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Continuous Performance Tests

Continuous performance tasks, or continuous performance tests (CPTs), are neuropsychological measures designed to assess the complex area of attention. CPTs are designed to assess sustained attention, or a person’s ability to maintain focus on a particular task or stimulus. They also assess one’s ability to inhibit inappropriate responses (i.e., impulsivity). Difficulties with sustained attention and impulsivity can be a result of brain damage and are core deficits in psychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD) and schizophrenia. A growing body of research has indicated the utility of CPTs to detect neurological conditions, and as a result, CPTs are increasingly being used as a clinical tool to assess conditions such as ADHD. This entry examines the measurement of executive function and why CPTs are valuable.

Measuring Executive Function

Executive function involves the ability to process information in an organized and efficient manner. This ability is required for everyday tasks such as maintaining and directing attention, organizing, planning, problem solving, following rules, and adjusting to new situations. CPTs are often designed to assess both selective and sustained attention through a go/no-go design (i.e., respondents are asked to focus on stimuli and quickly respond to targets while inhibiting response to nontargets). These tests are intended to be repetitive and boring to make sustaining attention more challenging.

Clinical Utility

CPTs are often used to assess for potential deficits in different areas of executive functioning. When used in conjunction with clinical interviews and other measures, especially rating scales, CPTs have been used to assist with the diagnosis of clinical disorders, such as ADHD. Some research suggests that the addition of CPTs when diagnosing ADHD improves diagnostic accuracy.

Most CPTs provide four basic scores that have been compared across populations to determine what level of deficit is considered clinically significant. Correct detection is the number of times a patient correctly identifies the target stimulus. The higher this score is, the more likely that that patient has a normal ability to sustained attention. Errors of commission are the number of times the patient incorrectly indicates that the target stimulus was presented. A high number of commission errors indicates impulsivity. Errors of omission are the number of times that the patient did not identify the target stimulus when it was presented. A high number of omission errors indicates the patient was not paying attention (i.e., inattentiveness). Reaction time is the time it takes the patient to respond to a stimulus once it is presented.

Commonly Used CPTs

The first CPT was introduced in 1956 as a diagnostic test for brain-damaged patients. Since that time, several CPTs have been developed and tested. The Conners Continuous Performance Test (Conners CPT) is one of the most widely used CPTs. The third edition of the adult version for individuals ages 8 years and older (CPT3) lasts 14 minutes and includes 360 trial administrations. Respondents are asked to hit the space bar each time they see a letter except when the “X” appears. A child version (K-CPT 2) is intended for ages 4 to 7 years. Administration takes 7.5 minutes and asks children to respond to familiar pictures of objects (e.g., train, boat) while inhibiting their response to a nontarget (i.e., soccer ball).

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