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

Assessing the credibility of presented problems is an essential part of the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. We conducted a systematic review and meta-analysis to examine Continuous Performance Tests (CPTs) as embedded validity indicators. Eighteen studies (<i>n</i> = 3,021; 67 effect sizes) were analyzed: eight simulation studies and ten criterion studies. Moderating variables included study design (simulation vs. criterion) and sample type (student vs. nonstudent). CPTs effectively distinguish between credible and noncredible performance (<i>g</i> = 0.73). Effect sizes were nearly twice as large in simulation studies (<i>g</i> = 0.94) compared to criterion group studies (<i>g</i> = 0.55), underscoring the influence of study design on the interpretation of research findings. Student and nonstudent groups did not differ significantly. CPTs are valuable as embedded validity indicators. Given the moderate effects, clinical decisions should not rely on a single CPT but on a variety of measures.