Table 10, KQ1 summary of findings and strength of evidence for neuropsychological tests - ADHD Diagnosis and Treatment in Children and Adolescents

KQ1 Diagnostic Test	Outcome	Number of Studies and IDs	Findings	Reasons for Downgrading	SoE
KQ1 Neuropsychological tests	Sensitivity	52 studies¹⁸^, ²¹^, ¹¹²^, ¹¹⁹^, ¹⁴¹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²¹³^, ²⁴⁶^, ²⁵³^, ²⁶⁷^, ²⁷⁶^, ²⁹³^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁴⁷^, ³⁵¹^, ³⁵²^, ³⁷⁹^, ³⁹³^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴³⁶^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁷^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁷⁷^, ⁴⁸²^, ⁴⁸⁶^, ⁴⁹³^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶¹⁴^, ⁶¹⁵^, ⁶³⁹^, ⁶⁴⁷	Sensitivity ranged from 28% (corresponding specificity 95%)⁴⁴⁵ to 100% (corresponding specificity up to 100%)¹⁴¹^, ¹⁵² differentiating ADHD and neurotypical development Sensitivity ranged from 22% (corresponding specificity 96%)⁵⁶⁴ to 91% (corresponding specificity 22%)⁶³⁹ in clinical samples	S, I	Low
KQ1 CPT	Sensitivity	35 studies²¹^, ¹¹²^, ¹¹⁹^, ¹⁴¹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁵³^, ²⁷⁶^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³⁴⁶^, ³⁴⁷^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴³⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁸²^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶³⁹^, ⁶⁴⁷	Sensitivity ranged from 22% (corresponding specificity 96%)⁵⁶⁴ to 100% (corresponding specificity 100%) for a brief neuropsychological measure supported by machine learning	S, I	Low
KQ1 CPT Attention	Sensitivity	3 studies²¹^, ²⁴^, ¹⁶²	Sensitivity ranged from 48% (corresponding specificity 83%)²⁴ to 68% (corresponding specificity 76%,)²¹	S, I	Low
KQ1 CPT Impulsivity	Sensitivity	2 studies²⁴^, ¹⁶²	Sensitivity ranged from 48% (corresponding specificity 83%)²⁴ to 55% (corresponding specificity 64%)¹⁶²	S, I	Low
KQ1 Neuropsychological tests	Specificity	54 studies¹⁸^, ²¹^, ¹¹²^, ¹¹⁹^, ¹²⁴^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²¹³^, ²⁴⁶^, ²⁵³^, ²⁶⁷^, ²⁷⁶^, ²⁸⁴^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁵¹^, ³⁵²^, ³⁷⁹^, ³⁸⁸^, ³⁹³^, ⁴⁰²^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴³⁶^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁷⁷^, ⁴⁸²^, ⁴⁸⁶^, ⁴⁹³^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶¹⁴^, ⁶¹⁵^, ⁶³⁹^, ⁶⁴⁷	Specificity ranged from 46% (corresponding sensitivity 85%)⁴⁶⁹ to 100% (corresponding sensitivity 100% and 75% respectively)¹⁵²^, ⁴⁵⁰ differentiating ADHD and neurotypical development Specificity ranged from 22% (corresponding sensitivity 91%)⁶³⁹ to 85% (corresponding sensitivity 63%)¹⁵³ in clinical samples	S, I	Low
KQ1 CPT	Specificity	33 studies²¹^, ¹¹²^, ¹¹⁹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁵³^, ²⁷⁶^, ²⁹⁸^, ³²³^, ³⁴⁶^, ³⁴⁷^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴³⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁸²^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶³⁹^, ⁶⁴⁷	Specificity ranged from 22% (corresponding sensitivity 91%) using TOVA⁶³⁹ to 100% (corresponding sensitivity 89%) using the PANDAS⁴⁵⁰	S, I	Low
KQ1 CPT Attention	Specificity	3 studies²¹^, ²⁴^, ¹⁶²	Specificity ranged from 64% (corresponding sensitivity 55%)¹⁶² to 83% (corresponding sensitivity 48%)²⁴	S, I	Low
KQ1 CPT Impulsivity	Specificity	2 studies²⁴^, ¹⁶²	Specificity ranged from 64% (corresponding sensitivity 55%)¹⁶² to 83% (corresponding sensitivity 48%)²⁴	S, I	Low
KQ1 Neuropsychological tests	Accuracy	40 studies¹⁸^, ¹¹²^, ¹⁴¹^, ¹⁵²^, ¹⁵⁹^, ¹⁶²^, ¹⁷⁰^, ¹⁸⁴^, ¹⁸⁵^, ¹⁹⁸^, ²¹³^, ²⁵³^, ²⁸⁴^, ²⁹³^, ²⁹⁸^, ³⁰⁷^, ³¹⁶^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁵¹^, ³⁸⁸^, ⁴⁰²^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁷^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁹³^, ⁵⁰⁰^, ⁵³⁷^, ⁵⁴¹^, ⁵⁴³^, ⁶⁰⁷^, ⁶³²	Accuracy ranged from 34% using the TOVA⁵⁰⁰ to 100%¹⁵² for a brief neuropsychological measure supported by machine learning differentiating ADHD and neurotypical development Accuracy ranged from 67%¹⁶² in children with co-occurring oppositional defiance disorder to 95% for a combination measure¹⁸	S, I	Low
KQ1 CPT	Accuracy	26 studies¹¹²^, ¹⁴¹^, ¹⁵²^, ¹⁶²^, ¹⁸⁵^, ¹⁸⁹^, ¹⁹⁸^, ²⁵³^, ²⁹⁸^, ³⁰⁷^, ³¹⁶^, ³²³^, ³⁴⁶^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁵^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁵⁰⁰^, ⁵³⁷^, ⁵⁴³^, ⁶³²	Accuracy ranged from 57% using a virtual reality CPT ⁵⁰⁰ to 95% using TOVA¹⁴¹	S, I	Low
KQ1 Neuropsychological tests	AUC	26 studies¹⁴⁰^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁶³^, ²⁶⁷^, ³¹⁶^, ³⁴⁶^, ³⁴⁷^, ³⁵²^, ³⁸²^, ³⁹³^, ⁴⁰¹^, ⁴⁰⁷^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁶⁷^, ⁴⁶⁹^, ⁴⁷⁷^, ⁴⁸⁶^, ⁴⁹³^, ⁵⁶⁴^, ⁵⁷⁶^, ⁶²⁷	AUC ranged from 0.65⁴⁶⁹ to 0.93 for individual Go/No-Go task measures³⁹³ differentiating ADHD and neurotypical development AUC ranged from 0.59⁵⁶⁴ to 0.87²⁶³ in clinical samples	S, I	Low
KQ1 CPT	AUC	15 studies¹⁴⁰^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁶³^, ³¹⁶^, ³⁴⁶^, ³⁴⁷^, ³⁸²^, ⁴⁰¹^, ⁴⁰⁷^, ⁴⁶⁹^, ⁵⁶⁴^, ⁵⁷⁶	AUC ranged from 0.65 using the Advanced Test of Attention⁴⁶⁹ to 0.92 using the MOXO CPT ¹⁴⁰	S, I	Low
KQ1 Neuropsychological tests	Rater agreement	3 studies¹⁷⁰^, ²⁶³^, ⁶³⁹	Neurotypical samples: Kappa was 0.55 between Cognitive Assessment System discriminant function analysis classifications and a priori diagnosis¹⁷⁰ Clinical samples: Kappa 0.15 between Groundskeeper game and Conners subscales, 0.18 between Groundskeeper game and CPT, and 0.3 between Conners subscales and Conners CPT²⁶³ Kappa 0.15 between Test of Variables of Attention and diagnosis by clinical assessment⁶³⁹	S, I	Low
KQ1 Neuropsychological tests	Internal consistency	2 studies¹⁹⁸^, ⁵⁰⁰	Cronbach’s alpha ranged from 0.906 to 0.987 across 15 variables in the diagnosis-supported decision support system (DS-ADHD) across all children¹⁹⁸ Cronbach’s alpha for a virtual reality instrument was 0.72⁵⁰⁰	C	Low
KQ1 Neuropsychological tests	Test-retest reliability	1 study²¹³	ICC less than 0.5 for the ADHD group on all visual and auditory test variables on The Advanced Test of Attention repeated after 2 weeks⁴⁶⁹	C	Insufficient
KQ1 Neuropsychological tests	Misdiagnosis impact	0 studies	No data	C	Insufficient
KQ1 Neuropsychological tests	Costs	1 study³¹⁵	£31 [~$42] for QbTest including 30-minute appointment, £108 a consultation within the UK Medway NHS Trust at the time of audit³¹⁵ in a clinical sample	C	Insufficient

KQ1 Diagnostic Test

Outcome

Number of Studies and IDs

Findings

Reasons for Downgrading

KQ1 Neuropsychological tests

Sensitivity

52 studies¹⁸^, ²¹^, ¹¹²^, ¹¹⁹^, ¹⁴¹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²¹³^, ²⁴⁶^, ²⁵³^, ²⁶⁷^, ²⁷⁶^, ²⁹³^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁴⁷^, ³⁵¹^, ³⁵²^, ³⁷⁹^, ³⁹³^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴³⁶^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁷^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁷⁷^, ⁴⁸²^, ⁴⁸⁶^, ⁴⁹³^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶¹⁴^, ⁶¹⁵^, ⁶³⁹^, ⁶⁴⁷

Sensitivity ranged from 28% (corresponding specificity 95%)⁴⁴⁵ to 100% (corresponding specificity up to 100%)¹⁴¹^, ¹⁵² differentiating ADHD and neurotypical development

Sensitivity ranged from 22% (corresponding specificity 96%)⁵⁶⁴ to 91% (corresponding specificity 22%)⁶³⁹ in clinical samples

S, I

Low

KQ1 CPT

Sensitivity

35 studies²¹^, ¹¹²^, ¹¹⁹^, ¹⁴¹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁵³^, ²⁷⁶^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³⁴⁶^, ³⁴⁷^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴³⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁸²^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶³⁹^, ⁶⁴⁷

Sensitivity ranged from 22% (corresponding specificity 96%)⁵⁶⁴ to 100% (corresponding specificity 100%) for a brief neuropsychological measure supported by machine learning

S, I

Low

KQ1 CPT Attention

Sensitivity

3 studies²¹^, ²⁴^, ¹⁶²

Sensitivity ranged from 48% (corresponding specificity 83%)²⁴ to 68% (corresponding specificity 76%,)²¹

S, I

Low

KQ1 CPT Impulsivity

Sensitivity

2 studies²⁴^, ¹⁶²

Sensitivity ranged from 48% (corresponding specificity 83%)²⁴ to 55% (corresponding specificity 64%)¹⁶²

S, I

Low

KQ1 Neuropsychological tests

Specificity

54 studies¹⁸^, ²¹^, ¹¹²^, ¹¹⁹^, ¹²⁴^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²¹³^, ²⁴⁶^, ²⁵³^, ²⁶⁷^, ²⁷⁶^, ²⁸⁴^, ²⁹⁸^, ³⁰⁷^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁵¹^, ³⁵²^, ³⁷⁹^, ³⁸⁸^, ³⁹³^, ⁴⁰²^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴³⁶^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁷⁷^, ⁴⁸²^, ⁴⁸⁶^, ⁴⁹³^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶¹⁴^, ⁶¹⁵^, ⁶³⁹^, ⁶⁴⁷

Specificity ranged from 46% (corresponding sensitivity 85%)⁴⁶⁹ to 100% (corresponding sensitivity 100% and 75% respectively)¹⁵²^, ⁴⁵⁰ differentiating ADHD and neurotypical development

Specificity ranged from 22% (corresponding sensitivity 91%)⁶³⁹ to 85% (corresponding sensitivity 63%)¹⁵³ in clinical samples

S, I

Low

KQ1 CPT

Specificity

33 studies²¹^, ¹¹²^, ¹¹⁹^, ¹⁵²^, ¹⁵³^, ¹⁶²^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁵³^, ²⁷⁶^, ²⁹⁸^, ³²³^, ³⁴⁶^, ³⁴⁷^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴³⁶^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁸²^, ⁴⁹⁶^, ⁵¹⁵^, ⁵³⁷^, ⁵⁴³^, ⁵⁶⁴^, ⁶³⁹^, ⁶⁴⁷

Specificity ranged from 22% (corresponding sensitivity 91%) using TOVA⁶³⁹ to 100% (corresponding sensitivity 89%) using the PANDAS⁴⁵⁰

S, I

Low

KQ1 CPT Attention

Specificity

3 studies²¹^, ²⁴^, ¹⁶²

Specificity ranged from 64% (corresponding sensitivity 55%)¹⁶² to 83% (corresponding sensitivity 48%)²⁴

S, I

Low

KQ1 CPT Impulsivity

Specificity

2 studies²⁴^, ¹⁶²

Specificity ranged from 64% (corresponding sensitivity 55%)¹⁶² to 83% (corresponding sensitivity 48%)²⁴

S, I

Low

KQ1 Neuropsychological tests

Accuracy

40 studies¹⁸^, ¹¹²^, ¹⁴¹^, ¹⁵²^, ¹⁵⁹^, ¹⁶²^, ¹⁷⁰^, ¹⁸⁴^, ¹⁸⁵^, ¹⁹⁸^, ²¹³^, ²⁵³^, ²⁸⁴^, ²⁹³^, ²⁹⁸^, ³⁰⁷^, ³¹⁶^, ³²³^, ³²⁷^, ³⁴⁶^, ³⁵¹^, ³⁸⁸^, ⁴⁰²^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴²²^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁷^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁴⁹³^, ⁵⁰⁰^, ⁵³⁷^, ⁵⁴¹^, ⁵⁴³^, ⁶⁰⁷^, ⁶³²

Accuracy ranged from 34% using the TOVA⁵⁰⁰ to 100%¹⁵² for a brief neuropsychological measure supported by machine learning differentiating ADHD and neurotypical development

Accuracy ranged from 67%¹⁶² in children with co-occurring oppositional defiance disorder to 95% for a combination measure¹⁸

S, I

Low

KQ1 CPT

Accuracy

26 studies¹¹²^, ¹⁴¹^, ¹⁵²^, ¹⁶²^, ¹⁸⁵^, ¹⁸⁹^, ¹⁹⁸^, ²⁵³^, ²⁹⁸^, ³⁰⁷^, ³¹⁶^, ³²³^, ³⁴⁶^, ⁴⁰⁷^, ⁴¹⁷^, ⁴²¹^, ⁴⁵⁰^, ⁴⁶²^, ⁴⁶⁵^, ⁴⁶⁹^, ⁴⁷⁰^, ⁴⁷⁵^, ⁵⁰⁰^, ⁵³⁷^, ⁵⁴³^, ⁶³²

Accuracy ranged from 57% using a virtual reality CPT ⁵⁰⁰ to 95% using TOVA¹⁴¹

S, I

Low

KQ1 Neuropsychological tests

AUC

26 studies¹⁴⁰^, ¹⁷⁰^, ¹⁷⁷^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁶³^, ²⁶⁷^, ³¹⁶^, ³⁴⁶^, ³⁴⁷^, ³⁵²^, ³⁸²^, ³⁹³^, ⁴⁰¹^, ⁴⁰⁷^, ⁴⁴⁵^, ⁴⁴⁶^, ⁴⁶⁷^, ⁴⁶⁹^, ⁴⁷⁷^, ⁴⁸⁶^, ⁴⁹³^, ⁵⁶⁴^, ⁵⁷⁶^, ⁶²⁷

AUC ranged from 0.65⁴⁶⁹ to 0.93 for individual Go/No-Go task measures³⁹³ differentiating ADHD and neurotypical development

AUC ranged from 0.59⁵⁶⁴ to 0.87²⁶³ in clinical samples

S, I

Low

KQ1 CPT

AUC

15 studies¹⁴⁰^, ¹⁸⁹^, ¹⁹⁰^, ¹⁹⁸^, ²⁴⁶^, ²⁶³^, ³¹⁶^, ³⁴⁶^, ³⁴⁷^, ³⁸²^, ⁴⁰¹^, ⁴⁰⁷^, ⁴⁶⁹^, ⁵⁶⁴^, ⁵⁷⁶

AUC ranged from 0.65 using the Advanced Test of Attention⁴⁶⁹ to 0.92 using the MOXO CPT ¹⁴⁰

S, I

Low

KQ1 Neuropsychological tests

Rater agreement

3 studies¹⁷⁰^, ²⁶³^, ⁶³⁹

Neurotypical samples:

Kappa was 0.55 between Cognitive Assessment System discriminant function analysis classifications and a priori diagnosis¹⁷⁰

Clinical samples:

Kappa 0.15 between Groundskeeper game and Conners subscales, 0.18 between Groundskeeper game and CPT, and 0.3 between Conners subscales and Conners CPT²⁶³

Kappa 0.15 between Test of Variables of Attention and diagnosis by clinical assessment⁶³⁹

S, I

Low

KQ1 Neuropsychological tests

Internal consistency

2 studies¹⁹⁸^, ⁵⁰⁰

Cronbach’s alpha ranged from 0.906 to 0.987 across 15 variables in the diagnosis-supported decision support system (DS-ADHD) across all children¹⁹⁸

Cronbach’s alpha for a virtual reality instrument was 0.72⁵⁰⁰

Low

KQ1 Neuropsychological tests

Test-retest reliability

1 study²¹³

ICC less than 0.5 for the ADHD group on all visual and auditory test variables on The Advanced Test of Attention repeated after 2 weeks⁴⁶⁹

Insufficient

KQ1 Neuropsychological tests

Misdiagnosis impact

0 studies

No data

Insufficient

KQ1 Neuropsychological tests

Costs

1 study³¹⁵

£31 [~$42] for QbTest including 30-minute appointment, £108 a consultation within the UK Medway NHS Trust at the time of audit³¹⁵ in a clinical sample

Insufficient

From: 4, Results: Diagnosis of ADHD

Cover of ADHD Diagnosis and Treatment in Children and Adolescents

ADHD Diagnosis and Treatment in Children and Adolescents [Internet].

Comparative Effectiveness Review, No. 267.

Peterson BS, Trampush J, Maglione M, et al.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Mar.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 10KQ1 summary of findings and strength of evidence for neuropsychological tests