The Test of Variables of Attention (T.O.V.A.®), a 21.6 minute computerized continuous performance test used by professionals in the Whole Life Centre clinic for the diagnosis and monitoring of treatment of attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) in children and adults. The standardized test is well normed and extremely helpful in predicting responsiveness to treatment modality.

Ages: 4-80+
Test Duration : 21.6 minutes with a 3 minute Practice Test
Scores/Interpretation: Raw Scores, Standard Scores, Standard Deviations.
Author: Lawrence M. Greenberg, MD

How it works

The computerized tests ask the subjects to press a specially designed Microswitch/scorebox with a +/- 1 millisecond variance whenever the appropriate "target" or stimulus appears on the screen. The "target" is when a little square appears in the upper portion of another square and the "non-target" is when the little square is in the bottom portion of the bigger square. So, every 2 seconds a stimuli will flash on the screen and the subject then responds to the "targets" and not to the "non-targets". Errors of omission (inattention), errors of commission (impulsivity), response times, variability of response times, post-commission response time, anticipatory, and multiple responses are all recorded for each 5 minute quarter and 10 minute halfs, as well as overall total scores for each variable. Scores are then compared to standardized norms and an interpretation of the data is reported in our clinical report (up to 8 pages).

Measuring the subject's response time and variability accurately is crucial for any continuous performance test. The T.O.V.A. test was specifically developed to minimize timing errors associated with measuring these variables. For example, the T.O.V.A. uses the only commercially available CPT standard input device, the T.O.V.A. Microswitch which reduce timing errors, such as those encountered when running the test on different computer platforms with different I/O devices.

Other CPTs available are not as optimized. None use a standard input device: instead, they utilize any available mouse and keyboard inputs. While the inherent inconsistency of a mouse or keyboard is of little importance in word processing, it is very important when trying to precisely measure response time and variability, the two CPT factors with the highest correlation to diagnosis and effectiveness of treatment. Compounding this error, other CPTs may not have the software optimization necessary to maintain their accuracy across computer platforms.

Why T.O.V.A

The T.O.V.A.® is highly effective to screen, diagnose, and monitor medication or treatment.

Clinicians utilize it: 

As a measure of attention in neurological injuries and disorders
As a diagnostic tool, in a multifaceted, multidisciplinary assessment of children, adolescents, and adults
As a way to titrate medication.
As a tool to monitor the patient's response to medication over time

Schools benefit because it: 

Can be used as a screening tool for attention problems on site.
Can be used as a screening before problems occur.
New Features! The Test of Variables of Attention - Auditory (T.O.V.A.-A®) now available.

The T.O.V.A.-A is a new, freestanding, auditory CPT, designed for use in the diagnosis and treatment of children and adults with

• auditory processing problems
• attentional problems (including ADHD)

Extensively normed with 2550 children and teenagers (ages 6-19), the T.O.V.A.-A results are analyzed by gender in six month intervals. Like the T.O.V.A., which is the visual CPT, it utilizes a specially designed, highly accurate electronic Microswitch (+ 1 ms) to record responses. Also, like the visual T.O.V.A., the T.O.V.A.-A uses a non-language based, non sequential stimuli with both vigilance and disinhibition subtests (11 minutes each) to measure:

• Inattention (errors of omission)
• Impulsivity (errors of commission)
• Response Time
• Variability
• Signal Detection Indices
• Anticipatory Errors ( a validity measure)

The T.O.V.A.-A. was developed to increase the diagnostic "hit rate", define and clarify recommendations for the school and work place, more accurately predict and titrate medication response, and measure treatment efficacy over time in individuals

• with ADHD who perform within normal limits on visual CPTs (especially if high IQ and savvy computer game players)
• with auditory processing problems with/without a visual component
• who are visually impaired
• with low seizure thresholds (especially photic driven)

In working with ADHD we use the visual based T.O.V.A. as our primary diagnostic and treatment tool, supplemented by the T.O.V.A.-A, particularly in those cases listed above. In neuropsychological assessments and developing recommendations for schools, both the T.O.V.A. and the T.O.V.A.-A. are valuable tools when used together.
Please note: Since the T.O.V.A.-A., like the T.O.V.A., was normed in mornings only (because of significant performance variability in some cases) and before the subject was fatigued, we because of recommend that the two tests be administered on two different mornings.