Auditory & Visual Attention: New Developments in Assessment Using CPTs

1. Auditory & Visual Attention: New Developments in Assessment Using CPTs C. K. Conners, Ph.D.

2. Conners’ CPT II Continuous Performance Test II

3. Conners’ CPT II Development & Standardization

4. Normative Data • Nonclinical N = 1920 • N = 812 Epidemiological Study • N = 1108 Multi-Site Study • ADHD N = 378 • Neurological N = 223 (Adults)

5. Gender Composition of the CPT II Nonclinical Sample

6. Ethnic Composition of the CPT II Nonclinical Sample *Note: The epidemiological sample classified individuals as “African American” or “Other,” producing a large percentage of “Other” classifications.

7. Diagnostic Breakdown of Neurological Sample

8. Conners’ CPT II Developmental Trends (Nonclinical Norm Data)

9. Hit Reaction Time (HRT)

10. Standard Error (SE)

11. Commissions

12. Omissions

13. Test-Retest Correlation Coefficients for the CPT II (n = 23) • * p < .05 • ** p < .01

14. CPT II Discrimination of Clinical and Nonclinical Groups

15. 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

16. 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)

17. 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

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

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

20. Neurological Impairment vs. Nonclinical: Contribution of Measures to Discriminant Function

21. 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

22. Group Differences for 6-17 Year Olds, ADHD vs. Nonclinical 0 = Nonclinical 1 = ADHD

23. Group Differences for 18+ Year Olds, ADHD vs. Nonclinical 0 = Nonclinical 1 = ADHD

24. Group Differences for 18+ Year Olds, Neuro. vs. Nonclinical 0 = Nonclinical 2 = Neurological

25. Classification Accuracy and Error Rates

26. Reduce False Positives (Option) • Adjusts for Base Rates • Increases certainty of need for follow-up (i.e., helps avoid “false alarms”)

27. Classification Accuracy (Reduce False Positives Option Used)

28. Minimize False Negatives (Option) • In clinical settings, may be used to adjust for Base Rates • Useful Option when focus is on corroboration of Dx

29. Classification Accuracy (Reduce False Negatives Option Used)

30. Conners’ CPT II Features of the Software

31. Single Administration Report Options

32. Multiple Administration Report Options

33. Multi-Admin Comparison Graph

34. 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.

35. CPT II Preference Options

36. CPT II Medication List

37. C-DATA • Why do we need an auditory CPT? • What is the goal of this project?

38. C-DATA • Development of Auditory Attention • LD, ADHD, CAPD

39. C-DATA • Paradigm • Likely need to diverge from visual CPT type paradigms

40. 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

41. 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

42. C-DATA • Paradigms • Tone condition • Dichotic Condition

43. C-DATA • Statistics • Hits to targets • False alarms to warnings • Omissions to targets • Delayed responses • Mobility • REA • Laterality