Computer-based Continuous Performance Test Research Articles

Attentiveness and mental health in adolescents with moderate-to-severe atopic dermatitis without ADHD

Patients with moderate-to-severe atopic dermatitis (AD) experience intense chronic itch and impaired sleep. Reports from parents and teachers suggest that AD patients may also have attention problems. However, attention has not yet been directly assessed in AD patients. We utilized an objective, computer-based continuous performance test (CPT) validated for use in attention-deficit/hyperactivity disorder (ADHD) diagnosis to formally evaluate attention in adolescent AD subjects. This was a single-visit, cross-sectional, non-interventional study of moderate-to-severe (Investigator’s Global Assessment [IGA] ≥ 3) AD subjects aged 12–17 years without clinician-diagnosed ADHD. Attention was evaluated using two performance-based measures: Conners, CPT-3 and the Stroop Color and Word Test. The primary parameter was CPT-3 detectability (d’) measure. Lesional severity measures included Eczema Area and Severity Index (EASI) and body surface area (BSA) involvement. Subjects completed self-report rating scales assessing sensory responsiveness patterns (Adult/Adolescent Sensory Profile [AASP]), itch (Peak Pruritus Numerical Rating Scale [PP-NRS]), skin pain, quality of life, sleep, anxiety, and depressive symptoms. A total of 44 subjects were included in the study (61.4% female; mean age 15.0 [SD 1.78] years; mean EASI 20.4 [SD 7.8]; mean PP-NRS 7.0 [SD 1.8]). Results indicated substantial disease impact on sleep, quality of life, and comorbid anxiety and depressive symptoms. The mean (SD) Conners, CPT-3 dʹ T-score was 48.7 (SD 10.7), similar to the expected mean from a randomly selected age/gender-matched sample of the general population (50 [SD 10], by definition). Overall, 13.6% of subjects exhibited a dʹ T-score ≥ 60 (clinically significant poor performance), which was not greater than the expected general population value (15.9%). Subject-level data review by two psychologists determined that only 2 subjects demonstrated an overall response pattern that clearly indicated attention deficit. Many subjects had atypical sensory responsiveness profiles: sensory hypersensitivity (38.6%), sensory avoidance (50%), and low registration (hypo-sensitivity, 36.4%). Adolescents with moderate-to-severe AD without existing ADHD diagnosis did not demonstrate greater attention problems on performance-based measures than would be expected in age/gender-matched peers.Trial registration NCT05203380.

Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without Attention-Deficit/Hyperactivity Disorder.

Sleep-related problems are highly prevalent comorbidities in Attention-Deficit/Hyperactivity Disorder (ADHD). This study aimed to investigate the associations between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children with and without ADHD. A total of 341 children were included (ADHD group: 155, control group: 186; age: 6-10 years). The participants' sleep-related symptoms were assessed using a parent-rated questionnaire, and they were categorized into low- and high-risk SDB groups based on their scores. Behavioral symptoms were assessed using the Behavioral Assessment System for Children, Second Edition (BASC-2), and cognitive sustained attention and inhibitory control were assessed using a computer-based continuous performance test. In the ADHD group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in externalizing problems (F=4.22; P=0.042), including hyperactivity (F=4.65; P=0.033) and attention problems (F=8.19; P=0.005), but not internalizing problems. Meanwhile, in the control group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in internalizing problems (F=9.89; P=0.002), depression (F=9.45; P=0.002), and somatization (F=7.83; P=0.006), as well as in externalizing problems (F=7.72; P=0.006), including hyperactivity (F=6.23; P=0.013), aggression (F=5.00; P=0.027), and conduct problems (F=6.79; P=0.010). Contrary to the behavioral outcomes, none of the attention performance subscale scores showed significant differences between the high- and low-risk SDB groups in either the ADHD or control group. The present findings suggest that SDB is associated with behavioral problems in children with ADHD and controls, with stronger associations in control children. On the contrary, SDB has no association with cognitive attention performance. This study extends our understanding of the associations of SDB with behavioral symptoms and cognitive functions in children.

Associations between urinary cotinine and symptoms of attention deficit/hyperactivity disorder and autism spectrum disorder

BackgroundThe present study investigated associations between urinary cotinine levels as a biomarker of secondhand smoke exposure and symptoms of attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). MethodsA total of 520 child participants (200 with ADHD, 67 with ASD, and 253 normal control subjects) were assessed using the Korean version of the ADHD rating scale (K-ARS), Autism spectrum screening questionnaire (ASSQ), and Behavioral Assessment System for Children, second edition (BASC-2). The Korean version of the computer-based continuous performance test was used to assess cognitive function. Urinary cotinine was evaluated as a biomarker of secondhand smoke exposure. ResultsUrinary cotinine levels were significantly and positively associated with K-ARS score (B = 4.00, p < 0.001), ASSQ score (B = 1.71, p = 0.030), the behavioral problem subscales of the BASC-2 (B = 1.68–3.52, p < 0.001–0.045), and omission and commission errors in the continuous performance test (B = 6.21–8.42, p < 0.001–0.019). Urinary cotinine levels were also associated with the increased odds ratio of ADHD (OR = 1.55, 95% CI 1.05–2.30, p = 0.028) and ASD (OR = 1.89, 95% CI 1.12–3.21, p = 0.018). ConclusionUrinary cotinine levels were associated with lower behavioral adaptation and cognitive function and increased odds ratios of ADHD and ASD, indicating a negative effect of secondhand smoke exposure on the symptomatic manifestation of ADHD and ASD.

Reduced Social Network Drinking is Associated with Improved Response Inhibition in Women During Early Recovery from Alcohol Use Disorders: A Pilot Study.

Social support for recovery from alcohol use disorders (AUDs) is associated with improvements in self-reported impulsive behavior in individuals treated for AUDs. We build on these findings using a behavioral task-based measure of response inhibition, a well-defined component of impulsivity, to examine the association of disinhibition with alcohol-specific social network characteristics during early recovery. Women (n=28) were recruited from treatment for AUD within 3 to 4weeks of their last drink and were assessed at baseline and again 3months later. Outcome measures were level of disinhibition at baseline and change in disinhibition from baseline to follow-up, measured using a computer-based continuous performance test. The primary independent variables were level of drinking in the social network at baseline and change in network drinking from baseline to follow-up. The sample [50% black, age M (SD)=42.3 (9.5)] reported high rates of physical and sexual abuse before age 13 (43%), psychiatric disorder (71%), drug use disorder (78%), and previous treatment (71%). More drinking in participants' social networks was associated with greater disinhibition at baseline (β=12.5, 95% CI=6.3, 18.7). A reduction in network drinking from baseline to follow-up was associated with reduced disinhibition (β=-6.0, 95% CI=-11.3, -0.78) independent of IQ, recent alcohol consumption, and self-reported negative urgency. This study extends previous findings of an association between social networks and self-reported impulsivity to a neurobehavioral phenotype, response inhibition, suggesting that abstinence-supporting social networks may play a role in cognitive change during early recovery from AUDs.

Attention deficits after aneurysmal subarachnoid hemorrhage measured using the test of variables of attention.

The aim of this pilot study was to assess attention deficits in patients with aneurysmal subarachnoid hemorrhage using the test of variables of attention (TOVA). This is a computer-based continuous performance test providing objective measures of attention. We also compared the TOVA results with the attention and concentration domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment, 2 examiner-administrated neuropsychological instruments. Nineteen patients with moderate to good recovery (Glasgow outcome scale, 4-5) were assessed using the TOVA, Montgomery Åsberg Depression Rating Scale, and Montreal cognitive assessment. The measurements were done when the patients visited the hospital for a routine magnetic resonance imaging control of the aneurysm. TOVA performance was pathological in 58%. The dominating pattern was a worsening of performance in the second half of the test, commonly a failing to react to correct stimuli. We found no correlation between TOVA and the performance in concentration and attention domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment. Attention deficits, measured by the TOVA, were common after subarachnoid hemorrhage. This should be further studied to improve outcome.

Relationships Between Computer-Based Testing and Behavioral Ratings in the Assessment of Attention and Activity in a Pediatric ADHD Stimulant Crossover Trial

This study investigated the relationships between computer-based testing and behavioral ratings in the assessment of stimulant-induced changes in attention and activity in a pediatric ADHD crossover trial with methylphenidate, dextroamphetamine, and a placebo. Here 36 children between 9 and 14 years old were randomly and evenly assigned to each of six counterbalanced drug orders. A computer-based continuous performance test combined with a motion-tracking system (cb-CPT-MTS) and an ADHD questionnaire rated by teachers constituted the outcome measures. All outcome measures responded to stimulants in a comparable way at the group level, as shown by significant treatment effects of similar size for the two stimulants compared with a placebo. Computer-based and rating-based measures were unrelated in the assessment of stimulant-induced changes in attention and activity in individual children; no significant correlations between these measures in the assessment of change from placebo to stimulant conditions across the sample were detected. Results suggest that computer-based testing and behavioral ratings cannot be considered equivalent in the assessment of stimulant-induced changes in attention and activity among ADHD children.

Comparison between neurological examination and computerized test of attention for suspected ADHD: implications for assessment of a common childhood disability

AbstractThe aim of this study was to determine the role of the Test of Variables of Attention (TOVA), a computer-based continuous performance test (CPT), in assessing suspected attention-deficit/hyperactivity disorder (ADHD), a pervasive cause of disability in children and adolescents.One hundred and fifty children and adolescents referred to a community-hospital-based neurology clinic for suspected ADHD underwent a comprehensive clinical evaluation by a pediatric neurologist in addition to the TOVA test. Retrospective chart data were analyzed separately for children aged 6–12 years (n=101) and adolescents (13–18 years) (n=49). Parents and teachers completedThe correlation between the neurologist’s impression of the presence of attention deficit and the TOVA scores was good in the younger group (r=0.28, p≤0.001) and weaker in the older group (r=0.29, p≤0.05). On nonparametric analysis, the neurological evaluation did not distinguish between low and high TOVA scorers in the older group. The neurologist’s impression correlated more closely with the DSM-IV parents ratings (r=0.29, p≤0.01) than the teachers’ (r=0.08, p≤0.05).The TOVA correlated well with clinical assessment of ADHD and has added value in the evaluation of ADHD in adolescents, for whom standardized rating scales are lacking. In younger children, an experienced clinician can usually reach an accurate diagnosis based on accepted clinical criteria, including parent and teacher reports.

Does Atomoxetine Improve Executive Function, Inhibitory Control, and Hyperactivity?

The primary objective of this study was to evaluate the efficacy of atomoxetine (ATX) on attention-deficit/hyperactivity disorder (ADHD)-related symptoms assessed as standard variables of a computer-based continuous performance test (cb-CPT) combined with a motion-tracking (MT) device. This was a 2-arm, 8-week, randomized, double-blind, placebo-controlled study in patients with ADHD (6-12 years). Therapy with ATX started with 0.5 mg/kg per day for 1 week, followed by 7 weeks on the target dosage of 1.2 mg/kg per day. Primary outcomes were cb-CPT/MT standard scores after 8 weeks using mixed models for repeated measurements. In addition, investigator-rated ADHD Rating Scale (ADHD-RS), Weekly Ratings of Evening and Morning Behavior (WREMB), and Clinical Global Impression - Severity-ADHD (CGI-S-ADHD) scores were assessed. Of 128 patients randomized, 125 were evaluated (ATX/placebo: 63/62). Baseline characteristics were comparable in both groups (overall, 80.2% boys; mean [SD] age, 9.0 [1.79] years; comorbid Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis, 40.0% oppositional defiant disorder/conduct disorder; prior stimulant treatment, 24.8%; ADHD-RS total score, 36.99 [11.56]). At week 8, all cb-CPT/MT q-scores were significantly reduced versus placebo (all P < 0.001) with effect sizes (ESs) of reaction time (RT) variation (ES = 0.71), mean RT (ES = 0.41), number of microevents (ES = 1.00), commission error rate (ES = 0.50), distance of movement (ES = 0.90), area of movement (ES = 1.08), omission error rate (ES = 0.70), time active (ES = 0.69), motion simplicity (ES = 0.38), and normalized variance of RT (ES = 0.50). Secondary end points also improved significantly in favor of ATX: ADHD-RS (total score ES = 1.30, P < 0.001; hyperactivity/impulsivity subscore ES = 1.37, P < 0.001; inattention subscore ES = 1.07, P < 0.001), WREMB (total score ES = 1.00, P < 0.001; morning subscore ES = 0.59, P = 0.002; evening subscore ES = 1.02, P < 0.001), CGI-S-ADHD (ES = 1.11, P < 0.001). The results of this study show that ATX for 8 weeks significantly reduced ADHD-related symptoms as measured by the cb-CPT/MT.

Does Comorbid Disruptive Behavior Modify the Effects of Atomoxetine on ADHD Symptoms as Measured by a Continuous Performance Test and a Motion Tracking Device?

Objective: To compare the reduction of ADHD symptoms under atomoxetine in patients with and without comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) using a computer-based continuous performance test (cb-CPT) combined with an infrared motion tracking (MT) device. Method: Secondary analysis of a placebo-controlled study in ADHD patients (6-12 years old) treated with atomoxetine (target dose: 1.2 mg/kg per day). Cb-CPT/MT scores were analyzed using ANCOVA (last observation carried forward [LOCF]). Results: The data (N = 125) suggested a more pronounced atomoxetine effect in the group with comorbid ODD/CD as measured by all cb-CPT/MT parameters except for “normalized variation of reaction time” (nVRT). Conclusion: The results showed that atomoxetine reduced ADHD severity as measured by cb-CPT and MT parameters regardless of whether comorbid ODD/CD was present. The treatment effect of atomoxetine on hyperactivity appears to be more pronounced in the subgroup of patients with comorbid ODD/CD than in the subgroup without this comorbidity.

Does Stimulant Pretreatment Modify Atomoxetine Effects on Core Symptoms of ADHD in Children Assessed by Quantitative Measurement Technology?

Objective: To compare the reduction of ADHD symptoms under atomoxetine (ATX) in patients with and without pretreatment with a stimulant medication using a computer-based Continuous Performance Test (cb-CPT) combined with an infrared motion tracking (MT) device. Method: Double-blind, placebo-controlled study in ADHD patients (6-12 years) treated with ATX (target dose = 1.2 mg/kg per day). The cb-CPT/MT scores were analyzed using ANCOVA (last observation carried forward). Results: Patient data (n = 125) suggested a differential ATX treatment effect between pretreated and stimulant-naïve patients in terms of three cb-CPT/MT parameters. Conclusion: This secondary analysis provided evidence that ATX reduced ADHD symptom severity measured by cb-CPT/MT parameters regardless of stimulant pretreatment. A few differential effects were seen based on the cb-CPT/MT. However, no clear pattern could be identified and, overall, the observed differences have no larger clinical relevance. The ATX effect in this study seemed to be largely independent of any previous exposure to stimulants.

Neuropsychological Outcomes Across the Day in Children with Attention-Deficit/Hyperactivity Disorder Treated with Atomoxetine: Results from a Placebo-Controlled Study Using a Computer-Based Continuous Performance Test Combined with an Infra-Red Motion-tracking Device

The effect of atomoxetine (ATX) on executive function has been assessed by means of questionnaires only. The aim of this study was therefore to evaluate the efficacy of ATX using standard variables of a computer-based continuous performance test (cb-CPT) combined with an infra-red motion-tracking device at different times of the day. One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were randomized in the study. The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device. The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity, inattention, or impulsivity. One hundred five patients completed the study (ATX group: n=54; placebo group: n=51). ATX (target dose 1.2 mg/kg/day) over 8 weeks was significantly superior to placebo in reducing hyperactivity, inattention, and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT. Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device. In summary, this study demonstrated a positive effect of ATX on some aspects of executive function, inhibitory control, and hyperactivity compared with placebo.

PW01-66 - Does atomoxetine improve executive function and inhibitory control as measured by an objective computer-based test? A randomized, placebo-controlled study

ObjectivesPrimary objective was to evaluate the influence of atomoxetine on standard variables of a computer-based Continuous Performance Test (cb-CPT) that reflects executive function and inhibitory control in children with ADHD.MethodsTwo-arm, 8-week, placebo-controlled, randomized, double-blind study in ADHD patients (6-12yrs). Atomoxetine was initiated at 0.5 mg/kg qd for 1 week, followed by 7 weeks on the target dose of 1.2 mg/kg qd. Primary outcome were the q-scores of the cb-CPT standard variables after 8 weeks using mixed models for repeated measurement. Additionally, ADHD-RS scores, WREMB (Weekly Ratings of Evening and Morning Behavior) and CGI-S-ADHD were assessed (weeks 0,1,2,4,6,8).ResultsN=128 patients were randomized, N=125 evaluated (atomoxetine/placebo: 63/62). Baseline characteristics were comparable (77.6% boys; 40.0% patients with ODD/CD; 24.8% prior stimulant treatment; mean (±SD) age 9.0±1.79yrs; mean ADHD-RS total score 36.99±11.56). At Week 8, all primary outcomes (cb-CPT q-scores) were significantly reduced vs. placebo (all p&lt; 0.001) for mean (effect size [ES] 0.41), variance (ES=0.71), and normalized variance (ES=0.50) of “Reaction time”, “Number of microevents” (ES=1.00), “Commission errors” (ES=0.50), “Omission errors” (ES=0.70), “Distance of movement” (ES=0.90) and “Area of movement” (ES=1.08), “Time active” (ES=0.69), and “Motion simplicity” (ES=0.38). Secondary endpoints at Week 8 improved significantly in favor of atomoxetine: ADHD-RS: total score ES=1.30, p&lt; 0.001; hyperactive/impulsive subscore ES=1.37, p&lt; 0.001; inattentive subscore ES=1.07, p&lt; 0.001). WREMB: total score ES=1.00, p&lt; 0.001; morning subscore ES=0.59, p=0.002.; evening subscore ES=1.02, p&lt; 0.001. CGI-S-ADHD: ES=1.11; p&lt; 0.001.ConclusionsAtomoxetine for 8 weeks significantly reduced ADHD symptoms as measured by the objective cb-CPT.