595697

research-article2015
JADXXX10.1177/1087054715595697Journal of Attention DisordersHult et al.

Article
Journal of Attention Disorders

ADHD and the QbTest: Diagnostic Validity

1­–7
© 2015 SAGE Publications
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DOI: 10.1177/1087054715595697
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Nicklas Hult1, Josefin Kadesjö1, Björn Kadesjö1, Christopher Gillberg1,

and Eva Billstedt1

Abstract
Objective: We assess the diagnostic accuracy of the QbTest, which measures the cardinal symptoms of ADHD. Method:
The study group comprised 182 children (mean age about 10 years), of whom 124 had ADHD and 58 had other clinical
diagnosis of which 81% had ASD. Results: Only QbTest parameters for inattention and hyperactivity differentiated between
ADHD and other clinical diagnoses at the p ≤ .01 level, not for measures of impulsivity. Sensitivity ranged from 47% to
67% and specificity from 72% to 84%. Positive predictive value ranged from 41% to 86%, and negative predictive value from
43% to 86%. Area under the curve varied from .70 to .80. Conclusion: The ability of the individual QbTest parameters
to identify ADHD was moderate. The test’s ability to discriminate between ADHD subtypes was unsatisfactory. (J. of Att.
Dis. XXXX; XX(X) XX-XX)

Keywords
QbTest, inattention, hyperactivity, impulsivity, attention deficit/hyperactive disorder, ASD, diagnosis

Introduction CPTs have been widely used as an objective measure of

Over the past 20 years, many millions of children globally
have been identified, diagnosed, and treated because of
ADHD. It is recommended (National Collaborating Centre
for Mental Health (UK) [NCCMH], 2009) that the diagno-
sis (Diagnostic and Statistical Manual of Mental Disorders
[4th ed.; DSM-IV]; American Psychiatric Association,
1994) be made on the basis of a full clinical and psychoso-
cial assessment, a full developmental and psychiatric his-
tory, and independent observer reports and that the
diagnostic criteria of the DSM-IV (ADHD) or International
Statistical Classification of Diseases and Related Health
Problems (10th rev. [ICD-10]; hyperkinetic disorder, World
Health Organization, 1992) be met. Many subjective instru-
ments with the purpose of “guiding” the diagnostic work-up
have been developed over the years, particularly self-rating
scales or informant rating scales, for example, the Swanson,
Nolan and Pelham-IV (SNAP) (Bussing et al., 2008), and
the Conners parent and teacher rating scales (Conners,
Parker, Sitarenios, & Epstein, 1998; Conners, Sitarenios,
Parker, & Epstein, 1997). Clinical instruments and neuro-
psychological tests such as Continuous Performance Tests
(CPTs), proposing to objectively measure the “endopheno-
types” of ADHD (e.g., “inattention,” “hyperactivity,” and
“impulsivity”), have entered the arena in the last decades.
The idea is appealing to clinicians who struggle with inter-
rater disagreement or contradictions found in information
from parents and teachers.
attention in children with ADHD. As the name implies,
CPTs require the participant to pay attention over a rela-
tively long period of time by monitoring a sequence of audi-
tory and/or visually presented stimuli and to respond
whenever a previously designated target stimulus appears.
As it is impossible to compensate once the stimulus presen-
tation is over and as the stimuli are presented rather rapidly
and over an extended period of time, even brief periods of
inattention can be assessed. There are several CPTs on the
market with reliable psychometric qualities. For example, a
study by Soreni, Crosbie, Ickowicz, and Schachar (2009)
showed that Conner’s CPT (CCPT) demonstrated higher
test–retest reliability than more subjective instruments such
as behavioral questionnaires. Halperin, Sharma, Greenblatt,
and Schwartz (1991) showed that CPTs had adequate split-
half and test–retest reliability.
Meta-analyses of validity have shown that children with
ADHD generally perform poorly on CPTs compared with
those without ADHD (Losier, McGrath, & Klein, 1996).
However, McGee, Clark, and Symons (2000) showed that
1
University of Gothenburg, Sweden
Corresponding Author:
Nicklas Hult, Gillberg Neuropsychiatry Centre, Sahlgrenska Academy,
University of Gothenburg, Kungsgatan 12, SE-411 19 Gothenburg,
Sweden.
Email: nicklas.hult@kan.nu
2 Journal of Attention Disorders 
Table 1.  Demographical and Clinical Descriptive of the Sample.
ADHD n = 124
  n (%)
M age (SD) 10.3 (1.7)
Mean full scale IQ (SD) 89.5 (13.2)
Male/female 97/27 (78/22)
Autism spectrum disorders 35 (28)
Tic disorders 5 (4)
DCD 39 (32)
Borderline intellectual functioning 12 (10)
Dyslexia 38 (31)
Language disorder 11 (9)
Depression/anxiety disorder 6 (5)
Note. CC = clinical comparison; DCD = developmental coordination disorder.
CCPT did not differentiate between children with ADHD
from clinical controls. Zelnik, Bennett-Back, Miari, Goez,
and Fattal-Valevski (2012) examined conditional probabili-
ties for the Test of Variables of Attention (TOVA) finding a
sensitivity of .91 and specificity of .21, that is, 79% false
positives when used as a diagnostic instrument. Edwards
et al. (2007) evaluated CCPT regarding validity and utility in
assessment of ADHD in a study of 104 children 6 to 12 years
of age. The CCPT performed better than a random test in
classifying ADHD, but the receiver operating characteristic
(ROC) analysis showed the accuracy of the CCPT to be low.
The CPTs mentioned above measure many of the core
symptoms in ADHD, but “hyperactivity” is not included. A
CPT test measuring aspects of motor activity is the QbTest.
Sharma and Singh (2009) reported that the results of the
QbTest agreed with ADHD diagnosis in 90% of cases. They
estimated sensitivity at .96 and specificity at .81, respec-
tively. Vogt and Shameli (2011) evaluated the clinical utility
of the QbTest and found that it provided an increased
robustness of the clinical diagnosis. There is a clear need to
further evaluate the diagnostic accuracy of the QbTest in the
assessment of ADHD and to (a) study QbTest’s ability to
identify ADHD in clinical groups, and (b) assess its power
to separate ADHD subtypes from each other. The present
study was launched with these two objectives.
Method
Procedure
The study was conducted between 2005 and 2009 at the
Child Neuropsychiatry Clinic (CNC), a statewide regional
and specialized clinic for the assessment of ADHD, autism,
and other neurodevelopmental disorders, in Gothenburg,
Sweden. A total of 322 children between 6 and 12 years of
age were referred to CNC with suspected ADHD, autism, or
another neurodevelopmental disorder during this period and
CC n = 58
n (%) p
10.8 (1.8) n.s.
92.2 (14.6) n.s.
53/5 (91/9) .001
47 (81) .001
7 (12) n.s.
4 (7) .001
9 (16) n.s.
6 (10) <.01
6 (10) n.s.
4 (7) n.s.
were all given the QbTests as part of a neuropsychiatric
assessment. All the children were comprehensively evalu-
ated including examination by a child psychiatrist/pediatric
neurologist, and a neuropsychologist. The diagnosis of
ADHD and other neurodevelopmental disorders was per-
formed according to “gold standard” in clinical setting
including assessment by a multi-professional team using
LEAD procedure (Longitudinal, Experts, All, Data; Spitzer,
1983). The diagnosis was based on behavioral criteria
according to the DSM-IV on the basis of all available infor-
mation except that collected from the QbTest. The diagnos-
tic decision was not made on the basis of results obtained at
the QbTest. Different rating scales were used as guidelines
in the diagnostic work-up, but the clinician’s judgment was
decisive. Exclusionary criteria were as follows: (a) ongoing
medication with central stimulants at the time of the assess-
ment (n = 85), (b) not valid QbTest (e.g., computer failure,
noncompliance; n = 32), (c) Wechsler Intelligence Scale for
Children-IV (WISC-IV) or Wechsler Preschool and Primary
Scale of Intelligence-III (WPPSI-III) full scale IQ at or
below 70 (n = 18), and (d) syndromal medical disorder diag-
nosis including 22q11 deletion syndrome (n = 4) or Ehler
Danlos syndrome (n = 1). This means that 182 children were
left for inclusion in the study. Retrieval of data was made by
one of the authors (J.K.) who examined all CNC-files and
registered diagnoses, IQ, comorbidity, QbTest scores, and
ongoing medication at the time of the assessment.
Participants
As already mentioned, 182 children met criteria for inclusion
in the study; these including the ADHD group (n = 124), with
a mean age of 10.3 ± 1.7 years and the non-ADHD clinical
comparison (CC) group (n = 58) with a mean age of 10.8 ± 1.8
years (Table 1). The boy:girl ratios were 3:1 in the ADHD
group and 9:1 in the CC group. In the ADHD group, 88 chil-
dren were diagnosed with ADHD combined subtype, 30 with
Hult et al. 3
inattentive subtype, 2 with hyperactive/impulsive subtype,
and 4 were diagnosed as ADHD-NOS (ADHD–not otherwise
specified). As shown in Table 1, the most frequent comorbidi-
ties in the ADHD group were developmental coordination
disorder (DCD; 32%), dyslexia (31%), and autism spectrum
disorder (ASD; 28%). In the CC group, the majority of the
participants had ASD (81%). Borderline intellectual level
(IQ = 70-84), language disorder, tics, and depression/anxiety
disorder were found in small subgroups in both the ADHD
and CC groups. No significant differences were found
between groups regarding age or full scale IQ. Number of
comorbid diagnosis averaged 2.4 (SD = 1.4) in the ADHD
group and 1.4 (SD = 0.6) in the CC group. For assessment of
effects of ASD comorbidity on QbTest performance, we
divided the ADHD group (n = 124) in two subgroups: ADHD
+ ASD (n = 35) and ADHD−no ASD (n = 89).
Instrument
The QbTest is a computerized CPT including measures of
inattention/impulsivity combined with a motion tracking
device recording activity measures. The QbTest measures
the three cardinal symptoms of ADHD; inattention, hyperac-
tivity, and impulsivity presented in the test report as cardinal
parameters—QbInattention, QbActivity, and QbImpulsivity.
The test report is calculated by the QbTest software. There is
no total ADHD score provided in the QbTest report.
The test developer assumed that some parameters mea-
sure the same underlying construct. By using statistical pro-
cedure of factor analysis (principal–component analysis) to
identify parameters that are strongly correlated with each
other, three cardinal parameters were created to aid in the
test result interpretation. Each parameter included in the
cardinal parameters is weighted differently depending on
their correlation (factor loading) to the cardinal parameter
(Knagenhjelm & Ulberstad, 2010). QbActivity includes
data from the parameters Time Active, Distance, Area, and
Micro Events registered during the second half of the test.
QbInattention include the parameters Omission Errors,
Reaction Time, and Reaction Time Variation during the sec-
ond half of the test. QbImpulsivity is computed from
Commission Errors, Normalized Commission Errors, and
also includes Anticipatory responses. The cardinal parame-
ters are weighted by a component score coefficient. During
the attention task test, a high-resolution infrared camera
monitors the head movements of the participant responding
to stimuli appearing on the computer screen. The results are
compared with a norm group of the same age and gender.
The raw score is transformed and presented as Q-score,
equivalent to Z-score, and percentiles in the test report
(Knagenhjelm & Ulberstad, 2010). The norm sample,
according to the QbTest manual, comprised 426 children
aged between 6 and 12 years from six different schools situ-
ated in cities of different sizes and level of urbanization in
the central parts of Sweden. The sample was representative
of Swedish demographics in terms of parent ethnicity, par-
ent marital status, possession of car in the household, and
the free-time activities that the child took part in.
Cardinal parameters
QbInattention provides an index of inattention based on
Omission Errors, Reaction Time, and Reaction Time
Variation (see Points 1-3 below).
QbActivity provides an index of the patient’s ability to
regulate motor activity. It is based on Time active,
Distance, Area, and Micro Events (see Points 4-7 below).
QbImpulsivity provides an index of impulsivity based on
Commission Errors, Normalized Commission Errors,
and Anticipatory Responses (see Points 8-10 below).
Attention parameters
1.  Reaction Time, measured in milliseconds, is the
average time between stimulus presentation and
correct button press.
2.  Reaction Time Variation is the standard deviation of
the Reaction Time and reflects Reaction Time
consistency
3.  Omission Errors is a measure of registered omitted
responses to the targets.
Activity parameters
4.  Time active is a measure of the test participant’s
movement during the test period and is calculated
on a second to second basis. Each second with
movement more than 1 cm is counted.
5.  Distance indicates the amount of total activity for
the test period and is measured as the distance in
meters that the marker on the headband has
traveled.
6.  Area reflects how vivid the movements are during
the test, measured as the surface covered by the
marker on the headband reflector.
7.  Micro Events reflect the degree of activity during
the test period, which is measured by quantifying a
change in position greater than 1 mm since the last
micro event.
Impulsivity parameters
8.  Commission Errors occur when a response is regis-
tered on a nontarget stimulus.
9.  Normalized Commission Errors is measured by
examining the percentage of Commission Error
rates relative to the percentage of correct responses
to target.
10.  Anticipatory is a response detected just before or
just after a stimulus is presented (“guesses”).
4 Journal of Attention Disorders 

Statistical Analysis  Table 2.  Comparisons of ADHD Group (n = 124) With CC

(n = 58) in QbTest Parameters Using Mann–Whitney U Test.
The Mann–Whitney U test was used for group comparison.
The Pearson two-tailed test was used to correlate number of ADHD total CC
comorbidities and QbTest cardinal parameters. The level of
n = 124 n = 58
significance was set at p ≤ .01. For evaluation of the diag-
nostic utility of QbTest cardinal parameters, we used ROC QbTest parameter Q-score (SD) Q-score (SD)
curves and computed the area under the curve (AUC). We
also calculated sensitivity (Se), specificity (Sp), positive QbActivity 1.7 (1.2)* 0.5 (1.2)
QbInAttention 1.2 (1.1)* 0.2 (0.9)
predictive value (PPV), and negative predictive value
QbImpulsivity 1.1 (1.6) 0.4 (1.3)
(NPV)—with a 68% prevalence of ADHD in this clinical
Activity
sample. This required both the use of a reference standard,
  Time active 1.1 (0.8)* 0.6 (1.1)
“gold standard” for diagnosis and a cutoff score for the
 Distance 1.8 (1.5)* 0.6 (1.3)
QbTest. Our “gold standard” was the clinical diagnosis of  Area 1.9 (1.5)* 0.8 (1.5)
ADHD and the QbTest cutoff was a q-score of 1.25 as rec-   Micro Events 1.5 (1.0)* 0.6 (1.1)
ommended by the test developer. For all statistical analyses, Inattention
we used SPSS statistical package system version 20.   Reaction time 0.6 (1.3)* 0.1 (1.1)
  Reaction time variation 2.0 (2.0)* 0.1 (1.8)
Ethics   Omission error 1.5 (1.0)* 0.6 (1.3)
Impulsivity
The study was approved by the Ethics Committee at the   Commission error 0.8 (1.1) 0.0 (1.0)
University of Gothenburg.   Normalized commission 0.8 (1.4) 0.1 (1.4)
 Anticipatory 0.9 (1.1)* 0.2 (1.0)
Results Note. CC = clinical comparison.
*p = .01.
QbTest Cardinal Parameters in ADHD Total
Group and CC Group .66 and specificity between .72 and .83. PPVs ranged from
.76 to .86 and NPVs from .37 to .50.
The cardinal parameters QbActivity and QbInattention
median scores were significantly higher, indicating more
deficits, in the ADHD total group than in the CC group Diagnostic Accuracy of Cardinal Parameters in
(Table 2). No difference was found between the ADHD ADHD Subtypes
total group and CC group regarding QbImpulsivity. In the ADHD combined group (n = 88), QbInattention and
QbActivity showed a moderate overall capacity (AUCs =
QbTest Standard Parameters in ADHD Total .77 and .74, respectively) to identify true positives.
Group and CC Group QbImpulsivity was found to have a slight overall capacity
(AUC = .62). Sensitivity ranged between .44 and .67 and
Group medians were significantly higher in the ADHD total specificity between .72 and .83. PPVs ranged from .71 to
group in 8 out of 10 ordinary test parameters (Table 2). No .82 and NPVs from .46 to .53 (Table 3).
differences were found between ADHD total and CC group Regarding predominantly inattentive subtype (n = 30),
regarding Commission Error and Normalized Commission. AUCs for QbInattention and QbActivity was moderate
All ordinary test parameters measuring activity were sig- (AUCs = .73 and .76), whereas QbImpulsivity was slight
nificantly different between ADHD group and CC group. (AUC = .62). Sensitivity ranges were between .37 and .60
and specificity between .72 and .83. PPVs ranged from .41
Diagnostic Accuracy of Cardinal Parameters in to .58 and NPVs from .69 to .78.
ADHD Total Group Due to small sample size in the hyperactive/impulsive
group (n = 2), analysis of diagnostic accuracy was not carried
The cardinal parameters ability to correctly classify those out in this group as well as in the ADHD-NOS group (n = 4).
with and without ADHD is presented as AUC in Table 3. In
the ADHD total group (n = 124) QbInattention and
Comorbidity and QbTest Results
QbActivity showed a moderate overall capacity (AUCs =
.76 and .74, respectively) to identify true positives. We found a positive correlation between number of comor-
QbImpulsivity was found to have a relatively weak overall bid diagnosis and QbActivity (r = .195, p = .05) but not
capacity (AUC = .62). Sensitivity ranged between .42 and regarding QbInattention and QbImpulsivity.
Hult et al. 5

Table 3.  Clinical Utility of QbTest for Identifying ADHD and ADHD Subtypes With Cutoff Set at Recommended 1.25 Q-Score.

95% Confidence interval

  AUC Se Sp PPV NPV

ADHD total (n = 124)
 QbActivity .74 [.66, .82] .63 [.56, .73] .74 [.61, .84] .84 [.75, .91] .50 [.39, .61]
 QbInAttention .76 [.69, .84] .48 [.39, .57] .83 [70, .91] .86 [.75, .93] .43 [.34, .53]
 QbImpulsivity .62 [.53, .70] .42 [.33, .51] .72 [.59, .83] .76 [.64, .86] .37 [.28, .46]
ADHD-Combined (n = 88)
 QbActivity .74 [.66, .83] .67 [.56, .76] .74 [.61, .84] .80 [.68, .88] .60 [.47, .71]
 QbInAttention .77 [.69, .85] .51 [.40, .62] .83 [.70, .91] .82 [.69, .90] .53 [.42, .63]
 QbImpulsivity .62 [.53, .71] .44 [34, 55] .72 [59, 83] .71 [57, 82] .46 [36, 57]
ADHD-Inattentive (n = 30)
 QbActivity .73 [.63, .84] .60 [.41, .77] .74 [.61, .84] .55 [.37, .71] .78 [.65, .88]
 QbInAttention .76 [.66, .86] .47 [.29, .65] .83 [.70, .91] .58 [.37, .77] .75 [.62, .85]
 QbImpulsivity .62 [.50, .74] .37 [.21, .56] .72 [.59, .83] .41 [.23, .61] .69 [.56, .80]

Note. AUC = area under the curve; Se = sensitivity; Sp = specificity; PPV = positive predictive value; NPV = negative predictive value.

Table 4.  Comparison of CC Group (n = 58) With ADHD−No ASD (n = 89) and ADHD + ASD (n = 35) Groups in QbTest Cardinal
Parameters Using Mann–Whitney U Test.

ADHD total n = 124

ADHD–no ASD (n = 89) ADHD + ASD (n = 35) CC (n = 58)

Cardinal parameter Q-score (SD) Q-score (SD) Q-score (SD)

QbActivity 1.6 (1.2)* 1.7 (1.2)* 0.5 (1.2)
QbInAttention 1.5 (1.1)* 0.9 (0.9)* 0.2 (0.9)
QbImpulsivity 0.8 (1.5) 1.6 (1.9)* 0.4 (1.3)

Note. CC = clinical comparison; ASD = autism spectrum disorder.

*p = .01.

Comparison Between the CC Group and
ADHD–No ASD and ADHD + ASD on Cardinal
Parameters Using Mann–Whitney U Test
The CC group performed significantly better than both the
ADHD + ASD and ADHD−no ASD groups regarding two of
the cardinal parameters, QbInattention and QbActivity (p =
.01; Table 4). However, only the ADHD + ASD group
showed significantly higher results regarding QbImpulsitivity
than the CC group (p = .01). Compared with the ADHD−no
ASD group, the ADHD + ASD performed better regarding
QbInattention.
Discussion
The QbTest differentiated between clinical groups with and
without ADHD at a group level. Three quarters of all the
activity, inattention, and impulsivity parameters clearly sepa-
rated ADHD from non-ADHD on a group-wise basis.
However, the cardinal parameter QbImpulsivity only showed
a trend toward separation of the two groups (p < .05).
The overall capacity for the different QbTest parameters
to accurately identify individual cases of ADHD in the clin-
ical sample was only moderate. The AUC was similar for
the ADHD-Combined and ADHD-Inattentive subgroups
indicating that the test has similar capacity independent of
ADHD subtype. This is in line with previous studies that
have shown that behavior ratings of inattentive symptoms
are more related to objective measures of hyperactivity than
to those of inattention (Günther, Kahraman-Lanzerath,
Knospe, Herpertz-Dahlmann, & Konrad, 2012). Thus, the
individual test parameters could not discriminate between
ADHD subtypes. With cutoff set to 1.25 Q-score, as recom-
mended by the manufactor, sensitivity ranged from .47 to
.67, and specificity from .72 to .84. Results which replies
findings from Sharma and Singh (2009).
When analyzing the effect of comorbidity as expressed by
number of comorbid disorders on Qb results, we found that
activity was influenced by the load of comorbidity. This result
highlights the role of motor control problems as a signal that
should lead to a comprehensive assessment including not only
attentional deficits but also other comorbid disorders.
6 Journal of Attention Disorders 
Our results are representative of a clinical sample with a
high prevalence of ADHD and other neurodevelopmental
disorders and have implications for specialized clinics for
ADHD assessments. It is not necessarily representative of
clinics in primary care as it is heavily weighted with ASD.
In clinical settings, high rates of PPV, presumably above
85% to 90%, are desired for instruments chosen for guid-
ance in the diagnostic processes as diagnostic tests are
meant to provide the clinician with some surety that an ill-
ness/condition is present. The individual QbTest parameters
do not appear to have these characteristics in this clinical
study. In our study, the PPV for the cardinal parameters
ranged from .76 to .86 and for the NPV from .37 to .50. In
other words, among those who had a positive test result, the
probability of having ADHD was 76% to 86% (depending
on which cardinal parameter is analyzed), and for those
who had a negative test result, the probability of not having
ADHD was 37% to 50%. This emphasizes that ADHD
assessment needs to be performed by experienced clinical
practitioners, that interpretation of the QbTest result should
be made with caution, and that the clinical evaluation should
still remain the gold standard for diagnosis. The QbTest
captures the core symptoms of ADHD at a group level and
also includes objective activity measures, which no other
test does. Like other neuropsychological tests, it provides a
setting for relevant clinical observation. This indicates that
the administration of the test and evaluation of test results
should be in the hands of experienced clinicians. Although
this study showed moderate validity for the individual
QbTest parameters, the intended use of the test is to comple-
ment the clinical interview and validated symptom rating
scales to improve assessment precision in ADHD.
Further on, the clinician needs to pay attention to comor-
bid ASD. It is well known that almost half the children with
ASD suffer from hyperactivity, inattention, and impulsivity
(Murray, 2010; Sturm, Fernell, & Gillberg, 2004; Yoshida
& Uchiyama, 2004). This study highlights the similarities
of CPT profiles in children with ADHD and children with
ASD, with or without coexisting ADHD. However, when
comparing children with ADHD (and no ASD) to those
with ADHD combined with ASD or to the CC group (where
a majority had ASD but no ADHD), we found interesting
differences in impulsivity among the groups that the comor-
bid ADHD + ASD group were more impulsive than the
ADHD group and CC group. We also found that the comor-
bid ADHD + ASD group received lower scores on inatten-
tive test parameters, whereas all groups performed similar
on QbInattentive cardinal parameter. This raises the ques-
tion whether the clinical presentation of ADHD in children
with coexistence of ADHD and ASD is different from in
children with only ADHD. Inhibitory control is an impor-
tant component in executive functions, and individuals with
ASD are reported to encounter inhibitory control deficits
(Geurts, van den Bergh, & Ruzzano, 2014). The higher
impulsivity score seen in the ADHD + ASD group might be
a double effect of inhibitory deficit due both to ASD and
ADHD. The difference in inattention might be explained by
different attentive styles, for example, that individuals with
ASD may exhibit selective inattention to social stimuli or to
unmotivated activities, whereas sustaining focus on activi-
ties with limited connection to social stimuli (as in a com-
puterized test) is easier.
To sum up, the individual QbTest parameter ability to dif-
ferentiate between ADHD and CC group was good, but the
ability to identify ADHD in a clinical sample was moderate
and the ability to discriminate between ADHD subtypes was
unsatisfactory. However, analyzing QbTest performances in
different clinical groups (including ADHD) might give valu-
able information on clinical presentation that might explain
more than the broad diagnostic categories.
Strengths and Limitations
The strengths of the study is that the study group is repre-
sentative of patients who will receive the test in practice and
that both the study group and the comparison group had
received the same reference test, a clinical diagnostic work-
up using ADHD criteria according to DSM-IV.
A limitation in the study is that although the ADHD
diagnosis was not based on results from the QbTest, the
results were known to some of the clinicians, whose infor-
mation could have contributed to the final diagnosis.
Another limitation is that no interrater reliability tests
regarding diagnoses were carried out.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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Author Biographies
Nicklas Hult is a clinical psychologist, working as a neuropsy-
chologist at a child and adolescent clinic in Gothenburg and is also
a PhD student at the Gillberg Neuropsychiatry Centre, at the
University of Gothenburg.
Josefin Kadesjö is a clinical psychologist working both as a
school psychologist and a clinical psychologist at a child and ado-
lescent clinic in Gothenburg.
Björn Kadesjö is a paediatrician at the Child Neuropsychiatric
Clinic at Queen Silvias Children´s Hospital, Gothenburg.
Christopher Gillberg is professor Gillberg Neuropsychiatry
Centre at the University of Gothenburg and child psychiatrist at
the Child Neuropsychiatric Clinic at Queen Silvias Children´s
Hospital, Gothenburg.
Eva Billstedt is an associate professor at Gillberg Neuropsychiatry
Centre, University of Gothenburg and clinical psychologist at the
Child Neuropsychiatric Clinic at Queen Silvias Children´s
Hospital, Gothenburg.