Evaluating Continuous Performance Tests as Embedded Measures of Performance Validity in ADHD assessments: A Systematic Review and Meta-Analysis

We conducted a systematic review and multilevel meta‑analysis to evaluate the utility of continuous performance tasks (CPTs) as embedded validity indicators in adult ADHD assessments. Failing to assess performance validity can result in misinterpretation of neuropsychological test results, potentially leading to inappropriate treatment recommendations and evaluations. Understanding the ability of CPTs to reliably distinguish credible from non‑credible performance is therefore vital for both clinical practice and research. In this meta‑analysis, we estimated the overall ability of CPTs to discriminate between credible and non‑credible performance and examined the role of potential moderating factors, including the variant of CPT, specific outcome measures (omission errors, commission errors, reaction time and reaction time standard deviation), study design (criterion‑group vs. simulation group), and sample characteristics (student vs. non-student). We hypothesized that CPTs would demonstrate moderate effectiveness in identifying non‑credible performance, with larger effects in simulation group design in comparison to criterion group design. We expected the effect larger in non-student samples in comparison to student samples. We did not formulate hypotheses regarding differences in CPT variants or outcome measures, as these analyses were conducted in an exploratory manner. Results will clarify the role of CPTs as embedded validity indicators and guide clinicians and researchers in selecting and interpreting CPT results as embedded validity indicator in adult ADHD assessments.