McCall Letterle: Qbtech and rethinking how we diagnosis ADHDNov 13, 2023
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“With the long waiting lists, patients are losing years of their life or their education going undiagnosed and untreated, even if they’ve been identified and gotten into the system.”
McCall is Qbtech’s Head of Commercial Operations - North America, where she is responsible for the regulatory, research, and clinical operations in the United States. Qbtech is a leading provider of objective ADHD tests, designed to help clinicians around the world measure ADHD symptoms more accurately.
We talk about how Qbtech is working with clinicians around the world to develop and implement objective, standardized ADHD testing for children and adults. We also discuss some of the gaps in our healthcare systems and ways to improve ADHD management and care.
And we also talk about some of the global cultural differences that affect how clinicians are viewing ADHD diagnosis and management. And how therapists are using Qbtech testing to help guide their treatment plans.
McCall Letterle 0:00
For people with Keno kind of that, I don't want to say true ADHD because it really, I think, is an evolving concept. But this idea that the brain isn't getting the trigger to add in the extra components that it needs to stay on task, and that for many people has kind of historic tracking, where they can relate to that in adolescence. They can recognize when it happened as young children, but situationally, it's really intense, because everything else is adding in our environment to amplifying how significant it is.
Katy Weber 0:37
Hello, and welcome to the women and ADHD podcast. I'm your host, Katy Weber. I was diagnosed with ADHD at the age of 45. And it completely turned my world upside down. I've been looking back at so much of my life, school jobs, my relationships, all of it with this new lens and it has been nothing short of overwhelming I quickly discovered I was not the only woman to have this experience. And now I interview other women who liked me discovered in adulthood they have ADHD and are finally feeling like they understand who they are and how to best lean into their strengths, both professionally and personally. All right, before we get started, I would love to share with you this review from a listener named Stevie H H on the Apple podcast platform in the UK. It's entitled hugely helpful after my son was first seen for ADHD still not completed three years later, as I failed to put together the long list of written evidence requester and experiencing serious impairment in an otherwise highly successful career and going to talks on neurodiversity. By chance I twigged I've managed to have myself referred not really worrying about speed. I know the answer, but a diagnosis is helpful for getting my children to see it positively in themselves. And I'm determined to finalize my son's diagnosis. Listening to these podcasts has been hugely helpful understanding problems I've faced through my life and realizing it's not me failing repeatedly. Understanding what is seen as a superpower is one but can also break you as you get older and take on everything to an insane degree massively appreciated. Well, thank you Stevie. I feel like your experience is so common and this review is very timely given this week's episode, which we will get into in a moment. But first, thank you for submitting this review. And I'm so glad to hear these interviews have been helpful in understanding your brain. So here we are at episode 163 in which I interviewed McCall literally have a call is QB Tech's head of commercial operations in North America where she's responsible for the regulatory research and clinical operations in the US. QB Tech is a leading provider of objective ADHD tests designed to help clinicians around the world measure ADHD symptoms more accurately, McCall and I talk about how QB tech is working with clinicians around the world to develop and implement objective standardized ADHD testing for children and adults. We also talk about some of the gaps in our healthcare systems and various ways to improve ADHD management and care. And we also talk about some of the global cultural differences that affect how clinicians are viewing ADHD diagnosis and management and how therapists are also using QB tech testing to help guide their treatment plans. Now I just loved this conversation with the McCall you're gonna love it too. It's just she's fantastic. But I have to add that after our incredible conversation, I was able to take the QB check test at home, it wasn't an official test because I wasn't under the care of a clinician, but I was able to give it a bit of a test drive. And I have to say I thought I did very well on the test. So naturally, I was terrified that it was going to come back that I do not in fact have ADHD. I spent three days between actually completing the test and getting my results spiraling worrying that I might have to shut down the podcast because it may be you know, it turns out I don't have ADHD and what is this gonna say about my future in this field and I had to laugh at by the way in which I completely spiraled after taking this test. So anyway, it turns out once I got the results, not only do I have ADHD, but it turns out I am hella ADHD. So it was really fun to take the test. But again, this test is only available for clinicians. So if you want to take the QB test or the QB check, you do need to take it with the guidance of a professional that said again, I had a really great conversation with McCall and I am so excited for you to hear it. So here it is. I have a call. Thank you so much for joining me today.
McCall Letterle 4:40
Hey, Katie, great to join you. Thanks for having me.
Katy Weber 4:43
Okay, so normally I start out my podcast asking my guests about their adult diagnosis journey or their or you know, their journey into an ADHD diagnosis. But we're gonna start this a little differently because you do not have ADHD. You're one of my I could count on one hand I think The number of guests I've had who are in the ADHD world, doing really, really passionate work for at, you know, with ADHD clients and around ADHD research but don't actually have ADHD themselves. So how did you get involved in this particular work? Where Where did your interest in ADHD stem from?
McCall Letterle 5:18
Yeah, I appreciate it. It's it comes from Bumblebee organically the same place most of your guests find it, which is frustration and identifying ADHD in and of itself and finding the right providers and connecting the right stream of people. I came from a family where I had a sibling that really, really struggled. So this is back in the early 80s, to find the right diagnosis. Now, this was a male sibling of mine. But I think a lot of the problems, at least in early identification, tend to be the same across both groups. And my brother really, really struggled. And my mother struggled to put together a team of people that really understood what was going on. And back in the day, I think less was understood about it. So she ended up having to become her son's advocate having to put together her own team of providers. And I watched this struggle year over a year over year and how much it just, you know, it drains the soul and the family. And it's it's a lot to put together. But then I've seen what happens when the right team comes together. And the right identification comes in the right education around ADHD, and the difference in what that kind of takes off and source for an individual. And I just thought it was the coolest thing in the world. And so I've been really fortunate to align myself with the company, I got into the clinical world. So I have a master's in clinical mental health, I focused and trained within ADHD and worked in multidisciplinary teams. But then I've gotten really lucky in my career to be part of a company that shares that almost identical mission. So we're a privately held company. And it's a core value of ours because the owners and early investors in our company have almost the same story as me. Very, very different stories between a proper diagnosis and delayed and misdiagnosis. And so it's been a pleasure for the last decade to work with them and really try to change what's happening for ADHD errs and how they're diagnosed. And especially women because this is such a unique group. Right?
Katy Weber 7:24
Yeah, I mean, I, I was diagnosed around three years ago. So in 2020, relatively at the beginning of the pandemic, I was 45. I started this podcast shortly after, in fact, I've admitted on this podcast before that I started the podcast before I was officially diagnosed and was terrified that I didn't actually have ADHD. And through the course of this podcast, we talk a lot about the same topics, or at least I do, which is, is this really ADHD like, there's so much self doubt involved in this diagnosis. And I think, you know, a lot of it has to do with lack of, what's the word I'm looking for, like a formulaic testing, right? Like, I had a half hour conversation with my GP, and she was like, Yeah, you have ADHD. And that was it. And I've often wished I had a certificate or a card or something I could pull out of my wallet, when I was second guessing you know what this was, whereas my children had the four hour psych assessment, all of the Woodcock Johnson, all of those brief tests. And I've heard other people refer to the conversation with the GP as a soft diagnose this. So it's definitely something I think a lot of us relate to, which is even if we do get diagnosed by a medical professional, the doubt still lingers, right. And then the other side is with online testing. There's that feeling of, did I just pay for this diagnosis, and they just want my money, right. So or other I don't feel like there are other diagnoses that feel this confusing and problematic in terms of the self report and the self diagnosis leading to the official diagnosis. Like sometimes it just really feels like the wild west out there. So
McCall Letterle 9:09
you're highlighting? I love this, you're highlighting so many themes that we see. So I work with 1000s of clinicians across the country. And you know, what you're kind of identifying is one of the first validation right like there is such an element where you question there's so many overlapping symptoms to other disorders, you know, anxiety and depression create inattention and it creates elements of impulsivity and forgetfulness. And you do wonder and doubt yourself and women do that more so than men most often. And that validation piece is so important. The other thing you're really highlighting is there is no clear direction in our healthcare system as to who the right person to go to is like who is the doctor that is the one that gives you the proper diagnosis and how does that work out? And we really see that patients struggle to kind of navigate that, and it's different for children than it is for adults, you know, you're identifying such a late in life diagnosis that I'm sure you probably feel would have been really beneficial to know, way in advance. But that's really where I think, you know, we're pushing for, and I'm pushing for such a change in where we recommend people to go, who the right people are in providing clarity, so that that validation comes much sooner than you've experienced.
Katy Weber 10:33
Right? I know. And I think, you know, you're just reminded me of the, the brain scans to which I'm not going to go on a whole tirade about those but but you know, and I was, I remember also reading a study on some, like African tribes that had diverted into an agrarian tribe and more of a nomadic tribe. And they had tested each of the tribe members for ADHD. And there was like, had done a genetic test for some sort of gene. And I was like, Wait, what is that all I got out of that study was, what is this gene? And why wasn't I tested for it? Right? Like, yeah, like I really, the really the need for what is the word I'm looking for? I keep this to get the unification or standardization.
McCall Letterle 11:14
Yes, standardization. And what we really encourage is objectivity. So what you kind of highlighted is, you know, you had a 30 minute consult with your GP, which usually involves like a clinical interview. So you're going through history and background and the GPS, trying to use their expertise to put together your symptoms in the context, and try to identify where is this organically coming from. And some professionals are really well trained in that and have a lot of experience, but a lot of professionals have not had a ton of training and ADHD. And so they're trying to navigate and put together these pieces when there isn't kind of standardization across all types of providers, nurse practitioners, GPS, pediatrician, psychiatry. And so what you're talking about is like, you know, so many people think like, where's the test that tells me the blood test, or the brain scan that tells me this is what it is? Because we know that individuals have to kind of check boxes, right? So you've got this subjective checklist that you go through. And sometimes you even question yourself, and we find that patients tend to be very poor self readers, especially when they have ADHD. And especially when it is untreated, they gauge their symptomology very different because it's, it's coming in the context of inattention and hyperactivity issues. And so there's a really big need for something objective that clinicians can use, where a patient can take a test, and it's not going to be a test that spits out a letter that says, like, you know, congratulations, you've got it, or, you know, congratulations, you don't. But what it is going to do is it's going to quantify your symptoms. And this is kind of the world that I work in is that we quantify the symptoms hyperactivity, inattention impulsivity, and say, How significant because we know tons of people have difficulty paying attention. What we want to know with ADHD is it to a clinically significant degree where the impairment is so high that your brain is having difficulty internally regulating the things it needs to do. And it doesn't have the mechanisms to cope or make that better internally. And so what we tried to do is we gauge this against people that are your same age, and your same sex at birth, because there are biological components to these symptoms. And that helps us say whether or not the symptoms are severe enough. And it gives the doctor something else to look at to say like, Okay, I've put clinical history together, it's starting to make sense, the patient is identifying through the rating scales, that there's some issues here. And now we've tested the patient to gauge what happens when they are under stimulated, can they sustain attention? What happens to their hyperactivity? And what happens to their impulsivity? And is it more severe than we would expect to see, for instance, for a 45 year old woman, instead of comparing you to the 43 year old male that the doctor just saw an hour before you and had a totally different set of symptoms? Because these are very, very different manifestations?
Katy Weber 14:26
Yeah. One thing that I heard was you were talking about the biological differences, which I want to get back to because a topic we talk a lot about on a podcast called Women and ADHD is the differences in terms of how we're socialized. And in terms of asking for support, how we're socialized in terms of domestic chores, and you know, the mental load and all of this, so we talk about all of that, but what what do you can you talk more about the actual biological differences that you've seen in testing? Yeah, so
McCall Letterle 14:59
there So, there's a lot and oftentimes, you know, well women typically tend to be diagnosed with quote, inattentive type ADHD more frequently than males. There is hyperactivity components to female ADHD that look different than male ADHD it manifests itself differently. And what's important is to quantify those two separately of each other. So male hyperactivity tends to look like you know, what we see in children, the typical disruptions standing up unable to stay focused. For women, what we tend to see is a lot more of the small fidgeting components. So shaking or tapping of the leg, or fidgeting with various different things. It's more quiet, less disruptive types of hyperactivity. And that's why it's so important to compare these symptoms against other women that may be displaying these symptoms. So, for instance, a couple of years back, we took a look at the internal data that we have from the QB testing system. So that's the system we work with it's a computerized test can be done at home or in the clinic. And it measures hyperactivity, inattention, and impulsivity in patients ages six to 60 years old. So we have this really rich set of data that we were able to take a look at, we looked at 120,000 patients, both males and females between 270 clinics globally. And we try to look and say, What was the difference within symptomology between the males and the females. And one of the most interesting findings was that in the female population, their severity, compared to other females without ADHD, was more severe than the males severity compared to people, other males with ADHD. So it's not that the females had more symptoms than the males. But when they were compared to non ADHD women, they had a much bigger discrepancy between their impairment than the males did to their non male, to their non ADHD counterparts. And so this idea that women have less symptoms, or less severe symptoms is really outdated. And we really know that women display it differently. And we're finding that it's more severe in impairment levels than it is for males. Yeah.
Katy Weber 17:25
And I think why so many women are diagnosed in adulthood speaks a lot to how we're able to manage a lot of these symptoms. And then something happened, a catalyst comes along there, we hit our breaking point. For me, it was the pandemic, sometimes it's babies, you know, whatever it is. But I also feel like I've talked to a lot of women who are Peri menopausal, who get their diagnosis, because they just like, can't anymore, fill it, they just can't blank and, you know, fill in the blank. And we're, you know, we often have that conversation where it's like, is it just because I'm a feminist? And I just don't want to do it anymore? Or is it? Because I've, you know, is it estrogen and all of the heart? You know, the hormone question becomes such a big one, too, in terms of like, you know, where are those peaks in terms of diagnoses throughout our lifetime,
McCall Letterle 18:13
there's something to interesting elements there, you know, the wear out effect. So this is not in the criteria that clinicians look at is how exhausted and time after time women are reporting this, I am exhausted, I am burnt out, I met my breaking point, that's when I arrived at the clinic. And it's nowhere in the checklist that symptomology. And those factors are nowhere in the DSM criteria that clinicians utilize. But it's such a significant factor of what helps us identify ADHD in women, is this burnout factor, they can hang on a lot longer than men tend to be able to hang on with that burnout rate. That same data that we looked at also showed referral rates for testing. So it was really interesting because we looked at young children, adolescents and adults. And the gap between female referrals and male referrals for testing was huge. In the younger population. It gets slightly smaller, but the gap is still significant in adolescence. And by the time we looked at the adult population, the gap which was much closer together, so the referral rates were starting to become more equal. And we're finding that it's really because women are then able to self refer into the system. They're not being identified as young girls when it isn't easy to self refer. And we are finding that that burnout is really significant once you get into that older age for women in ADHD.
Katy Weber 19:43
I think another conversation that I have a lot given the what feels like a tremendous increase in diagnoses in adult women over the last three years and it could just be the fact that it's all I do and think about but it feels like thanks to tick tock and the pandemic I'd like it feels like there has been a tremendous increase in self diagnosis of ADHD. And so then that begs the question, Is this actually ADHD? Or is something else happening? Are we tied to our phones? Are we is there the trauma of the pandemic? I mean, all of these questions that are leading to like ADHD like symptoms, that then again leads to, you know, a lot of those conversations with doctors that end with just get more sleep, you know, or get a new planner, or get a housekeeper or whatever those ways in which there's a lot of that kind of gatekeeping that happens sometimes in the doctor's office. So what are your thoughts? Do you feel like this is really ADHD that we're talking about? And there's just been an explosion in awareness? Or do you feel like maybe something else is going on? Yeah, it's
McCall Letterle 20:48
a good question. The answer, I, from my perspective, is both yes and no. So I think my half answer is that we are seeing just a rise in awareness. So right now on social media, health influencers are now risen to the number one amount of influencers, so they reach about 1.5 billion people every year, there is a rise in the awareness of it. And I think the more that we start to reduce the stigma and add to the information, women and adult men are also starting to, you know, self refer into the system. So there is a truth within that. I do think that there's a lot more research that needs to happen related to kind of the situational ADHD. So where you do have a lot of different stressors, and distractors that are coming up, you know, even in this, in this conversation that we're having today, I had to make sure that nine different devices were shut down, so that nothing popped up as we had a conversation. So there is kind of environmental impact. But I think it's why objective data in the evaluation and treatment process is so important. Because with objective data, you're measuring the brain's ability to regulate that focus and that stimulation over the period over a course of time, and for people myself, I don't personally have ADHD, when my brain deems something under stimulating and boring, it's adding in that extra dopamine that I need, it gets that triggers as Wow, she's really bored or dopamine is dropped, it adds in that dopamine for me, and I'm able to get myself back on task. And for people with, you know, kind of that I don't want to say true ADHD, because it really, I think, is an evolving concept. But this idea that the brain isn't getting the trigger, to add in the extra components that it needs to stay on task. And that for many people has kind of historic tracking, where they can relate to that in adolescence. They can recognize when it happened as young children, but situationally, it's really intense, because everything else is adding in our environment to amplifying how significant it is. So there's, there's, I think, a truth to both elements. But I do believe that there is just the rise in awareness is making us understand that the prevalence rates for ADHD are probably much higher than we realize.
Katy Weber 23:06
Yeah, yeah, I think so. And I think there is sort of a chicken egg scenario, especially with social media, right with you know, a lot of times you'll hear curmudgeon tours last sort of like tick tock is causing people to have a more ADHD and you're like no people with ADHD just like tick tock because of the scroll and all the dopamine to get right. So I'm like, we're like moths to a flame when it comes to certain devices. So is it causing ADHD? No. Is it exacerbating ADHD symptoms? Probably. And that's where I, I feel like I always get back to that same question of like, okay, what are we talking about here? Are we talking about a certain type of brain that has difficulty with dopamine regulation? And like you said, there's probably a lot more than five to 10% of us who have this, it's just a matter of and our coping skills are what then we have to talk about in terms of severity of ADHD. So are we talking about our behaviors in relation to our coping mechanisms, or our environment and classrooms and nine to five jobs and all these things that are changing how we behave? Is that what we're talking about in terms of ADHD? Because that feels like it's really manageable, incurable? Or is this a brain that needs to be helped with psychotropic medication? Because a lot of the time I feel like many of us, you know, we go we get our diagnosis. The doctor is like, Okay, here's your, here's your prescription. Good luck. And that's the that's the conversation, right? And then it's up to ourselves to really come up with a treatment plan. Yeah, but I think there's this there's this sort of pathologize ation of ADHD in which does sort of feel like a lot of the time, take this pill and you're cured. And that is, I can attest, that's not
McCall Letterle 24:49
No, and, you know, the other component of this is that treatment follow up in this country is really lacking. You know, you oftentimes have to advocate for yourself have. And again, there's no standardization in how we measure the treatment. So oftentimes one type of medication or prescription is prescribed at one dose. And they say good luck, maybe the patient doesn't have a great response to it doesn't like how it makes them feel, they report it back to their clinician, and now it's deemed this type, you know, pharmacological treatment is not an option. And what we really need to start having is a better conversation between the clinician and the providers around what's available, what options very often, pharmaceuticals need to be used in conjunction with other support mechanisms for them to be fully successful. But you can also use objective data to drive that treatment process. So you can measure how severe the symptoms are at the time of diagnosis, and have a baseline for where somebody is how severe their symptoms are. But that same mechanism, that same type of testing, can be utilized to measure. Okay, you've tried your first trial of, you know, let's say it's not always pharmacological, but it's usually the first line of defense. So you've tried your first trial, how effective was it for you, some patients do objective data testing, and it actually is making their symptoms worse. And that's why they feel terrible on the medication because all of a sudden, they're now more hyperactive, or they're more distractible. And it needs to be honed. And I think we really haven't gotten into a point in our healthcare society where we say, this treatment is not a one visit and you're cured, or one visit and it didn't work. And sorry, your options are just really limited. It's a process that needs a lot of conversation. And I think we can do a lot better job standardizing that and using data to drive those decisions. So patients feel more confident in what's happening.
Katy Weber 26:50
Yeah, that's amazing. I didn't realize I knew I've heard of QB tech many times for diagnostics, but I didn't realize that there was like an ongoing kind of quantitative measure on my for people like me, who really geek out on quantitative data. I'm like, Oh, I have like, I want to see, you know, I'm like, Can I have it next to my bed and just test myself every day? So So let's so who is using QB tech? I know is it GPS? Is it psychiatrists? Is it really anybody who is interested at what has been the reception to QB tech, because it's international, too, right? It
McCall Letterle 27:27
is, it is sort of Swedish based company. And we grew really significantly in Europe, we came over to the US in 2012. So we've got FDA clearance for both diagnosis and treatment follow up. So really great utilization from kind of end to end clinical journey for the patient. It's interesting, because we've seen a shift, so pre pandemic, and I've been with the company since 2012. So I was one of the first hires here, pre pandemic, it was largely used by pediatricians, pediatrician for wanting an additional tool, they felt, oftentimes ill equipped to handle the amount of ADHD that was coming into their doors, and then the pandemic hit. And we saw a massive shift, a massive shift over to mental health care providers, so psychiatrists who were inundated with patients, they felt that the caseload was too significant, and they needed something to help get them on a standardized process. We've seen a huge influx of nurse practitioners, a lot of areas where we talk about these kinds of care deserts, where there are not professionals in a lot of rural counties. So 90% of counties in the United States do not have a child and adolescent psychiatrist available to them. So we've seen a really big step up in nurse practitioners, physician's assistants, and psychiatrists that are stepping up to try to answer the demand. And that's really who has kind of shifted to a big portion of our clientele. And they're finding it really, really helpful to not just make them feel confident in who they're helping or who they're diagnosing or that this really is kind of a chicken or the egg ADHD came first. And now it's created all these other symptoms, but helping them to better treat and manage and give the patient something that feels tangible and validated and confirming or in a lot of cases non confirming it's ruled out ADHD it said, yeah, you you know, situationally, you may be feeling XY and Z, but we're not typically seeing the severity levels we see with ADHD. So now let's talk about what else it might be. Maybe it's anxiety, maybe it's depression, maybe it's other things that are influencing this. So I think clinicians are really finding it is such a critical tool to help with this influx. Yeah,
Katy Weber 29:49
I see that and I see you know, so many of us are misdiagnosed or or diagnosed previously with like, with depression and anxiety but also, you know, bipolar Older too, and, and borderline personality disorder. So it's these are very different treatment plans that we're talking about here. So yeah, to even be able to rule out ADHD I think is really important. And I feel like there is a lot of that caution from clinicians who say, Well hold on, don't self diagnose, it could be something else, but then it just stops there. And you're like, Well, what else could it be? It feels like this is really you know, what it is, and or we could just gonna go back to that, that, you know, so many of us, I think, felt very lost or frustrated by the depression and anxiety diagnosis, because there's a lot of that like, well, now what, it's not getting better, and ADHD feels. So it's like a window opening for so many of us. It's such life changing information, that when I feel like there's, I feels like when there is clinical gatekeeping around the diagnosis, it's like, Oh, God. All right, one more thing I'm wrong about right. And so yeah, just this idea of having something that even a GP could fall back on and feel confident with, I think it's amazing.
McCall Letterle 31:05
And I think a lot of times, you know, so our reports are really visual. So they don't just give, you know, like I said, they did definitely do not give a yes, no ADHD, because it's meant to be used in conjunction with a full assessment. But it does give not only quantitative numbers, here's the severity, but it gives you a visual presentation of what that looks like. And it presents it against a visual presentation of what someone without ADHD looks like. And that profound moment is huge for so many patients, because they can finally say like, oh my gosh, like, I've been trying to put words to this. And I haven't figured out how to put words to this. I didn't know somebody else functions like this. And in the US healthcare system, there's a lot of because patients are in the driver's seat. So you choose who you go to first, and you choose who you go to next. And so if a patient arrives at their GP, and they feel like their GP does a quick evaluation, it may be the right diagnosis at the endpoint. But if the patient doesn't feel confident that that was the right one, they're on this exhaustive journey to find the person that's going to explain it to them and give it to them. And it's costly for the patient. It's exhausting to the patient. I'm sure we've all experienced it. It's you know why I got into the industry. And I think objective data is really giving patients some tool to feel confident that their provider is on the right track, or to feel confident that I have felt like it might be this. And it's really not feeling like it is now let me address these other components in my life that that I may need to talk about. Yeah. It's a heavy topic. And a fun one. It's like one of my favorite things to talk about. Because I think there is there is so much hope and this industry now COVID, as the catalyst has just spiraled it forward, and I think patients starting to vocalize how exhausted they feel as a huge driver.
Katy Weber 33:12
And I think, you know, that was a question for myself and a lot of us, which is, how do you even quantify the struggle, right, which is, well, maybe it's all in my head, or maybe if I just tried harder, you know, so much of that of like, not even realizing how much you are struggling until you stop. But you know, it's like we're playing Whack a Mole so much that oftentimes we don't get a chance to sit and reflect as to whether this is, you know, typical or not. And oh, and the other thing I wanted to add to was the waitlist to I think it was so many GPS referring out, you know, especially in UK and Australia, even like, you know, places that have better public health care than the US. One of the nice things about the broken US system is how quickly we will find a private edition. A lot of times for sure, I know, right? But you know, in the UK, it's like a four year weightless now, because I think GPS just don't want to do it deal with it. Right. I think there's a fear there. And so to have some to have a tool that will be able to allow more clinicians, you know, like, first enough first responders, but you know what I mean, like that first initial intake session that have that be a little more productive than just say, alright, we'll add you to the list. Yeah, I
McCall Letterle 34:26
think I think it's an interesting component. So he'd be tech actually, in the UK just received a pretty awesome award for healthcare innovation for some work that we did in the NHS system. So QB test was added in 130 sites, and they looked at the utilization because like you said, they've got three, four or five year waitlist, that's just to get a diagnosis. There's even an additional weight to get proper treatments. So patients could be using not just years of their life, but years of their education in going undiagnosed and untreated either. And if they've identified it and gotten in the system, and what we found in the evaluation was that it freed up clinicians time, nearly 30%. So it made clinicians more efficient in getting through the diagnosis because they were able to have a little bit more concrete data at the front end of the evaluation process. So they were able to get patients in and through quicker, and it reduced wait times and weightless at the various different clinics up to 55%. So when we're talking about even just clinical efficiency, objective data makes clinicians feel more confident and helps them standardized to get patients through the system in a more efficient way. And that used to not be the case in the United States, prior to the pandemic, weightless weren't as long, you know, you could go two to four weeks and get into a specialist. You try to get into a specialist today and you're waiting two to four months. So we're seeing that really significantly increase even in our health care system that previously didn't have those issues.
Katy Weber 36:03
What and I think the big shift to has been availability of virtually for people in rural communities, right, who didn't have access to specialists. And now suddenly, it's like there the ability to get this not only get this information online, but then also seek treatment. I think there's more people who are feel like they have options than perhaps before. Yeah,
McCall Letterle 36:29
I think the Healthcare Area in telehealth is really looming because they you know, the DEA and the FDA have some big decisions that they are trying to make about whether or not we will continue this telehealth access past November because it was an exception during the pandemic. And I think a lot of patients benefited from that when you couldn't find a specialist in your area, you did have access to a qualified healthcare professional. And objective data like QB tests can be done remotely in a virtual platform. So QB Tech was actually just invited to the FDA listening sessions last week, where they are looking for solutions to try to figure out how can we continue to offer telehealth visits and telehealth treatment options for ADHD patients? And what are some solutions that are out there and we were one of 61 guests that were invited to speak on behalf of, of ADHD patients. So hopefully, these these availability of providers will continue to remain?
Katy Weber 37:27
Oh, I know such a fascinating time, right?
McCall Letterle 37:31
Moving a lot evolving every month, it feels like something in ADHD is changing. Well, and
Katy Weber 37:36
especially with the online, you know, not only the online diagnosis, but then also the online mental health providers. And so there's like, you know, people are having more access to this, but also doubting the quality, right? I had a client recently who got a diagnosis through one of the online companies, which I'm not going to mention, but even though she got the diagnosis, she needs to get medication from her GP and she's worried that the GP isn't going to respect the diagnosis because it was online, which it's not unfounded, right, like there is a lot of that doubt, right now in terms of like, are we just paying, you know, is this just a pill mill? Or are we just paying for these,
McCall Letterle 38:12
that's the disconnect. So you know, that is my my family's struggle as well. And why I got into it is like, you as a patient have to piece that together. So he or she paid for this evaluation. And you know, if the quality was high, and it was the right diagnosis, she now has to take that information and go find who's going to listen to it and who's going to help her on the next step. And I think it's so important that we start to push for like universalized data where that clinician that she goes to knows what he's being handed knows where it's coming from knows the quality level. And the patient doesn't have to work so hard to put together their team of providers. And we really struggled with that personally within our family of you know, my mother had to quit her job and focus full time on putting a care team together for my brother to ensure success. And it just it shouldn't be that hard.
Katy Weber 39:10
Yeah, well, and I think even just knowing what the treatment plan is, is a full time job sometimes right in terms of like, what do I need most in this moment? Now you worked with Ned Halliwell at some point, right?
McCall Letterle 39:24
I did. I did, actually. So he was an advisor to the clinic that I helped create around this concept. So it was called the attention Center in Cleveland, Ohio. And it was around this concept that the entire multidisciplinary team everything in ADHD patients should need should be under one roof. And Dr. Halliwell was a key factor in putting together who are those right components. And he was a great adviser to the clinic because he's also done this in his various different clinics and setups, used objective data to get a strong ADHD diagnosis and then made sure that all of the care team, whether it was an ADHD coach, or a therapist, or a prescribing clinician, or someone who did you know, more expansive testing was all under one roof, talking to each other and communicating to each other about the care of the patient. But unfortunately, those types of clinics are so few and far between so, but when you find them it's a it's a beautiful diamond in the rough.
Katy Weber 40:23
I know right? It feels like this like dream of like a bright white, you know, room and you'd walk in and some angel holds your hand I pictured like, I pictured bed Halliwell, like at a white suit, like, the guy from Love Boat, right? And like just somebody holding your hand and bringing up like, here's the diagnosis. And now we're gonna move on to the, you know, medication and titration. And then we're gonna move on to therapy and do you know, accountability, all of that stuff, like just having somebody because it is it's just so much work. And, you know, this is an executive function issue for us, like we just getting the diagnosis is traumatic. So like all of those steps, it really it feels so necessary.
McCall Letterle 41:06
I know. net net would love to hear that he was in a white coat loading and helping patients through the process for sure. And I think that's speaking to something because, you know, Dr. Halliwell, was one of the first early people in the 90s to, like, grab the hands of patients and say, like, it's fine. It's awesome. It's a gift. So it is it is this idea that, you know, there's a really positive aspect to this. And so I think he would love the concept that he was, you know, flooding through the clinics helping patients.
Katy Weber 41:37
It but it's true, he really was the kind of pioneer in terms of mindset, right, and how important mindset and self regard and positive regard is, in terms of living with ADHD, which I think you know, before that, I don't know if he was the first person to do that. But it does feel like there was a real shift from you outgrow this, you just need to, you know, this is something you need to work on in childhood, and let's, you know, just get your act together. Too much more of a sense of like, this is how you move through the world, there's nothing wrong with you.
McCall Letterle 42:09
Yes, this driven to distract him was profound for so many parents. And it was in our own personal household of finding some sort of path or somebody that understood that, like, No, my child is awesome. Or my you know, my daughter is awesome. But we've just got to hone XY and Z. And he was also one of kind of the first early users of objective data in the evaluation process. So really important to try to identify it and get it right in the beginning and use data driven decisions to then guide this treatment path that led a lot of patients to success. So I think that was it was definitely an early catalyst.
Katy Weber 42:48
Yeah. Oh, God, I feel so validated. geeking out with you about all this. I love when somebody really knows their stuff. Like, it's so great.
McCall Letterle 42:58
I've been around the world, I've been from the kind of the patient perspective. And I think, you know, I've been behind the clinic side. So trying to create this clinic, which in the US is sometimes hard because insurance drives so much of what happens for patients and where they go, you've talked about your children, receiving kind of that expansive testing, which, if you want school accommodations, is really important to understand, you know, the, the Wechsler and all those various different types of tests. But adults don't need that type of kind of full evaluation. Oftentimes, they're not looking for maybe necessarily work accommodations where that type of data could could drive it, but they are looking for something that helps quantify and put into perspective what they've been doing. And I think that's so important. Right?
Katy Weber 43:45
The validation aspect for sure. Now, I'm curious, are there like, I don't even know if you can tell me, but are there like countries where clinicians are more resistant to, to this sort of testing? Because I feel like there are definitely pockets of Europe where they're like, No, ADHD doesn't exist here.
McCall Letterle 44:06
There are definitely pockets of that. There are definitely pockets of that. And I do think that there are some tech focus clinicians in those countries that are really trying to call to action, something that helps to validate it, because I do think a lot of those countries, they feel that way, oftentimes, because the evaluation has been so subjective, previously, checklists and quick sign offs, and so there isn't allowed to validate it. So hopefully, we'll start to make progress and more of those countries. What I will say is a cultural difference in Europe. And we can use the NHS for instance, as as an example. The cultural differences that there is more need for consensus across different types of clinicians to achieve a diagnosis. So that is oftentimes what will slow down the process that it's not just a doctor that signs off but the psychologist needs to agree as well and we have to have A long evaluation period to understand and make sure that we're really getting this drill down and correct. Whereas in the US, my European colleagues used to sometimes be shocked at the fact that, you know, to go, how long would it take to get a diagnosis is that sometimes a day, you know, you could arrive at your clinician, and you can leave with a prescription. And there's pros and cons to that, I think if we can start to make that evaluation more robust in the evaluation process, we can ensure that we're getting the diagnosis correct, a lot better. And it doesn't necessarily need to take expansive amounts of time. But we need to make sure that it's around a lot of data. And it's data driven, if we are evaluating in a shorter period of time. So I would say that's the biggest difference between various different countries is that there's a lot more need for consensus of multiple clinicians, because it's in a kind of single payer health care system where our health care system is a lot more complex. Yeah,
Katy Weber 46:02
interesting. So your challenge is to make the testing more robust, yet at the same time, more accessible,
McCall Letterle 46:10
and more efficient. So we wanted to, you know, not take too much time for the patient, but take enough time that we are positive, the data is strong. And that's our sweet spot. So our test takes if you're a child or adolescent, it takes 15 minutes. And if you're an adolescent or adult, so 12 and older, it takes 20 minutes. And we found this to be a really good sweet spot where we can test the duration of attention long enough to have enough data to really help to secure a really valid set of information for the doctor.
Katy Weber 46:45
So now, as a patient, how can I make sure more doctors are using this test? Do we just ask for it as patients? Yeah,
McCall Letterle 46:53
that's a that's a great question. Yes, of course, you know, we would love that. I think there's kind of two ways you can search for QB tests, QB tech providers, there are tons out there, we exist in 42 states. So we have a huge provider network. So most likely, you can find somebody we have telehealth capabilities as well. So if you're, let's say in rural Alabama, you have a lot of care options, because you have a really massive amount of clinicians doing in clinic testing, and ones that are doing telehealth testing as well. So you can search for somebody, we also have we pair with a group called the ADHD expert Consortium. So this is a group of different types of clinicians that have come together across the US, we've been really fortunate to work and support them, they have a call to action that you can find on either our website, or adda, which is the adult ADHD patient organization also hosted where you can actually add your signature to say that we want to, you know, I stand behind adding more robust data and better validation tools for clinicians. And we're using that at all different levels. We're using that within our congressional conversations that we're having, having conversations alongside the DEA to say, you know, this is something that the patients are calling for, so you can search for it, you can try to find a clinician that has it and you will be very high likelihood to find it. Or you can add your voice behind the ADHD expert consortium and sign the petition.
Katy Weber 48:31
Yeah, I'll definitely I'll put a link to the petition in the show notes too. So head there. That's fantastic. Gosh, this is amazing. Thank you so much. This is so great. I had was so excited. I've you know, obviously have heard of QB tech, but we had already gotten my diagnosis. So it was sort of felt like it was was wonderful. And something to keep track of. But also I think, you know, it answers so many of the questions that so many of us have in terms of this process, and what is difficult about this process and just even obtaining the diagnosis. And for so many women, it's just like, well, you know, I've heard women whose doctors are like, Well, you've made it this far. Why bother get with a diagnosis? You know, just there seems like there's such a disconnect in terms of how important and validating this diagnosis is and the fact that we don't view it as pathological. Right? We don't see this diagnosis. As you know, when I always joke like when you tell other people with ADHD, you've been diagnosed, they're all like, congratulations. Whereas if you tell people who don't know about it, they're like, I'm sorry about your disorder. It is, I think, really interesting to see just how many barriers we are met with as somebody who has, you know, okay, maybe I'm self diagnosing and I don't I need the validation and then going to a doctor and being told, you know, a myriad of reasons why it's probably not that so yeah, I think this is this is the this is the AAA A card that I need in my wallet, this is
McCall Letterle 50:04
well, I hope you feel you know, technology is evolving, acceptance of technology is evolving and well validated. Technology is evolving. So hope is out there, validation is out there, there are really fantastic providers that are leading the way and companies that are trying to really make a big step for patients to say, you know, this can be easier. So hopefully, hopefully everyone feels positively about that. Yeah,
Katy Weber 50:29
that's wonderful. Is there any? Oh, and then the other thing I wanted to ask just quickly was like, You were talked about therapists and mental health counselors using this as part of their diagnostic tool, which I think so is this a scenario in which like a therapist would you would would perform the test? And then you would take this test to somebody, you whoever can prescribe? Yeah,
McCall Letterle 50:53
yeah, absolutely. So we have a lot of therapists that connect with various different clinicians to utilize the testing done within their office for clinical treatment, but also using it for clinical care. On the therapy side, understanding how severe is the patient? symptomology? Is this really what we're dealing with? Or do we need to do therapy for anxiety and depression and other disorders, so using it to guide the clinical decision, but then also using it to say, you know, let's start to try to implement some things that can help to reduce the anxiety around this and put some executive function components together that hopefully make a difference. That's
Katy Weber 51:33
great. You know, I'm actually I'm going back to grad school, I'm getting my clinical mental health counselor degree. And it's funny because I'm like reading through all of these case studies, and every one of these case studies where it's like, the client has depression and anxiety. I'm like, I don't know sounds like ADHD and autism to me. Um, I just look, I feel like I'm diagnosing every case study with ADHD and autism, but I'm like, maybe I'm looking for it in places it isn't. But then I'm also like, or maybe that maybe it's just that I'm under diagnosed? I don't know.
McCall Letterle 52:05
The nice part is, is you'll start to both from the patient perspective and the clinician perspective, understand how to kind of chip away at the components that could mask that. And hopefully, that is also coming to the masters level clinicians as well.
Katy Weber 52:20
Yeah, exactly. I hope. So. Let's just also just how varied and holistic the treatment. Protocol is for every person. Oh, well, thank you. Oh, my goodness, this was awesome. I'm sorry. I really, really was so excited to pick your brain. And I was just glad you were up for Eddie, thanks so
McCall Letterle 52:37
much for having me. I really appreciate it. And I love the work that you're doing for all of your listeners and giving them validation support. I think it's a it's a huge lift, but also probably a great outlet for your creativity.
Katy Weber 52:52
So thanks again, with all Thank you.
There you have it. Thank you for listening, and I really hope you enjoyed this episode of the women and ADHD podcast. If you'd like to find out more about me and my coaching programs, head over to women and adhd.com If you're a woman who was diagnosed with ADHD and you'd like to apply to be a guest on this podcast, visit women and adhd.com/podcast guest and you can find that link in the episode show notes. Also, you know, we ADHD ears crave feedback. And I would really appreciate hearing from you the listener, please take a moment to leave me a review on Apple podcasts or audible. And if that feels like too much, and I totally get it. Please just take a few seconds right now to give me a five star rating or share this episode on your own social media to help reach more women who maybe have yet to discover and lean into this gift of nerd of urgency. And they may be struggling and they don't even know why. I'll see you next week when I interview another amazing woman who discovered she's not lazy or crazy or broken. But she has ADHD and she's now on the path to understanding her neuro divergent mind and finally using this gift to her advantage. Take care till that