Journal of Abnormal Child Psychology

, Volume 31, Issue 5, pp 543–554 | Cite as

Relations Between Continuous Performance Test Performance Measures and ADHD Behaviors

  • Jeffery N. EpsteinEmail author
  • Alaatin Erkanli
  • C. Keith Conners
  • John Klaric
  • Jane E. Costello
  • Adrian Angold


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 β. 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 β, 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.

ADHD CPT symptomatology CPT performance parameters 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Bulington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual for mental disorders (4th edition). Washington, D.C.: Author.Google Scholar
  3. Angold, A., and Costello, E. J. (1995). A test–retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychological Medicine, 25, 755-762.Google Scholar
  4. Angold, A., and Costello, E. J. (2000). The Child and Adolescent Psychiatric Assessment (CAPA). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 39-48.Google Scholar
  5. Angold, A., Prenergast, M., Cox, A., Harrington, R., Simonoff, E., and Rutter, M. (1995). The Child and Adolescent Psychiatric Assessment (CAPA). Psychological Medicine, 25, 739-753.Google Scholar
  6. Barkley, R. A. (1988). Child behavior rating scales and checklists. In M. Rutter, A. H. Tuma, & I. Lann (Eds.), Assessment and diagnosis in child psychopathology (pp. 113-155). New York: Guilford Press.Google Scholar
  7. Barkley, R. A. (1991). The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. Journal of Abnormal Child Psychology, 19, 149-178.Google Scholar
  8. Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775-789.Google Scholar
  9. Chee, P., Logan, G., Schachar, R., Lindsay, P., & Wachsmuth, R. (1989). Effects of event rate and display time on sustained attention in hyperactive, normal, and control children. Journal of Abnormal Child Psychology, 17, 371-391.Google Scholar
  10. Conners, C. K. (1994a). The Conners Continuous Performance Test. Toronto, Canada: Multi-Health Systems.Google Scholar
  11. Conners, C. K. (1994b). The continuous performance test (CPT): Use as a diagnostic tool and measure of treatment outcome. Paper presented at the Annual Meeting of the American Psychological Association, Los Angeles, CA.Google Scholar
  12. Conners, C. K., Epstein, J. N., Angold, A., & Klaric, J. (2003). Continuous Performance Test Performance in a Normative Epidemiological Sample. Journal of Abnormal Child Psychology, 31, 557-564.Google Scholar
  13. Corkum, P. V., & Siegel, L. S. (1993). Is the continuous performance task a valuable research tool for use with children with attention-deficit-hyperactivity disorder? Journal of Child Psychology and Psychiatry, 34, 1217-1239.Google Scholar
  14. Eliason, M. J., & Richman, L. C. (1987). The Continuous Performance Test in learning disabled and nondisabled children. Journal of Learning Disabilities, 20, 614-619.Google Scholar
  15. Epstein, J. N., Conners, C. K., Sitarenios, G., & Erhardt, D. (1998). Continuous performance test results of adults with Attention Deficit Hyperactivity Disorder. The Clinical Neuropsychologist, 12, 155-168.Google Scholar
  16. Grunebaum, H., Weiss, J. L., Gallant, D., & Cohler, B. J. (1974). Attention in young children of psychotic mothers. American Journal of Psychiatry, 131, 887-891.Google Scholar
  17. Halperin, J. M., Sharma, V., Greenblatt, E., & Schwartz, S. T. (1991). Assessment of the Continuous Performance Test: Reliability and validity in a nonreferred sample. Psychological Assessment, 3, 603-608.Google Scholar
  18. Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443-463.Google Scholar
  19. Inoue, K., Nadaoka, T., Oiji, A., Morioka, Y., Totsuka, S., Kanbayashi, Y., et al. (1998). Clinical evaluation of attention-deficit hyperactivity disorder by objective quantitative measures. Child Psychiatry Human Development, 28, 179-188.Google Scholar
  20. Jerison, H. J., Pickett, R. M., & Stenson, H. H. (1965). The elicited observing rate and decision processes in vigilance. Human Factors, 7, 107-128.Google Scholar
  21. Klee, S. H., & Garfinkel, B. D. (1983). The computerized continuous performance task: A new measure of inattention. Journal of Abnormal Child Psychology, 11, 487-495.Google Scholar
  22. Lassiter, K. S., D'Amato, R. C., Raggio, D. J., Whitten, J. C., & Bardos, A. N. (1994). The construct specificity of the Continuous Performance Test: Does inattention relate to behavior and achievement? Developmental Neuropsychology, 10, 179-188.Google Scholar
  23. Leth-Steenson, C., Elbaz, Z. K., & Douglas, V. I. (2000). Mean response times, variability, and skew in the responding of ADHD children: a response time distributional approach. Acta Psychologica, 104, 167-190.Google Scholar
  24. Losier, B. J., McGrath, P. J., & Klein, R. M. (1996). Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: A meta-analytic review. Journal of Child Psychology and Psychiatry, 37, 971-987.Google Scholar
  25. Mackworth, J. F. & Taylor, M. M. (1963). The d' measure of signal detectability during vigilance-like situations. Canadian Journal of Psychology, 17, 302-325.Google Scholar
  26. McGee, R. A., Clark, S. E., & Symons, D. K. (2000). Does the Conners' Continuous Performance Test aid in ADHD diagnosis? Journal of Abnormal Child Psychology, 28, 415-424.Google Scholar
  27. O'Dougherty, M., Neuchterlein, K. H., & Drew, B. (1984). Hyperactive and hypoxic children: Signal detection, sustained attention, and behavior. Journal of Abnormal Psychology, 93, 178-191.Google Scholar
  28. Schachar, R., Logan, G., Wachsmuth, R., & Chajczyk, D. (1988). Attaining and maintaining preparation: A comparison of attention in hyperactive, normal, and disturbed control children. Journal of Abnormal Child Psychology, 16, 361-378.Google Scholar
  29. Sergeant, J. & Van der Meere, J. (1990). Additive factor method applied to psychopathology with special reference to childhood hyperactivity. Acta Psychologica, 74, 277-295.Google Scholar
  30. Swets, J. A. & Pickett, R. M. (1982). Evaluation of diagnostic systems: Methods from signal detection theory. New York: Academic Press.Google Scholar
  31. Werry, J. S., Elkind, G. S., & Reeves, J. C. (1987). Attention deficit, conduct, oppositional, and anxiety disorders in children, III: Laboratory differences. Journal of Abnormal Child Psychology, 15, 409-428.Google Scholar
  32. Zahn, T. P., Kruesi, M. J. P., & Rapoport, J. L. (1991). Reaction time indices of attention deficits in boys with disruptive behavior disorders. Journal of Abnormal Child Psychology, 19, 233-252.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Jeffery N. Epstein
    • 1
    Email author
  • Alaatin Erkanli
    • 1
  • C. Keith Conners
    • 1
  • John Klaric
    • 1
  • Jane E. Costello
    • 1
  • Adrian Angold
    • 1
  1. 1.Department of PsychiatryDuke University Medical CenterDurham

Personalised recommendations