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The Test of Variables of Attention (TOVA)

    

  A box flashes once a second either at the top or the bottom of the screen.  The client presses a button only if it is at the top.  This test is purposely designed to be boring.  The idea is see if  the client can remain vigilant and attentive under boring conditions.  

 

What it is

The TOVA is an objective measure of the problems a person with ADHD or ADD is having in focusing attention. In most cases it has better "judgment" than most people do about the presence or absence of an attentional disorder. It is a computer test in which the person (child or adult) holds a "clicker" in one hand while they watch a little box flash at either the top of 

the screen or at the bottom of the screen.  The idea is to press the button on the clicker as fast as you can if the box is at the TOP of the screen.   But the trick is to do nothing if the box flashes at the BOTTOM of the screen.  The flashing boxes are random so the client never knows if it will be top or bottom.  The TOVA is extremely useful in both understanding (1) if a person has ADHD/ADD and, (2) to judge the effectiveness of medication.  In most cases it can be used to figure out optimal dosages a child or adult should take (not too much or too little).  Please note: we cannot give you medical advice, that must be done by your physician.  We can, and do, relay the results of this test to your doctor and the great majority of physicians find it useful and act on it.

How we use it:

The TOVA has a "cutting score" of -1.80.  If a person has a score below this number then they are in the range of having ADHD/ADD symptoms.  For example, if a person had an ADHD Score of -5.64 that would considered very impaired because it is lower (more negative) than the cutting score of -1.80.

In our experience we like to see ADHD Scores of +1.0 to +2.0 because at those scores kids and adults commonly enjoy good ability to stay focused and organized.  Children often respond much better to parenting and we frequently have excellent results in training them to study on-task and turn homework in on-time with the Academic Skills Workshop.  

Sample Data

This data shows the advantage of using the TOVA.  In particular, notice that with stimulant medication more is not necessarily better.   In fact, in the table below the higher dosages of medication produce everyone's worst nightmare - higher dosages that produce deteriorating performance.

Dosage

ADHD Score

Comment

 

 

 

None

-5.64

very impaired/has ADHD/ADD

Concerta, 18 mg

-3.06

impaired

Concerta, 36 mg

-1.58

weak normal

Concerta, 54 mg

+2.07

Excellent Attention       (STOP HERE)

Concerta, 72 mg -1.50 back to weak normal
Concerta, 90 mg -4.45 very impaired

Final note

The TOVA is very often a valuable addition to the history and rating scale data we collect about a person with ADHD/ADD.   However, like all tests used by psychologists it has an error rate.  There are times when it is appropriate to disregard these results in the context of all the data in the bigger picture. 

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