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Two Times the Charm: Repeat Administration of the CPT-II Improves Its Classification Accuracy as a Performance Validity Index

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Abstract

The Conners’ Continuous Performance Test – Second Edition (CPT-II) has demonstrated utility as a performance validity test (PVT). Early research also identified several benefits of repeat administration. This study was designed to evaluate the potential of repeat administrations of the CPT-II to enhance its clinical utility in detecting ADHD or non-credible responding. Data were collected from a consecutive case sequence of 100 patients (MAge = 41.5; MEducation = 13.8) referred for neuropsychological assessment. Performance validity was psychometrically defined using a combination of free-standing and embedded PVTs. The CPT-II was administered twice to all patients: once in the morning and once at the end of the testing appointment. Data supported previously identified validity cutoffs for the CPT-II, with the notable exception of Commission errors. Patients with ADHD were less likely to fail validity cutoffs than those without ADHD, suggesting that ADHD alone does not explain failure on PVTs. At Time 1, the CPT-II was insensitive to a clinical diagnosis of ADHD; at Time 2, only one significant contrast emerged. Self-report measures more effectively differentiated between patients with and without ADHD. Test-retest reliability was generally higher in patients with valid performance (0.33-0.83) compared to those with invalid performance (0.38-0.77), with notable variation across scales. Two sets of CPT-II scores increased confidence in the ADHD diagnosis and the remainder of the neurocognitive profile. The CPT-II is self-administered and automatically scored, making routine double administration more practical than might first be thought.

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Authors and Affiliations

  1. Department of Psychology, Louisiana State University, Baton Rouge, LA, USA

    Anthony Robinson & Matthew Calamia

  2. Department of Psychology, University of Windsor, 168 Chrysler Hall South, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada

    Nathanael Penner & Laszlo A Erdodi

  3. Department of Biology, University of Windsor, Windsor, ON, Canada

    Noor Assaf

  4. Faculty of Nursing, University of Windsor, Windsor, ON, Canada

    Parveen Razvi

  5. Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Robert M Roth

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Contributions

The first and second authors produced the Introduction and parts of the Discussion section; the second, third and fourth authors performed a comprehensive review of the literature and summarized relevant studies to be references in the Introduction, Methods and Discussion; the sixth author provided supervision during data collection and expertise in integrating the existing research literature with the findings of the study as well as identifying their clinical relevance to practicing neuropsychologists; the last author was responsible for research design, data collection/analysis and finalizing the text of the manuscript.

Corresponding author

Correspondence to Laszlo A Erdodi.

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Conflict of Interest

Robert M. Roth, PhD is an author of the BRIEF-A and receives royalties from the publisher (Psychological Assessment Resources, Inc.). The Authors declare no other conflict of interest.

Compliance with Ethical Standards

The data set used in this study was approved for use for research purposes both by the hospital where the clinical assessments were performed (holder of the records) and the university listed as the corresponding author’s institutional affiliation. To protect confidential patient information, only irreversibly de-identified data were collected.

Ethics Approval

Relevant ethical guidelines were followed throughout the project. All data collection, storage and processing was done with the approval of relevant institutional authorities regulating research involving human participants, in compliance with the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards.

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Robinson, A., Calamia, M., Penner, N. et al. Two Times the Charm: Repeat Administration of the CPT-II Improves Its Classification Accuracy as a Performance Validity Index. J Psychopathol Behav Assess 45, 591–611 (2023). https://doi.org/10.1007/s10862-023-10055-7

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