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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BackgroundMethod
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Result
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Background
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Method
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Background
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“These behavioural tasks can be broadly divided into (a) reward-choice tasks (Mischel and Underwood 1974; Green and Myerson 2004) 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) and stop tasks (Logan et al.”
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Assessment of attention and working memory among young adults using computer games
Basu, S., Saha, S., Das, S., Guha, R., Mukherjee, J., & Mahadevappa, M. (2022) · Journal of Ambient Intelligence and Humanized Computing · doi:10.1007/s12652-022-04494-5 · Cited by 6
“The CPT examines human vigilance or sustained attention (Corkum et al. 1993; Epstein et al. 2003; Klee et al. 1983).”
Background
EVALUACIÓN DE LA ATENCIÓN SOSTENIDA DE NIÑOS CON TRASTORNO POR DÉFICIT DE ATENCIÓN CON HIPERACTIVIDAD Assesment of Sustained Attention of Children with Attention Deficit Hyperactivity Disorder
Soroa, M., Iraola, J. Á., Balluerka, N., & Soroa, G. (2009) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.1387/revpsicodidact.248 · Cited by 5
“Esta mayor lentitud de los niños con TDAH en el tiempo de respuesta es consistente con los resultados obtenidos en estudios previos (Berlin et al., 2003; Epstein et al., 2003; Mullins et al., 2005; Van deer Meere et al., 1992).”
Influential
The effect of methylphenidate on sustained attention among adolescents with attention-deficit hyperactivity disorder
Lufi, D., Bassin-Savion, S., & Rubel, L. (2015) · Neurocase · doi:10.1080/13554794.2015.1023317 · Cited by 6
“Sustained attention has been found to be the major factor in explaining the difficulties of attention-deficit hyperactivity disorder (ADHD) (to name only a few studies: Epstein et al., 2003; Johnson et al., 2007; Tsal et al., 2005).”
Background
Protocolo Interdisciplinar de Avaliação Neuropsicológica, Comportamental e Clínica para Crianças e Adolescentes com Queixas de Desatenção e Hiperatividade
Carreiro, L. R. R., Schwartzman, J. S., Cantiere, C. N., Ribeiro, A. D. F., Silva, N. A., Martin, M. A. F., Chiquetto, C. M., Baraldi, G. D. S., Mariani, M., Seraceni, M. F. F., et al. (2014) · Psicologia - Teoria e Prática · doi:10.15348/1980-6906/psicologia.v16n3p155-171 · Cited by 6
“Conners, C. K., Epstein, J. N., Angold, A., & Klaric, J. (2003).”
BackgroundInfluential
Altered Brain Structure-Function Relationships Underlie Executive Dysfunction in 22q11.2 Deletion Syndrome
Jonas, R. K., Jalbrzikowski, M., Montojo, C. A., Patel, A. B., Kushan, L., Chow, C. C., Vesagas, T., & Bearden, C. E. (2015) · Complex Psychiatry · doi:10.1159/000441979 · Cited by 7
The Mesulam Continuous Performance Test (M-CPT): Age-Related and Gender Differences in the Sustained Attention of Elementary School Children
Sussman, J., & Tasso, A. F. (2013) · The New School psychology bulletin · Cited by 5
Reading Comprehension Impairment in Children With Neurofibromatosis Type 1 (NF1): The Need of Multimodal Assessment of Attention
Biotteau, M., Tournay, E., Baudou, É., Destarac, S., Iannuzzi, S., Faure-Marie, N., Castelnau, P., Schweitzer, E., Rodriguez, D., Kemlin, I., et al. (2021) · Journal of Child Neurology · doi:10.1177/0883073820981270 · Cited by 6
Cognitive mechanisms of methylphenidate in ADHD: Do improvements in sustained attention mediate behavioral improvements in the natural environment?
Merrill, B. M., Raiker, J. S., Evans, S. W., Gnagy, E. M., & Pelham, W. E. (2021) · Child Neuropsychology · doi:10.1080/09297049.2020.1862074 · Cited by 6
“Bias has been shown to be robustly, but nonspecifically, related to ADHD symptoms in an epidemiological sample, though relation to symptoms decreased when performance over time was evaluated (Epstein et al., 2003).”
Background
Assessment Instruments for Impulsivity and Impulse Control Disorders
Matusiewicz, A. K., Reynolds, B. A., & Lejuez, C. W. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195389715.013.0141 · Cited by 6
Atención e impulsividad en Niños con Alta Capacidad Intelectual y Niños con TDAH
Sierra, M. D. L. D. V., Maldonado, L. A. A., González, J. S. M., Verche, E., Borges, Á., & Cervantes, C. J. R. (2018) · Electronic Journal of Research in Educational Psychology · doi:10.25115/ejrep.v16i46.2232 · Cited by 6
Performance on the Flicker Task and Conners' CPT in Children with ADHD
Cohen, A. L. (2009) · Cited by 6
The aorticorenal ganglion in 10 weeks old pig fetuses.
Pospieszny, N. (1986) · PubMed · Cited by 6
Interaction of mercury exposure and DNA methylation with sustained attention in children in a novel analysis of epigenetic susceptibility
Ehlinger, J. V., Goodrich, J. M., Dolinoy, D. C., Watkins, D. J., Cantoral, A., Mercado‐García, A., Basu, N., Téllez‐Rojo, M. M., & Peterson, K. E. (2025) · Current Zoology · doi:10.1093/eep/dvaf011 · Cited by 5
Enhancing ADHD Diagnostic Assessments with Virtual Reality integrated with Biofeedback and Artificial Intelligence
Garg, A., Reza, S. M., & Babinski, D. E. (2025) · International Conference on Information and Computer Technologies (ICICT) · doi:10.1109/icict64582.2025.00075 · Cited by 5
“Continuous Performance Tests (CPT) are widely used to evaluate attention, impulsivity, and response variability in ADHD diagnosis [12].”
BOLD Activation During the Application of MOXO-CPT in School Patients With and Without Attention Deficit Hyperactivity Disorder
Beristaín, J. C. G., Alonso, B. D. C., Pérez, E. B., Dies-Suárez, P., & Hidalgo-Tobón, S. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231217093 · Cited by 5
“Examples of computerized testing approaches include Continuous Performance Testing (CPT) (Areces, Dockrell, et al., 2018; Bart et al., 2014; Epstein et al., 2003).”
BackgroundMethod
Comparison between manual aiming control and sex in different task constraints
Fernandes, L. A., Ugrinowisch, H., de Oliveira, J. R. V., Salvador, M. G., Bicalho, L. E. A., & Lage, G. M. (2018) · Motriz Revista de Educação Física · doi:10.1590/s1980-6574201700030029 · Cited by 5
The Effects of Noise and Reverberation Time on Auditory Sustained Attention
Li, L., Liu, Y., & Li, L. (2023) · Applied Sciences · doi:10.3390/app13148256 · Cited by 5
One‐year outcomes of deep brain stimulation in refractory Tourette syndrome
Lee, J., Chang, K. W., Jung, H. H., Kim, D., Chang, J. W., & Song, D. (2023) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13584 · Cited by 5
“’ Cognitive function and symptoms of ADHD were also assessed with the Korean Wechsler Adult Intelligence Scale-IV and Continuous Performance Test, 41 respectively, before surgery.”
Method
Validity of Diagnostic Support Model for Attention Deficit Hyperactivity Disorder: A Machine Learning Approach
Chu, K., Huang, H.-J., & Huang, Y. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13111525 · Cited by 5
“Additionally Additionally, children with ADHD had slower response times compared to those without ADHD [29].”
Result
Is the Conners’ continuous performance test helpful for assessing attention deficit hyperactivity disorder in a clinical setting?
Johnsen, K., Kvitland, L. R., Sollie, H., Reiestad, M. T., Jonsbu, E., Hagen, K., & Weidle, B. (2023) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2023.2279640 · Cited by 5
“One CPT variable, mean HRT, was minimally related to ADHD symptoms overall but showed some specificity to symptoms of hyperactivity [38].”
Background
An investigation of the usefulness of the Conner’s Continuous Performance Test II in the assessment of inattention and hyperactivity in the school
Kallitsoglou, A. (2013) · European Journal of Special Needs Education · doi:10.1080/08856257.2013.797707 · Cited by 5
“It has also been proved to be sensitive to change in ADHD as a result of medication and standard services treatment (Wang et al. 2011).”
BackgroundInfluential
From early risk via cognitive functioning to ADHD phenotype: A longitudinal study of boys at familial risk for ADHD
Einziger, T., Zilberman‐Hayun, Y., Atzaba‐Poria, N., Auerbach, J. G., & Berger, A. (2021) · Early Childhood Research Quarterly · doi:10.1016/j.ecresq.2021.06.003 · Cited by 7
Sustained attention in sensory modulation disorder and attention deficit/hyperactivity disorder
Mazor‐Karsenty, T., Parush, S., & Shalev, L. (2019) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2019.02.004 · Cited by 5
Exploring the dynamics of design fluency in children with and without ADHD using artificial neural networks
Gauthier, B., Parent, V., & Lageix, P. (2014) · Child Neuropsychology · doi:10.1080/09297049.2014.988606 · Cited by 9
“Another relatively common process measure is the standard deviation of reaction time, large values of which seem to characterize the disorder (e.g., Epstein et al., 2003; Forbes, 1998; Sjöwall, Roth, Lindqvist, & Thorell, 2013; Sonuga-Barke et al., 2010).”
Background
Processing Speed and ADHD
Kleinmann, A. E., Lewandowski, L. J., Sheffield, R. A., & Gordon, M. (2005) · The ADHD Report · doi:10.1521/adhd.13.1.6.61561 · Cited by 5
Contribuição de múltiplos informantes para avaliação comportamental de adolescentes com queixas de desatenção e hiperatividade
da Rocha, M. M., Ribeiro, A. D. F., Marino, R. L. D. F., Cantiere, C. N., Teixeira, M. C. T. V., Schwartzman, J. S., & Carreiro, L. R. R. (2017) · Psico · doi:10.15448/1980-8623.2017.4.25859 · Cited by 5
Exploring the neural basis of reaction time variability in ADHD: The importance of examining data at the trial level
Tamm, L., Dudley, J. A., Karalunas, S. L., Simon, J. O., Maloney, T. C., Atluri, G., & Epstein, J. N. (2025) · NeuroImage: Reports · doi:10.1016/j.ynirp.2025.100263 · Cited by 4
“Higher RTV is associated with inattention symptom ratings (Ali et al., 2019; Cai et al., 2021; Epstein et al., 2003; Kofler et al., 2013), ratings of attentional impulsiveness (Swick et al., 2013), objectively coded behavioral inattention (Antonini et al., 2013), and multiple negative sequelae…”
Self-citation
Efficacy and Compliance of a Working Memory Multitasking Task Mobile Intervention for Children With Attention-Deficit/Hyperactivity Disorder: Single-Arm, Pre-Post Pilot Study
Jung, M., Woo, J., Kim, S. J., Lim, Y. B., Kim, Y., Kang, D., Min, J., & Kim, B.-N. (2025) · JMIR Human Factors · doi:10.2196/70479 · Cited by 4
“It is a type of continuous performance test [46,47] and features both ADS visual and auditory (ADS-A) modules, each containing 3 distinct stimuli (1 target and 2 nontargets).”
Clinical Utility of Virtual Kitchen Errand Task for Children (VKET-C) as a Functional Cognition Evaluation for Children with Developmental Disabilities
Ju, Y., Kang, S., Kim, J., Ryu, J.-K., & Jeong, E.-H. (2024) · Children · doi:10.3390/children11111291 · Cited by 5
Attentiveness and mental health in adolescents with moderate-to-severe atopic dermatitis without ADHD
Paller, A. S., González, M. E., Barnum, S., Jaeger, J., Shao, L., Ozturk, Z. E., & Korotzer, A. R. (2024) · Archives of Dermatological Research · doi:10.1007/s00403-024-03210-x · Cited by 4
“…was chosen as the primary outcome assessment tool due to its frequent use in clinical evaluation of attention problems and the correlation between outcome parameters of CPT-3 and the specific symptoms of ADHD, including those suggested by the study in AD patients by Kruse and colleagues [14, 18 ].”
Response inhibition as a critical executive function in differentiating attention-deficit/hyperactivity disorder from autism spectrum disorder: a comprehensive attention test study
Lee, K., Cho, I. H., Park, J. H., Choi, H., & Cheon, K.-A. A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1426376 · Cited by 5
Reduced recruitment of inhibitory control regions in very young children with ADHD during a modified Kiddie Continuous Performance Task: A fMRI study
Bayat, M., Hernandez, M. L., Curzon, M., Garic, D., Graziano, P. A., & Dick, A. S. (2024) · Cortex · doi:10.1016/j.cortex.2024.11.025 · Cited by 4
The DiViSA’s Predictive Validity by Age: An Objective Online Test of Attention
Santacreu, J., & Quiroga, M. Á. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.103 · Cited by 4
“…or sustained attention/inhibition – children with attention deficits exhibit: longer and more variable reaction times, and lower sensitivity (d’) (Epstein et al., 2003; Hooks, Milich, & Pugzles-Lorch, 1994; Losier, McGrath, & Klein, 1996; Oades, 2000; Stins et al., 2005; SwaabBarneveld et…”
Background
Moving to Capture Children’s Attention: Developing a Methodology for Measuring Visuomotor Attention
Hill, L. J. B., Coats, R. O., Mushtaq, F., Williams, J. H. G., Aucott, L. S., & Mon-Williams, M. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0159543 · Cited by 4
The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population
Smith, A. A., Thomas, J., Friedhoff, C., & Chin, E. (2021) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acab065 · Cited by 4
Nutrition for ADHD and Autism
Duff, J. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-396988-0.00014-3 · Cited by 4
Cutting Corners: Neuropsychological Research into the Energetics of ADHD
Egeland, J. (2012) · InTech eBooks · doi:10.5772/30006 · Cited by 4
“While hyperactivity and impulsivity are considered to mediate the attention deficit of subjects with ADHD (Epstein et al, 2003), subjects with schizophrenia may have an impairment initially focusing attention, but may profit from exercise (Egeland et al., 2003, Egeland et al., 2007).”
Diagnostic Utility of the Pediatric Attention Disorders Diagnostic Screener
Newman, E. R., & Reddy, L. A. (2014) · Journal of Attention Disorders · doi:10.1177/1087054714526431 · Cited by 4
“Although research comparing the diagnostic utility of these measures has been equivocal, some studies have shown that they discriminate ADHD children from controls (e.g., DeShazo, Grofer, Lyman, Bush, & Hawkins, 2001; Epstein et al., 2003; Homack & Riccio, 2004; Romine et al., 2004).”
Result
Transcranial Doppler sonography reveals sustained attention deficits in young adults diagnosed with ADHD
Shaw, T. H., Curby, T. W., Satterfield, K., Monfort, S. S., & Ramirez, R. (2018) · Experimental Brain Research · doi:10.1007/s00221-018-5432-y · Cited by 4
Using an objective computer task (QbTest) to aid the identification of attention deficit hyperactivity disorder (ADHD) in the Children and Young People Secure Estate (CYPSE): a feasibility randomised controlled trial
Chitsabesan, P., Hall, C. L., Carter, L., Reeves, M., Mohammed, V., Beresford, B., Young, S., Kraam, A., Trowse, S., Wilkinson-Cunningham, L., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-064951 · Cited by 3
Fluctuations of Attention During Self-paced Naturalistic Goal-Directed Behavior in Attention-Deficit/Hyperactivity Disorder
Salmi, J., Merzon, L., Eräste, T., Seesjärvi, E., Huhdanpää, H., Aronen, E. T., Mannerkoski, M., MacInnes, W. J., & Laine, M. (2023) · JAACAP Open · doi:10.1016/j.jaacop.2023.12.002 · Cited by 4
Utility of Parent and Teacher Behavior Ratings for Self-Regulatory Outcomes of Preschool Children: A Multi-Study Examination
DeCamp, C., Hoffman, M. E., Allan, D. M., Morris, B. M., & Lonigan, C. J. (2025) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01286-7 · Cited by 4
“For example, continuous performance tests (CPTs) are some of the most widely used measures of attention in research and clinical settings (Hall et al., 2016; Riccio et al., 2002 ) and are a direct correlate of ADHD behaviors (e.g., Epstein et al., 2003 ).”
Comorbidity of ADHD and Anxiety: From Basic to Applied Research
Jarrett, M. A. (2013) · The ADHD Report · doi:10.1521/adhd.2013.21.5.1 · Cited by 3
“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).”
Result

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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