Computerized ADHD assessment revisited

In 1995, and again in 2001, I reviewed computerized ADHD assessment tools in The National Psychologist.  It is now time for an update. Recent large-scale national studies estimate that between 7 percent and 9 percent of children and 4 percent of adults have been diagnosed with ADHD and roughly half are currently taking medication. Depending on the study, these estimates vary but the bottom line is that ADHD is a major problem.

Assessing ADHD and monitoring the effects of medication is an important and controversial issue. Some studies rely on parental or teacher behavioral reports and DSM-IV symptoms lists, while others attempt to demonstrate attentional correlates of these self-reported symptoms. This review takes another look at three computerized assessment tools – CPT-II, IVA+Plus and PADDS. All three have strong research backing with evidence of validity and reliability and normative comparisons with ADHD and non-ADHD samples.

To start, I developed a fictitious profile of Larry, a 10-year-old boy who has attentional and focusing difficulties. (Now, where was I?) I used the most recent versions of the instruments to see how they assessed Larry. Each takes a unique approach and all three came to the same conclusion – Larry has a problem! Here are the details  – in alphabetical order – along with purchase information. Each offers a preview copy and that cost may be applied to the purchase price.

Conners’ Continuous Performance Test (CPT-II) is a straightforward attention test for children and adults 6 years and older. A letter appears on the screen and the subject is asked to press the space bar only if the letter is NOT AN “X.” The letters appear one, two or four seconds apart and the test takes 14 minutes. The measures include response time, variability in response time, error rate (both omissions and commissions) and a confidence index comparing the subject to ADHD and non-ADHD population norms. A variety of reports are available which present tables, graphs and summaries including assessments of inattention, impulsivity and vigilance. The CPT II is published by Multi-Health Systems and more information can be found at www.mhs.com. The CPT II costs $677 for unlimited use on a single computer.

The IVA+Plus is a 13 minute test for children (6-years-old plus) and adults, where the subject is required to click a mouse when he or she either sees or hears the number “1” and not respond when seeing or hearing the number “2.” For this test you need either a desktop with a mouse or a laptop with a USB mouse – IVA+Plus will not work with the built-in mouse button on a laptop but a USB mouse costs less than $15. As opposed to the CPT II which is based on visual attention only, the IVA+Plus assesses both visual and auditory attention. Over 500 trials the ratio of “1” to “2” varies so that sometimes “1” appears many more times  looking for impulsive behaviors while other times “2” appears  more often looking for inattention or vigilance. The IVA+Plus provides a large variety of scores conveniently presented using familiar IQ-type scales with a mean of 100 and standard deviation of 15.  The scores are initially presented as Full Scale Response Quotients and Full Scale Attention Quotients and then each of those are broken down into subscales that measure impulsivity, response inhibition, stamina, focus and speed. The IVA+Plus also provides additional information about “fine motor regulation” (looking at inadvertent mouse clicks or other extraneous mouse behaviors), auditory or visual learning style balance, plus three  scales (comprehension, persistence and sensory/motor) which help further identify factors affecting potential attentional problems.  Taken together, the IVA+Plus provides a wealth of easily interpretable information across two sensory modalities. The IVA+Plus is available at www.braintrain.com with three pricing plans: $1,895 for unlimited use on one computer, $899 for 25 tests on one computer ($199 for 25 additional tests) or $499 for 10 tests on one computer ($209 for 10 additional tests). Special $60 discounts on additional tests are offered for the first 90 days or with a yearly $99 support plan after 90 days.
 
The Pediatric Attention Disorder Diagnostic Screener (PADDS) relies on a different method of identifying potential ADHD children between 6 and 12 years old. Rather than measuring attention and continuous focus, the PADDS measures problems in three executive function skills – working memory, sequential memory and procedural memory – which are often seen in ADHD children. The PADDS integrates parent, teacher and clinician diagnostic assessments in making its overall assessment. The child testing takes approximately 25 to 30 minutes but it is designed to be more like a video game and I found that the time went very quickly.  In fact, I found the CPT II and IVA+Plus, which are shorter, to be more mentally taxing, although this is precisely how they measure attention and focus. The parent and teacher ratings can be done on  paper forms and transferred to computer assessment. The authors estimate that the entire battery can be completed in less than 45 minutes including child, parent, teacher and clinician assessments. The executive function tests offer the child three different tasks using bright colored objects that are either compared or ordered. When I asked a friend’s 8-year-old to try it, he appeared to be very engaged in all three tasks, often peering intently at the screen in anticipation. In the past I have administered both the IVA and CPT II to children and found that their attention tends to wander which, again, is the purpose of the tasks. The PADDS is available at www.targettest.com and costs $695 for an unlimited use on one computer.

 Overall, the three tests tap into different dimensions and apply different strategies to offer important, interpretable information for assessing ADHD. They were all quite easy to install and all had excellent manuals. While each provided either paper or on-screen visual help, the PADDS, in keeping with its video game-like interface, had a colorful manual and an engaging, animated on-screen tutorial.  The bottom line appears to be how you approach ADHD. If it is an attentional issue then you should consider either the CPT II or IVA+Plus. If you are more interested in whether there are cognitive executive function deficiencies, the PADDS is a good choice. They are all excellent at what they measure and well normed and documented. You can’t go wrong with any of them. In fact, my recommendation would be to use the PADDS coupled with one of the other two to get a comprehensive picture of a complex psychological issue.

The TOVA (Test of Variables of Attention) is another computerized assessment instrument. We requested a copy for review. A company spokesman said that it is being updated. A version was not made available to The National Psychologist for testing.

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