Comprehensive Attention Test as a Diagnostic Tool for Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) significantly affects mental health in all age groups; however, its diagnosis remains challenging. This study evaluated the diagnostic accuracy of the Comprehensive Attention Test (CAT), a computerized tool designed to assess various aspects of attention in children with ADHD, in order to provide the groundwork for clinically applicable interpretation guidelines.

Factor analysis was performed on the scores of seven CAT subtests (visual and auditory selective attention tasks, sustained attention task, flanker task, divided attention task, and spatial working memory tasks) collected from 5214 subjects aged 4-49 years diagnosed with ADHD at 15 psychiatric clinics in South Korea. Their scores were compared with those of 500 participants with no attention problems.

CAT subtests were grouped into either three or four factors depending on the age group. Omission error, commission error, and response time variability formed either one or two factors that effectively distinguished ADHD from non-ADHD with high sensitivity and specificity (4-5 years old: areas under the receiver operating characteristic curve [AUROCs] 0.937 and 0.779; 6-8 years old: AUROCs 0.841 and 0.878; 9-18 years old: AUROC 0.864; 19-49 years old: AUROC 0.792). The mean response time and working memory test results formed separate factors. While mean response time was a poor diagnostic indicator of ADHD, it revealed significant differences when psychiatric comorbidities were present.

CAT results can be categorized into factors reflecting inattentiveness, disinhibition, and working memory. These factors may help diagnose ADHD or detect psychiatric comorbidities.