Title: Using an objective computer task (QbTest) to aid the identification of Attention Deficit Hyperactivity Disorder (ADHD) in young people in the criminal justice secure estate: A feasibility randomised controlled trial
Funder: Department of Health and Social Care

Abstract: Background: Young people in the Criminal Justice Secure Estate (CJSE) are more likely to have Attention Deficit Hyperactivity Disorder (ADHD) than young people in the general population (12% vs. 5%). However, for a diagnosis to be made, clinicians use multiple sources of information, including parents and teachers. This information can be particularly difficult to obtain for those in the CJSE and this can lead to slow and less accurate diagnosis, thus leading to poorer health and criminal justice outcomes. There are effective treatments for ADHD and evidence of improved outcomes for those accessing these treatments. Introducing QbTest into the usual assessment processes within the CJSE could help the diagnostic process by providing an additional and immediate source of information, not reliant on informants. However, it is unclear if it is feasible or acceptable to implement QbTest within the CJSE. Aim: Our long term goal is to undertake a randomised controlled trial (RCT) of the effectiveness of including QbTest in the diagnostic assessment processes of young people with ADHD in the CJSE. However, before this can be undertaken a study is required to understand the feasibility of the proposed trial design/protocol, and the feasibility and acceptability of QbTest. Setting: HMP Young Offenders Institution Wetherby is a large establishment with a capacity of 336 boys aged 15-18 years and in 2015/2016 had approximately 700 admissions over 12 months. Young people identified as requiring an ADHD assessment will be eligible to participate. Consenting participants will be randomised to receive QbTest in addition to usual care (n=30) or to usual care only (n=30). Outcome measures will be completed at baseline and 3 and 6 months. Objective 1: To assess feasibility of the trial design/study protocol To meet this objective we will: a) Assess the number of eligible young people; b) Assess numbers who consent to take part and withdraw; c) Randomise young people to receive treatment as usual or QbTest, and record acceptability of randomisation; d) Assess follow-up and attrition rates, post randomisation; e) Assess whether outcome data can be reliably and feasibly collected; f) Assess estimates for a sample size calculation; and g) Assess adherence to the study protocol and reasons for non-adherence. Objective 2: To assess feasibility and acceptability of implementing QbTest To meet this objective we will: a) Assess the numbers of young people agreeing to sit the QbTest and the number who complete QbTest; b) Obtain feedback from young people receiving QbTest and health professionals using a questionnaire; c) Interview young people to determine the acceptability of QbTest; and d) Interview health professionals, other CJSE staff and commissioners to obtain perspectives on facilitators and barriers to using QbTest within the CJSE. Objective 3: To develop an RCT protocol If the findings from objective 1 & 2 support a larger trial a full trial protocol will be developed. Benefits to patients and the NHS Direct benefits: a) Access to QbTest assessments which have the potential to improve earlier identification of ADHD and therefore more timely access to treatment; and b) Staff training and supervison in use of QbTest. Long-term benefits: A successful RCT could lead to the national usage of QbTest within the assessment process for young people with ADHD within the CJSE which could contribute to: a) Earlier identification and treatment of ADHD; b) Prevention of secondary mental and physical health needs (morbidity and mortality) e.g. later development of depression, self-harm/suicide, substance misuse, sexually transmitted disease and cardiovascular illness; and c) Reduction in violence and aggressive behaviour within the CJSE.

Lay abstract: Young people in prison are more likely to have Attention Deficit Hyperactivity Disorder (ADHD). To help us decide if a young person has ADHD information from parents/teachers is helpful. Often this information is not available for young people in prison and therefore they miss getting the help they need. This means that some young people can be aggressive or experience a greater number of physical and mental health problems later in life. Our study will try to identify young people with ADHD using a computer task called QbTest which does not need information from parents/teachers. This has not been tried before in prison with young people and we need to test out how we will go about using it by doing a small randomised controlled trial. Part 1 of the study will involve 60 young people from one prison. Half (30) will be randomly selected to QbTest in addition to normal care, and 30 to normal care alone. This will help us to understand if the larger trial can be done, how willing young people are to take part and how they feel about the study. In Part 2 we will interview young people and health professionals to see what they think about QbTest and how it might be used in the real world. We will work alongside patients and members of the public in the study. They will help us decide how the study will be done and make sure the views of young people are fully included. At the end of the study we will write up our findings and decide if a large trial can be done. The larger trial could lead to better ways prisons can identify young people with ADHD and this could help more young people get the help they need.

Research activity codes: 4.4 POPULATION SCREENING
Health categories: MENTAL HEALTH