NIHR MindTech Healthcare Technology Co-operative

1. Snappy App: A mobile continuous performance test with physical activity measurement for assessing Attention Deficit Hyperactivity Disorder NIHR MindTech Healthcare Technology Co-operative Zoe Young, Michael P. Craven, Maddie Groom and John Crowe

2. NIHR Healthcare Technology Co-operatives (HTCs) Bradford: Wound Prevention & Treatment Leeds: Colorectal Therapies Sheffield: Devices for Dignity Nottingham: Mental Health Cambridge: Brain Injury Birmingham: Trauma Management Bart’s: Gastrointestinal Disease Guys: Cardiovascular Disease

4. What is ADHD? • Attention Deficit Hyperactivity Disorder (ADHD) affects 3-5% of school-aged children and persists into adulthood for most • Three core behaviours associated with ADHD; 1. (in)attention 2. impulsivity 3. (hyper)activity • Assessment of ADHD heavily reliant on subjective measures and interpretation of interviews and standardised rating scales • Objective measures of attention are now being used in the assessment of ADHD and to measure response to medication

5. Continuous Performance Tests (CPT) • Computer based task widely used to objectively measure attention and impulsivity and response to medication • Requires the detection of low probability targets and inhibit response to non-targets • A-X task highly specific – ADHD and controls clearly differentiated (van Leeuwenet al., 1998) • Methylphenidate can improve performance on CPT (Klormanet al., 1981) • One CPT (QbTest) includes measurement of motor activity - activity higher in ADHD children and adults and co-varied with cognitive performance (Lis et al., 2010) – QbTest

6. Snappy App • A CPT on a smartphone • Objective measure of attention, impulsivity and activity • Capture of movement data during the test • Early stages of development – pilot test Objective Establish whether a new smartphone application combining the cued CPT with a physical activity measure could be appropriate for monitoring symptoms in a clinical population.

11. Methods Participants • 11 healthy UK University staff and students Measures • CPT(completed 3 times) – records Omission Errors, Commission Errors, Reaction Time (RT) and Reaction Time variation • UPPS-P self-reporting Impulsive Behaviour Scale • Participant feedback questionnaire

12. Results • No significant differences between testing sessions – suggests no effects of practice or deterioration • All measures stable over the course of each test (except Omission Errors on Test 3 showed a decrement in performance)

13. Results • Some sensitivity to ADHD-related traits in healthy individuals (as correlated with UPPS) • Overall, participants rated their experience of using the App positively

14. Discussion Points • Good test-retest reliability- a decrement in performance is seen in ADHD but not expected in healthy controls • Small sample and restricted to University staff and students • UPPS only measures impulsivity (not attention and activity) • Some difficulties with the activity measurement • Further pilot testing in a clinical sample needed

15. Key Challenges • Will it be sensitive to ADHD population? • Movement data – reliable on a smartphone? • Cost (of phones & data), phone signal, usability, access • Privacy, trust, consent and data security • Motivation to complete – Gamifythe App?

16. Contacts Dr Michael Craven michael.craven@nottingham.ac.uk