Neuropsych testing for adhd

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Measures of impulsivity and inattention as given by the CPT standard cardinal parameters or by more sophisticated exGaussian analysis are not very successful in differentiating between patients with ADHD and other psychiatric disorders. This raises the question whether these constructs are really overlapping with clinical symptoms of inattention and impulsivity.


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<cite>Source: Brunkhorst-Kanaan, N., Verdenhalven, M., Kittel-Schneider, S., Vainieri, I., Reif, A., Grimm, O., 2020. The Quantified Behavioral Test—A Confirmatory Test in the Diagnostic Process of Adult ADHD? Front Psychiatry 11. [https://doi.org/10.3389/fpsyt.2020.00216](https://doi.org/10.3389/fpsyt.2020.00216)</cite>


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It has been critically discussed, whether neuropsychological testing under these circumstances makes sense at all in ADHD. 

A neuropsychological assessment to assess a behaviorally defined ADHD construct will always result in suboptimal accuracy of the instruments in question because of the heterogeneity in the functional level of patients behaviorally classified as having ADHD (54, 55). 

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<cite>Source: Brunkhorst-Kanaan, N., Verdenhalven, M., Kittel-Schneider, S., Vainieri, I., Reif, A., Grimm, O., 2020. The Quantified Behavioral Test—A Confirmatory Test in the Diagnostic Process of Adult ADHD? Front Psychiatry 11. [https://doi.org/10.3389/fpsyt.2020.00216](https://doi.org/10.3389/fpsyt.2020.00216)</cite>

Continuous Performance Test

title: Continuous Performance Test small utility
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**Results:** Only 51.7% of the participants were classified as likely to have a disorder characterized by attention deficit, such as ADHD, by the CPT. The relationships between CPT variables and ADHD symptoms were small. The classification error was 80.3% for the inattentive presentation and 22.5% for the hyperactive presentation when using the CPT to identify ADHD presentations. 

**Conclusion:** There was no evidence of the clinical utility of the CPT to assess or monitor ADHD in adult populations diagnosed and treated for ADHD.

<cite>Source: [Does the Continuous Performance Test Predict ADHD Symptoms Severity and ADHD Presentation in Adults? - Stéphanie Baggio, Roland Hasler, Véronique Giacomini, Hiba El-Masri, Sébastien Weibel, Nader Perroud, Marie-Pierre Deiber, 2020](https://journals.sagepub.com/doi/abs/10.1177/1087054718822060)</cite>

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Overall, unlike in previous research, there was no evidence of phenotypic (nor preliminary evidence for genetic) associations between ADHD and CPT-derived ERPs in this study. Hence, it may be currently premature for genetic analyses of ADHD to be guided by CPT-derived ERP parameters (unlike alternative cognitive-neurophysiological approaches which may be more promising). Further research with better-powered, population-based, genetically-informative and cross-disorder samples are required, which could be facilitated by emerging mobile EEG technologies.

<cite>Source: [No evidence of associations between ADHD and event-related brain potentials from a continuous performance task in a population-based sample of adolescent twins](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223460)</cite>

title: CPTs do not help to identify patients with ADHD 
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"Patients with ADHD showed significant higher activity (2.07 ± 1.23) than patients without ADHD (1.34 ± 1.27, dF=112; p=0.019), whereas for the other core parameters, inattention and impulsivity no differences could be found. Reaction time variability has been discussed as a typical marker for inattention in ADHD. Therefore, we investigated how well ex-Gaussian analysis of response time can differentiate between ADHD and other patients, showing, that it does not help to identify patients with ADHD. Even though patients with ADHD showed significantly higher activity, this parameter differed only poorly between patients (accuracy AUC 65% of an ROC-Curve). We conclude that CPTs do not help to identify patients with ADHD in a specialized outpatient clinic. The usability of this test for differentiating between ADHD and other psychiatric disorders is poor and a sophisticated analysis of reaction time did not decisively increase the test accuracy."

"We conclude that CPTs do not help to identify patients with ADHD in a specialized outpatient clinic. The usability of this test for differentiating between ADHD and other psychiatric disorders is poor and a sophisticated analysis of reaction time did not decisively increase the test accuracy."

<cite>Source: [Frontiers | The Quantified Behavioral Test—A Confirmatory Test in the Diagnostic Process of Adult ADHD? | Psychiatry](https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00216/full)</cite>

QBTest

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In conclusion, our study shows that ==the QbTest® is not able to discriminate between ADHD patients and non-ADHD patients in an outpatient clinic.== As the QbTest® currently is used in clinical practice especially under private reimbursement schemes, its application and clinical usefulness has to be critically discussed at present. 

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<cite>Source: Brunkhorst-Kanaan, N., Verdenhalven, M., Kittel-Schneider, S., Vainieri, I., Reif, A., Grimm, O., 2020. The Quantified Behavioral Test—A Confirmatory Test in the Diagnostic Process of Adult ADHD? Front Psychiatry 11. [https://doi.org/10.3389/fpsyt.2020.00216](https://doi.org/10.3389/fpsyt.2020.00216)</cite>

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Autism moc
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