Please note: The Creyos ADHD Clinical Protocol and Report is not a standalone diagnostic tool. As with other Creyos Health assessments, any conclusions drawn from the Creyos ADHD Clinical Report should be paired with clinical interviews and observations, other mental health examinations or assessments administered, and other evaluations of the patient and/or the patient's family history.
In the coming weeks, select customers will be provided access to a new ADHD protocol in Creyos Health. Once a patient completes this protocol, a validated, objective and easy-to-interpret clinical report focused exclusively on ADHD will be instantly generated. This is the first of many condition-focused protocols that we will be releasing this year.
This new report is a direct result of feedback received from the Creyos community and is fundamentally different from the reports you have reviewed to-date. Specifically, this new report examines 14 specific “markers” within five Creyos cognitive tasks that have been proven, via published peer-reviewed academic papers, to be associated with ADHD—as opposed to percentile ranks or standard scores on existing reports. This new report then highlights whether the individual is within, or outside, the typical range for each marker.
If you're interested in receiving early access to this new ADHD protocol, please fill out the request form. In the meantime, keep reading for additional details, and if you have any questions, don’t hesitate to contact us — we are always happy to hear from you.
Why does this matter?
Attention Deficit Hyperactivity Disorder (ADHD) has become one of the most common conditions that healthcare providers are dealing with every day. As per this article in the National Library of Medicine, it is one of the fastest growing conditions, among youth in particular:
National population surveys reflect an increase in the prevalence [of ADHD] from 6.1% to 10.2% in the 20-year period from 1997 to 2016 and experts continue to debate and disagree on the causes for this trend. On the one hand, while there are children whose diagnoses are irrefutable and undeniably require treatment, some experts worry about the risk of over diagnosis and subsequent over prescription of stimulants and other psychotropics. Like with most psychotropic medications, treatment consideration needs to be carefully weighed with regards to potential adverse outcomes.
Many sources claim that this trend has only worsened in recent times (2020 onward), due to "a lack of structure and anxiety about Covid or jobs during the pandemic". And this sudden explosion in demand for ADHD diagnoses and treatment has created a service bottleneck—ADHD has traditionally required a clinical diagnosis, which is, in the best case scenario, accomplished through a 1 to 3 hour neuropsychiatric assessment. These appointments can take up to 6 months to book and often require out-of-pocket expenses for the patient. Due to the long wait times and high costs, clinicians and patients have little choice but to rely solely on ADHD questionnaires (such as the ASRS or VADRS, to name a few) and/or clinical interviews to reach a diagnosis. And while other computerized assessments also exist (such as 20+ minute continuous performance tasks), they are usually offered by ADHD specialists; however, they are tedious to administer, may need hardware or require specialized training and expertise to appropriately interpret results.
In speaking to Creyos clients, we consistently heard that clinicians needed an objective clinical report focused on ADHD (or other conditions)—so the solution became clear: Utilize the latest advances in neuroscience, drawn from over 350+ peer-reviewed studies involving Creyos tasks, to develop a fast and efficient ADHD-focused protocol that results in an objective and comprehensive, yet easy-to-interpret, report.
This is where the new Creyos ADHD Protocol and Clinical Report come in. Here's what you need to know at high-level regarding this new feature:
- This is a new pre-built ADHD protocol, different from any existing ADHD protocols you may have created or used in Creyos Health.
- It takes less than 25 minutes to complete and consists of four cognitive tasks, as well as the sustained attention to response task (SART) and an age-appropriate questionnaire. Note that SART is a brand new 6-minute task within the family of continuous performance tasks commonly used with ADHD populations. SART tests an individual’s ability to keep sustained attention to stimuli over prolonged periods.
- As with any assessment in Creyos Health, a validated and objective report is instantly generated when an assessment has been completed. This particular report conveys performance with respect to specific markers of our tasks (as opposed to percentile ranks or standard scores) that have been shown through extensive research (i.e, the hundreds of papers published utilizing Creyos tasks) to be associated with ADHD.
For full details on the science behind this report and a complete walkthrough of this new feature, keep reading.
Science Behind the New Creyos ADHD Clinical Report
When the Creyos teams first embarked on building a new clinical report focused on ADHD, naturally the first question that arose was: can we actually do it? After an initial investigation, it quickly turned out that we could, and, after more than 5 months of research, combing through pages and pages of academic papers, we found 14 "markers"—that is, performance indicators contained in our tasks that are reliably associated with ADHD—that formed the foundation of this new ADHD protocol and report. To confirm the validity of the markers, we had stringent conditions—for instance, we needed to find multiple studies that were published by different authors in different journals that reported similar findings for the same marker.
10 of those 14 markers are contained in four of the 12 Creyos cognitive tasks (Spatial Planning, Token Search, Feature Match, and Double Trouble). Four more markers are contained in the Sustained Attention to Response Task (SART)—this is a brand new 6-minute task available exclusively as part of the Creyos ADHD protocol. The SART is a common task used with the ADHD population, and is part of the Continuous Performance Test family—that is, tasks that measure attention and response inhibition over longer periods of time. The version of SART included in Creyos Health specifically measures the ability to sustain mindful, conscious information processing, even in repetitive, boring or distracting situations. Completing the SART is simple: numbers flash on the screen and patients must press the spacebar (or on touch devices, the "Go" button, as shown below) for all numbers except the number 3.
For a full list of markers, marker definitions, associated tasks and academic references, please download the Creyos ADHD Marker Details document.
How can I administer the Creyos ADHD Protocol?
Administering the Creyos ADHD Protocol in your Creyos Health Account
To get started, click "Start Protocol" on the Patient Details page as you normally would.
Then, select your administration method:
Once you have decided on your administration method, you will notice a new screen appear with the option to choose between two types of protocols, as shown below. Selecting "Administer Your Own Protocol" will take you down the familiar path of either choosing an existing protocol you have created, or creating a custom protocol on the fly. To administer the new pre-built ADHD protocol, click "Choose A Condition-Focused Protocol"
On the next screen, you will select from the available condition-focused protocols. Please note: while ADHD is the only one available now, you will have the ability to choose from other condition-focused protocols in the future. If a protocol is not yet available for the condition you were looking to assess, click "Would you rather administer your own protocol?" right above the "Next" button to switch to the custom protocol flow, where you can assemble your own set of tasks and questionnaires or select protocols you have already built. Psst… We want to hear from you about what condition you want to see a protocol and clinical report for next. Click here to submit your request.
On the next screen you will have the chance to review the cognitive tasks and questionnaires included in the assessment, as well as the time required to complete the overall protocol.
Note: Depending on your patient’s age, the appropriate questionnaire will automatically be included, alongside scientifically validated tasks that are proved to correlate with ADHD via peer-reviewed academic papers. Regardless of what questionnaire is added, the protocol as a whole should take at most 25 minutes to complete.
As mentioned above, the Sustained Attention to Response Task (SART) is a new addition to the Creyos Health battery and is currently exclusive to the ADHD protocol. As mentioned, the SART is a 6-minute task that measures the ability to sustain mindful, conscious information processing, even in repetitive, boring or distracting situations. Completing the SART is simple: patients need to press the spacebar (or on touchscreen devices, the "GO" button) when any number, except a 3, appears on the screen.
Detailed Overview of the Creyos ADHD Clinical Report
Once your patient completes their assessment, you'll be able to access a simple, easy-to-read report focused on ADHD in the same ways as you always do – i.e. right from the patient’s details page or the general reports page:
Much like the cognitive reports you are accustomed to, the first three pages of the report are summaries that you can use to quickly derive useful clinical insights. On all summary pages, the rows highlighted in red indicate when a flag is met for a particular marker (see blue arrows), and gives you an easy way to review the information that matters most. The summary pages also have a section right at the top that both verbally and visually shows how many markers were met for that particular section (see section below highlighted in blue). An overview of all data and metrics on the summary report is provided below:
Each marker has a threshold used to determine if a patient’s score falls outside the typical range. The typical range corresponds to performance commonly associated with people who are not diagnosed with ADHD. When performance on a marker is "outside the typical" range, statistically speaking, this corresponds to the performance being one standard deviation away from the mean, in the same direction as people diagnosed with ADHD in published studies.
You'll notice the markers are not exclusive to cognitive tasks. For instance, responses to questions in the Vanderbilt ADHD Diagnostic Rating Scale (VADRS), Strengths and Weaknesses of Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) and Adult ADHD Self-Report Scale (ASRS) have a severity rating—for the ASRS and VADRS, for responses defined by the author that meet the sufficient "severity" to be noteworthy are "flagged" as a marker. The sum of all scores, either for a subtype or the condition as a whole, are then compared to the respective questionnaire's threshold and scoring system. Here's what the ASRS summary report looks like:
For all questionnaires, behaviors tied to each individual response that meet the severity threshhold to be noteworthy are also highlighted. For example, on the ASRS, any behavior associated with a question that the patient responds to experience “often” would show up in the symptom section at the bottom of the page. This allows you to quickly see specific behavioural problems or issues that the patient is experiencing:
As you flip through the reports, you'll also see "Details" sections which provide additional context behind each task and its associated markers, allowing you to assess how close or far away from the threshold the individual scored (a proxy for severity). Also included on the Details pages are references that speak to the validity of each marker in the report:
That covers the end-to-end experience for this new clinical report focused on ADHD.
Have Questions or Want Early Access?
If you want early access, fill out this form. If you'd like to submit a request for the next condition-specific protocol and report, do so by clicking here. If you have any questions or comments as you begin to use your redesigned Creyos Health account, please let us know—you can contact us at help@creyos.com or send a line directly to your Customer Success Manager. We look forward to hearing from you.
The Creyos Health Product Team