Commentary: Are We Ready for Computerized Adaptive Testing?

Abstract

Creating item banks that aggregate data across populations and settings makes it possible to equate assessments conducted with different items to enrich available evidence about the prevalence of disorders, course of illness, and the impact of interventions. One can envision multiple applications of CAT in clinical and research settings. For example, a computer kiosk in a primary care waiting room could be used to screen patients for common mood and anxiety disorders. After a brief interaction with a touchscreen monitor, each patient’s results could be available to primary care providers by the time the patient reaches the exam room. Longitudinal follow-up assessments in a drug trial could be tailored to each patient’s previously reported symptoms and be administered and recorded by an interviewer using a handheld device communicating with a distant item bank. A Web-based depression management program could elicit patient-reported assessments individualized to each participant’s prior experiences and convert responses to the metrics of other standardized measures. Unfortunately, the technology and infrastructure needed to implement CAT are currently beyond the reach of most clinicians and researchers. Basic computer equipment is often unavailable. Assessments are frequently conducted in settings where computer use is impractical. Existing CAT software is highly technical. Implementation of CAT relies on large banks of previously collected and calibrated responses to multiple measures. Banks of items relevant to psychiatric services are not widely available, and when they exist, they are not readily accessible. Considerable collaborative effort is needed to develop the infrastructure that would make mental health–focused CAT widely available and ac