What is a CPT?
At first glance, it looks like a pretty boring game. You have to press a key as soon you see the right cue. An example of what the “game” may look like: a screen shows red dots or blue dots, one color at any given time, and you have to respond quickly whenever the red dot (the cue) appears. Pretty straightforward, pretty uneventful.
But the thing about CPT is that, despite its simplicity, it can reveal a lot about a person’s inattention, inhibition, and impulsivity. For example, a kid who’s very impulsive would make many errors, such as pressing the key when they shouldn’t have, mainly because they wanted to show a fast reaction. If you take a moment to think about it, you can recall moments from your everyday life where impulsive behaviors occur, even during the most mundane of tasks. CPTs help shed light on these types of behaviors through the results of the test and they also provide the expert conducting the CPT with the ability to pinpoint if there’s an issue.
Why is it Used?
Mental health professionals use many tools to assess their clients and to monitor their progress over time. Most of these tools are subjective and rely on questionnaires that are usually filled by the clients or their parents. However, it is important to also include objective measures that cannot be skewed by one’s subjective biases. That is why CPTs are considered a good objective measurement tool when it comes to assessing inattention, impulsivity, and inhibition.
What are the commonly used CPTs out there?
Below is a list of tools frequently used by clinicians to assess their clients’ progress over the course of their mental health program.
Audience: Ages 4+
Test Duration: 21.6 minutes
One of the most commonly used CPTs, the TOVA is utilized both as a diagnostic aid and to monitor treatment efficacy for attention deficits by providing objective measures of attention and inhibitory control. It measures response time, variability (in response time), and accuracy in terms of commission and omission errors.
Three age-specific versions are available: pre-school age, school age, and adults. The test is available in visual, auditory, or mixed format, with each format containing language and culture-free stimuli. The test involves no left/right discrimination or sequencing, and responses are measured with a unique microswitch to maximize precision in recording responses.
For each quarter of the test, scores are compared to a large age and gender-matched normative sample. An ‘Attention Comparison Score’ compares performance to a group of independently diagnosed individuals with ADHD.
The TOVA system includes hardware and software compatible with both Windows and Mac operating systems and provides immediate, easy-to-read results reporting and comparisons on the testing computer; no network access is required.
To find out more information about the TOVA system, click here.
Audience: Ages 6+
Test Duration: 14-18 minutes
The MOXO d-CPT provides four major indices of performance: attentiveness, timeliness, impulsiveness, and hyperactivity. This cloud-based test measures user responses with a game-like format that incorporates visual and auditory distracters. There are two versions of the test ‒ one for children, and the other for teens and adults. Since the test does not require any verbal skill or reading ability, it is suitable for all users, irrespective of their primary language.
MOXO d-CPT can be used as a diagnostic aid and for monitoring progress over the course of treatment in clients with attention-related disorders. It is also suitable for longitudinal tracking in individuals aiming to achieve peak performance. Clinician reports show performance with standardized (z) scores that compare the client’s score with a group of the same gender and similar age. Reports also give a record of the user’s performance during the various segments of the test, illustrating how performance was affected by each type of distracter.
3. Conners’ CPT3
Audience: Ages 8+
Test Duration: 14 minutes
The Conners’ CPT3 test may be used as a diagnostic aid for attention deficits and related conditions, as well as for progress monitoring. The test measures inattentiveness, impulsivity, sustained attention, and vigilance. It provides clinicians with detailed performance data for individual assessments and facilitates the tracking of treatment efficacy over time.
Detailed scores include: detectability (d’), omissions, commissions, perseverations, hit reaction time (HRT), HRT standard deviation (SD), HRTSD variability, change in HRT across blocks, and change in HRT at various inter-stimulus intervals. Scores are compared to a large normative sample representative of the United States population on key demographic variables.
The test is administered on a Windows-based PC and requires custom hardware and software. The Conners’ CPT3 includes visual stimuli but can be used in conjunction with the Conners’ Continuous Auditory Test of Attention (CATA) for a more comprehensive evaluation.
4. NeuroTrax Go-NoGo Test
Audience: Ages 9+
Test Duration: 2-6 minutes
The NeuroTrax Go-NoGo test is a brief CPT that is part of a comprehensive cognitive assessment suite. The Go-NoGo test contributes to indices of executive function, attention, and working memory (depending upon the battery). No network connectivity is required during testing, and results are available immediately after testing.
During the test, clients are presented with a series of colored squares at variable delays. Each square may be one of four colors. The task is to respond as rapidly as possible by pressing a mouse button if the square is any color but red.
Test scores include accuracy, response time, response time standard deviation, a composite score (computed from accuracy and response time), number of omission errors, number of commission errors, and response time associated with commission errors. An “expanded” version is available for certain batteries that includes test levels with a shorter inter-stimulus interval, greater proportion of red squares, and visual distracters.
In addition to a CPT, NeuroTrax batteries include a Stroop test, another classical response inhibition paradigm in which the client is challenged to ignore conflicting information between letter color and word meaning (e.g., the word ‘green’ shown in red letters). There are also related tests of psychomotor function and information processing speed. Other cognitive domains covered by NeuroTrax tests are memory (verbal and visual), visual spatial processing, verbal function, motor skills, and problem solving. The full battery takes 45-60 minutes.
The NeuroTrax data report gives summary and detailed scores, including graphs that facilitate tracking change over time. Raw scores are standardized by age and education according to a database of over 1500 cognitively healthy individuals.
5. CPT in Myndlift Assessment
Audience: Ages 6+
Test Duration: 8 minutes
Administration: Myndlift mobile app
Finally, our personal favorite (okay, maybe we’re a bit biased), the Myndlift assessment includes a CPT that provides indices of focus and timing, as well as a general measure of task performance. This is especially important given that Myndlift's neurofeedback training can help in improving these parameters.
In the Myndlift CPT, the user is presented with a series of trials in which an arrow-like shape pointing in a particular direction is shown in the middle of the screen. The user’s task is to tap the screen only when the shape is pointing upward (target stimulus) and not when the shape is pointing in another direction (non-target).
During certain portions of the test, audiovisual distracter stimuli appear, making the task more challenging. Trials may get slower or faster, and target stimuli may appear more or less frequently in different parts of the test. The Myndlift CPT is language-independent, using exclusively non-verbal stimuli.
In addition to the focus, timing, and task performance summary measures, detailed scores are available both to the user (in-app) and the clinician (on Myndlift’s clinical dashboard). These scores include: (total) accuracy, commission errors, omission errors, reaction time, and reaction time variability.
Each of these scores measures a different aspect of performance. A commission error is when a non-target was presented but the user responded anyway. This type of error is related to hyperactivity/impulsiveness. An omission error is when a target was presented but the user did not respond. This type of error is a measure of inattention.
Raw and standardized versions of the detailed scores are provided. Standardization is based on data collected from all clients in the Myndlift reference database as of the date of the first assessment. Standardized performance is given as categories by percentile ranges and as z-scores.
Clinicians may also opt to include CPT assessment scores on reports generated via the Myndlift report generator. These reports allow the clinician to compare performance between two assessments (typically pre- and post-training).