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  • robagnew

Why I don't use Qb Check or Qb Test

I get asked this every now and again, and I have worked in services where the Qb is used. This is my opinion:

The Qb test is a computerised test which looks at eye gaze and behavioural impulsivity. It basically asks you to look at something, and push a button. The idea being people who are inattentive will find it harder to look at the screen consistently, and will impulsively push the button.

It's great in theory, and if I had scores of patients coming to me saying "You just can't take me on the bus, I'll have him stopping at every stop cuz I'll just keep pushing the button" or "I have no idea what I'm doing when I'm writing an email cuz I keep looking away from the screen" then maybe I'd consider using it. But.... I don't.

No. What I have is people saying things like "My whole family think I'm lazy" and "I don't know why I keep getting so upset when someone has a different opinion to me" and "I was great at secondary school, but now at Uni I am finding it so hard" and "Why can't I start something I want to do?". How does Qb tap into the actual lived experience of ADHD?

The Qb check is not a diagnostic test. If a person does well on it, but still has the developmental history and concurrent presentation I am not going to withhold a diagnosis because they were able to look at a screen and push a button. Even I can do that, but it would exhaust me. There are many other diagnostic reasons why a person might not do well on the Qb and these need to be taken into consideration.

There is discourse suggesting that the main focus on ADHD diagnosis should be a thorough cognitive assessment. But unfortunately we know that cognitive assessment is also far from perfect, and gives you snapshot of performance on tasks that mostly have no real world relevance. Where a person does not have neurological damage, these tests become even less relevant.

ADHD is not brain damage, it is a type of neurodifference. The problem is in how the person with ADHD has to function in the world built for neurotypical people. Focusing on cognitive indices removes the detail of the presentation and changes the nature of the condition. Even when we successfully resolve attentional and impulsivity issues with medication, there remains a personality and set of behaviours that the person has learned in the context of a world that has forced them to act and live in a way that is not suitable for them.

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