Continuous performance tests in the assessment of children with attention-deficit/hyperactivity disorder: a narrative review
Year: 2026
Type: review
Abstract: Attention-deficit/hyperactivity disorder (ADHD) is diagnosed primarily through clinical interviews, behavioral observations, and rating scales, while continuous performance tests (CPTs) provide complementary, performance-based measures of sustained attention, response inhibition, and response consistency. This narrative review compares major CPT paradigms used in pediatric ADHD assessment according to their cognitive targets, task characteristics, psychometric properties, ecological validity, clinical applications, and evidence maturity. Traditional standardized paradigms generally provide more established normative and psychometric frameworks, with the strongest support available for the Conners CPT series and TOVA, whereas distraction-enhanced, motion-integrated, virtual reality-based, and eye-tracking-integrated approaches extend assessment toward more complex and ecologically relevant behavioral contexts. Evidence from systematic reviews and meta-analyses supports group-level differences in core CPT measures, particularly reaction time variability, omission errors, and commission errors; however, substantial overlap across ADHD, psychiatric comorbidities, developmental stages, and other clinical conditions limits their specificity for individual diagnosis. Technology-enhanced paradigms may provide additional information regarding distractibility, motor activity, and gaze behavior, but their incremental clinical value remains uncertain because of heterogeneous methodologies, limited independent replication, and insufficient large-scale cross-cultural normative data. CPTs should therefore be interpreted as objective adjuncts within a multimodal assessment framework rather than as standalone diagnostic or subtype-classification tools. Future research should prioritize standardized outcome definitions, age-appropriate normative datasets, management of practice effects in repeated testing, and prospective multicenter studies evaluating whether specific CPT paradigms add clinically meaningful information beyond established diagnostic and treatment-monitoring procedures.
Source: Frontiers in Neuroscience
Authors: Yao Zhou, Xiaoke Zhao
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223185057