Digital technologies for assessing attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterised by a persistent pattern of hyperactivity, impulsivity, and inattention that interferes with daily and occupational functioning.

This may manifest as: wandering off-task; having difficulty sustaining focus; being disorganised; excessive motor activity when it is not appropriate; excessive fidgeting, tapping and talkativeness; social intrusiveness; and making important decisions without considering the long-term consequences. People with ADHD may take hasty actions that occur in the moment without forethought and that have high potential for harm to the individual.

The global prevalence of ADHD in children is estimated to be around 5%. In the UK, the prevalence of ADHD in adults is estimated at 3% to 4%. It is more commonly diagnosed in boys than girls.

ADHD is associated with psychiatric disorders including oppositional defiant disorder, conduct disorder, substance misuse, and mood disorders such as depression and mania. Autism spectrum disorder, dyslexia, dyscalculia, and dyspraxia commonly co-occur in people with ADHD. Overall prognosis may depend on the severity and management of any comorbid disorders.

Treatment for ADHD may be non-pharmacological, including psychoeducation, ADHD coaching, parent training, or environmental changes. Pharmacological treatment may include stimulant or non-stimulant medication. Medication doses are titrated against symptoms and adverse effects until dose optimisation is achieved.

The NICE guideline on attention deficit hyperactivity disorder: diagnosis and management describes the care pathway. People presenting to primary care with behavioural or attention problems that suggest ADHD are referred to secondary care for assessment.

A clinical assessment for ADHD by a specialist healthcare professional involves gathering information about a person's symptoms and behaviours. This includes the person's developmental, medical, educational and mental health history, and ADHD-specific history. Information may come from the person themselves, a parent or carer, schoolteachers (for children), or employers (for adults). Information can be collected using interviews, observer reports and standardised rating scales.

Standard clinical assessment for ADHD is based on diagnostic criteria that require training and experience to apply correctly and require clinical judgement, relying on information obtained from a range of sources. Information from these sources may often be incomplete or contradictory, requiring multiple clinic visits or observations to reach a diagnostic decision. Diagnosis of ADHD is further complicated by similarities in presentation and overlap with other neurodevelopmental disorders and mental health conditions, which may lead to difficulties and delays in decision making.

Digital technologies that combine measures of cognition and motor (physical) activity may help healthcare professionals when considering a diagnosis of ADHD, by providing additional objective information. This could reduce the number or length of clinical appointments needed to reach a diagnosis, reducing patient waiting lists and freeing up NHS resources. It may also provide people with quicker access to appropriate further care or assessment.