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The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: a systematic review

Abstract

Attention-deficit hyperactivity disorder (ADHD) is typically diagnosed using clinical observation and subjective informant reports. Once children commence ADHD medication, robust monitoring is required to detect partial or non-responses. The extent to which neuropsychological continuous performance tests (CPTs) and objective measures of activity can clinically aid the assessment and titration process in ADHD is not fully understood. This review describes the current evidence base for the use of CPTs and objectively measured activity to support the diagnostic procedure and medication management for children with ADHD. Four databases (PsycINFO, Medline, Allied and Complementary Medicine (AMED), and PsycARTICLES) were systematically searched to understand the current evidence base for (1) the use of CPTs to aid clinical assessment of ADHD; (2) the use of CPTs to aid medication management; and (3) the clinical utility of objective measures of activity in ADHD. Sixty relevant articles were identified. The search revealed six commercially available CPTs that had been reported on for their clinical use. There were mixed findings with regard to the use of CPTs to assess and manage medication, with contrasting evidence on their ability to support clinical decision-making. There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation, which appears sensitive to medication effects and would also benefit from further research on their clinical utility. The findings suggest that combining CPTs and an objective measure of activity may be particularly useful as a clinical tool and worthy of further pursuit.

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Fig. 1

Notes

  1. 1.

    Excluding an erratum to the Rielly et al. article [27], the correct specificity figures were obtained from the Rielly et al. erratum [28].

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Acknowledgments

The study was funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC-EM). The research reported in this paper was also conducted by the NIHR MindTech Healthcare Technology Co-operative. This work has been funded by the National Institute for Health Research. The views represented are the views of the authors alone and do not necessarily represent the views of the Department of Health in England, NHS, or the National Institute for Health Research. The funding body had no role in the design, collection, analysis and interpretation of data, or in the writing of the manuscript.

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Correspondence to Charlotte L. Hall.

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The paper is not a human or animal study so ethical approval was not required. However, all work was undertaken under the auspices of the AQUA-Trial, which has ethical approval.

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Charlotte L. Hall and Althea Z. Valentine are joint first authors.

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Hall, C.L., Valentine, A.Z., Groom, M.J. et al. The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: a systematic review. Eur Child Adolesc Psychiatry 25, 677–699 (2016). https://doi.org/10.1007/s00787-015-0798-x

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Keywords

  • Attention-deficit hyperactivity disorder (ADHD)
  • Continuous performance tests (CPTs)
  • Activity
  • Objective measures
  • Systematic review