Tova

Test of Variables of Attention, or T.O.V.A., is an objective, neuropsychological test that measures a persons sustained and selective attention. The T.O.V.A. is the most widely used objective measure of attention in the world, and is considered the "Gold Standard" among measures of its type. [ Leark, R. A., Greenberg, L. K., Kindschi, C. L., Dupuy, T. R., & Hughes, S. J. (2007). Test of Variables of Attention: Clinical Manual. Los Alamitos: The TOVA Company. ]

Over 150 studies have been done utilizing the T.O.V.A. to detect attention in people with attention disorders and traumatic brain injuries. It is the most widely used commercially available Computerized Performance Test in the world. In addition, The TOVA Research and Education Foundation has provided researchers with the T.O.V.A. to be used in objective assessment of attention at no cost.

Although the T.O.V.A. can accurately identify 87% of normal people, 84% of non-hyperactive ADHD, and 90% of the hyperactive that take the test, the test or its makers never make a claim the test can diagnose medical conditions such as Attention Deficit Disorders or Traumatic Brain Injuries. The test is a tool that the clinician can use along with history, interviews, behavior ratings and symptom checklists to accurately diagnose and treat attention disorders. [ [http://www.vaxa.com/ADHD-tests.cfm ADHD Tests: Knowing how to get a true diagnosis on ADHD] ]

Origins

The T.O.V.A. was developed by Dr. Lawrence Greenberg, Professor Emeritus and former Head of Child and Adolescent Psychiatry at the University of Minnesota, a clinician and a leader in research in Attention Deficit Disorders for over 25 years. [ http://www.counselling.nb.ca/TOVA2.asp T.O.V.A® and T.O.V.A.-A ® ]

Development began back in the mid-1960’s with the first mechanical machine that could test response time. Utilizing tachistoscopic technology, Herman (named after one of the children it was ran on) ran the program VIRTEST (Test of Variability, Inattention, and Response Time), which was designed to randomly present two different geometrical visual stimuli, and the child was asked to press a response button only when they saw the one that was the designated target.

Dr. Greenberg tested the children for 4 different medications utilizing Herman: Chlorpromazine (tranquilizer), Dextroamphetamine (psychostimulant), Hydroxyzine (minor tranquilizer), and Placebo. After each medication was administered he took behavior ratings from “Herman”, the mothers of the child, and the teachers of the child. Although the mothers preferred the tranquilizer, both Herman and the teachers preferred the Dextroapmphetamine. Ironically, the mothers preferred their children to be sleepy and under control which in turn, did not help with attention levels. However, the teachers and “Herman”, showed that the child was still full of energy but able to focus better and learn.

Upon the findings of this study Dr. Greenberg decided that using behavioral ratings alone was too subjective and that the ratings themselves would be influenced by the testing environment and the raters bias. Dr. Greenberg continued to develop an objective means to determine how to help with diagnosis and treatment of those with attention problems. With the advance of computers, the T.O.V.A. was made commercially available in 1991.

Testing

It’s a 21.6 minute test with two types: Visual and Auditory. During the first section of the test, the objective is to measure attention during a boring task. This section is 10.8 minutes long and the target is presented 1 time for every 3.5 times the non-target is presented. The second section of the test is a measure of attention while attending to a stimulating task. This section is also 10.8 minutes long and the target is presented 3.5 times for every 1 time a non-target is presented.

The visual T.O.V.A. uses two simple geometric figures and involves clicking the microswitch when the person taking the test sees the target figure and not clicking when it’s the non-target figure. The visual T.O.V.A. target is a square with a second but smaller square inside of it, near the upper border. The nontarget is a square with the smaller square near the lower border.The auditory test is the same process. The test taker clicks when they hear the target and does not click when they hear the non-target. The target tone is G above Middle C (392.0 Hz) and the non-target tone is Middle C (261.6 Hz).

The test is monochromatic, non-sequential, language and culturally independent. It is presented in both clinical and screening versions. Clinical version is used by health professionals. The screening version has no diagnostic terms and is used by school-based professionals.

coring & Variables

The T.O.V.A. measures 8 different variables to measure whether or not response times and attention is at the normal range for the sex and age of the test taker. Over 2000 normal people without attention problems, were measured to determine what is normal response times for the sex and age of the test taker as a basis for the interpretation provided.

*Response Time Variability: A time measurement of how consistently the microswitch is pressed.
*Response Time: A time measurement of how fast or slow information is processed and responded to.
*d’ Signal Detection: A time measurement of how fast performance drops.
*Commission Errors: A measure of impulsivity: how many times the non-target is pressed.
*Ommission Errors" A measure of inattention: how many times is the target not pressed.
*Post-Commission Response Time: A time measurement of how fast or slow a response is after a commission Error.
*Multiple Responses: A measure of how many times the button is pressed repeatedly. (Indicator of other problems)
*Anticipatory Responses: A time measurement how often a person is guessing rather than responding.

Unlike any other CPT's commercially available, The T.O.V.A. uses a microswitch to record responses. Due to the fact that 5 out of 8 of the determining factors are time based, any delay can severely affect the scoring of the user. The microswitch is used because it can obtain very accurate time measurements (±1 msec). Computer keyboards and mouses, are not as reliable and can vary significantly (±28 msec).

References

See also

* Continuous Performance Task
* Attention-deficit hyperactivity disorder
* Adult attention-deficit disorder

Further reading

* [http://www.tovatest.com/adhd/ ADHD and T.O.V.A.]
* Chae, P. K. (1999). Correlation study between WISC-III scores and TOVA performance. Psychology in theSchools, 36(3), 179-185.
* Fitzgerald, R. L. (2001). Statistical reliability of the T.O.V.A.RTM test of variables of attention. DissertationAbstracts International: Section B: The Sciences and Engineering, 61 (7-B), 3895.
* Greenberg, L. M., & Waldman, I. D. (1993). Developmental normative data on the test of variables ofattention (T.O.V.A.). Journal of Child Psychology and Psychiatry, 34(6), 1019-1030.
* Leark, R. A., Wallace, D. R., & Fitzgerald, R. (2004). Test-retest reliability and standard error ofmeasurement for the test of variables of attention (T.O.V.A.) with healthy school-age children. Assessment,11(4), 285-289.
* Li, X., & Wang, Y. (2000). A preliminary application of the test of variables of attention (TOVA) in china. [Chinese] . Chinese Mental Health Journal, 14(3), 149-152.
* Mann, J. B. (1997). Assessment of ADHD: Does the addition of continuous performance tests, memorytests, and direct behavioral observations enhance informants' ratings of the child? Dissertation AbstractsInternational: Section B: The Sciences and Engineering, 58 (5-B), 2688.