Cited by 520Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyNeural and Behavioral Psychology Studies

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Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

Epstein, Jeffery N., Erkanli, Alaatin, Conners, C. Keith, Klaric, John, Costello, Jane E., Angold, Adrian·2003·Journal of Abnormal Child Psychology

DOI 10.1023/a:1025405216339

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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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“The diagnostic method based on cognitive neurophysiology [17] is affected by the emotional tension of the participants, resulting in inaccurate evaluation results.”
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BackgroundResultInfluential
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“…that Continuous Performance Test (CPT) commission errors are often considered to measure impulsivity and are sensitive to medication response (Epstein et al., 2003; Hale et al., 2005; Losier, McGrath, & Klein, 1996; Riccio, Reynolds, Lowe, & Moore, 2002; Riccio, Waldrop, Reynolds, & Lowe,…”
Background
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“Performance-based measures of EF such as go/No-go tests have served as an initial tool to probe individuals’ vulnerability to ADHD (Epstein et al., 2003).”
Method
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“…& Marks, 2004; Walker, Shores, Trollor, Lee, & Sachdev, 2000) or administering the CPT in isolation (Conners, Epstein, Angold, & Klaric, 2003; Epstein et al., 2003; Levy & Hobbes, 1997; Lindsay, Tomazic, Levine, & Accardo, 2001) or varying the order of the tests in an attempt to randomize…”
Background
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BackgroundSelf-citation
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“The finding that RT was not related to any of the symptom ratings is consistent with previous research findings where the variability of RT over time seems to be a much more robust measure [23].”
Result
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“However, it may be difficult to separate problems with attention from response inhibition since both can indiscriminately impact performance on these tests of attention (Epstein et al. 2003).”
Background
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BackgroundInfluential
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“…2006; DuPaul & Power, 2000; Frazier, Youngstrom, Glutting, & Watkins, 2007; Mayes & Calhoun, 2007; McInnes, Humphries, Hogg-Johnson, & Tannock, 2003), but also on working memory (Barkley, 1997) and vigilance (e.g., Barkley, Grodzinsky, & DuPaul, 1992; Epstein et al., 2003; Shallice et al., 2002).”
Background
Mice haploinsufficient for Map2k7, a gene involved in neurodevelopment and risk for schizophrenia, show impaired attention, a vigilance decrement deficit and unstable cognitive processing in an attentional task: impact of minocycline
Openshaw, R. L., Thomson, D. M., Penninger, J. M., Pratt, J. A., & MORRIS, B. J. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4463-y · Cited by 20
“Moreover, it is under investigation as a reliable predictor for those who are at risk of developing schizophrenia (Shin et al. 2013), ADHD (HenrίquezHenrίquez et al. 2015) and even for cognitive function in itself (Grand et al. 2016).”
Background
Is a Virtual Reality Test Able to Predict Current and Retrospective ADHD Symptoms in Adulthood and Adolescence?
Areces, D., García, T., Cueli, M., & Rodríguez, C. (2019) · Brain Sciences · doi:10.3390/brainsci9100274 · Cited by 19
EEG-ERP dynamics in a visual Continuous Performance Test
Karamacoska, D., Barry, R. J., Blasio, F. M. D., & Steiner, G. Z. (2019) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2019.08.013 · Cited by 20
Neonatal 6-OHDA Lesion Model in Mouse Induces Cognitive Dysfunctions of Attention-Deficit/Hyperactivity Disorder (ADHD) During Young Age
Bouchatta, O., Manouze, H., Ba-M’hamed, S., Landry, M., & Bennis, M. (2020) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2020.00027 · Cited by 20
Microsoft Kinect-based Continuous Performance Test: An Objective Attention Deficit Hyperactivity Disorder Assessment
Delgado‐Gómez, D., Peñuelas‐Calvo, I., Masó-Besga, A. E., Vallejo-Oñate, S., Baltasar-Tello, I., Arrua-Duarte, E., Vera-Varela, C., Carballo, J. J., & Baca‐García, E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6985 · Cited by 19
Psychometric properties of a combined go/no-go and continuous performance task across childhood.
Clark, C. A. C., Cook, K. A., Wang, R., Rueschman, M., Radcliffe, J., Redline, S. S., & Taylor, H. G. (2023) · Psychological Assessment · doi:10.1037/pas0001202 · Cited by 20
Association of salivary dehydroepiandrosterone levels and symptoms in patients with attention deficit hyperactivity disorder during six months of treatment with methylphenidate
Wang, L., Hsiao, C., Huang, Y., Chiang, Y.-L., Ree, S., Chen, Y., Wu, Y., Wu, C., Shang, Z.-Y., & Chen, C. (2011) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2011.02.014 · Cited by 19
“Many CPT performance, particularly two signal detection measures of d’ and beta, demonstrated correlation with ADHD behaviors (Epstein et al., 2003).”
Time-Related Changes in Conners' CPT-II Scores: A Replication Study
Erdődi, L. A., & Lajiness-O'Neill, R. R. (2013) · Applied Neuropsychology Adult · doi:10.1080/09084282.2012.724036 · Cited by 19
“…Etefia, & Marks, 2004; Walker, Shores, Trollor, Lee, & Sachdev, 2000), administered the CPT in isolation (Conners, Epstein, Angold, & Klaric, 2003; Epstein et al., 2003; Levy & Hobbes, 1997; Lindsay, Tomazic, Levine, & Accardo, 2001), or varied the order of the tests to randomize ‘‘carryover…”
The Clinical Utility of the Conners’ Continuous Performance Test-II in Traumatic Brain Injury
Zane, K. L., Gfeller, J. D., Roskos, P. T., & Bucholz, R. D. (2016) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acw078 · Cited by 21
The efficacy of Ritalin in ADHD children under neurofeedback training
Pakdaman, F., Irani, F., Tajikzadeh, F., & Jabalkandi, S. A. (2018) · Neurological Sciences · doi:10.1007/s10072-018-3539-3 · Cited by 20
Effects of Extended-Release Methylphenidate Treatment on Cognitive Task Performance in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder
Pearson, D. A., Santos, C. W., Aman, M. G., Arnold, L. E., Lane, D. M., Loveland, K. A., Mansour, R., Ward, A. R., Casat, C. D., Jerger, S. W., et al. (2020) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2020.0004 · Cited by 20
“The CPT differentiates children with and without ADHD in the general pediatric population (e.g., Sykes et al. 1971; Riccio et al. 2001; Epstein et al. 2003), as well as children with and without ADHD who have intellectual disabilities (Aman et al.”
Background
Improved Attentional Performance Following Citicoline Administration in Healthy Adult Women
McGlade, E., Locatelli, A. E., Hardy, J., Kamiya, T., Morita, M., Morishita, K., SUGIMURA, Y., & Yurgelun-Todd, D. A. (2012) · Food and Nutrition Sciences · doi:10.4236/fns.2012.36103 · Cited by 19
“been shown to be a reliable measure for sustained and selective attention [21,22].”
Background
Executive Function/Cognitive Training for Children with ADHD: Do Results Warrant the Hype and Cost?
Orban, S. A., Rapport, M. D., Friedman, L. M., & Kofler, M. J. (2014) · The ADHD Report · doi:10.1521/adhd.2014.22.8.8 · Cited by 22
“…with ADHD demonstrate vigilance/ sustained attention deficits; however, performance on vigilance/sustained attention tasks is correlated weakly to moderately with parent and teacher ratings of core ADHD symptoms (Epstein et al., 2003) and objectively observed classroom attention (Barkley, 1991).”
Background
Continuous performance test in pediatric obsessive-compulsive disorder and tic disorders: the role of sustained attention
Lucke, I. M., Lin, C., Conteh, F., Federline, A., Sung, H., Specht, M. W., & Grados, M. A. (2014) · CNS Spectrums · doi:10.1017/s1092852914000467 · Cited by 19
“In a study that focused on RT variability in children with ADHD, affected children had greater RTvariability than controls across several tests of attention and inhibitory control (child attentional network task, go/no-go task, stop signal task, N-back task).(65) Similarly, another study in 57 children with ADHD vs.”
Result
Standard experimental paradigm designs and data exclusion practices in cognitive psychology can inadvertently introduce systematic “shadow” biases in participant samples
Siritzky, E. M., Cox, P., Nadler, S. M., Grady, J. N., Kravitz, D. J., & Mitroff, S. R. (2023) · Cognitive Research Principles and Implications · doi:10.1186/s41235-023-00520-y · Cited by 20
“…has some merit given that lab-based tasks can actually be quite similar in nature to clinical tasks used to diagnose ADHD (e.g., continuous performance tests) due to their exacerbation of participants’ ability to sustain attention and inhibit responses (Baggio et al., 2020; Epstein et al., 2003).”
Background
Cognitive functions in adults with β‐thalassemia major: before and after blood transfusion and comparison with healthy controls
Raz, S., Koren, A., Dan, O., & Levin, C. (2016) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.13103 · Cited by 18
Reliability and Validity of the Online Continuous Performance Test Among Children
Bart, O., Raz, S., & Dan, O. (2014) · Assessment · doi:10.1177/1073191114530777 · Cited by 18
“Different versions of CPTs have shown greater response time variability and higher frequencies of omission and commission errors in patients with ADHD, as compared with healthy controls (Conners, 2004; Epstein et al., 2003; Klein, Wendling, Huettner, Ruder, & Peper, 2006).”
Background
Neurological soft signs in children with attention deficit hyperactivity disorder: Their relationship to executive function and parental neurological soft signs
Gong, J., Xie, J., Gui, C., Zhang, Y., & Wang, S. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.04.017 · Cited by 18
“, 2007), and repetitive motor impairment (Epstein et al., 2003; Dickstein et al., 2005) in cases of ADHD.”
Background
Relationship between intraindividual auditory and visual attention in children with ADHD
Lin, H., Chang, W., Hsieh, H.-C., Yu, W.-H., & Lee, P. (2020) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2020.103808 · Cited by 17
Frequency of Attention Deficit in First-Episode Schizophrenia Compared to ADHD
Egeland, J. (2010) · Applied Neuropsychology · doi:10.1080/09084280903297859 · Cited by 17
“Several studies have, however, indicated that attention tests are not sufficiently sensitive to the attention problems evident in everyday functioning (Epstein et al., 2003; McGee, Clark, & Symons, 2000; Øie & Rund, 1999; Solanto, Etefia, & Marks, 2004).”
Background
Sex Differences in Dimensions of Impulsivity in a Non-Clinical Sample
Lage, G. M., Albuquerque, M. R., Fuentes, D., Corrêa, H., & Malloy‐Diniz, L. F. (2013) · Perceptual and Motor Skills · doi:10.2466/15.19.pms.117x18z2 · Cited by 18
Detecting Symptom Exaggeration in College Students Seeking ADHD Treatment: Performance Validity Assessment Using the NV-MSVT and IVA-Plus
Leppma, M., Long, D., Smith, M. L., & Lassiter, C. (2017) · Applied Neuropsychology Adult · doi:10.1080/23279095.2016.1277723 · Cited by 17
“CPTs are computerized tests that have been shown to help in differentiating between ADHD and non-ADHD groups (Epstein et al., 2003).”
Background
Differential Diagnosis in Patients with Substance Use Disorder and/or Attention-Deficit/Hyperactivity Disorder Using Continuous Performance Test
Slobodin, O., Blankers, M., Kapitány‐Fövény, M., Kaye, S. S., Berger, I., Johnson, B., Demetrovics, Z., van den Brink, W., & van de Glind, G. (2020) · European Addiction Research · doi:10.1159/000506334 · Cited by 18
Continuous Performance Testing in the Differential Diagnosis of ADHD
Homack, S. R., & Reynolds, C. R. (2005) · The ADHD Report · doi:10.1521/adhd.2005.13.5.5 · Cited by 17
Relationship between theta-phase gamma-amplitude coupling and attention-deficit/hyperactivity behavior in children
Kim, J. W., Lee, J., Kim, H.-J., Lee, Y. S., & Min, K. J. (2015) · Neuroscience Letters · doi:10.1016/j.neulet.2015.01.068 · Cited by 16
“In the diagnosis of ADHD, the continuous performance task (CPT) has been recognized as a valuable tool that is capable of discriminating children with ADHD from normally developing peers [11,16,19,49].”
A quantitative analysis of fidgeting in ADHD and its relation to performance and sustained attention on a cognitive task
Son, H. M., Calub, C. A., Fan, B., Dixon, J. F., Rezaei, S., Borden, J., Schweitzer, J. B., & Liu, X. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1394096 · Cited by 20
Neuronal codes for the inhibitory control of impulsive actions in the rat infralimbic cortex
Tsutsui‐Kimura, I., Ohmura, Y., Izumi, T., Matsushima, T., Amita, H., Yamaguchi, T., Yoshida, T., & Yoshioka, M. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2015.08.025 · Cited by 16
The Utility of the CPT in the Diagnosis of ADHD in Individuals with Substance Abuse: A Systematic Review
Slobodin, O. (2020) · European Addiction Research · doi:10.1159/000508041 · Cited by 16
Road-Crossing Behavior in Complex Traffic Situations: A Comparison of Children With and Without ADHD
Tabibi, Z., Schwebel, D. C., & Zolfaghari, H. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-021-01200-y · Cited by 19
Relations between response trajectories on the continuous performance test and teacher-rated problem behaviors in preschoolers.
Allan, D. M., & Lonigan, C. J. (2014) · Psychological Assessment · doi:10.1037/pas0000054 · Cited by 16
Attention lapses in children with spina bifida and hydrocephalus and children with attention-deficit/hyperactivity disorder
la Torre, G. G. D., Martin, A., Cervantes, E., Bozal, R. G., & Navas, J. M. M. (2016) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2016.1249828 · Cited by 16
“Several studies report high error rates (Losier, McGrath, & Klein, 1996; Miranda et al., 2012) and reaction time variability in ADHD children (Epstein et al., 2003; Tamm et al., 2012).”
BackgroundMethod
First-Dose Methylphenidate–Induced Changes in Brain Functional Connectivity Are Correlated With 3-Month Attention-Deficit/Hyperactivity Disorder Symptom Response
Silberstein, R. B., Lévy, F., Pipingas, A., & Farrow, M. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2017.03.022 · Cited by 16
Embedding values: how science and society jointly valence a concept—the case of ADHD
Hawthorne, S. C. C. (2010) · Studies in History and Philosophy of Science Part C Studies in History and Philosophy of Biological and Biomedical Sciences · doi:10.1016/j.shpsc.2009.12.005 · Cited by 17
Attribution and Self-Evaluation of Continuous Performance Test Task Performance in Medicated and Unmedicated Adults With ADHD
Barrilleaux, K., & Advokat, C. D. (2008) · Journal of Attention Disorders · doi:10.1177/1087054708314604 · Cited by 16
“The CPT has been found to be a reliable measure for assessing inattention and impulsivity, it is resistant to practice effects (Halperin, Sharma, Greenblatt, & Schwartz, 1991), and unmedicated children with ADHD have been shown to make more errors on the task than those without ADHD (Epstein et al., 2003).”
Background
Maturation of response time and attentional control in ADHD: Evidence from an attentional capture paradigm
Bourel‐Ponchel, E., Querné, L., Moing, A. G. L., Delignières, A., de Broca, A., & Berquin, P. C. (2010) · European Journal of Paediatric Neurology · doi:10.1016/j.ejpn.2010.08.008 · Cited by 14
A Novel Feed-Forward Modeling System Leads to Sustained Improvements in Attention and Academic Performance
McDermott, A. F., Rose, M. C., Norris, T. W., & Gordon, E. (2016) · Journal of Attention Disorders · doi:10.1177/1087054715623044 · Cited by 21
“Given the complexity of that relationship, it appears advisable to not focus training on only one skill, but rather train a set of skills that children with ADHD struggle to use effectively (Castellanos, Sonuga-Barke, Milham, & Tannock, 2006; Epstein et al., 2003; Jonsdottir, Bouma, Sergeant, & Scherder, 2006; Rapport…”
BackgroundResultInfluential
Methylphenidate significantly improves neurocognitive impairments in children with ADHD
İzmir, S. B. İ., İpçi, M., & Ercan, E. S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114492 · Cited by 17
Gender Differences in the Behavioral Symptoms and Neuropsychological Performance of Patients with Attention-Deficit/Hyperactivity Disorder Treated with Methylphenidate: A Two-Year Follow-up Study
Wang, L., Chen, C., & Huang, Y. (2015) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2014.0175 · Cited by 15
“Neuro-psychological functioning is not necessarily correlated with every domain of clinical ADHD symptoms (Epstein et al. 2003).”
Neurocognitive Performance and Behavioral Symptoms in Patients with Attention-Deficit/Hyperactivity Disorder During Twenty-Four Months of Treatment with Methylphenidate
Wang, L., Chen, C., & Huang, Y. (2015) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2014.0015 · Cited by 15
“However, whether neuropsychological tests could serve as a reliable screening diagnostic tool for ADHD remains controversial (Epstein et al. 2003; Pineda et al. 2007).”
A Combination of Impulsivity Subdomains Predict Alcohol Intoxication Frequency
O’Halloran, L., Pennie, B., Jollans, L., Kiiski, H. S. M., Vahey, N. A., Rai, L. A., Bradley, L., Lalor, R., & Whelan, R. (2018) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13779 · Cited by 17
Diagnostic Utility of Conners Continuous Performance Test-3 for Attention Deficit/Hyperactivity Disorder: A Systematic Review
Callan, P. D., Swanberg, S. M., Weber, S. K., Eidnes, K., Pope, T. M., & Shepler, D. K. (2024) · Journal of Attention Disorders · doi:10.1177/10870547231223727 · Cited by 14
“…and systematic reviews have demonstrated the utility of continuous performance tests (CPTs) to differentiate children and adults with ADHD from those with other diagnoses and from healthy controls (Epstein et al., 2003; Frazier et al., 2004; Hall et al., 2016; Losier et al., 1996; Slobodin, 2020).”
Background
Computerized versus manual versions of the Wisconsin Card Sorting Test: Implications with typically developing and ADHD children
Filippetti, V. A., Krumm, G., & Raimondi, W. (2019) · Applied Neuropsychology Child · doi:10.1080/21622965.2019.1570198 · Cited by 14
“This assessment enables to discriminate between children with ADHD and TD children (Nichols & Waschbusch, 2004) and to predict the presence of ADHD symptomatology (Epstein et al., 2003).”
Background
Brief report: Relationship between performance testing and parent report of attention and executive functioning profiles in children following perinatal arterial ischemic stroke
Krivitzky, L. S., Bosenbark, D. D., Ichord, R., Jastrzab, L. E., & Billinghurst, L. L. (2019) · Child Neuropsychology · doi:10.1080/09297049.2019.1588957 · Cited by 14
“, 2009; Raggio, Rhodes, & Whitten, 1999) while some studies have shown that parent ratings have a significant relationship with CPT variables (Epstein et al., 2003; Raggio et al., 1999).”
The Benefit of Recreational Physical Activity to Restore Attentional Fatigue: The Effects of Running Intensity Level on Attention Scores
Norling, J. C., Sibthorp, J., Suchy, Y., Hannon, J. C., & Ruddell, E. J. (2010) · Journal of Leisure Research · doi:10.1080/00222216.2010.11950198 · Cited by 14
Attention-Deficit/Hyperactivity Disorder in Preschool Children: An Investigation of Validation Based on Visual Attention Performance
Tandon, M., Si, X., Belden, A. C., & Luby, J. L. (2009) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2008.048 · Cited by 14
“However, similar to ﬁndings from the current study, several of these investigations in school-aged children also found that these errors were nonspeciﬁc across symptom domains (Barkley 1991; Chhabildas et al. 2001; Epstein et al. 2003).”

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
Publisher: Springer Science and Business Media LLC
Published: 2003-10
Volume: 31
Issue: 5
Pages: 543-554
ISSN: 0091-0627 (ISSN-L)
1573-2835
DOI: 10.1023/a:1025405216339
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: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
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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Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

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