Beyond Traditional Continuous Performance Tests: The Incremental Diagnostic Value of Distractor-Embedded Paradigms.

IF 2 4区医学 Q3 PSYCHIATRY

Psychiatry Investigation Pub Date : 2026-08-01 Epub Date: 2026-08-04 DOI:10.30773/pi.2026.0080

Şenay Kılınçel, Furkan Bulut, Oğuzhan Kılınçel

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引用次数: 0

Abstract

Objective: Distractor-embedded continuous performance test (CPT) paradigms have been developed to enhance the ecological validity and diagnostic precision of attention-deficit/hyperactivity disorder (ADHD) assessment. This study aimed to quantitatively synthesize the diagnostic performance of distractor-embedded CPT models and evaluate their incremental validity beyond traditional CPT paradigms.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched through February 2026. Studies were included if they employed distractor-embedded CPT paradigms and reported sufficient data to compute standardized mean differences between ADHD and control groups. Hedges g was calculated for each study. Random-effects meta-analyses (DerSimonian-Laird method) were performed to estimate pooled effect sizes.

Results: Eight studies comprising 2,135 participants were included. The pooled standardized mean difference was 1.14 (95% confidence interval: 0.53-1.75), indicating substantial separation between ADHD and control groups. Subgroup analyses revealed comparable pooled effects for MOXO-based (|g|=1.26) and virtual reality (VR)-based paradigms (|g|=1.30), with lower heterogeneity observed in VR-based studies. Domain-specific analyses showed the largest effect for attention (g=1.35), followed by impulsivity (g=0.82) and hyperactivity (g=0.80). Incremental validity findings demonstrated improved diagnostic precision when eye-tracking augmentation and multivariate composite scoring methods were applied. Sensitivity analyses confirmed stability of the pooled estimates.

Conclusion: Distractor-embedded and ecologically enriched CPT paradigms demonstrate robust diagnostic discrimination in ADHD assessment. Multimodal and integrated models may provide incremental advantages over conventional CPT approaches. These findings support the integration of ecologically valid and multimodal objective measures into ADHD diagnostic frameworks.

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超越传统的连续性能测试：干扰物嵌入范式的增量诊断价值。

目的：为提高注意力缺陷/多动障碍（ADHD）评估的生态效度和诊断精度，建立了嵌入干扰物的连续行为测试（CPT）范式。本研究旨在定量综合干扰物嵌入CPT模型的诊断性能，并评估其超越传统CPT范式的增量效度。方法：根据PRISMA 2020指南进行系统评价和荟萃分析。PubMed、Scopus和Web of Science的检索截止到2026年2月。如果研究采用了嵌入干扰物的CPT范式，并报告了足够的数据来计算ADHD组和对照组之间的标准化平均差异，则纳入研究。为每项研究计算对冲。随机效应荟萃分析（dersimonan - laird方法）用于估计合并效应大小。结果：纳入了8项研究，包括2135名参与者。合并标准化平均差为1.14(95%可信区间：0.53-1.75)，表明ADHD组与对照组之间存在明显的分离。亚组分析显示，基于moxo的模式（|g|=1.26）和基于虚拟现实（VR）的模式（|g|=1.30）的合并效应相当，基于VR的研究的异质性较低。特定领域的分析显示，对注意力的影响最大（g=1.35），其次是冲动（g=0.82）和多动（g=0.80）。增量效度结果表明，当眼动追踪增强和多元复合评分方法应用时，诊断精度有所提高。敏感性分析证实了合并估计的稳定性。结论：干扰物嵌入和生态丰富的CPT范式在ADHD评估中具有较强的诊断辨别力。与传统的CPT方法相比，多式联运和集成模型可能提供增量优势。这些发现支持将生态有效和多模式客观测量纳入ADHD诊断框架。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychiatry Investigation PSYCHIATRY-

CiteScore

4.10

自引率

3.70%

发文量

105

审稿时长

6-12 weeks

期刊介绍： The Psychiatry Investigation is published on the 25th day of every month in English by the Korean Neuropsychiatric Association (KNPA). The Journal covers the whole range of psychiatry and neuroscience. Both basic and clinical contributions are encouraged from all disciplines and research areas relevant to the pathophysiology and management of neuropsychiatric disorders and symptoms, as well as researches related to cross cultural psychiatry and ethnic issues in psychiatry. The Journal publishes editorials, review articles, original articles, brief reports, viewpoints and correspondences. All research articles are peer reviewed. Contributions are accepted for publication on the condition that their substance has not been published or submitted for publication elsewhere. Authors submitting papers to the Journal (serially or otherwise) with a common theme or using data derived from the same sample (or a subset thereof) must send details of all relevant previous publications and simultaneous submissions. The Journal is not responsible for statements made by contributors. Material in the Journal does not necessarily reflect the views of the Editor or of the KNPA. Manuscripts accepted for publication are copy-edited to improve readability and to ensure conformity with house style.