Test of Variables of Attention A Computerized Assessment to help in the diagnosis of ADHD "Test of Variables of Attention" TOVA

Test of Variables of Attention
(TOVA)
A Computerized Assessment
to assist in the diagnosis of ADHD

One of the evaluation procedures used for diagnosing ADHD is the Test of Variables of Attention (TOVA), a computerized Continual Performance Test (CPT) used to help identify factors related to problems with attention and impulsivity. In some ways it is like a "stress test for the brain." The TOVA helps the clinician see how a person does in a boring task that requires vigilance.

The TOVA can be used as young as age 4, although beginning at age 6 is more practical. It is also normed for adults through age 70.

The visual version of the TOVA uses only two symbols. No reading skill is needed. The person being tested is to push the button on the microswitch when they see the target, and "pass" when they see the non-target. The images flash on the screen for just a moment, about 2 seconds apart. There are 648 decisions to be made during the 22 minute test.

Target Non-target

The Auditory version of the TOVA uses two tones. The higher tone is the target tone, and the lower tone is the non-target tone. Again, the tones are presented in a random sequence, one every two seconds for the duration of the test.

The TOVA is a 22 minute test that helps determine how well one can focus on a simple task that requires constant attention. The test is done in both a visual version as well as an auditory version. The TOVA addresses several factors:

Variability- the evenness of a person's response times.
Response Time- how fast the person responds
Errors of Commission-a measure of impulsivity
Errors of Omission -a measure of inattentiveness
Anticipatory Errors (pushing the button before you see the target) measure problems with holding back as required, versus "jumping the gun."
Post commission response time (do you slow down or speed up after errors)
Response data by quarters so can tell how well one does over time
Low brain stimulation task for first half of the test, and a high brain stimulation task for second half of the test
Compares the person to others by age and sex.
Uses micro-switch accurate to 1/1000 of a second to measure response time
Provides the counselor an opportunity to observe vigilance on a boring task
Has an ADHD score in the visual mode that compares to those who have been diagnosed with ADHD

No one test, checklist or brief interview is adequate to evaluate for ADHD or any other disorder for that matter. The total pattern of problems, as well as the disabling quality of the problems is important in order to get an accurate diagnosis. It also assists in identifying areas to observe for improvement when medication is administered. The TOVA can be administered after giving medication to monitor medication improvements.

The TOVA alone does not determine ADHD. But it can help confirm the diagnosis, and help more clearly see the type of problems that a person with ADHD has.

A video about the TOVA can be seen here. TOVA video

Frequently Asked Questions (FAQ)

How many sessions are needed to complete the TOVA? A minimum of three (3) sessions are required to adequately complete the TOVA.

The first session is to understand your unique situation, and identify the exact purpose of giving the TOVA. An introduction and trials of the TOVA are also given.
The second session is usually the visual version of the TOVA. A brief verbal interpretation is shared with the client and/or family. I usually gather more information, and will often give feedback regarding questionnaires that have been completed.
The third session is usually the auditory version of the TOVA. At this point a summary of the testing to date is shared with the client and/or family. A brief discussion about implications of the testing is discussed, such as further counseling, referral for medication, or parenting strategies that might be helpful.

How much does it cost. There is a charge for three visits, plus an $80.00 additional fee.

What is this $80.00 fee for? The additional $80.00 fee covers administrative fees for the TOVA, time spent outside the session interpreting the results, and time writing a report. Most insurance companies will not cover this fee. This test needs to be paid prior to the report being given.

Is there a special time of the day to take the test? The test is administered only in the morning. The reason for this is that all of the comparative data was completed on other people in the morning. Generally, people with ADHD perform less well as the day progresses.

Is there anything else I should do before the test? It is always a good idea to get a good nights rest before the test, as well as have a good breakfast. However, please do not eat or drink anything that might have caffeine in it. Caffeine can effect the results of the TOVA.

Do I get to watch my child take the test? No other family member is in the room while the test is being given. This is to avoid unnecessary distractions. Also there are some family members who cannot resist coaching or commenting during the test.