BGaze has developed an online version of the ADHD Child Evaluation (ACE) and ACE+ (for adults) tools designed to support healthcare practitioners to assess and diagnose ADHD. The ACE/ACE+ interviews lead the assessor through the diagnostic process by assessing the core symptoms of ADHD and the extent to which they impair functioning. The interviews set out a series of questions that correspond with the core symptoms of inattention, hyperactivity and impulsivity, and typical examples of the manifestation of these symptoms are provided, which can be used to prompt the assessor and guide clinical judgement. In order to assess whether the core symptoms are causing significant interference in two or more settings, ACE/ACE+ prompts the investigation of each symptom in both home and school/work situations. Additionally, the tool leads the clinician to take a background history and consider the presence of comorbid conditions. The assessor can elect to apply either DSM-5 or ICD-10 criteria to make the diagnosis. Moreover, using Artificial Intelligence BGaze system is able to score, interpret and present the findings in a user-friendly report format.
ACE is a clinical interview that should be administered by a healthcare practitioner to individuals who are close to the child. The individual must have known the child for a considerable time and be familiar with the child’s functioning in different settings. Typically, parents/carers or other family members who are familiar with the home setting are interviewed. Usually, the child is also invited to contribute to the interview as this provides the opportunity to obtain the child’s perspective, as well as the opportunity to observe their behaviour in the assessment setting. Whenever possible, independent evidence should be obtained from school (i.e. a teacher interview and/or examination of school reports). For older children in their mid-teens, ACE can be administered directly to the child; nevertheless, it is advisable to gain corroborative information from appropriate informants and to obtain school reports if possible. For adults, ACE+ is administered directly to the individual, although whenever possible collateral information is also of value.
Introduction to the ACE and ACE+ interviews
Prior to administering the interview, the assessor should establish rapport with the interviewee in order to make them feel comfortable, settled and at ease. It is useful to establish what daily life is like for the child and those around them, and to understand what is expected of the child at home (i.e.: behaviours, chores) and how the child is progressing at school. When beginning administration of the ACE or ACE+ interview, it is important to ‘set the scene’ by explaining to the interviewee that you will ask specific questions related to the symptoms within the diagnostic criteria, and they will be invited to consider whether these symptoms have been present over the past six months. Ask the interviewee to provide examples (as many as possible) of how the symptoms manifest at home, school or other activities. You should also ask the interviewee to consider whether the symptoms seem to occur with greater frequency compared with others of a similar (e.g. with siblings or peers).
Administering the ACE and ACE+ interviews
The interview commences with a background information section. In addition to demographic information, this section enquires about the presence of early risk factors in the child’s life, their medical history, educational history, peer relationships and family background. It is important to take time over these questions as these details are necessary for understanding the context of the child/adults’s behaviour and may provide insight regarding impairment.
Then there follows items relating to the symptom criteria of inattention (nine items), hyperactivity (five items) and impulsivity (four items). The interviewee is prompted to describe specific situations and/or to give specific examples of when the symptom or problem is present, the onset of the symptom or problem, its contextual presentation, its frequency, severity and mediating factors. It is particularly important to consider the degree of impairment experienced by the child/adult due to this symptom/problem and, with respect to children, whether it occurs more frequently than would be expected for a child of a similar age and developmental level. From this in-depth exploration of each symptom, the assessor will judge whether a symptom is present and if it is impairing. If there are uncertainties that prevent a clear decision being made, it may be helpful to refer to documents for collateral information (such as school reports) and/or to seek the perspective of others involved in the child/adult’s care and/or other activities.
An observation section is provided where the assessor can make notes regarding their observations of the child or adult being assessed.
Co-existing problems and disorders
Following the observation section, the assessor is steered to consider the issue of differential or co-occurring presentations by referring to a comprehensive list of possible alternative and/or common co-existing problems. These include neurodevelopmental/cognitive, behavioural, emotional, physical and medical disorders, and each include a brief description that prompts the assessor to consider the presentation of the child from a different perspective. This section is not intended to make a diagnosis; rather it aims to identify behaviours that should be considered as potential differential or co-existing conditions that require further investigation.
Scoring the interview
Instructions for scoring the ACE interview are provided at the end of the interview; the assessor can select to apply either DSM-5 or ICD-10 diagnostic criteria. In addition, the BGaze system applies Artificial Intelligence to improve the interpretation of the scoring.