Transcript Conners’ CPT II

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
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
ADHD
N = 378
Neurological
(Adults)
N = 223
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 or
Secondary 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)
Frontal Lobe Syndrome (310.0)
Headaches (784.0)
Dementia (290.13, 290.43, 294.1)
6
5
5
5
Pain disorder associated with psychological and medical
conditions (307.89)
5
Late effects of cerebrovascular disease: Cognitive deficits
(438.0)
Cortical contusion with loss of consciousness (851.02)
3
Disorder of written expression (315.2)
Other
2
11
2
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)
Response Style
(Beta)
.76**
Confidence Index (ADHD)
.89**
.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

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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
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
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. Nonclinical
Under 18
83% (17%)
82% (18%)
ADHD vs. Nonclinical
18 Years & Above
87% (13%)
88% (12%)
Neuro. vs. Nonclinical
18 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. Nonclinical
Under 18
95% (5%)
55% (45%)
ADHD vs. Nonclinical
18 Years & Above
98% (2%)
71% (29%)
Neuro. vs. Nonclinical
18 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. Nonclinical
Under 18
57% (43%)
95% (5%)
ADHD vs. Nonclinical
18 Years & Above
63% (37%)
96% (4%)
Neuro. vs. Nonclinical
18 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 Analysis
Second 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 Administration
First 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)
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Measure lateral preference
Mobility of Attention measured
Signal Detection Theory/Response bias
Stimulus onset asynchrony varied
Inter-Stimulus Interval varied
Vigilance measured
C-DATA
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Paradigms
• Tone condition
• Dichotic Condition
C-DATA
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Statistics
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Hits to targets
False alarms to warnings
Omissions to targets
Delayed responses
Mobility
REA
Laterality