# Tele-Assessment of Executive Functions in Young Adults with ADHD: A Pilot Study
## 4 Tele-Assessment of Executive Functions  
The Cognitive Tele-Assessment (CTA) approach has been extensively applied in adults across clinical, research, and screening contexts. In recent decades, the CTA has also emerged as a valuable method for assessing neurodevelopmental disorders in both healthcare and educational environments, leading to the development of new assessment tools. Compared to the traditional In-Person Assessment (IPA), the CTA offers several potential benefits, including improved accessibility, shorter waiting times, reduced travel and time-related costs, and enhanced infection control through limited physical interaction. The research findings indicate comparable performance outcomes between the CTA and IPA, along with high levels of participant cooperation [66]. Although an executive function (EF) evaluation is mandatory for individuals with ADHD [2], it is not routinely conducted in young adults with this diagnosis. This may largely stem from the lack of clearly defined assessment protocols and the need to streamline functional evaluations into fewer sessions. In this context, a tele-assessment using computerized tasks represents a promising approach for profiling EF components in ADHD. Research comparing remote and in-person EF assessments has shown no significant differences between the two methods, indicating that a remote assessment is feasible during the developmental stages [67]. Additionally, a computerized tele-assessment offers several advantages: it allows for a precise, standardized, and replicable administration, which helps reduce scoring errors and shortens the administration time. This facilitates more straightforward comparisons across different tasks and conditions [68]. These benefits are particularly crucial for the EF assessment, since the EF encompasses multiple cross-modal components that must be evaluated under varying conditions, with the accurate measurement of both the response accuracy and reaction time, e.g., [68; 69]. A recent line of research investigated the effects of environmental distractors on ADHD symptoms using the MOXO d-CPT, a continuous performance test (CPT) with visual and auditory distractors [37; 70; 71]. Continuous performance tests (CPTs) are considered a gold standard for ADHD evaluation and are currently the most widely used objective laboratory measures to support the clinical diagnosis of the disorder because they can detect the patient's typical behavior in the context of daily life [72; 73; 74; 75]. Indeed, [PERSON] et al. [76] showed that children diagnosed with ADHD exhibit more variable reaction times and produce more errors of commission and omission than undiagnosed children in sustained attention tasks. The MOXO d-CPT is a recent version of the CPT task that integrates visual and auditory distractors, making it even more ecologically valid than the classic CPT. The results of studies using the MOXO d-CPT for children and adults showed that subjects with ADHD had greater distractibility than controls when performing the CPT, measured by errors of omission in the presence of distracting visual and auditory stimuli, as well as a combination of distracting stimuli employing both sensory channels [41; 77]. In addition, the results showed that auditory and visual distractors had different effects on sustained attention and inhibitory control [38]. The MOXO d-CPT is based on a go/no-go task that requires the subject to maintain attention on a continuous stream of stimuli and respond to a predetermined target stimulus. In addition, contrary to other CPTs, the MOXO d-CPT includes a measurable and environmentally friendly distractor system. Distractors are visual stimuli in motion and auditory stimuli associated with them, which can appear separately or together and simulate events and sounds typical of everyday life. Two different versions of the MOXO d-CPT have been designed, with different stimuli and distractors, as well as different durations. The Teens and Adults version is designed for the 13-70-year age group and lasts 18 min.