Review of ADHD

September is Back to School Time and ADHD Awareness Month

By Carrie Mulherin – Vice President, BioBehavioral Diagnostics
Health News Digest, Aug 26, 2009

What is ADHD?

( – Attention-deficit/hyperactivity disorder (ADHD) is a common condition of the brain that makes it difficult to control behavior. Everybody knows someone with ADHD. It affects approximately 9.5 million school-aged boys and girls, adolescents and adults. People with ADHD have trouble paying attention, controlling impulsive behaviors, and in some cases, are overly active. Three times more boys than girls are diagnosed with ADHD. Symptoms persist into adulthood in as many as 60 percent of cases. Although these characteristics are present to some extent in everyone, when the symptoms are developmentally extreme, pervasive and persistent, it might be ADHD.
Although individuals with ADHD can be very successful in life, without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, risk for accidental injuries and job failure. Early identification and treatment are extremely important.

There are three sub-types of ADHD.

These symptoms are present in everyone at some level. If symptoms are extreme, consider making an appointment for a full evaluation.

Predominantly Hyperactive-Impulsive Type
Fidgets with hands or feet; squirms in chair
Runs about or climbs excessively
Has difficulty remaining seated
Difficulty in engaging in activities quietly
Acts as if driven by a motor
Talks excessively
Blurts out answers before questions are completed
Difficulty in waiting or taking turns
Interrupts or intrudes upon others

Predominantly Inattentive Type
Fails to give close attention to details or makes careless mistakes
Has difficulty sustaining attention and does not appear to listen
Struggles to follow through on instructions
Has difficulty with organization
Avoids or dislikes tasks requiring sustained mental effort
Loses things
Is easily distracted
Is forgetful in daily activities

Combined Type
Has both sets of inattention and hyperactive/ impulsive symptoms

Historically Difficult to Diagnose – A New Tool for ADHD Assessment

ADHD historically has been challenging to diagnose because many of the assessment tools rely largely on subjective information from parents and teachers, in addition to clinical evaluation. Fortunately, new technology is now available and is an important addition to the doctor’s toolbox. The Quotient™ ADHD Test gives clinicians objective and accurate data to perform better assessments and to guide treatment decisions.

The Quotient™ ADHD System accurately measures motion and analyzes shifts in attention state to give a clear picture of the core symptom areas of ADHD: hyperactivity (the difficulty in staying focused and on task), impulsivity (the inability to control movement and sit still while working) and inattention (the inability to inhibit inappropriate responses).

The Quotient™ ADHD Test takes 15 minutes for kids under 13 or 20 minutes for adolescents and adults. The system collects data on the person’s ability to sit still, inhibit impulsivity and respond accurately to images on a computer screen. The test report provides analysis of motion, attention, and shifts in attention states. Integrated composite scores report the level and severity of inattention, hyperactivity and impulsivity compared to other people of the same age and gender. The report is available to the clinician within minutes of the test completion.

The Quotient™ ADHD Report is divided into the following sections:

Motion graphic and analysis
Attention response graphic and analysis
Attention State analysis
Scaled scores

Within each section, the data is analyzed and presented in a graphical format, a results table with numerical values, reference ranges for age and gender on each parameter and percentiles. Like other evaluation tools, results from the Quotient™ ADHD System are a key component of a comprehensive diagnostic evaluation for ADHD. The interpretation of Quotient™ ADHD System results should be interpreted in the context of full clinical information.

Motion Analysis

The Motion Analysis section reports information gathered by the infrared Motion Tracking System that measures movement 50 times per second and records movements greater than 1 millimeter. Behavioral activity and the pattern of movement can be correlated to the symptoms of hyperactivity, which are characteristic of ADHD.

Attention Response Analysis

The Attention Analysis section reports information gathered from patient responses to the computerized attention task. There are two stimuli in the child attention task; one target (8-point star) and one non-target (5-point star). The patient is instructed to hit the space bar whenever a target appears on the screen and is not to press any key when the non-target appears.

The graphic display shows the patient’s responses to each and every target and non-target presented by the Quotient™ ADHD System during the 15-minute test.

The response pattern graph in this section of the report allows for a quick and easy analysis of the general amount and proportion of correct and incorrect responses based wholly on the appearance of stimuli and the individual’s response to it during test administration.

Correct Passes patient correctly identifies a non-target and lets it pass
Correct Hits patient correctly identifies target and correctly responds
Incorrect Passes patient incorrectly passes on a target
Incorrect Hits patient incorrectly responds to a non-target

Attention State Analysis

The attention state section provides a summary of the patient’s response patterns over 30-second episodes and classifies the attention pattern as one of four attention states. Each episode captures the patient’s fluctuating attention states over the course of the test. The four different states of attention response are:

Attentive Good level of accuracy (>85%) with consistency in response time and limited errors of omission or commission

Impulsive Good level of accuracy (>85%), but with inconsistently fast response times and/or significant errors of commission

Distracted Fair level of accuracy (>50%), inconsistently slow response times and/or significant errors of omission

Disengaged Accuracy no better than chance (<50%). Also called R.M.C. for Random,

Minimal or Contrary

Each 30 seconds of the 15-minute test is represented by one box in the line of 30 boxes for the entire test. The patient’s attention state during each 30 second period is represented by the color of the box. The attention state is determined by a statistical analysis of the patient’s performance during the 30 second period.

Seven parameters are considered in the analysis for possible fluctuations in the patient’s attention states during the attention task. Individuals with ADHD are much more likely to have difficult sustaining focused attention across the entire 15-minute task. Key in this analysis is the recognition that the greater percent of time spent “off-task” (not in attentive state) and the greater number of shifts in attention state during the attention task are strongly associated with individuals who have sufficient difficulty sustaining attention that they will meet diagnostic criteria for ADHD.

Motion, Attention and Global Scaled Scores

The Motion and Attention Scaled Scores are composites of the patient’s motion analysis and attention analysis compared to age and gender matched peers in the community reference sample. The Global Scaled Score averages the Motion and Attention Scales Score to demonstrate a patient’s overall performance compared to age and gender matched peers. As with other diagnostic instruments in the ADHD field, impulsivity is reported as an individual measure on the Patient Report and is then integrated into the Scaled Scores. High Quotient™ ADHD Scaled Scores indicate significant deficits and are associated with the scores that are more typical of individuals with ADHD.

The last step in interpreting the report is to integrate information from both the motion and attention analysis sections of the report and review the relationships noted between different parts of the assessment. Quotient™ ADHD System test is a complex task which requires a patient to maintain appropriate stillness and motion control, sustain focused attention to a lengthy monotonous task, and inhibit tendencies to respond impulsively. The test report analyzes these component tasks into results that are easy to review and appreciate. The Scaled Scores of the report provide an integrated view of the neural control functioning observed during the assessment and a quantification of any deficits noted.


The Quotient™ ADHD System is available in select physician offices in the United States and will be available nationwide soon. Doctors are using the Quotient™ ADHD Test in baseline assessments as well as in follow-up assessments to check that therapy is working for a particular patient. Check with your doctor to see if he/she offers the test, or get a referral to a nearby Quotient™ ADHD Testing Center.

To Learn More Visit for information about the test and a list of providers.

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