environment. So it can be incredibly validating. So coming back to the title and why I called it this, when seeing is believing. I I thought about this when we were asked to to present here because I've worked with individuals across the lifespan within my clinic. So young people is my specialty and but have also worked with adults and has specialized working with women. The number of times I have shown them their QbTest or their QbCheck reports and they have burst into tears because they felt so validated and empowered around, okay, I can actually.

See what's going on here. It's not in my head and this gives me a way to express it. So I appreciate this. This looks fairly small on screen, but I'm gonna navigate you around it. So in the top left, you're gonna see like a small... Oh, thank you. You're gonna see a small bump, a colorful bump, and the number 96. This is your total symptom score and total symptom level. So what this is showing is it is comparing your results to age and sex match known groups of the individuals of the same age of biological sex at birth, but also to a clinical group. So it's indicating with your results how close are you to those with ADHD who have done a Qbtech test or to those who do not have ADHD who have done a Qbtech test. The.

Items on the right under objective measures, you've got activity, impulsivity, and inattention. Again, we are quantifying each domain here. And this isn't about saying, oh, these are not high enough or or they're not hitting a certain point. This is gonna help you pick up on individual symptoms. Are you particularly struggling with inattention or do you find that as you're asked to to focus more, your activity levels go up. We will be able to see that through the visual image. If you come down to the bottom left, you'll see a series of crosses. This is your activity throughout the test. And often you can see that increase over time and at the bottom left is the individual's response to those shapes that I showed you earlier on screen.

So the green are our correct responses, the reds are when we clicked when we didn't need to, and right at the bottom there's some little black lines where we've accidentally missed any responses. Crucially then to the right of that is a comparison. This isn't an average. This is a real individual from the same age group who does not have ADHD. And it begins to start a talking point around where the areas of of the QbCheck were that you found easier, What were the things that you felt you needed more support with? And are there certain domains that actually.

You notice are sometimes more challenging in day to day life, which are really depicted here? Like, I've tried really hard, and I've tried to sit sit really still, but I find that the more I do that, it's harder to maintain attention because I'm constantly thinking about the task. You can visually see that on screen. You also get a subjective report as well. So you remember me saying earlier that we want kind of both elements of of data, there's also a written narrative around those DSM five symptom criteria. Those those diagnostic criteria for ADHD. And you can indicate on there how much the activity levels impact you and the inattention and impulsivity as well. And we're looking at that data together.

That's how it feels subjectively on the outside, match how how things perform in the task. And if there are differences, why do you feel those differences? Again, it's a talking point to really get under the hood with this. And what we tend to find is that individuals who have tried really hard over the years often to their their own exhaustion to to to really kind of manage their symptoms that pops up on the test. And I've had women say, I work so hard but I burn out in my job and you can see on this report how hard I am working and that just blows my mind. And so we can also use this in a treatment setting as well. And so now on this this slide.

Again, it's it's quite small, but if we've got the option to move in, what this is showing you instead of comparing to the sample report, it is showing your test one versus your test two. And at the bottom, it has got the figures of your total symptoms score and each of your activity in attention and impulsivity parameters. The light blue reflects your first test and the dark blue reflects your second test. So you know from the objective data, are things improving? Are they moving towards that kind of zero mark in the middle? And if they're not, you've got an opportunity to discuss.

With your clinician or if you're a clinician reviewing this data with the individual in front of you why why they're not working and what we may need to do differently. And similarly, you can do this at multiple time points. Let's say you've been prescribed medic net up to 20 then up to 40. You can compare the different doses and you can find the point at which it it really works for you. And so it's starting to use the visuals and the data to express how how you feel. And I was thinking about how about this a little more before I came on and being able to go back to your GP or go to another provider and go look, this is how my brain works in terms of my activity, my attention.

My impulsivity and this is how my medicine works at this dose. It's so empowering to start that conversation with data to back it up as well as your own kind of narratives and experiences. So this is an additional tool within that toolkit. And we have data on this as well and and we've... We're really fortunate on our website. We've got a whole list of our research backing. But an analysis found that you get us, you can show a significant difference between your baseline and your follow-up treatment and with objective data, you can find effects earlier as well. So as a clinician and as an individual, you've got more time to focus on side effects and how the efficacy of the medication over time.

When you can see, okay, is this working? Is this affecting the area and the main goals that we were looking to work on when we started out with our treatment plan as well. And it's not just me saying about it. I could talk about it all day having utilized it in clinic and seen the kind of powerful difference to help explain my feedback as well as a clinician and how I'm reaching my conclusions. But people speak for themselves and there's some testimonies on screen from both individuals who have gone through their assessment process but also clinicians. And and you can see that people find it really helpful just to get a visual depiction of what happens with their activity, their attention, and their impulsivity.

And then if they choose to go down a route of treatment or another form of intervention then how does that impact? Are we kind of making waves towards where we want to go with it? But thank you so much for your time. Thank you for listening. The QR code takes you to our website if you would like to find out more And I hope you enjoy the rest of your conference today. Thank you so much.

Jess, thank you so much. That was very, very interesting. Qbtech is obviously very important used at the numbers you gave on. It's used across the world and UK are staggering in an endorsement of how useful people find it. And I think very helpful to talk people through the results and and how to understand. So thank you. I need to celebrate you, and then we're running slightly behind time, so I have to... Because I want to, because thank you. So thank you for Thank your time, you. I get that at every conference. Jess, you're absolutely amazing. Thank you so much for talking to us today. Thank you for being part of the ADHD Conference.

I hugely value it, and thank you. Thank you so much, and goodbye. Goodbye, James. Thank you for your time. Thank you. Bye. Very important technology used significantly and very grateful to have them at the conference and Jess there talking to us and telling us about it. I'm.