Estimates of the Validity and Utility of the Conners’ Continuous Performance Test in the Assessment of Inattentive and/or Hyperactive-Impulsive Behaviors in Children

This study evaluated the validity and classification utility of the Conners' Continuous Performance Test (CCPT) in the assessment of inattentive and hyperactive-impulsive behaviors in children. Significant, positive correlations between the CCPT parameters and behavioral ratings of ADHD behaviors were hypothesized. In addition, it was hypothesized that the CCPT parameters would perform better than a random test (chance) and show fair to moderate utility of classification across the different indices. Participants were 104 children between 6 and 12 years of age who were referred for evaluation of attention problems. The first hypothesis was not supported. There were no significant, positive correlations between the CCPT parameters and parent and teacher ratings of inattentive and hyperactive-impulsive behaviors. The second hypothesis was only partially supported. The CCPT Overall Index and the Omission Errors (84th percentile cutoff) performed better than a random test; however, the utility of the CCPT Overall Index only ranged from poor to slight. Receiver operating characteristic analyses showed the accuracy of the CCPT to be low. The implications and limitations of this study and future research directions are discussed.     

No vigilance deficit found in either young schizophrenic or ADHD subjects

Vigilance deficits have been found in both schizophrenic and ADHD subjects. The two patient groups have never been directly compared on any vigilance measure, however. In the present study 20 early-onset schizophrenics were compared to 20 ADHD adolescents on a Degraded Stimulus Continuous Performance Test (DS-CPT). A comparison group of 30 normal adolescents was also included. Results showed no significant differences between the three groups on any of the DS-CPT measures. Different hypotheses are put forth to explain the findings, among them that the task may be insensitive to identifying sustained attention deficits in adolescent populations.     

Development of Sustained Attention Assessed Using the Continuous Performance Test among Children 6–15 Years of Age

The Continuous Performance Test (CPT) is a widely used measure of sustained attention, which may rely on the efficiency of cognitive inhibition. We examined the relationships of age and sex with CPT performance among 341 randomly selected school children 6–15 years of age. Multiple regression analyses revealed that the hit rate, false alarm rate, and sensitivity of both the undegraded and the degraded CPT were associated with age by a quadratic relationship. The age–development curves for the hit rate and sensitivity were convex, whereas that for the false alarm rate was concave. Sex was associated with the hit rate and sensitivity on the degraded CPT only. Our findings are consistent with the hypothesis that sustained attention develops during the primary school ages. The data reported are essential for identifying children with conditions associated with sustained attention deficit, such as attention-deficit hyperactivity disorder, as well as those at an increased risk for developing schizophrenia.     

Emotional Problems Suppress Disorder/Performance Associations in Adult ADHD Assessment

Issues related to Attention Deficit Hyperactivity Disorder (ADHD) are commonly assessed using a combination of indicators, including patient report and performance on cognitive tasks. The current study investigates the potential that emotional problems may suppress the relationship between objective continuous performance test (CPT) results and ADHD symptoms in a sample of 53 young adults referred to an outpatient clinic for cognitive evaluations, 26 of whom met diagnostic criteria for ADHD. Data indicate that emotional problems and continuous performance represent unique elements of adult ADHD, whether assessed via interview or self-report. Results also indicate that emotional problems do suppress CPT–ADHD relations, suggesting that failure to control for emotional problems may account, in part, for modest associations in the literature between CPT performance and other indicators of ADHD.     

Comparison between two continuous performance tests for identifying ADHD: Traditional vs. virtual realityEjecución continua para la detección del TDAH: pruebas tradicionales frente a la realidad virtual

Background/Objective: Continuous Performance Tests (CPTs) have demonstrated validity when differentiating children with ADHD from healthy controls. However, these CPTs have limitations such as low ecological validity. New CPTs based on the use of Virtual Reality (VR) have appeared as supposedly improved methods for assessing ADHD. This study aims to compare the discriminant value of attentional variables produced by a VR CPT (Aula Nesplora) with that of variables from a traditional CPT (Test of Variables of Attention; TOVA) for identifying ADHD. Method: A total of 338 children aged between 6 and 16 years old (M = 10.84, SD = 3.01) participated in the study: 31.95% correspond to the inattentive presentation, 15.38% to the impulsive-hyperactive presentation, 22.78% to the combined presentation, and the remaining 29.88% correspond to children without ADHD. Results: Results indicated that Aula Nesplora predicts ADHD presentations better than TOVA. It also differentiates better between ADHD and non-ADHD students. Conclusions: These findings show the potential advantages of using virtual reality in ADHD assessment, as it facilitates the diagnosis of ADHD and the differentiation of its presentations in a realistic environment.     

Utility of a CPT in Diagnosing ADHD among a Representative Sample of High-Risk Children: A Cautionary Study

Continuous performance tests (CPTs) are widely used in the assessment and study of attention deficit hyperactivity disorder (ADHD). Although CPTs have reliably found differences between children with ADHD and normal controls, discriminating between children with ADHD and children with subclinical levels of behavioral or cognitive problems is a more clinically relevant and difficult endeavor. Additionally, most studies use convenience samples from clinical care settings that may not represent the ADHD population as a whole. The current study assessed the utility of a clinically used CPT, the Test of Variables of Attention (TOVA), in distinguishing between children with ADHD and children with subclinical levels of attention/behavior problems. Participants constituted a representative sample of elementary school students at high risk for ADHD, including 116 children with ADHD and 51 subclinical controls. Results found no significant differences between the ADHD and subclinical group on CPT variables, and CPT performance did not reliably predict group membership. Implications of the findings are discussed.     

Using Explicit Case Formulation to Improve Cognitive Processing Therapy for PTSD

We investigated the utility of explicit case formulation (CF) within Cognitive Processing Therapy (CPT) for individuals with posttraumatic stress disorder (PTSD). An uncontrolled pre-posttreatment design was used. Participants attended 12–16 weekly sessions of CPT with explicit CF, where CF guided treatment length and treatment components. Treatment was completed by 19 of the 23 participants who started therapy. Results revealed significant reductions in PTSD and depression severity as well as unhelpful PTSD-related beliefs from pre- to posttreatment (ds between 1.10 – 1.92) and treatment gains were maintained at 3-month follow-up. Of the participants available at posttreatment for assessment, 69% (n = 11/16) met good end-state functioning for PTSD and 62% (n = 8/13) did so at follow-up. Finally, 72% (n = 13/18) of those interviewed at posttreatment no longer met criteria for PTSD and this was found for 93% of those assessed at follow-up (n = 14/15). Treatment, and CF in particular, was found to be acceptable by participants. Explicit case formulation did not interfere with positive outcomes of Cognitive Processing Therapy for PTSD. Further clinical implications and future directions for research are discussed.     

Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

The Conners' Continuous Performance Test (CPT) is a neuropsychological task that has repeatedly been shown to differentiate ADHD from normal groups. Several variables may be derived from the Conners' CPT including errors of omission and commission, mean hit reaction time(RT), mean hit RT standard error, d', and . What each CPT parameter actually assesses has largely been based upon clinical assumptions and the face validity of each measure (e.g., omission errors measure inattention, commission errors measure impulsivity). This study attempts to examine relations between various CPT variables and phenotypic behaviors so as to better understand the various CPT variables. An epidemiological sample of 817 children was administered the Conners' CPT. Diagnostic interviews were conducted with parents to determine ADHD symptom profiles for all children. Children diagnosed with ADHD had more variable RTs, made more errors of commission and omission, and demonstrated poorer perceptual sensitivity than nondiagnosed children. Regarding specific symptoms, generalized estimating equations (GEE) and ANCOVAs were conducted to determine specific relationships between the 18 DSM-IV ADHD symptoms and 6 CPT parameters. CPT performance measures demonstrated significant relationships to ADHD symptoms but did not demonstrate symptom domain specificity according to a priori assumptions. Overall performance on the two signal detection measures, d' and , was highly related to all ADHD symptoms across symptom domains. Further, increased variability in RTs over time was related to most ADHD symptoms. Finally, it appears that at least 1 CPT variable, mean hit RT, is minimally related to ADHD symptoms as a whole, but does demonstrate some specificity in its link with symptoms of hyperactivity.