Systematic review and meta-analysis: clinical utility of continuous performance tests for the identification of attention-deficit/hyperactivity disorder
Systematic review and meta-analysis: clinical utility of continuous performance tests for the identification of attention-deficit/hyperactivity disorder
Objective: we aimed to quantify the clinical utility of continuous performance tests (CPTs) for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) compared to a clinical diagnosis in children and adolescents.
Method: four databases (MEDLINE, PsycINFO, EMBASE, and PubMed) were screened until January 2023. Risk of bias of included results was judged with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We statistically pooled the area under the curve, the sensitivity, and the specificity of 3 commonly used CPTs subscales: omission/inattention, commission/impulsivity, and total number of errors/ADHD subscales (PROSPERO registration: CRD42020168091).
Results: a total of 19 studies using commercially available CPTs were identified. Results from up to 835 control individuals and 819 cases were combined in the summary receiver operating characteristic (ROC) curve analyses (sensitivity and specificity pooling), and up to 996 cases and 1,083 control individuals in the area under the curve (AUC) analyses. Clinical utility as measured by AUCs could be considered as barely acceptable (between 0.7 and 0.8) for the most part, with the best results for the total/ADHD score, followed by omissions/inattention, and poorest for commission/impulsivity scores. A similar pattern was found when pooling sensitivity and specificity: 0.75 (95% CI = 0.66-0.82) and 0.71 (0.62-0.78) for the total/ADHD score; 0.63 (0.49-0.75) and 0.74 (0.65-0.81) for omissions; and 0.59 (0.38-0.77) and 0.66 (CI = 0.50-0.78) for commissions.
Conclusion: at the clinical level, CPTs as a stand-alone tool have only a modest to moderate ability to differentiate ADHD from non-ADHD samples. Hence, they should be used only within a more comprehensive diagnostic process.
attention-deficit/hyperactivity disorder, diagnosis, neuropsychological tests, sensitivity and specificity
154-171
Arrondo, Gonzalo
04d06971-cf7c-4753-9f46-d6fa37468022
Mulraney, Melissa
341bbe7d-3eb2-4b02-bf12-cc5b3992b6ac
Iturmendi-sabater, Iciar
fc0683c9-f0e8-4ae1-800c-41f9456a2e37
Musullulu, Hande
1abe8a20-06ef-40af-be5c-4c3ee1959279
Gambra, Leyre
ce7fe7f3-5b96-473f-881d-6a352c977001
Niculcea, Teodora
8e1d7e17-518d-40f6-a5b5-bfb94e65bc45
Banaschewski, Tobias
38efbc13-9f75-4834-a9fd-6f4b10bd634b
Simonoff, Emily
f47d91a8-3d57-4183-bf24-80352c55eedc
Döpfner, Manfred
cf7a4f00-b116-4d6f-8761-769ef42f1355
Hinshaw, Stephen P.
7faf6f64-2994-4842-bef4-eb6295bb47bb
Coghill, David
d7cba8fd-4fcb-48bc-9e92-5aff85a75b50
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
February 2024
Arrondo, Gonzalo
04d06971-cf7c-4753-9f46-d6fa37468022
Mulraney, Melissa
341bbe7d-3eb2-4b02-bf12-cc5b3992b6ac
Iturmendi-sabater, Iciar
fc0683c9-f0e8-4ae1-800c-41f9456a2e37
Musullulu, Hande
1abe8a20-06ef-40af-be5c-4c3ee1959279
Gambra, Leyre
ce7fe7f3-5b96-473f-881d-6a352c977001
Niculcea, Teodora
8e1d7e17-518d-40f6-a5b5-bfb94e65bc45
Banaschewski, Tobias
38efbc13-9f75-4834-a9fd-6f4b10bd634b
Simonoff, Emily
f47d91a8-3d57-4183-bf24-80352c55eedc
Döpfner, Manfred
cf7a4f00-b116-4d6f-8761-769ef42f1355
Hinshaw, Stephen P.
7faf6f64-2994-4842-bef4-eb6295bb47bb
Coghill, David
d7cba8fd-4fcb-48bc-9e92-5aff85a75b50
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Arrondo, Gonzalo, Mulraney, Melissa, Iturmendi-sabater, Iciar, Musullulu, Hande, Gambra, Leyre, Niculcea, Teodora, Banaschewski, Tobias, Simonoff, Emily, Döpfner, Manfred, Hinshaw, Stephen P., Coghill, David and Cortese, Samuele
(2024)
Systematic review and meta-analysis: clinical utility of continuous performance tests for the identification of attention-deficit/hyperactivity disorder.
Journal of the American Academy of Child & Adolescent Psychiatry, 63 (2), .
(doi:10.1016/j.jaac.2023.03.011).
Abstract
Objective: we aimed to quantify the clinical utility of continuous performance tests (CPTs) for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) compared to a clinical diagnosis in children and adolescents.
Method: four databases (MEDLINE, PsycINFO, EMBASE, and PubMed) were screened until January 2023. Risk of bias of included results was judged with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). We statistically pooled the area under the curve, the sensitivity, and the specificity of 3 commonly used CPTs subscales: omission/inattention, commission/impulsivity, and total number of errors/ADHD subscales (PROSPERO registration: CRD42020168091).
Results: a total of 19 studies using commercially available CPTs were identified. Results from up to 835 control individuals and 819 cases were combined in the summary receiver operating characteristic (ROC) curve analyses (sensitivity and specificity pooling), and up to 996 cases and 1,083 control individuals in the area under the curve (AUC) analyses. Clinical utility as measured by AUCs could be considered as barely acceptable (between 0.7 and 0.8) for the most part, with the best results for the total/ADHD score, followed by omissions/inattention, and poorest for commission/impulsivity scores. A similar pattern was found when pooling sensitivity and specificity: 0.75 (95% CI = 0.66-0.82) and 0.71 (0.62-0.78) for the total/ADHD score; 0.63 (0.49-0.75) and 0.74 (0.65-0.81) for omissions; and 0.59 (0.38-0.77) and 0.66 (CI = 0.50-0.78) for commissions.
Conclusion: at the clinical level, CPTs as a stand-alone tool have only a modest to moderate ability to differentiate ADHD from non-ADHD samples. Hence, they should be used only within a more comprehensive diagnostic process.
Text
Arrondo
- Accepted Manuscript
More information
Accepted/In Press date: 29 March 2023
e-pub ahead of print date: 31 March 2023
Published date: February 2024
Additional Information:
Funding Information:
The authors have reported no funding for this work. Dr. Arrondo is supported by Grant RYC2020-030744-I funded by MCIN/AEI/ 10.13039/501100011033 and by “ESF Investing in your future”; he is also supported by the 2022-2023 Institute for Culture and Society (ICS) challenge on ”Youth, relationships and psychological well-being“ of the University of Navarra, and has received funding from the Spanish Ministry of Science, Innovation and Universities to facilitate the mobility of researchers to foreign higher education and research centers (Ref. CAS19/00249). Ms. Iturmendi-Sabater receives the support of a fellowship from “La Caixa” foundation (ID100010434) to pursue postgraduate studies. The fellowship code is LCF/BQ/EU21/11890074. Prof. Simonoff receives funding from the National Institute of Health Research, UK, UKRI, EU Innovative Medicines Initiative and the Maudsley Charity. Prof. Cortese is supported by NIHR awards NIHR203684, NIHR130077, RP-PG-0618-20003, and NIHR203035.
Keywords:
attention-deficit/hyperactivity disorder, diagnosis, neuropsychological tests, sensitivity and specificity
Identifiers
Local EPrints ID: 477404
URI: http://eprints.soton.ac.uk/id/eprint/477404
ISSN: 1527-5418
PURE UUID: 6fdf4294-6adc-4fe0-9a1a-fe77f278e599
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Date deposited: 06 Jun 2023 16:43
Last modified: 29 May 2024 04:01
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Contributors
Author:
Gonzalo Arrondo
Author:
Melissa Mulraney
Author:
Iciar Iturmendi-sabater
Author:
Hande Musullulu
Author:
Leyre Gambra
Author:
Teodora Niculcea
Author:
Tobias Banaschewski
Author:
Emily Simonoff
Author:
Manfred Döpfner
Author:
Stephen P. Hinshaw
Author:
David Coghill
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