Braingaze, a spin-off of the University of Barcelona, has spent the last six years developing BGaze, a digital platform that aims to improve the diagnostic process and the treatment of ADHD in children and adults. In the diagnostic field, BGaze ACE includes ACE (ADHD Child Evaluation) and ACE+ (the version for adults) semi-structured interviews to collect information from patients and informants. ACE/ACE+ were developed by the renowned clinical psychologist Dr. Susan Young, who gave us an interview:
You have dedicated a lot of time and effort to study ADHD not only in children but also in adults. What’s the current state of diagnosis and treatment of ADHD in this part of the population?
The current state of diagnosis and treatment of ADHD varies widely across Europe – in fact across the whole world. Some countries, like the UK and the USA are relatively advanced in diagnosing, assessing and treating ADHD, others are not. There really are huge variations across the world in this respect. In the UK clinical services are reasonably good for children and adolescents with ADHD, but we are woefully behind in services for adults. There are reports of very long waiting lists for an assessment, some even being up to four years, and the service you get depends very much on your postcode – on where you’re living in the UK. I think this reflects uncertainty, lack of training and support in assessing ADHD in adulthood. There are also problems for assessment of children with ADHD, but they are different problems. Some parents have difficulty accessing services for their children due to the perception that ADHD is a behavioural disorder characterized by disruptive or aggressive behaviours. Females in particular are underdiagnosed in both childhood and adulthood. So I think we’ve made great advances over the years, but we still have a way to go, unfortunately.
How can ACE/ACE+ interviews provide objective measurements for symptoms such as inattention, hyperactivity and/or impulsivity?
I developed ACE and ACE+ in response to my own clinical practice. I’m very experienced in assessing ADHD in children, adolescents and adults and I felt that there was a need for better clinical support to make the diagnosis. These instruments aim to provide a semi-structured, systematic interview that supports the process of assessing core symptoms of ADHD (inattention, hyperactivity, impulsivity) in children and in adults. I think this is important because the symptoms change as a young person grows up. I remember when I worked in child services, seeing children in my consulting room who were very hyperactive, who couldn’t sit still, who were rolling around on the floor, sticking their fingers into plug sockets… they needed to be constantly monitored. You don’t find that with adults. Adults feel restless inside but are more able to control these feelings, even though they may find it difficult. They also describe feeling their brains are overactive; they describe this as a ceaseless mental energy that is difficult to switch off.
To my knowledge, ACE and ACE+ are the only interviews that include a background interview followed by an assessment of symptoms and prompts to consider coexisting mental health and associated conditions. The healthcare practitioner can opt to apply DSM or ICD diagnostic criteria. This is a comprehensive process – ACE and ACE+ are not rating scales nor do they apply a dropdown ‘tickbox’ procedure, but instead they guide the healthcare practitioner to conduct a thorough and comprehensive clinical assessment, without missing important information. They guide them to consider potential differential diagnosis and/or co-morbid problems. This supports the healthcare practitioner to confidently reach a decision regarding diagnosis. It’s essential to get this right, as a comprehensive understanding of the individual’s difficulties will inform the treatment approach.
BGaze ACE applies an online version of ACE/ACE interviews. In your opinion, what are the key strengths of BGaze ACE and this digital format?
The advantage of BGaze ACE is, simply put, that it is in a digital format. This means that people can record their notes in a user-friendly way. As they go through the assessment, they can make their notes directly onto a laptop or an iPad. The decision-making algorithm is automatically populated from the symptom ratings and the healthcare practitioner is prompted to ensure the diagnostic criteria are met, such as symptoms being pervasive across settings and causing impairment from a young age. A brief summary report is generated and the healthcare practitioner has the option to amend this, adding supplementary information and/or recommendations.
How do you expect to see the future of ADHD diagnostics?
Technology is advancing at a rate that many can’t imagine, let alone keep up with. In the coming years, we’ll undoubtedly witness major advances in the application of digital technologies in the field of psychiatry. In particular, artificial intelligence (AI) algorithms will increasingly inform clinical practice.
ACE’s paper version is currently available in 19 languages and more translations are on the way. The digital version is currently available in English and Spanish in BGaze ACE.