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Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors
Abstract
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 beta. 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 beta, 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.
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In a study examining individual ADHD symptoms, reaction time variability was significantly related to all 18 ADHD symptoms, suggesting no specificity between reaction time variability and specific ADHD behaviors.
“In a study examining whether RTV was specifically correlated with individual ADHD symptoms (e.g., short attention span), significant relations were observed between RTV and all 18 ADHD symptoms, suggesting no specificity between RTVand specific ADHD behaviors [55].”
From Reaction Time Variability in ADHD: A Review (2012) · cites this paper as [55]
Sustained attention abilities predict objective and subjective reports of classroom behavior, academic performance, special education placement, and comorbid learning disabilities.
“sustained attention abilities predict objective and subjective reports of classroom behavior (Brocki, Tillman, & Bohlin, 2010; Epstein et al., 2003; Rapport et al., 1987), academic performance (Molina et al., 2009; Rapport et al., 1994), special education placement, and comorbid learning disabilities (Faraone et al., 1993).”
From Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches (2014) · cites this paper as Epstein et al., 2003
Epstein et al. reported variability in d', lnβ, and RT to be strongly associated across multiple ADHD symptom domains.
“Epstein and colleagues (Epstein et al., 2003) reported variability in d’, lnβ, and RT to be strongly associated across multiple ADHD symptom domains.”
From The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD? (2011) · cites this paper as Epstein et al., 2003
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“Both the attentional and impulse control deficits seen in ADHD patients can be illustrated by their performance of the CPT. ADHD subjects have slower and more variable reaction times, and make more errors of omission indicative of poor attentional ability (e.g. (Epstein et al., 2003).”
Evidence-Based Assessment of Attention Deficit Hyperactivity Disorder in Children and Adolescents
Pelham, Jr., Fabiano, G. A., & Massetti, G. M. (2005) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3403_5 · Cited by 803
“…basis of ADHD may well be one reason that tests and procedures that tap those domains are not currently useful in diagnosis or assessment (AAP, 2000; Barkley, in press; Epstein et al., 2003; Matier-Sharma, Perachio, Newcorn, Sharma, & Halperin, 1995; Rapport, Chung, Shore, Denney, & Isaacs, 2000).”
BackgroundReaction time variability in ADHD: A meta-analytic review of 319 studies
Kofler, M. J., Rapport, M. D., Sarver, D. E., Raiker, J. S., Orban, S. A., Friedman, L. M., & Kolomeyer, E. G. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.06.001 · Cited by 648
“…is influenced heavily by RT variability (Schmiedek et al., 2007; Wagenmakers & Brown, 2007), and several studies suggest that the MRT of children with ADHD is not slower than their peers after accounting for RT variability using ex-Gaussian methods (e.g., Buzy et al., 2009; Epstein et al., 2003).”
BackgroundMethodRapport, M. D., Orban, S. A., Kofler, M. J., & Friedman, L. M. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.08.005 · Cited by 517
“Performance on vigilance/sustained attention tasks is correlated weakly to moderately with parent and teacher ratings of attention (Epstein et al., 2003; Klee & Garfinkel, 1983) and hyperactivity/impulsivity (Brocki, Tillman, & Bohlin, 2010), as well as with objectively observed classroom attention (Barkley, 1991; Rap…”
BackgroundPlichta, M. M., & Scheres, A. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.07.012 · Cited by 424
“Additionally, impulsivity has been assessed with behavioural measures which can be broadly divided into (a) reward-choice tasks (Green and Myerson, 2004; Mischel, 1974) and (b) rapid-response tasks that assess the ability to inhibit a prepotent motor response: go/no-go tasks (Conners et al., 2003; Epstein et al., 2003…”
MethodContinuous Performance Test Performance in a Normative Epidemiological Sample
Conners, C. K., Epstein, J. N., Angold, A. C., & Klaric, J. (2003) · Research on Child and Adolescent Psychopathology · doi:10.1023/a:1025457300409 · Cited by 463
“This correlation was significantly negative (rDi:32; p Epstein et al., 2003 ) suggesting a trade-off between speed and accuracy or impulsiveness.”
BackgroundSelf-citationResponse inhibition and psychopathology: A meta-analysis of go/no-go task performance
Wright, L., Lipszyc, J., Dupuis, A., Thayapararajah, S. W., & Schachar, R. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0036295 · Cited by 360
Han, D. H., Lee, Y. S., Na, C., Ahn, J. Y., Chung, U., Daniels, M. A., Haws, C. A., & Renshaw, P. F. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.08.011 · Cited by 353
“Many ADHD studies that have examined the prefrontal cortex have suggested that ADHD causes deficits in working memory [11-13].”
BackgroundReaction Time Variability in ADHD: A Review
Tamm, L., Narad, M. E., Antonini, T. N., O'Brien, K. M., Hawk, L. W., & Epstein, J. N. (2012) · Neurotherapeutics · doi:10.1007/s13311-012-0138-5 · Cited by 324
“, short attention span), significant relations were observed between RTVand all 18 ADHD symptoms, suggesting no specificity betweenRTVand specific ADHDbehaviors [55].”
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“The CPT-II (Epstein et al., 2003) provides measures of sustained attention and impulsiveness.”
BackgroundKaralunas, S. L., Geurts, H. M., Konrad, K., Bender, S., & Nigg, J. T. (2014) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12217 · Cited by 278
“Results suggest a possible parallel course for cognitive and symptom improvements (either developmentally or with specific treatment) that warrants more study (Buzy, Medoff, & Schweitzer, 2009; Epstein et al., 2003; W ahlstedt, Thorell, & Bohlin, 2009).”
Li, C.-S. R., & Sinha, R. (2008) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2007.10.003 · Cited by 345
“, 2004), and are more common in individuals with anorexia nervosa (Butler and Montgomery, 2005), attention deficit hyperactivity disorder (Epstein et al., 2003), reading disorder (Beale et al.”
BackgroundJohnson, K. A., Kelly, S. P., Bellgrove, M. A., Barry, E., Cox, M., Gill, M., & Robertson, I. H. (2007) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2006.03.034 · Cited by 262
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“…failed to show time-on-task effects with children with ADHD (Stins et al., 2005; van der Meere, Wekking, & Sergeant, 1991), although other studies have demonstrated significant deficits in performance over the duration of the task (Epstein et al., 2003; Heinrich et al., 2001; Johnson et al., 2007).”
Assessing inattention and impulsivity in children during the Go/NoGo task
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“This non-invasive paradigm and its requirement for attentional control has made it very attractive for studying disorders such as ADHD (Epstein et al., 2003).”
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Distractibility in Attention/Deficit/ Hyperactivity Disorder (ADHD): The Virtual Reality Classroom
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“Specifically, those with ADHD make more omission errors ( Barkley, Grodzinsky, & DuPaul, 1992 ; Epstein, Erkanli, Conners, Klaric, Costello, & Angold, 2003 ; Shallice et al, 2002 ), commission errors (Epstein et al.”
The role of executive function in children's competent adjustment to middle school
Jacobson, L. A., Williford, A. P., & Pianta, R. C. (2011) · Child Neuropsychology · doi:10.1080/09297049.2010.535654 · Cited by 244
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“This result is consistent with previous work that showed that, among CPT indices, RT variability was most strongly related to AD/HD symptomatology (Epstein et al. 2003).”
ResultWhite matter growth as a mechanism of cognitive development in children
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“It is well established as a measure of sustained attention: increased standard error in reaction time (i.e., increased variability in the speed of responding) is associated with poor accuracy (Epstein et al., 2003).”
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“The continuous performance task is one of the most frequently used examples of attention/ memory assessments of impulsivity and has demonstrated significant relationships with attention and inhibition difficulties observed in attention deficit hyperactivity disorder [30].”
BackgroundLiterature Review: ADHD in Adults
Davidson, M. (2007) · Journal of Attention Disorders · doi:10.1177/1087054707310878 · Cited by 211
“Cognitive assessments are useful, however, in that they can (a) improve the validity of an ADHD assessment and (b) be used in assessing the efficacy of pharmacological and/or psychological interventions (Epstein et al., 2003).”
Impact of the COMT Val108/158 Met and DAT genotypes on prefrontal function in healthy subjects
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Killory, B. D., Bai, X., Negishi, M., Vega, C., Spann, M. N., Vestal, M. L., Guo, J. N., Berman, R., Danielson, N., Trejo, J., et al. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2011.03.036 · Cited by 173
“in prior behavioral studies of the CPT task (Buchanan et al., 2010; Conners et al., 2003; Epstein et al., 2003).”
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Avella-García, C. B., Júlvez, J., Fortuny, J., Rebordosa, C., García‐Esteban, R., Galán, I. R., Tardón, A., Rodríguez-Bernal, C. L., Íñiguez, C., Andiarena, A., et al. (2016) · International Journal of Epidemiology · doi:10.1093/ije/dyw115 · Cited by 166
“These K-CPT variables have all been correlated to ADHD symptoms and have been repeatedly used for ADHD research.(18,19) A common protocol was followed for evaluation.”
MethodMRI correlates of cognitive impairment in childhood-onset multiple sclerosis.
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“…been re- peatedly demonstrated in children with ADHD, namely, with regard to slowed response preparation and increased intraindividual variability in response time (Toplak & Tannock, 2005; Epstein et al., 2003; Mostofsky et al., 2001; Steger et al., 2001; Leth-Steensen, Elbaz, & Douglas, 2000).”
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“It reflects the ability to maintain a stable response pattern, which is an important parameter in evaluating sustained attention deficits [34].”
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Dadvand, P., Tischer, C., Estarlich, M., Llop, S., Dalmau-Bueno, A., López-Vicente, M., Valentín, A., de Keijzer, C., Fernández-Somoano, A., Lertxundi, N., et al. (2017) · Environmental Health Perspectives · doi:10.1289/ehp694 · Cited by 148
“The K-CPT has been demonstrated to be a valid tool to characterize attention in comparison with clinical (Epstein et al. 2003; Homack and Riccio 2006) and parental evaluations (Barnard et al. 2015).”
Schneider, M. F., Krick, C. M., Retz, W., Hengesch, G., Retz‐Junginger, P., Reith, W., & Rösler, M. (2010) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2010.04.005 · Cited by 152
“In a study examining performance on measures over time, increased mean hit reaction time and standard errors over time were highly associated withmost ADHD symptoms (Epstein et al., 2003).”
BackgroundClinical assessment and diagnosis of adults with attention-deficit/hyperactivity disorder
Haavik, J., Halmøy, A., Lundervold, A. J., & Fasmer, O. B. (2010) · Expert Review of Neurotherapeutics · doi:10.1586/ern.10.149 · Cited by 147
Attention and Memory Functioning Among Pediatric Patients with Medulloblastoma
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“This by guest on A pril 29, 2016 http://jpepsy.oxfordjournals.org/ D ow nloaded from implies that the cognitive phenotypes may be qualitatively different, although Epstein et al. (2003) found that both attentiveness and risk taking were strongly associated with ADHD symptoms.”
BackgroundAttention-Deficit/Hyperactivity Disorder: A Neuropsychological Perspective Towards DSM-V
Stefanatos, G. A., & Baron, I. S. (2007) · Neuropsychology Review · doi:10.1007/s11065-007-9020-3 · Cited by 158
“Performance on such tasks appears positively correlated with ADHD symptoms (Anderson, Anderson, & Anderson, 2006; Epstein et al., 2003; Mahone, Pillion, Hoffman, Hiemenz, & Denckla, 2005; Marks et al., 2005; Nichols & Waschbusch, 2004).”
BackgroundAssessing medication effects in the MTA study using neuropsychological outcomes
Epstein, J. N., Keith Conners, C., Hervey, A. S., Tonev, S. T., Eugene Arnold, L., Abikoff, H. B., Elliott, G., Greenhill, L. L., Hechtman, L., Hoagwood, K., et al. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2005.01469.x · Cited by 139
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Construct Validity of Parent Ratings of Inhibitory Control
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“Children diagnosed with ADHD have been found to make more errors of commission and omission, as well as have higher variability in reaction time on the CPT-II as compared to nondiagnosed children (Epstein et al., 2003).”
BackgroundWalderhaug, E., Magnússon, A., Neumeister, A., Lappalainen, J., Lunde, H. A., Refsum, H., & Landrø, N. I. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.02.012 · Cited by 142
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Transcranial direct current brain stimulation decreases impulsivity in ADHD
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“The Go/No-go task is a widely used task for assessment of neurocognitive impairment in ADHD patients [30,62].”
Edwards, M. C., Gardner, E. S., Chelonis, J. J., Schulz, E. G., Flake, R. A., & Diaz, P. F. (2007) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-007-9098-3 · Cited by 120
“Another study classified subjects based on a structured diagnostic interview of parents alone ( Epstein et al., 2003 ).”
BackgroundInfluentialEffects of Home Visits by Paraprofessionals and by Nurses on Children
Olds, D. L., Holmberg, J. R., Donelan‐McCall, N., Luckey, D. W., Knudtson, M. D., & Robinson, J. L. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.3817 · Cited by 122
Berger, I., Slobodin, O., & Cassuto, H. (2016) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acw101 · Cited by 122
“Ceiling effect due to insufficient cognitive demands is even more pronounced in older children and adolescents (Epstein et al., 2003).”
Genetics of impulsive behaviour
Bevilacqua, L. M., & Goldman, D. A. (2013) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2012.0380 · Cited by 127
Wåhlstedt, C., & Bohlin, G. (2010) · Child Neuropsychology · doi:10.1080/09297041003671176 · Cited by 115
“Some research has revealed a significant relation (e.g., Börger et al., 1999; Epstein et al., 2003; Hook, Milich, & Lorch, 1994), but a recent meta-analysis (Huang-Pollock & Nigg, 2003) failed to show impaired sustained attention in children with ADHD symptoms.”
BackgroundDimensions of impulsive behavior in obese, overweight, and healthy-weight adolescents
Fields, S. A., Sabet, M., & Reynolds, B. A. (2013) · Appetite · doi:10.1016/j.appet.2013.06.089 · Cited by 115
“…of inattention differentiate individuals diagnosed with attention deficit hyperactivity disorder (ADHD) and non-clinical control participants (e.g., Epstein et al., 2003; Losier, McGrath, & Klein, 2006) and also adolescent cigarette smokers from non-smokers (Fields, Collins, Leraas, & Reynolds,…”
BackgroundStevenson, J., Sonuga-Barke, E. J. S., McCann, D., Grimshaw, K. E. C., Parker, K. M., Rose-Zerilli, M. J. J., Holloway, J. W., & Warner, J. O. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.09101529 · Cited by 113
Kessler, D. A., Angstadt, M., & Sripada, C. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.0088 · Cited by 109
When distraction is not distracting: A behavioral and ERP study on distraction in ADHD
van Mourik, R., Oosterlaan, J., Heslenfeld, D. J., Konig, C. E., & Sergeant, J. A. (2007) · Clinical Neurophysiology · doi:10.1016/j.clinph.2007.05.007 · Cited by 115
“…with ADHD made more omission errors, a finding that has been frequently reported in continuous performance tasks (see for meta-analysis Losier et al., 1996) and is related to various ADHD symptoms including difficulties sustaining attention and being easily distracted (Epstein et al., 2003).”
Sagiv, S. K., Kogut, K. R., Gaspar, F. W., Gunier, R. B., Harley, K. G., Parra, K., Villasenor, D., Bradman, A., Holland, N., & Eskenazi, B. (2015) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2015.08.001 · Cited by 112
“Results from robust regression were similar to linear models (data not shown), with the exception of CPT II errors of omission and ADHD con fi dence index.”
BackgroundInfluentialKlarborg, B., Madsen, K. S., Vestergaard, M. D., Skimminge, A., Jernigan, T. L., & Baaré, W. F. C. (2012) · Human Brain Mapping · doi:10.1002/hbm.22139 · Cited by 114
Stress-response-dampening effects of alcohol: Attention as a mediator and moderator.
Sher, K. J., Bartholow, B. D., Peuser, K. A., Erickson, D. J., & Wood, M. D. (2007) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.116.2.362 · Cited by 105
“…as a measure of disorders of inhibition such as attention-deficit/hyperactivity disorder (ADHD; e.g., O'Daugherty, Nuechterlein, & Drew, 1984) and not only robustly distinguishes those with ADHD from controls but is associated with virtually all ADHD symptoms (e.g., Epstein et al., 2003).”
Measuring Several Aspects of Attention in One Test
Egeland, J., & Kovalik-Gran, I. (2008) · Journal of Attention Disorders · doi:10.1177/1087054708323019 · Cited by 104
Impact of time on task on ADHD patient’s performances in a virtual classroom
Bioulac, S., Lallemand, S., Rizzo, A., Philip, P., Fabrigoule, C., & Bouvard, M. P. (2012) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2012.01.006 · Cited by 100
Hong, S.-B., Zalesky, A., Fornito, A., Park, S., Yang, Y.-H., Park, M.-H., Song, I.-C., Sohn, C.-H., Shin, M.-S., Kim, B.-N., et al. (2014) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.12.013 · Cited by 99
Walshaw, P. D., Alloy, L. B., & Sabb, F. W. (2010) · Neuropsychology Review · doi:10.1007/s11065-009-9126-x · Cited by 105
“C=13 Epstein et al. (2003) ADHD=21 .46a - - - - - - - - - -”
A behavioral neuroenergetics theory of ADHD
Killeen, P. R., Russell, V. A., & Sergeant, J. A. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2013.02.011 · Cited by 97
The attention network test: a characteristic pattern of deficits in children with ADHD
Adólfsdóttir, S., Sørensen, L., & Lundervold, A. J. (2008) · Behavioral and Brain Functions · doi:10.1186/1744-9081-4-9 · Cited by 97
Fronto-striato-cerebellar dysregulation in adolescents with depression during motivated attention
Chantiluke, K., Halari, R., Simic, M., Pariante, C. M., Papadopoulos, A., Giampietro, V., & Rubia, K. (2012) · Biological Psychiatry · doi:10.1016/j.biopsych.2011.09.005 · Cited by 91
Albrecht, B., Banaschewski, T., Brandeis, D., Heinrich, H., & Rothenberger, A. (2005) · Behavioral and Brain Functions · doi:10.1186/1744-9081-1-22 · Cited by 94
Chacko, A., Kofler, M., & Jarrett, M. (2014) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-014-0171-5 · Cited by 93
“Similarly, sustained attention abilities predict objective and subjective reports of classroom behavior (Brocki et al. 2010; Epstein et al. 2003; Rapport et al. 1987), academic performance (Molina et al.”
Dimensions of impulsive behavior in adolescent smokers and nonsmokers.
Fields, S. A., Collins, C., Leraas, K., & Reynolds, B. A. (2009) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0017185 · Cited by 97
“…differentiate individuals diagnosed with attention deficit hyperactivity disorder (ADHD) from non-clinical control participants (e.g., Losier, McGrath, & Klein, 1996; Epstein et al., 2003); however, there has been little research on the association between impulsive inattention and substance abuse.”
BackgroundJarrett, M. A., Rapport, H. F., Rondon, A. T., & Becker, S. P. (2017) · Journal of Attention Disorders · doi:10.1177/1087054714560821 · Cited by 94
“These variables are frequently used in published research on the CPT-II (Epstein et al., 2003; Vaughn et al., 2011).”
MethodResultInfluentialChildren with low working memory and children with ADHD: same or different?
Holmes, J., Hilton, K. A., Place, M., Alloway, T. P., Elliott, J. G., & Gathercole, S. E. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00976 · Cited by 94
“This is one of the most widely reported deficits in ADHD (e.g., Epstein et al., 2003; Willcutt et al., 2005a; Rubia et al., 2007, 2009), and the present data indicates that it has a high degree of specificity to ADHD.”
BackgroundGrissom, N. M., Herdt, C. T., Desilets, J., Lidsky-Everson, J., & Reyes, T. M. (2014) · Neuropsychopharmacology · doi:10.1038/npp.2014.313 · Cited by 91
Bioulac, S., Micoulaud‐Franchi, J., Maire, J., Bouvard, M. P., Rizzo, A., Sagaspe, P., & Philip, P. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718759751 · Cited by 91
“We used the CPT II, one of the most useful measures for assessing ADHD (Conners & Staff, 2000; Epstein et al., 2003; Rosvold & Delgado, 1956).”
MethodHuang‐Pollock, C. L., Nigg, J. T., & Halperin, J. M. (2006) · Neuropsychology · doi:10.1037/0894-4105.20.4.420 · Cited by 91
Yeh, P., Wang, B., Oakes, T. R., French, L. M., Pan, H., Graner, J. L., Liu, W., & Riedy, G. P. (2013) · Human Brain Mapping · doi:10.1002/hbm.22358 · Cited by 90
“Errors of Commission are assumed to reflect impulsivity (responses that occur when on response is required), while errors of Omission are assumed to reflect symptoms of inattention [Epstein et al., 2003].”
BackgroundDickstein, D. P., Garvey, M. A., Pradella, A. G., GREENSTEIN, D. K., Sharp, W. S., Castellanos, F. X., Pine, D. S., & Leibenluft, E. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.12.010 · Cited by 89
Schneider, T., Ilott, N., Brolese, G., Bizarro, L., Asherson, P. J. E., & Stolerman, I. P. (2011) · Neuropsychopharmacology · doi:10.1038/npp.2010.249 · Cited by 97
Characteristics of Children With ADHD and Comorbid Anxiety
Jarrett, M. A., Wolff, J. C., Davis, T. E., Cowart, M. J. W., & Ollendick, T. H. (2012) · Journal of Attention Disorders · doi:10.1177/1087054712452914 · Cited by 84
“Although the three groups did not differ on mean reaction time, groups with ADHD were much more variable in their responses, consistent with research showing variable CPT responding in children with ADHD (Epstein et al., 2003).”
ResultChiang, H., Chen, Y.-J., Lo, Y., Tseng, W. I., & Gau, S. S. (2015) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.140106 · Cited by 85
Tung, Y.-H., Lin, H.-Y., Chen, C.-L., Shang, C.-Y., Yang, L.-Y., Hsu, Y.-C., Tseng, W.-Y. I., & Gau, S. S.-F. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20070999 · Cited by 79
Nelson, J. M., & Lovett, B. J. (2019) · Psychological Assessment · doi:10.1037/pas0000702 · Cited by 82
Young, J. W., Powell, S. B., Scott, C. N., Zhou, X., & Geyer, M. A. (2011) · Behavioural Brain Research · doi:10.1016/j.bbr.2011.03.054 · Cited by 82
“This pattern of deficient performance in Drd4 HT mice in the 5C-CPT is consistent with ADHD and BD patients in multiple CPT tasks, although hit rate was unaffected [16,70,71].”
ResultCao, Q., Zang, Y., Zhu, C., Cao, X., Sun, L., Zhou, X., & Wang, Y. (2008) · Brain Research · doi:10.1016/j.brainres.2008.04.028 · Cited by 80
“Indeed, it has been suggested that the measurement of RT variability is more sensitive to ADHD symptoms than the measurement of DHD group compared with the normal controls meanRT (Epstein et al., 2003).”
BackgroundColeman, B., Marion, S., Rizzo, A., Turnbull, J., & Nolty, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01851 · Cited by 78
“These findings are important due to the known characteristics of ADHD performance on CPT tasks: Typical response patterns show a decline in the percentage of correct responses and reaction time as a function of time from start to finish (Epstein et al., 2003).”
BackgroundAccornero, V. H., Amado, A. J., Morrow, C. E., Xue, L., Anthony, J. C., & Bandstra, E. S. (2007) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/01.dbp.0000268560.72580.f9 · Cited by 78
Areces, D., Rodríguez, C., García, T., Cueli, M., & Castro, P. G. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716629711 · Cited by 78
“…and have been shown to be useful in examining the relationships between various performance variables and the phenotypic behavior of ADHD students (Epstein et al., 2003) and in the differential diagnosis of ADHD and its different presentations (Bart, Raz, & Dan, 2014; González-Castro, Rodríguez,…”
BackgroundCaro, X. J., & Winter, E. F. (2011) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-011-9159-9 · Cited by 74
“Our data show that certain TOVA Ò sub-tests of attention , i.e. the ADHD score, Commission Errors, Response Time Variability, and d Prime (a measure of performance degradation over time), all improved significantly during EEG-BF in FMS subjects.”
InfluentialSolanto, M. V., Etefia, K., & Marks, D. J. (2004) · CNS Spectrums · doi:10.1017/s1092852900001929 · Cited by 75
Attention Network Test in adults with ADHD - the impact of affective fluctuations
Lundervold, A. J., Adólfsdóttir, S., Halleland, H. B., Halmøy, A., Plessen, K. J., & Haavik, J. (2011) · Behavioral and Brain Functions · doi:10.1186/1744-9081-7-27 · Cited by 72
Gruber, R., Grizenko, N., Schwartz, G. J., Bellingham, J., de Guzman, R., & Joober, R. (2007) · SLEEP · doi:10.1093/sleep/30.8.1003 · Cited by 72
A Four-Step Approach for Developing Diagnostic Tests in Psychiatry: EEG in ADHD as a Test Case
Boutros, N. N., Fraenkel, L., & Feingold, A. (2005) · Journal of Neuropsychiatry · doi:10.1176/jnp.17.4.455 · Cited by 71
Heidbreder, R. (2015) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-015-0171-4 · Cited by 81
Executive Functions in Youth With Spastic Cerebral Palsy
Pirilä, S., van der Meere, J. J., Rantanen, K., Jokiluoma, M., & Eriksson, K. J. (2011) · Journal of Child Neurology · doi:10.1177/0883073810392584 · Cited by 69
“The validity for the Conners Continuous Performance Test and its norms have been determined from documented performance differences between attention-deficit hyperactivity disorder (ADHD)(14) patient groups and agematched normal subjects derived from normative epidemiological samples.(15,16) It is hypothesized that sp…”
Sustained and Focused Attention Deficits in Adult ADHD
Marchetta, N. D. J., Hurks, P., de Sonneville, L. D., Krabbendam, L., & Jolles, J. (2008) · Journal of Attention Disorders · doi:10.1177/1087054707305108 · Cited by 73
“Our results with respect to speed (RT) variability with TOT are also consistent with similar research conducted in previous pediatric populations (Epstein et al., 2003; Kalff et al., 2005; Swaab-Barneveld et al., 2000).”
ResultExploring N -Back Cognitive Training for Children With ADHD
Jones, M. R., Katz, B., Buschkuehl, M., Jaeggi, S. M., & Shah, P. (2020) · Journal of Attention Disorders · doi:10.1177/1087054718779230 · Cited by 64
“Our task was modeled after Conners et al. (2003), consisting of 18 blocks with 20 trials each (360 total trials).”
MethodNeuropsychological Testing is Not Useful in the Diagnosis of ADHD: Stop It (or Prove It)!
Barkley, R. A. (2019) · The ADHD Report · doi:10.1521/adhd.2019.27.2.1 · Cited by 68
Conners’ Continuous Performance Test (CPT)
Conners, C. K., & Sitarenios, G. (2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_1535 · Cited by 69
Self-citationMühlberger, A., Jekel, K., Probst, T., Schecklmann, M., Conzelmann, A., Andreatta, M., Rizzo, A. A., Pauli, P., & Romanos, M. (2016) · Journal of Attention Disorders · doi:10.1177/1087054716647480 · Cited by 74
“As reaction times for children with ADHD compared with healthy controls were variable in various studies (Andreou et al., 2007; Epstein et al., 2003; Klein, Wendling, Huettner, Ruder, & Peper, 2006), intra-participant reactiontime variability has been suggested as the most appropriate measure of…”
ResultHollis, C., Hall, C. L., Guo, B., James, M., Boadu, J., Groom, M. J., Brown, N., Kaylor‐Hughes, C., Moldavsky, M., Valentine, A. Z., et al. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12921 · Cited by 67
“Specifically, although the CPT demonstrates good sensitivity to ADHD and correlates well with symptoms (Epstein et al., 2003), several studies have shown significant overlap in the performance of children with ADHD and typically developing children (Grodzinsky & Barkley, 1999; Schatz, Ballantyne, &…”
Metadata
- Authors
- Epstein, J. N., Erkanli, A., Conners, C. K., Klaric, J., Costello, J. E., & Angold, A.
- Affiliations
- Duke University (US)
- Corresponding author
- Epstein, Jeffery N.
- ORCID
- Epstein, Jeffery N.
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2003-10
- Volume
- 31
- Issue
- 5
- Pages
- 543-554
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- OpenAlex
- W1539412734
- Cited by
- 520
- References
- 31
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 16 · 2023: 18 · 2022: 14 · 2021: 10 · 2020: 27 · 2019: 22 · 2018: 31 · 2017: 16 · 2016: 34 · 2015: 35 · 2014: 42 · 2013: 28 · 2012: 35
- FWCI
- 5.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- attention deficit hyperactivity disorder, Conners' Continuous Performance Test, inattention, impulsivity, hyperactivity, reaction time variability, omission errors, commission errors, perceptual sensitivity, children
- MeSH terms
- Algorithms, Attention Deficit Disorder with Hyperactivity, Child, Humans, Neuropsychological Tests, Reaction Time, Severity of Illness Index, Reproducibility of Results, Diagnostic and Statistical Manual of Mental Disorders
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