Auditory & Visual Attention: New Developments in Assessment

Using CPTs

C. K. Conners, Ph.D.

Conners’ CPT II

Continuous Performance Test II

Conners’ CPT II

Development & Standardization

Normative Data

Nonclinical N = 1920• N = 812 Epidemiological Study• N = 1108 Multi-Site Study

ADHD N = 378 Neurological N = 223

(Adults)

Gender Composition of the CPT II Nonclinical Sample

Age Group Males Females

Under 18 52.5% 47.5%

18+ 28.8% 71.2%

Overall 47.2% 52.8%

Ethnic Composition of the CPT II Nonclinical Sample

Ethnic Group Count % of Sample % not including“Other”

White 904 47.0 59.9

Black 518 27.0 34.3

Asian 88 4.6 5.8

Other* 410 21.4 —

*Note: The epidemiological sample classified individuals as “African American” or “Other,” producing a large percentage of “Other” classifications.

Diagnostic Breakdown of Neurological Sample

Diagnostic Category % Occurrence as Primary orSecondary Diagnosis

Post-concussive (310.2) 29

Other Organic Brain Syndrome (310.8) 21

Concussion with brief loss of consciousness (850.1) 6

Variants of migraine (346.2) 6

Frontal Lobe Syndrome (310.0) 5Headaches (784.0) 5Dementia (290.13, 290.43, 294.1) 5

Pain disorder associated with psychological and medicalconditions (307.89)

5

Late effects of cerebrovascular disease: Cognitive deficits(438.0)

3

Cortical contusion with loss of consciousness (851.02) 2

Disorder of written expression (315.2) 2Other 11

Conners’ CPT II

Developmental Trends(Nonclinical Norm Data)

Hit Reaction Time (HRT)

Standard Error (SE)

Commissions

Omissions

Test-Retest Correlation Coefficients for the CPT II (n =

23)

Omissions .84** Perseverations .43*

Commissions .65** Hit RT Block Change .28

Hit RT .55* Hit SE Block Change .08

Hit RT Std Error .65** Hit RT ISI Change .51*

Variability .60* Hit SE ISI Change .05

Detectability(d prime)

.76** Confidence Index (ADHD) .89**

Response Style(Beta)

.62* Confidence Index (Neuro.) .92**

* p < .05** p < .01

CPT II

Discrimination of Clinical and Nonclinical Groups

ANCOVA Results Summary

ADHD, Neuro., and Nonclinical groups compared across measures controlling for Age and Gender

The clinical groups (ADHD & Neuro.) scored significantly higher (p < .001) than nonclinical on ALL measures

ANCOVA Results Summary (continued)

Also, relative to the ADHD group, the Neuro. Group• made more omission errors

(p < .001)• had slower RTs (p < .001)• had more variable responses

(p < .001)• responded less consistently by ISI (p

< .001)

Discriminant Functions

Used to identify best predictors for

differentiating between groups Different Functions used for child/adult,

ADHD/Neuro assessment

Used to determine classification accuracy

rates

ADHD vs. Nonclinical, Ages 6-17: Contribution of Measures to

Discriminant Function

ADHD vs. Nonclinical, Ages 18+: Contribution of Measures to

Discriminant Function

Neurological Impairment vs. Nonclinical: Contribution of Measures

to Discriminant Function

CPT II Confidence Indexes

Based on Discriminant Function Analysis Provides a Classification Prediction

• Index > 50 (Prediction: Clinical)• Index < 50 (Prediction: Nonclinical)

Exact value of index indicates the “probability” associated with the prediction

Incorrect to use index as the sole criterion for CPT II assessment

Group Differences for 6-17 Year Olds,

ADHD vs. Nonclinical

0 = Nonclinical 1 = ADHD

Group Differences for 18+ Year Olds,

ADHD vs. Nonclinical

0 = Nonclinical 1 = ADHD

Group Differences for 18+ Year Olds,

Neuro. vs. Nonclinical

0 = Nonclinical 2 = Neurological

Classification Accuracy and Error Rates

Specificity(False Positives)

Sensitivity(False Negatives)

ADHD vs. NonclinicalUnder 18 83% (17%) 82% (18%)

ADHD vs. Nonclinical18 Years & Above 87% (13%) 88% (12%)

Neuro. vs. Nonclinical18 Years & Above 92% (8%) 85% (15%)

Reduce False Positives (Option)

Adjusts for Base Rates

Increases certainty of need for

follow-up (i.e., helps avoid “false

alarms”)

Classification Accuracy (Reduce False Positives Option Used)

Specificity(False Positives)

Sensitivity(False Negatives)

ADHD vs. NonclinicalUnder 18 95% (5%) 55% (45%)

ADHD vs. Nonclinical18 Years & Above 98% (2%) 71% (29%)

Neuro. vs. Nonclinical18 Years & Above 98% (2%) 68% (32%)

Minimize False Negatives (Option)

In clinical settings, may be used to

adjust for Base Rates

Useful Option when focus is on

corroboration of Dx

Classification Accuracy (Reduce False Negatives Option Used)

Specificity(False Positives)

Sensitivity(False Negatives)

ADHD vs. NonclinicalUnder 18 57% (43%) 95% (5%)

ADHD vs. Nonclinical18 Years & Above 63% (37%) 96% (4%)

Neuro. vs. Nonclinical18 Years & Above 77% (23%) 93% (7%)

Conners’ CPT II

Features of the Software

Single Administration Report Options

Multiple Administration Report Options

Multi-Admin Comparison Graph

Multi-Admin Interpretation Text

Progressive AnalysisSecond Administration (Aug 09, 2000) vs. Third Administration (Aug 16,2000)

There was a substantial change in the Confidence Index between these two administrations. The decrease in the Confidence Index was sufficient to produce a nonclinical classification on the third administration while the second administration suggested a clinical classification. The change was statistically significant based on the Jacobson-Truax assessment procedure.

First Administration (Aug 02, 2000) vs. Second Administration (Aug 09, 2000)

There was a substantial change in the Confidence Index between these two administrations. The change was statistically significant based on the Jacobson-Truax assessment procedure. In both administrations, but especially in the first, the Confidence Index favored a clinical classification.

Current Performance vs. First AdministrationFirst Administration (Aug 02, 2000) vs. Third Administration (Aug 16, 2000)

There was a substantial change in the Confidence Index between these two administrations. The decrease in the Confidence Index was sufficient to produce a nonclinical classification on the third administration while the first administration suggested a clinical classification. The change was statistically significant based on the Jacobson-Truax assessment procedure.

CPT II Preference Options

CPT II Medication List

C-DATA

Why do we need an auditory CPT?

What is the goal of this project?

C-DATA

Development of Auditory Attention

LD, ADHD, CAPD

C-DATA

Paradigm

• Likely need to diverge from visual CPT type paradigms

C-DATA

Paradigm Criteria

• Applicable to wide age range• Measure ability to direct attention to one

channel or the other• Competing sounds included• Include consonant-vowel (CV) elements• Verbal and non-Verbal

C-DATA

Paradigm Criteria (Continued)

• Measure lateral preference• Mobility of Attention measured• Signal Detection Theory/Response bias• Stimulus onset asynchrony varied• Inter-Stimulus Interval varied• Vigilance measured

C-DATA

Paradigms

• Tone condition

• Dichotic Condition

C-DATA

Statistics

• Hits to targets• False alarms to warnings• Omissions to targets• Delayed responses• Mobility• REA• Laterality