Empirical foundations for the development of a brief attention test in children and adolescents with attention-deficit/hyperactivity disorder (ADHD)

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity associated with significant functional impairment. The Computerized Visual Attention Test (CVAT), in its 15-minute version, has demonstrated sensitivity in detecting attentional deficits in this population. Lengthy tasks, however, may induce fatigue and reduced motivation, potentially compromising performance and limiting clinical and research applicability. Identifying the most discriminative structural parameters of the test may support the development of a brief and effective screening version for ADHD in children and adolescents. Objective: Analyze the performance of children and adolescents with ADHD on the 15-minute CVAT to identify the combination of structural parameters most relevant for discriminating the disorder. Specifically, the study examined the effects of different target presentation frequencies (high vs. low) and inter-stimulus intervals (1, 2 and 4 seconds) on the most sensitive CVAT variable for ADHD: intra-individual variability of reaction time. Methods: This experimental, cross-sectional study included 232 children and adolescents recruited from public and private institutions in municipalities in the state of Rio de Janeiro. The ADHD group comprised participants presenting symptoms consistent with the disorder. The control group included students without behavioral problems. Exclusion criteria were learning difficulties, mood disorders or psychosis, Autism Spectrum Disorder, neurological conditions or medication use. Instruments used were: a clinical interview based on the diagnostic criteria for ADHD from the Diagnostic and Statistical Manual of Mental Disorders; a teacher rating scale addressing academic and behavioral difficulties; and the 15-minute CVAT, in which participants had to rapidly respond to the presentation of target stimuli. A separate analysis of covariance (ANCOVA) was conducted to examine the effects of target frequency and inter-stimulus interval on the variability of reaction time, with sex included as a covariate. Results: Participants with ADHD showed a greater reaction time variability compared to the controls. Separate ANCOVAs indicated that group differences were statistically significant under high target frequency (F = 4.281, df = 2/229, p = .040) but not under low frequency (F = 3.379, df = 2/229, p = .067). Regarding inter-stimulus intervals, significant differences were observed at 1 second (F = 6.086, df = 2/229, p = .014) and 2 seconds (F = 10.712, df = 2/229, p = .001), but not at 4 seconds (F = 2.702, df = 2/229, p = .102). Conclusion: A brief attention test combining high target frequency and short inter-stimulus intervals may provide greater sensitivity for screening ADHD in childhood and adolescence.