The Conners Continuous Performance Test-3 (CCPT-3) is a computerized test of attention frequently used in clinical neuropsychology. In the present factor analysis, we seek to assess the factor structure of the CCPT-3 and evaluate the suggested dimensions in the CCPT-3 Manual.
Method:
Data from a mixed clinical sample of 931 adults referred for neuropsychological assessment across four centers were analyzed. Nine standard and eight experimental measures were subjected to an exploratory factor analysis to evaluate factor models ranging from one to six factors.
Results:
The analysis supported a four-factor model with one overall attention factor and three factors of distinct mechanisms underlying inattention: impulsivity, vigilance, and sustained attention. This closely aligns with the four dimensions outlined in the CCPT-3 Technical Manual and the factor analyses from the CCPT-II. There were some differences between the four-factor model and the interpretations recommended in the Technical Manual. Perseverations were associated with the inattention factor rather than the impulsivity factor, and reaction time was exclusively linked to impulsivity. Incorporating error measures into the vigilance factor suggests that decreases in responsivity, rather than decreases in correct responses, underpin vigilance decrements. Including response bias by inter-stimulus interval (ISI) and by blocks in the analysis indicates that a decrease in arousal may also explain impairments in sustained attention.
Conclusion:
This study supports the notion in the Technical Manual that CCPT-3 measures both overall attention and three different mechanisms that mediate inattention: impulsivity, vigilance and sustained attention.
AduenP. A.KoflerM. J.BradshawC. P.SarverD. E.CoxD. J. (2020). The role of top-down attentional control and attention-deficit/hyperactivity disorder symptoms in predicting future motor vehicle crash risk. Neuropsychology, 34(8), 894–905. https://doi.org/10.1037/neu0000707
2.
AlbrechtB.Uebel-von SanderslebenH.WiedmannK.RothenbergerA. (2015). ADHD history of the concept: The case of the continuous performance test. Current Developmental Disorders Reports, 2(1), 10–22. https://doi.org/10.1007/s40474-014-0035-1
3.
ArrondoG.MulraneyM.Iturmendi-SabaterI.MusulluluH.GambraL.NiculceaT.BanaschewskiT.SimonoffE.DöpfnerM.HinshawS. P.CoghillD.CorteseS. (2024). Systematic review and meta-analysis: Clinical utility of continuous performance tests for the identification of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 63(2), 154–171. https://doi.org/10.1016/j.jaac.2023.03.011
BartlettM. S. (1951). The effect of standardization on a χ 2 approximation in factor analysis. Biometrika, 38(3/4), 337–344. https://www.jstor.org/stable/2332580
6.
Bella-FernándezM.Martin-MoratinosM.LiC.WangP.Blasco-FontecillaH. (2024). Differences in ex-Gaussian parameters from response time distributions between individuals with and without attention deficit/hyperactivity disorder: A meta-analysis. Neuropsychology Review, 34(1), 320–337. https://doi.org/10.1007/s11065-023-09587-2
7.
BergerI.SlobodinO.CassutoH. (2017). Usefulness and validity of continuous performance tests in the diagnosis of attention-deficit hyperactivity disorder children. Archives of Clinical Neuropsychology, 32(1), 81–93. https://doi.org/10.1093/arclin/acw101
8.
BorstingE.RouseM.ChuR. (2005). Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: A preliminary study. Optometry - Journal of the American Optometric Association, 76(10), 588–592. https://doi.org/10.1016/j.optm.2005.07.007
9.
BortolatoB.MiskowiakK. W.KöhlerC. A.VietaE.CarvalhoA. F. (2015). Cognitive dysfunction in bipolar disorder and schizophrenia: A systematic review of meta-analyses. Neuropsychiatric Disease and Treatment, 11, 3111–3125. https://doi.org/10.2147/NDT.S76700
10.
BrooksJ. M.GuilfoyleJ.AlfonsoD.OhA.NiliA. N.FrickL. A.ReschZ. J.SobleJ. R.UlrichD. M. (2024). Differentiating performance on the connors continuous performance test (CPT-3) as a function of comorbid internalizing psychopathology. Journal of Attention Disorders, 28(6), 1024–1031. https://doi.org/10.1177/10870547231219000
11.
BytoftB.KnorrS.VlachovaZ.JensenR. B.MathiesenE. R.Beck-NielsenH.GravholtC. H.JensenD. M.ClausenT. D.MortensenE. L.DammP. (2017). Assessment of attention deficits in adolescent offspring exposed to maternal type 1 diabetes. PLoS ONE, 12(1), e0169308. https://doi.org/10.1371/journal.pone.0169308
12.
CallanP. D.SwanbergS.WeberS. K.EidnesK.PopeT. M.SheplerD. (2024). Diagnostic utility of conners continuous performance test-3 for attention deficit/hyperactivity disorder: A systematic review. Journal of Attention Disorders, 28(6), 992–1007. https://doi.org/10.1177/10870547231223727
13.
ConnersC. K. (2014). Conners’ continuous performance test (3rd ed.). Multi-Health Systems.
14.
CoopermanA. W.WallerN. G. (2022). Heywood you go away! Examining causes, effects, and treatments for heywood cases in exploratory factor analysis. Psychological Methods, 27(2), 156–176. https://doi.org/10.1037/met0000384
15.
CurranP. J.WestS. G.FinchJ. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological Methods, 1(1), 16–29. https://doi.org/10.1037/1082-989X.1.1.16
16.
de WinterJ. C. F.GoslingS. D.PotterJ. (2016). Comparing the Pearson and Spearman correlation coefficients across distributions and sample sizes: A tutorial using simulations and empirical data. Psychological Methods, 21(3), 273–290. https://doi.org/10.1037/met0000079
17.
EgelandJ. (2007). Differentiating attention deficit in adult ADHD and schizophrenia. Archives of Clinical Neuropsychology, 22(6), 763–771. https://doi.org/10.1016/j.acn.2007.06.004
18.
EgelandJ.JohansenS. N.UelandT. (2009). Differentiating between ADHD sub-types on CCPT measures of sustained attention and vigilance. Scandinavian Journal of Psychology, 50(4), 347–354. https://doi.org/10.1111/j.1467-9450.2009.00717.x
19.
EgelandJ.Kovalik-GranI. (2010a). Measuring several aspects of attention in one test: The factor structure of conners’s continuous performance test. Journal of Attention Disorders, 13(4), 339–346. https://doi.org/10.1177/1087054708323019
20.
EgelandJ.Kovalik-GranI. (2010b). Validity of the factor structure of conners’ CPT. Journal of Attention Disorders, 13(4), 347–357. https://doi.org/10.1177/1087054709332477
21.
EgelandJ.LøvstadM.NorupA.NyboT.PerssonB. A.RiveraD. F.SchankeA.-K.SigurdardottirS.Arango-LasprillaJ. C. (2016). Following international trends while subject to past traditions: Neuropsychological test use in the nordic countries. Clinical Neuropsychologist, 30, 1479–1500. https://doi.org/10.1080/13854046.2016.1237675
22.
FeldmanJ. S.Huang-PollockC. (2021). Slow drift rate predicts ADHD symptomology over and above executive dysfunction. Child Neuropsychology, 27(6), 834–855. https://doi.org/10.1080/09297049.2021.1902490
23.
FuermaierA. B. M.FrickeJ. A.VriesS. M.de, TuchaL.TuchaO. (2019). Neuropsychological assessment of adults with ADHD: A delphi consensus study. Applied Neuropsychology: Adult, 26(4), 340–354. https://doi.org/10.1080/23279095.2018.1429441
24.
GagnonA.GrenierG.BoctiC.GilletV.LepageJ.-F.BaccarelliA. A.PosnerJ.DescoteauxM.TakserL. (2022). White matter microstructural variability linked to differential attentional skills and impulsive behavior in a pediatric population. Cerebral Cortex (New York, NY), 33(5), 1895–1912. https://doi.org/10.1093/cercor/bhac180
25.
GmehlinD.FuermaierA. B. M.WaltherS.TuchaL.KoertsJ.LangeK. W.TuchaO.WeisbrodM.AschenbrennerS. (2016). Attentional lapses of adults with attention deficit hyperactivity disorder in tasks of sustained attention. Archives of Clinical Neuropsychology, 31(4), 343–357. https://doi.org/10.1093/arclin/acw016
26.
HairJ. F. (2019). Multivariate data analysis (8th ed.). Cengage.
27.
HallC. L.ValentineA. Z.GroomM. J.WalkerG. M.SayalK.DaleyD.HollisC. (2016). The clinical utility of the continuous performance test and objective measures of activity for diagnosing and monitoring ADHD in children: A systematic review. European Child & Adolescent Psychiatry, 25(7), 677–699. https://doi.org/10.1007/s00787-015-0798-x
28.
Huang-PollockC. L.KaralunasS. L.TamH.MooreA. N. (2012). Evaluating vigilance deficits in ADHD: A meta-analysis of CPT performance. Journal of Abnormal Psychology, 121(2), 360–371. https://doi.org/10.1037/a0027205
KallitsoglouA. (2013). An investigation of the usefulness of the conner’s continuous performance test II in the assessment of inattention and hyperactivity in the school. European Journal of Special Needs Education, 28(3), 348–361.
31.
KeřkováB.KnížkováK.SiroňováA.HrubýA.VečeřováM.ŠustováP.JonášJ.RodriguezM. (2023). Smoking and attention in schizophrenia spectrum disorders: What are we neglecting?Frontiers in Psychology, 14, Article 1114473. https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1114473
32.
KoflerM. J.RapportM. D.SarverD. E.RaikerJ. S.OrbanS. A.FriedmanL. M.KolomeyerE. G. (2013). Reaction time variability in ADHD: A meta-analytic review of 319 studies. Clinical Psychology Review, 33(6), 795–811. https://doi.org/10.1016/j.cpr.2013.06.001
33.
KollinsS. H.DeLossD. J.CañadasE.LutzJ.FindlingR. L.KeefeR. S. E.EpsteinJ. N.CutlerA. J.FaraoneS. V. (2020). A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): A randomised controlled trial. The Lancet. Digital Health, 2(4), e168–e178. https://doi.org/10.1016/S2589-7500(20)30017-0
34.
LeysC.DelacreM.MoraY. L.LakensD.LeyC. (2019). How to classify, detect, and manage univariate and multivariate outliers, with emphasis on pre-registration. International Review of Social Psychology, 32(1), Article 5. https://doi.org/10.5334/irsp.289
35.
LeysC.KleinO.DominicyY.LeyC. (2018). Detecting multivariate outliers: Use a robust variant of the Mahalanobis distance. Journal of Experimental Social Psychology, 74, 150–156. https://doi.org/10.1016/j.jesp.2017.09.011
36.
LüdeckeD.Ben-ShacharM. S.PatilI.MakowskiD. (2020). Extracting, computing and exploring the parameters of statistical models usingR. Journal of Open Source Software, 5, 2445. https://doi.org/10.21105/joss.02445
37.
LüdeckeD.Ben-ShacharM. S.PatilI.WaggonerP.MakowskiD. (2021). Performance: An r package for assessment, comparison and testing of statistical models. Journal of Open Source Software, 6, 3139. https://doi.org/10.21105/joss.03139
38.
MardiaK. V. (1970). Measures of multivariate skewness and kurtosis with applications. Biometrika, 57(3), 519–530.
39.
MartellaD.AldunateN.FuentesL. J.Sánchez-PérezN. (2020). Arousal and executive alterations in attention deficit hyperactivity disorder (ADHD). Frontiers in Psychology, 11, Article 1991. https://doi.org/10.3389/fpsyg.2020.01991
40.
McClureG.HawesD. J.DaddsM. R. (2015). Borderline personality disorder and neuropsychological measures of executive function: A systematic review. Personality and Mental Health, 10(1), 43–57. https://doi.org/10.1002/pmh.1320
41.
MirandaM. C.BarbosaT.MuszkatM.RodriguesC. C.SinnesE. G.CoelhoL. F. S.RizzutiS.PalmaS. M. M.BuenoO. F. A. (2012). Performance patterns in Conners’ CPT among children with attention deficit hyperactivity disorder and dyslexia. Arquivos de neuro-psiquiatria, 70(2), 91–96. https://doi.org/10.1590/s0004-282x2012000200004
42.
MirskyA. F.AnthonyB. J.DuncanC. C.AhearnM. B.KellamS. G. (1991). Analysis of the elements of attention: A neuropsychological approach. Neuropsychology Review, 2(2), 109–145. https://doi.org/10.1007/BF01109051
43.
MowinckelA. M.PedersenM. L.EilertsenE.BieleG. (2015). A meta-analysis of decision-making and attention in adults with ADHD. Journal of Attention Disorders, 19(5), 355–367. https://doi.org/10.1177/1087054714558872
44.
PagánA. F.HuizarY. P.SchmidtA. T. (2023). Conner’s continuous performance test and adult ADHD: A systematic literature review. Journal of Attention Disorders, 27(3), 231–249. https://doi.org/10.1177/10870547221142455
45.
PetterssonR.SöderströmS.NilssonK. W. (2018). Diagnosing ADHD in adults: An examination of the discriminative validity of neuropsychological tests and diagnostic assessment instruments. Journal of Attention Disorders, 22(11), 1019–1031. https://doi.org/10.1177/1087054715618788
46.
PievskyM. A.McGrathR. E. (2018). The neurocognitive profile of attention-deficit/hyperactivity disorder: A review of meta-analyses. Archives of Clinical Neuropsychology, 33(2), 143–157. https://doi.org/10.1093/arclin/acx055
47.
PoltavskiD. V.BiberdorfD.MarkC. (2016). Association of asthenopia with sustained attention, accommodation and encephalographic activity. Vision Development & Rehabilitation, 2, 155–168. https://doi.org/10.31707/VDR2016.2.3.p155
48.
PoltavskiD. V.BiberdorfD.PetrosT. V. (2012). Accommodative response and cortical activity during sustained attention. Vision Research, 63, 1–8. https://doi.org/10.1016/j.visres.2012.04.017
49.
R Core Team. (2022). R: A language and environment for statistical computing. https://www.R-project.org/
50.
RabinL. A.PaolilloE.BarrW. B. (2016). Stability in test-usage practices of clinical neuropsychologists in the united states and canada over a 10-year period: A follow-up survey of INS and NAN members. Archives of Clinical Neuropsychology, 31(3), 206–230. https://doi.org/10.1093/arclin/acw007
51.
RatcliffR. (1978). A theory of memory retrieval. Psychological Review, 85(2), 59.
RobinsonO. J.VytalK.CornwellB. R.GrillonC. (2013). The impact of anxiety upon cognition: Perspectives from human threat of shock studies. Frontiers in Human Neuroscience, 7, Article 203. https://doi.org/10.3389/fnhum.2013.00203
54.
RossoG.PortaluppiC.TeobaldiE.Di SalvoG.MainaG. (2023). Assessing adult ADHD through objective neuropsychological measures: A critical overview. Journal of Attention Disorders, 27(7), 786–794. https://doi.org/10.1177/10870547231167564
55.
RouderJ. N.HaafJ. M. (2019). A psychometrics of individual differences in experimental tasks. Psychonomic Bulletin & Review, 26(2), 452–467. https://doi.org/10.3758/s13423-018-1558-y
56.
SalumG. A.SatoJ. R.ManfroA. G.PanP. M.GadelhaA.do RosárioM. C.PolanczykG. V.CastellanosF. X.Sonuga-BarkeE.RohdeL. A. (2019). Reaction time variability and attention-deficit/hyperactivity disorder: Is increased reaction time variability specific to attention-deficit/hyperactivity disorder? Testing predictions from the default-mode interference hypothesis. ADHD Attention Deficit and Hyperactivity Disorders, 11(1), 47–58. https://doi.org/10.1007/s12402-018-0257-x
57.
SawayaH.MillerJ. C.RainesJ. M. (2023). Review of studies on incremental validity of assessment measures used in psychological assessment of attention-deficit hyperactivity disorder. Assessment, 31(2), 518–537. https://doi.org/10.1177/10731911231159933
58.
SergeantJ. A. (2005). Modeling attention-deficit/hyperactivity disorder: A critical appraisal of the cognitive-energetic model. Biological Psychiatry, 57(11), 1248–1255. https://doi.org/10.1016/j.biopsych.2004.09.010
59.
ShakedD.FaulknerL. M. D.TolleK.WendellC. R.WaldsteinS. R.SpencerR. J. (2020). Reliability and validity of the Conners’ continuous performance test. Applied neuropsychology. Adult, 27(5), 478–487. https://doi.org/10.1080/23279095.2019.1570199
SlobodinO.YahavI.BergerI. (2020). A machine-based prediction model of ADHD using CPT data. Frontiers in Human Neuroscience, 14, Article 560021. https://doi.org/10.3389/fnhum.2020.560021
62.
ToplakM. E.WestR. F.StanovichK. E. (2013). Practitioner review: Do performance-based measures and ratings of executive function assess the same construct?Journal of Child Psychology and Psychiatry, 54(2), 131–143. https://doi.org/10.1111/jcpp.12001
63.
VarelaJ. L.MagnanteA. T.MiskeyH. M.OrdA. S.EldridgeA.ShuraR. D. (2024). A systematic review of the utility of continuous performance tests among adults with ADHD. The Clinical Neuropsychologist, 38(7), 1524–1585. https://doi.org/10.1080/13854046.2024.2315740
64.
VertinskiM. (2014). Factor structure of the CPT-II [UNLV Theses, Dissertations, Professional Papers, and Capstones]. UNLV. https://doi.org/10.34917/7048626
WatkinsM. (2020). A step-by-step guide to exploratory factor analysis with R and RStudio (1st ed.). Routledge. https://doi.org/10.4324/9781003120001
67.
WatkinsM. W. (2018). Exploratory factor analysis: A guide to best practice. Journal of Black Psychology, 44(3), 219–246. https://doi.org/10.1177/0095798418771807
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