Comparison of an objective measure of attention, activity and impulsivity in adults with a clinical diagnosis of ADHD or ASD Zoe Young 1&2, Maddie Groom 1&2, Alinda Gillott 3, Chris Hollis 1&2 1 Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, UK 2 Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), University of Nottingham, UK 3 Nottinghamshire Healthcare NHS Trust Nottinghamshire Healthcare NHS Trust, Intellectual and Developmental Disabilities Service, Specialist Services Directorate, Highbury Hospital, Nottingham, UK Background It is now widely accepted that symptoms of ADHD persist into adulthood and can have significant implications such as educational and occupational underachievement, and mental health co-morbidiites. 1,2. Symptoms of ADHD frequently co-occur with ASD. Whereas the DSM-IV did not allow for the diagnosis of both disorders, the new DSM-5 accepts their co-occurrence. However, accurately identifying ADHD symptoms in clinical populations with ASD remains problematic. Developing objective, reliable measures of ADHD symptoms could help to both discriminate these disorders and identify true comorbidity. QbTest is a newly developed tool which combines a Continuous Performance Test (CPT) with an infrared motion tracking system to provide objective measures of activity, attention and impulsivity. The test has been shown to reliably differentiate adults with ADHD from healthy controls 3 but has not yet been used to compare ADHD with other clinical populations. Aims: To compare adults with ADHD with adults with ASD on objective measures of attention, impulsivity and activity using QbTest. To determine whether QbTest measures correlate with self-reported symptoms. Conclusion Objective measures The results suggest a good clinical separation between ADHD and ASD participants on objectively measured attention, activity and impulsivity, with poorer performance from the ADHD group on all measures. Objective activity (Distance and Area) increased over the course of the test for both groups. For inattention, a decrement in performance over time was found for Omission Errors and a stable performance over time for RT variation. Patterns of performance over time only differed between groups on the inattention measure of Omission Errors. Objective vs. subjective measures The groups showed similar levels of self- reported inattention/memory (despite there being differences in the objective measures of inattention), suggesting participants may not have an accurate perception of their attentional abilities. This is supported by the lack of correlation between the subjective and objective measures of inattention. Objective measures of activity and impulsivity correlated with subjective ratings of ADHD symptoms showing a good awareness from participants of their abilities on these measures. Future research should employ a larger sample and include a comorbid ADHD/ASD group to further understand the similarities and differences between these clinical populations. Method Participants were 27 clinically diagnosed adults with ADHD and 25 clinically diagnosed adults with ASD, each under the care of a specialist adult ADHD or ASD service. The groups were compared on; Subjective self-reported symptom ratings of ADHD (Conner’s Adult ADHD Rating Scale, Self-report: Short version (CAARS- S:S), consisting of 5 subscales: CAARS_A inattention/memory problems, CAARS_B hyperactivity/restlessness, CAARS_C impulsivity/emotional lability, CAARS_D problems with self-concept, CAARS_E ADHD index Subjective self-reported symptom ratings of ASD (Autism Quotient 10 (AQ10)). Objective measurement of ADHD symptoms (QbTest: a 20 minute sustained attention task which uses an adapted version of the CPT). The test encompasses a novel infrared motion tracking system (see Figure 1). A summary score is calculated for each participant with reference to population norms in 3 domains: activity, inattention, impulsivity. For the purposes of this analysis we looked at the 3 subscales of these domains (QbActivity, QbInattention and QbImpulsivity) as well as 5 individual variables within these subscales (Distance, Area, Omission Errors, Reaction Time (RT) variation and Commission Errors). References 1.Faraone, S. V., Biederman, J., Spencer, T., Wilens, T., Seidman, L. J., Mick, E., & Doyle, A. E. (2000). Attention- Deficit/Hyperactivity Disorder in adults: an overview. Biological Psychiatry, 48, 9 – Biederman, J., Faraone, S., Milberger, S., Guite, J., Mick, E., Chen, L., … & Perrin, J. (1996). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry, 53, 437– Lis, S., Baer, N., Stein-en-Noss, C., Gallhofer, B., Sammer, G., & Kirsch, P. (2010). Objective measurement of motor activity during cognitive performance in adults with attention- deficit/hyperactivity disorder. Acta Psychiatrica Scandianvica, Results Sample characteristics and symptom ratings There was no statistical significant difference in age between the two groups. In general there were more males than females, especially in the ASD group. However, the Q-scores used to analyse performance on the QbTest are all standardized for age and gender. Comparison of QbTest measures between groups Q-scores for the three QbTest subscales (QbActivity, QbInattention and QbImpulsivity) revealed higher levels of activity (p<.001), poorer attention (p<.01) and higher impulsivity (p<.05) in the ADHD group than in the ASD group. This held true for all individual variables studied (Distance, Area, Omission Errors and RT variation) except for Commission Errors. Analysis of time on task measures To determine whether the patterns of performance over time varied between groups, an analysis of time on task was performed with the test split into 4 time points (quartiles). A main effect of time on task was found for Distance [F(1,50)=5.01, p<.01], Area [F(1,50)=8.57, p<.001] and Omission Errors [F(1,50)=6.30, p<.01], all of which followed a linear pattern indicating a decrement in performance over time. A significant time x group interaction was found for Omission Errors [F(1, 50)=3.33, p<.05] only, with the significant difference between quartiles 1 and 3 of the task. Similar temporal patterns of scores were found for all other measures. Correlations Objective activity and impulsivity scores were correlated with four out of five CAARS subscales (CAARS A, B, C and E (all p<.01). Objective inattention scores were only correlated with CAARS C (p<.05). No objective measures correlated with CAARS D. Figure 1: QbTest system For more information please contact Zoe Young by