There is no single test to diagnose ADHD. Therefore, a comprehensive evaluation is necessary to establish a diagnosis, rule out other causes, and determine the presence or absence of co-existing conditions. Such an evaluation requires time and effort and should include a comprehensive history and a clinical assessment of the individual’s academic, social, and emotional functioning and developmental level. 

Current procedures for medical diagnostic assessment of ADHD have been highly subjective with the use of clinical interviews and rating scales alone. If an individual has most of the symptoms listed in the DSM-5 diagnostic criteria for ADHD symptoms to a moderate or severe degree in comparison to the individual’s same-age peers, then psychological testing could be very useful to determine if the person has ADHD or not.

One thing science has learned is that attention and impulse control (two of the three primary symptoms of ADHD) are just two of several different “executive functions” of the brain. Other executive functions include organization, working memory, problem-solving, initiation, effort/persistence, follow-through, taking in feedback, and altering one’s effort in light of the feedback.

Individuals with ADHD have problems with most, if not all, of the executive functions. An ADHD child may not be organized enough to bring home books needed for homework. If he or she brings home everything needed to do homework, there may be a problem getting started, staying focused, persisting, or taking in feedback. Sometimes they actually finish their homework and then forget to turn it in the next day.

The best way to properly assess ADHD is to have a comprehensive psychological evaluation. Research indicates by the time the individual with ADHD reaches adulthood, there is about a 90% chance that the individual will have at least one other mental health diagnosis. Some 30-40% of people with ADHD also have a Learning Disability such as Dyslexia. Many more have Oppositional Defiant Disorder, depression, anxiety, autism, or some other disorder.

Our practice uses the most up-to-date and advanced psychological testing to assess attention and concentration, but we do much more. Most physicians and psychologists merely rely on interviews and rating scales. Most don’t even score the rating scales; they just look at them. We also use interviews and rating scales, but we use the national norms to score the rating scales. But more importantly, we use a variety of advanced psychological tests to properly access attention and concentration.

Many things we do in everyday life require continuous focus and attention, such as driving a car on the highway. We use an objective test called “continuous performance tests” (CPT). CPTs allow your provider to properly assess Sustained Attention. The individual must perform continuously without stopping (between 11 and 22 minutes, depending on the test and the age of the individual).

Our practice uses the CPT, the Test of Variables of Attention (T.O.V.A.®) version 9, to enhance the ADHD diagnostic and treatment process through the use of objective testing platforms. The T.O.V.A.® can be administered to individuals between the ages of 4 and 80.

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The Test of Variables of Attention (T.O.V.A.®) version 9​

​An FDA-cleared, computerized, and objective measure of attention and inhibitory control normed by gender for ages 4 to 80

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It is an FDA-cleared continuous performance test for both the diagnosis and treatment management of ADHD to enhance that procedure with objective data, which leads to improved diagnostic accuracy and a more efficient, precise process for treatment optimization. The test is not designed to be a stand-alone tool for the diagnosis of ADHD. Rather, it should be seen as a key component in the assessment together with other clinical data, such as structured clinical interviews and subjective information from validated rating scales.

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The T.O.V.A.® provides information that is not available through self-report or the report of others. It is used along with a clinical interview and subjective measures (such as behavior ratings) for a more comprehensive picture of academic, social, and personal performance and impairment. It is, however, important that the T.O.V.A.® can differentiate patients with ADHD from normative individuals. 

The T.O.V.A.® provides healthcare professionals with objective measurements of attention and inhibitory control. The visual T.O.V.A.® aids in the assessment of, and evaluation of treatment for, attention deficits, including attention deficit/hyperactivity disorder (ADHD).

 The auditory T.O.V.A.® aids in the assessment of attention deficits, including ADHD. T.O.V.A.® results should only be interpreted by qualified professionals.

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The T.O.V.A.®. is a culture- and language-free, sufficiently-long computerized test that requires no left/right discrimination or sequencing. Responses to visual or auditory stimuli are recorded with a unique, highly accurate (±1 ms) microswitch. The T.O.V.A.® calculates response time variability (consistency), response time (speed), commissions (impulsivity), and omissions (focus and vigilance). These calculations are then compared to a large age- and gender-matched normative sample, as well as to a sample population of individuals independently diagnosed with ADHD. These comparison results are used to create an immediately available, easy-to-read report.

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T.O.V.A.® Features

• Pre-school test (ages 4 - 5.5): 10.8 minutes

• School-age test (ages 5.5 - 17): 21.6 minutes

• Adult test with embedded performance validity (ages 17 - 80+)

• Visual and Auditory Test formats

• Language- and culture-free stimuli

• Extensively normed by gender for ages 4 to 80+

• Immediately available, easy-to-read report

• FDA cleared and CE Medical Device Directive compliant

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Frequently Asked Questions about the T.O.V.A.® Version 9

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Accuracy:

• With special tools, the T.O.V.A.® can control measurements and timing with ±1 ms accuracy

• Using an external measuring device (the T.O.V.A.® microswitch), more precise than a mouse or keyboard can be

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Duration:

• Research shows many individuals with attention problems can process information normally for 10-15 minutes and then experience difficulty.

• The T.O.V.A.® is the only CPT that measures attention variables for a full 21.6 minutes for subjects (5.5) years old and above.

• The T.O.V.A.® measures attention variables for a full 10.8 minutes for subjects (4.0 - 5.5) years old

• The T.O.V.A.® keeps the task long and boring.

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Stimuli:

Unlike other commercially available CPTs that use numbers or letters, the T.O.V.A.®. uses geometric shapes, so that language and learning disabilities do not interfere.

Simple task:

Unlike most CPTs that use complex tasks that are influenced by learning or working memory, the T.O.V.A.® uses a simple go/no-go task to obtain an objective measure of sustained attention.

When should the T.O.V.A be used to check and assess for ADHD?

The T.O.V.A.® is not needed in the most obvious cases of ADHD with clear signs of hyperactivity and impulse control difficulties. A majority of the children and adolescents we see fall into this category. In these cases, the individuals typically have parent and teacher informants to corroborate their symptoms. 

However, individuals presenting primarily with inattention and executive dysfunction are often diagnosed later in life since subjective teacher rating scales often fail to provide corroborating evidence to make a diagnosis. Girls and a small number of boys tend to fall into this category hence it is not uncommon for this group to be diagnosed during their late teens or young adulthood when symptoms begin affecting them in social, professional, and academic settings

Adults frequently present to our practice seeking evaluation for ADHD symptoms due to poor work or academic performance. These individuals typically have no treatment history. Some were diagnosed as a child but their parents refused to initiate ADHD medications due to stigma or fear of medication side effects. Many middle-aged adults presenting for ADHD evaluation report a lack of qualified providers when they were growing up. ADHD was simply something one dealt with.

We tend to reserve the use of the T.O.V.A.® for ADHD in these circumstances rather than as a routine to save on unnecessary costs.​

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T.O.V.A.® is useful for both (1) initially assessing a person in order to make a diagnosis and (2) assessing the effects of medication. Sometimes people come back to me years later to see if the medication is still working properly. Since stimulants are water-soluble, the concentration of the medication in the blood gets weaker as a child grows and gains weight. Thus, the dosage might need to be increased. T.O.V.A.® is very effective at assessing how well the medication is working.