TOVA - Continuous Performance/Attention Test




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Annotated Bibliography

An annotated bibliography of research studies using the T.O.V.A. ™

PLEASE NOTE: This is not a comprehensive list. If you would like to submit an article abstract or reference, we encourage you to email us a copy of the complete study (or even just a reference) for review and possible inclusion in this list.

Balakrishnan, J.D. (1998). Some More Sensitive Measures of Sensitivity and Response Bias. Psychological Methods, Vol. 3(1), pp. 68-90

In this article, the author proposes a new pair of sensitivity and response bias indices and compares them to other measures currently available, including d' and B of signal detection theory. Unlike d' and B, these new performance measures do not depend on specific distributional assumptions or assumptions about the transformation from stimulus information to a discrimination judgment. With simulated and empirical data, the new sensitivity index is shown to be more accurate than d' and 16 other indices when these measures are used to compare the sensitivity levels of 2 experimental conditions. Results from a perceptual discrimination experiment demonstrate the feasibility of the new distribution-free bias index and suggest that biases of the type defined within the signal detection theory framework (i.e., the placement of a decision criterion) do not exist, even under an asymmetric payoff manipulation.

Gail Burnstein, M.D., Marilyn Carroll, PhD, Ross Crosby, PhD, Amy Perwien, B.A., Frances Go, M.D., & Neal Benowitz, M.D. (1994). Caffeine Effects on Learning, performance, and Anxiety in Normal School-Age Children. Journal of American Academy of Child & Adolescent Psychiatry, 33, 3, March/April, pp. 407-415.

The purpose of this investigation was to study the acute effects of caffeine on learning, performance, and anxiety in normal prepubertal children. Twenty-one children were evaluated in a double-blind, placebo-controlled crossover design. Subjects were studied during four sessions, 1 week apart, under the following conditions: baseline, placebo, 2.5 mg/kg caffeine, and 5.0 mg/kg caffeine. Dependent measures included tests of attention, manual dexterity, short-term memory, and processing speed. Anxiety rating scales were also administered. Saliva samples were analyzed for caffeine levels. Caffeine improved performance on two of four measures of the Test of Variables of Attention and on a test of manual dexterity in the dominant hand. There was a trend toward increased current level of self-reported anxiety after caffeine ingestion than after placebo ingestion. In a small sample size, there was indication that caffeine enhanced performance on a test of attention and on a motor task. Children reported feeling significantly less "sluggish" but somewhat more anxious. Because caffeine is so widely available and frequently consumed by children, these results are important and need replication.

Forbes, Gordon B.(1998). Clinical Utility Of the Test Of Variables Of Attention (TOVA) In the Diagnosis of Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Psychology, Vol. 54 (4), 461-476.

Ability of the Test of Variables of Attention (TOVA) to distinguish between referred children with attention-deficit/hyperactivity disorder (ADHD) and other (OTHER) clinical diagnoses were studied. The ADHD group differed from the OTHER group on TOVA variables and most measures from the Revised Conners Teaching Rating Scale (RCTRS) and ADD-H Comprehensive Teacher’s Rating Scale (ACTeRS). The criteria of any one TOVA variable >1.5 standard deviations from the age and sex adjusted means correctly identified 80% of the sample with attention deficit disorders and 72$ of the sample without attention deficit disorder. Cases misclassified by teacher ratings were often correctly classified by the TOVA and conversely. The TOVA makes a unique and important contribution to diagnostic evaluations. (c)1998 John Wiley & Sons, Inc.

Lawrence M. Greenberg, M.D., Ross D. Crosby, PhD (1992). The assessment of Medication Effects in Attention Deficit Disorder Using the Test of Variables of Attention (T.O.V.A. ™®) Manuscript submitted for publication.

Although psychostimulants are frequently used to treat children with attention deficit disorders (ADD), there are few reliable and objective means of predicting and determining treatment outcome. In addition to behavioral ratings, continuous performa nce tests (CPT) are increasingly being used by clinicians to determine treatment effects. Two experiments are reported in which the Test of Variables of Attention (T.O.V.A. ™) a computerized visual CPT developed specifically for use with ADD, is the depen dent variable to determine its usefulness to assess outcome of methylphenidate (MPH) treatment of children with ADD and to predict (by means of a single challenge dose) which children would be MPH responders. The findings clearly support the use of the T .O.V.A. as part of the clinician's data base.

Lawrence M. Greenberg, M.D., Ross D. Crosby, PhD (1992). A Summary of Developmental normative Data on the T.O.V.A. ™® Ages 4 to 80+. Unpublished manuscript.

The Test of Variables of Attention (T.O.V.A. ™)is a nonlanguage based continuous performance test (CPT) that is used in the diagnosis, prediction and determination and monitoring of the efficacy of pharmacotherapy of children and adults with attention deficit disorders (ADD). A previous report presented the norms for the T.O.V.A. ™ for 775 children, ages 6 to 16. This report presents the norms for children ages 4-5, for adults age 19 to 80+, and expands the data base for 6-18 year olds.

Lawrence M. Greenberg & Irwin D. Waldman, PhD (1993). Developmental Normative Data on The Test of Variables of Attention (T.O.V.A. ™®). Journal of Child and Adolescent Psychiatry, 34, 6, pp. 1019-1030.

In the present report, we discuss the development of the Test of Variable of Attention, or T.O.V.A. ™® (formerly known as the MCA), outline its distinctive features and advantages as compared with similar measure, and present developmental normative dat a on a sample of 775 children ages 6 to 16. The T.O.V.A. ™ is an easily administered, 23-minute fixed-interval visual Continuous Performance Test that is not language-based and requires no left-right discrimination. One of two easily discriminated visual stimuli is presented for 100 msec every 2 seconds. The designated target is presented on 22.5% of the trials during the first half of the test and on 77.5% of the trials during the second half.

The T.O.V.A. ™ indices include: 1) omission errors, 2) commission errors, 3) mean response time for correct responses to the target, 4) standard deviation of response time for correct responses to the target, 5) multiple responses, and 6) anticipatory responses. These indices are recorded for each quarter of the test, thereby allowing users to examine the effects of practice or fatigue on inattention and impulsivity.

Attention and impulse control appeared to develop in a non-linear manner, with rapid changes early in childhood and a leveling off during later childhood and early adolescence. Sex differences were present on a number of T.O.V.A. ™ indices, especially at younger ages, suggesting that sustained attention and impulse control may develop later in males than in females although the developmental course for these abilities appeared to be similar in both sexes. A number of T.O.V.A. ™ indices varied strongly across the two halves of the test and from first to second quarter within each half indicating that the level of response demands as well as the level of fatigue significantly affected task performance. The T.O.V.A. ™ appeared to reflect developmental changes in attention and impulse control and may serve as a sensitive barometer of a child's attention and impulse control relative to age-appropriate norms. Findings to be presented elsewhere suggest that the T.O.V.A. ™ may be particularly useful measure of inattention and impulsivity in clinical settings. The developmental norms presented herein add significantly to its clinical utility.

Lawrence M. Greenberg & Irwin D. Waldman (1992). Inattention and Impulsivity Discriminate Among Disruptive Behavior Disorders. Manuscript submitted for publication.

Disruptive behavior disorders (e.g., Attention-Deficit Hyperactivity Disorder, or ADHD; Undifferentiated Attention-Deficit Disorder, or UADD; and Conduct Disorder, or CD) are among the most common childhood behavior problems, both in clinical and non-clinical populations, yet distinguishing among these problems remains difficult. In this study we demonstrate that laboratory measures of inattention and impulsivity can clearly distinguish among different disruptive behavior disorders. Subjects included 75 ADHD, 33 UADD, and 17 CD patients and 775 non-disordered comparison children. Subjects were tested on a measure of inattention and impulsivity, the Test of Variables of Attention (T.O.V.A. ™®), a 23-minute, fixed-interval Continuous Performance Test (CPT). Consistent with a priori hypotheses, 1) the ADHD and UADD groups were more inattentive than the CD and non-disordered groups, 2) the ADHD group was more inattentive than the UADD group, 3) the ADHD and CD groups were more impulsive than the UADD and non-disordered groups, and 4) the UADD group was more inattentive than the non-disordered group nor more impulsive than the ADHD group. These group differences remained after controlling for sex an age, but some of the differences varied by age. These findings suggest that clear and meaningful distinctions can be made among children with different disruptive behavior disorders on the basis of inattention and impulsivity. The findings also suggest that T.O.V.A. ™ assessments of inattention and impulsivity can be very useful in such group discrimination, as well as in understanding the underlying difficulties characteristic of the different disorders.

Lawrence M. Greenberg, M.D., Ross D. Crosby, Ph.D., & Richard L. Blade, PhD (1994). Attention Deficits in Incarcerated Youth -- A Preliminary Report. Paper presented at the International Association for Child and Adolescent Psychiatry and Allied Professions, July 28. San Francisco, CA.

Using the Test of Variables of Attention (T.O.V.A. ™), 70% OF 92 incarcerated youth were found to have sufficient attentional problems to warrant clinical assessment and consideration for treatment. Since these findings lead us to expect that incarce rated youth are at significantly far greater risk than nonincarcerated youth, we recommended that they be routinely screened for attention deficits.

Lawrence M. Greenberg, M.D., Ross D. Crosby, PhD (1992).Specificity and Sensitivity of the Test of Variables of Attention (T.O.V.A. ™®). Manuscript submitted for publication.

The Test of Variables of Attention (T.O.V.A. ™) is a standardized, visual Continuous performance test of attention. Sensitivity and specificity data are presented on the ability of the T.O.V.A. ™ to correctly classify 73 attention-deficit hyperactivity d isorder children and 775 normal controls. Results support the utility of the T.O.V.A. ™ both as a screening device in school settings and as a diagnostic tool for the clinician.

Cheri Hansen, M.S., Danielle Weiss, M.S., Cynthia G. Last, PH.D. (1999). ADHD Boys in Young Adulthood: Psychosocial Adjustment. ADHD Boys In Young Adulthood. pp. 165-171

Objective:To prospectively examine psychosocial functioning in young adulthood in children with attention-deficit/hyper-activity disorder (ADHD). Method:This 10-year prospective study compared psychosocial functioning in 18 young adult men in whom ADHD had been diagnosed in childhood and 18 male controls who had never been psychiatricaly ill. Subjects' average age was 21 years at follow-up. Interviews assessed subjects' educational, occupational, residential, and marital status; utilization of mental health services; and psychological status. Results: Young adults with ADHD were significantly more likely than controls to be using mental health services, to report psychological problems, and to have fathered children. In addition, a trend indicated that young men ADHD were more likely to have dropped out of high school but subsequently attained a graduate equivalency diploma. There was also a trend for young adults with ADHD to report a greater history of trouble with the law; however, the groups did not differ on current legal problems. Conclusions: Overall, these young adults with ADHD appear to have overcome educational and legal difficulties experienced during high school. However, continued problems in psychological functioning appear to persist into young adulthood. Key Words: attention-deficit/hyperactivity disorder, prospective, functioning, adjustment.

Henry S.R. Kao, Kenneth Leung, Grace Tam, Gao Ding-guo. Effects of Physical and Mental Practice of Chinese Calligraphy and Viewing on Visual-spatial Ability and Reaction Time.

This study had two objectives: (1) to probe the changes of reaction time after either real or mental Chinese calligraphy writing: (2) to find out the changes in visual-spatial ability after mentally writing Chinese calligraphy. Reaction time of undergraduate students significantly dropped after real writing of Chinese calligraphy but insignificantly after mental writing. The 2-D and 3-D visual-spatial abilities of the eighth-grade students were significantly enhanced after mentally practicing Chinese calligraphy. On the contrary, students who read Chinese stories or had a rest did worse in the post-treatment test than in the pre-treatment test.

S. Louise Norris, PH.D., Ching-tse Lee, PH.D., Juan Cea, and Dmitry Burshteyn. (1998). Performance Enhancement Training Effects on Attention: A Case Study. Journal of Neurotherapy. pp. 19-25

The purpose of this case study was to evaluate the effects of alpha-increase biofeedback training on human attention. A healthy twenty-three year old male college student had undergone twenty-three sessions of alpha increase biofeedback (8-13 Hz) at PZ electrode site for a period of eleven weeks. Pre-and post-visual TOVA CPT test was administered to assess the changes in reaction times and their variability. QEEG evaluation was conducted prior as well as upon the completion of the study. The results of the TOVA test clearly indicate an improvement in individual's reaction time variability. Statistical analysis showed that before and after QEEG evaluations were within normal limits.

Mark Reader, Emily Harris, Linda Schuerholz, & Martha Denckla (1994). Attention deficit hyperactivity and executive dysfunction. Developmental Neuropsychology, 10 (4): 493-512.

To evaluate the relationships between attention deficit hyperactivity disorder (ADHD) and executive functionings (EF) a sample of ADHD children (N-48) with above average IQs (median=117.5) was administered a battery of standardized norm-referenced t ests sensitive to EF. Below average performance was found on the Wisconsin Card Sorting Test and continuous performance test (Test of Variables of Attention, T.O.V.A. ™) but not on Word Fluency or the Rey Complex Fihure. Significant intraindividual discre pancies were found for a selected pair of content-matched tests that differed in EF task demands. Pennington, Groisser, and Welsh's (1993) "double dissociation" of ADHD and reading disability (RD) was tested by examining the EF performance of ADHD with a nd without RD. No significant differences between ADHD/no-RD and ADHD/RD were found on any of the EF measures.,

Elsa G. Shapiro, PhD, Meryl E. Lipton, MD, & William Krivit, MD, PhD (1992). White matter dysfunction and its neurological correlates: A longitudinal study of a case of metachromatic leukodystrophy treated with bone marrow transplant. Journal of Clinical and Experimental Neuropsychology, 14 (4):610-624.

A 10-year-old white female who had received a bone marrow transplant (BMT) at 57 months of age as treatment for late infantile onset metachromatic leukodystrophy (MLD), a neurodegenerative autosomal recessive storage disease, showed stabilization of the cognitive degenerative process and demonstrated a partial pattern cognitive deficits and behavioral abnormalities that has been called NLD (nonverbal learning disabilities) associated with white matter disease. A pattern of good rote memory, reading skills, and concrete language contrasted with poor visual spatial skills, mathematics, and abstract problem solving. She did not show usual speech prosody and social deficits associated with NLD.

Elsa G. Shapiro, PhD, Lawrence A. Lockman, MD, David Knopman, MD, & William Krivit, MD, PhD (1994). Characteristics of the dementia in late-onset metachromatic leukodystrophy. Neurology, 44 (April): 662-665.

Patients with metachromatic leukodystrophy (MLD) of juvenile or adult onset present with behavioral abnormalities. In nine patients, diagnosed between ages 11 and 33 years, behavior and neuropsychological test results disclosed a pattern of dementia combining features associated with both frontal and white matter abnormalities. All the patients had been considered to have a psychiatric disorder prior to the diagnosis of MLD, even though none had any of the cardinal features of schizophrenia or other major psychosis. Early diagnosis of late-onset MLD is important to provide access to appropriate effective therapy.

Elsa G. Shapiro & Kimberly A. Klein (1994). "Dementia in Childhood: Issues in Neuropsychological Assessment with Application to the Natural History and Treatment of Degenerative Storage Diseases. Chapter 4: In Tramontana, M, & Hooper, S.R. (Eds). Advances in Child Neuropsychology Vol. III. PP. 119-171

This chapter is about childhood dementia, a topic that has not received much attention from pediatric neuropsychologists. Many neuropsychologists are unfamiliar with disorders tat result in loss of mental function in children, and commonly, early dea th. They are rare disorders and many child neuropsychologists may spend an entire career without seeing such children. Furthermore, there are increasing numbers of cases being identified with childhood dementia from pediatric HIV and from neurotoxins. The need to document the course of these various childhood disorders and the outcomes of treatment from a neuropsychological perspective, and the unique opportunity these disorders afford to further our knowledge of developmental changes in brain-behavior relationships necessitate careful study of the characteristics of childhood dementia.

Martin Teicher, MD, PhD, Yutaka Ito, MD, PhD, Carol Glod, PhD, & Natacha Barber, MD (1996) "Objective Measurement of Hyperactivity and Attentional Problems in ADHD". Journal of American Academy of Child Adolescent psychiatry, March, 35:3, PP. 334-342.

Objective: To precisely describe movement abnormalities in seated children with attention-deficit hyperactivity disorder (ADHD) while they were engaged in a continuous performance task (CPT). Method: Diagnoses were made by using structured intervie ws (Schedule for Affective Disorders and Schizophrenia for School-Age hildren-Epidemiologic Version) and DSM-IV criteria. Movement patterns of 18 boys with ADHD (9.3+2.4 years) and 11 normal controls (8.6 + 1.8 years) were recorded using an infrared moti on analysis system that tracked the position of four markers 50 times per second to a resolution of 0.04 mm. Results: Boys with ADHD moved their head 2.3 times more often than normal children 9p<.002), moved 3.4 times as far (<.01), covered a 3.8-fold greater area (p<.001), and had a more linear and less complex movement pattern (p. 00004). They responded more slowly and with greater variability on the CPT. Compexity of head movement and variability in response latency significantly correlated with teacher ratings. A predefined composite of movement and attention discriminated 16 - 18 patients from 11 of 11 controls. Conclusions: The relative inability of boys with ADHD to sit still can be objectively verified, and 'fidgeting' apears to consist of more frequent, larger amplitude, whole body movements.

Gail Tripp, PH.D.., Siu L. Luk, MD, Elizabeth A. Schaughency, PH.D., and Rajiv Singh, MD, (1999). ADHD and Hyperkinetic Disorder. pp.156-164

Objective: To examine directly the extent to which ICD-10 hyperkinetic disorder and DSM-IV attention-deficit/hyperactivity disorder (ADHD) identify the same children with the same difficulties. Method: Participants were children referred for symptoms of overactivity, inattention, and impulsivity, and a normal control group. Diagnostic criteria for ICD-10 hyperkinetic disorder and DSM-IV ADHD were applied retrospectively. Four groups were identified: hyperkinetic disorder and ADHD (n=21), ADHD only (n=22), clinic control (n=15), and normal control (n=19). The groups were compared on measures reflecting the central characteristics of ADHD, neurodevelopmental functioning, academic, and cognitive functioning. Rates of conduct disturbance were similar in both ADHD groups. Conclusions: DSM-IV criteria identify a broader group of children than those identified by ICD-10. However there is substantial overlap between the groups formed with these different criteria. Key Words: DSM-IV, ICD-10, attention-deficit/hyperactivity disorder, hyperkinetic disorder.

Chandan J. Vaidya, Glenn Austin, Gary Kirkorian, Hugh W. Ridlehuber, John E. Desmond, Gary H. Glover, and John D. E. Gabrieli (1998).

Selective effect of methylphenidate in attention deficit hyperactivity disorder: A functional resonance study. Proc. Natl. Acac. Sci. USA. Vol. 95, pp. 14494-14499 Abstract: Functional MRI revealed differences between children with Attention Deficit Hyperactivity Disorder (ADHD) and healthy controls in their frontal-striatal function and its modulation by methylphenidate during response inhibition. Children performed two go/no-go tasks with and without drug. ADHD children had impaired inhibitory control on both tasks. Off-drug frontal-striatal activation during response inhibition differed between ADHD and healthy children: ADHD children had greater frontal activation on one task and reduced striatal activation on the other task. Drug effects differed between ADHD and healthy children: The drug improved response inhibition in both groups on one task and only in ADHD children on the other task. The drug modulated brain activation during response inhibition on only one task: It increased frontal activation to an equal extent in both groups. In contrast, it increased striatal activation in ADHD children but reduced it in healthy children. These results suggest that ADHD is characterized by atypical frontal-striatal function and that methylphenidate affects striatal activation differently in ADHD than in healthy children.

Arthur S. Walters, Davie E. Mandelbaum, Daniel S. Lewin, Steven Kugler, Sandra J. England, Micheal Miller, and the Dopaminergic Therapy Study Group (2000). Dopaminergic Therapy in Children with Restless Legs/Periodic Limb Movements in Sleep and ADHD. Pediatric Neurology. Vol. 22. No. 3, pp. 182-186.

The long term effects of monotherapy with levodopa or dopamine agonist pergolide on the motor/sensory, behavioral, and cognitive variables in seven children with restless legs syndrome/periodic limb movements in sleep (RLS/PLMS) and attention-deficit-hyperactivity disorder (ADHD) were investigated. Five of the seven children had previously been treated with stimulants that had either been determined to be ineffective or to have intolerable side effects. Dopaminergic therapy improved the symptoms of RLS and reduced the number of PLMS per hour of sleep (P=.0.018) and associated arousals (P=0.042) for the entire group. After treatment, three children no longer met the criteria for ADHD, and three reverted to normal on the Test of Variable Attention. ADHD improved in all seven measured by the Conners parent rating scale (P <0.04) and the Child Behavior Checklist (P <0.05). A significant improvement also occurred in the visual, but not verbal, memory scores on the Wide Range Assessment of Memory and Learning (P <0.001). Five of seven children continue on dopaminergic therapy 3 years after treatment initiation, with good response. We postulate that the improvement in ADHD may be the result of the amelioration of RLS/PLMS and its associated sleep disturbance. Alternatively, ADHD and RLS/PLMS may share a common dopaminergic deficit.

Lisa L. Weyandt, John A. Rice, Ian Linterman, Linda Mitzlaff, and Erik Emert. (1998).Neuropsychological Performance of a Sample of Adults With ADHD, Developmental Reading Disorder, and Controls. Developmental Neuropsychology, 14(4), pp. 643-656

In this study, we investigated the performance of adults with Attention Deficit Hyperactivity Disorder (ADHD), relative to adults with Developmental Reading Disorder (DRD), and controls on a battery of executive function tasks (Wisconsin Card Sorting Test [WCST], Test of Variables of Attention, Tower of Hanoi, and Ravens Progresive Matrices) and several self-report ADHD rating scales (Wender Utah Rating Scale, Patient Behavior Checklist, and Adult Rating Scale). Sixty-four participants took part in the study (21 with ADHD, 19 with DRD, and 24 controls). Kruskall-Wallis one-way analysis of variance results revealed a significant difference between groups, with the DRD group committing more WCST errors (total and preseveration) than the remaining groups. Group differences were also found on the ADHD ratings scales, with the ADHD group reporting higher ratings. Discriminant Function Analyses (using the rating scales and the neuropsychological tasks) correctly classified 67% and 44% of the cases, respectively. The psychometric properties of the ADHD rating scales were also explored.

Keith Owen Yeates, ph.d., Joseph Luria, MD, Henry Bartowski, MD, Jerome Rusin, MD, Lisa Martin, MD, Erin D. Bigler, ph.d., (1999) Postconcusive Symptoms in Children wih Mild Closed Head Injuries. Journal of Head Trauma Rehabilitation., pp. 337-350

Objective: To examine the incidence and neuropsychological, behavioral, and neuroimaging correlates of postconcussive symptoms (PCS) in children with mild closed injuries (CHI). Design: 26 Children with mild CHI and 8 of their uninjured siblings, from 8 to 15 years old, were recruited prospectively and assessed at baseline (i.e., within 7 days of injury) and at 3 months postinjury. Parents rated PCS, motivation and affective liability, and behavioral adjustment. Baseline ratings assessed premorbid functioning retrospectively, and follow-up ratings assessed postinjury status. On both occasions, children completed neuropsychological testing, and those with mild CHI also underwent magnetic resonance imaging (MRI). Results: Children with mild CHI did not differ from siblings in the baseline ratings of premorbid PCS but displayed higher ratings on several PCS at 3 months postinjury. Thirty-five percent of children with mild CHI showed increases in PCS, compared with baseline premorbid ratings, but none of the siblings did so.Children with mild CHI whose PCS increased from premorbid levels showed poorer neuropsychological functioning at baseline than did children whose PCS did not increase, although the differences had partially resolved by 3 months. They also displayed decreased motivation over time. Their behavioral adjustment was poorer and they had smaller white matter volumes on MRI, but the latter differences were present at baseline and did not change over time, suggesting that they existed prior to the injury. Conclusions: Postinjury increases in PCS occur in a sizable minority of children with mild CHI and more often than among uninjured siblings. Increases in PCS following mild CHI are associated with premorbid neurological and psychosocial vulnerability, but also with postinjury decrements in neuropsychological and neurobehavioral functioning.

A.M. Yellin (1980). A Standard Visual Stimulus for Use in Studies on Attention- Deficit Disorders: Toward the Development of Standardized Sustained and Selective Attention Tests. Research Communications in Psychology, Psychiatry, and Behavior, 5, pp. 137-143.

A visual stimulus if proposed for use in studies of attention and reaction-time and for assessing medication effects, especially in Attention Deficit Disorders (with and without hyperactivity). The advantages of the proposed stimulus are detailed in light of the desirability of developing and norming standardized sustained and selective attention and vigilance tasks that could be used routinely in many clinics.

Additional Studies and Articles

Absalom M. Yellin, John H. Hopwood and Lawrence M. Greenberg (1982). Adults and adolescents with attention deficit disorder (ADD): Clinical and behavior responses to psychostimulants. Journal of Clinical Psychopharmacology, 3:133-136.

W.D. Erickson, Absalom M. Yellin, John H. Hopwood, G. R. Realmuto and Lawrence M. Greenberg (1984). The effects of neuroleptic on attention in adolescent schizophrenics. Biological Psychiatry, 19:745-753.

Lawrence M. Greenberg (1987). An objective measure of methylphenidate response: Clinical use of the MCA. Psychopharmacology Bulletin, 23:279-282.

Nancy Raymond, Ross D. Crosby, Clifford L. Corman and Lawrence M. Greenberg (1993). Determining Optimal Dose of Methylphenidate. Manuscript submitted for publication.

Lawrence M. Greenberg (1994) Attention deficit disorders in adults. Employee Assistance, March, vol.6, 8, 31-34.

Ervin Betts, PhD. (1995). The use of technology in family psychology. The Family, Spring: 32.

Steven Gordon, & Michael Asher (1994). Meeting the ADD Challenge: A Practical Guide for Teachers. Research Press: Chanpagin, Il.v

Martin Baren,MD, & James M. Swanson, PhD (1996). How not to diagnose ADHD. Contempary Pediatrics. November: pp. 53-64

Ervin Betts, PhD. (1995). The use of technology in family psychology. The Family, Spring: 32.

Michael J. Boivin, & Laura S. Grillo (1997). Two Report Summaries (Abridged). West African Research Association Newsletter. Summer: pp. 16-17

Richard J. Degrandpre. (1999). Just Cause?. The Sciences. pp. 14-18

W.D. Erickson, Absalom M. Yellin, John H. Hopwood, G. R. Realmuto and Lawrence M. Greenberg (1984). The effects of neuroleptic on attention in adolescent schizophrenics. Biological Psychiatry, 19:745-753.

Steven Gordon, & Michael Asher (1994). Meeting the ADD Challenge: A Practical Guide for Teachers. Research Press: Chanpagin, Il.

Lawrence M. Greenberg (1987). An objective measure of methylphenidate response: Clinical use of the MCA. Psychopharmacology Bulletin, 23:279-282.

Nancy Raymond, Ross D. Crosby, Clifford L. Corman and Lawrence M. Greenberg (1993). Determining Optimal Dose of Methylphenidate. Manuscript submitted for publication.

Lawrence M. Greenberg (1994) Attention deficit disorders in adults. Employee Assistance, March, vol. 6, 8, 31-34.

Absalom M. Yellin, John H. Hopwood and Lawrence M. Greenberg (1982). Adults and adolescents with attention deficit disorder (ADD): Clinical and behavior responses to psychostimulants. Journal of Clinical Psychopharmacology, 3:133-136.

Alan J. Zametkin, M.D., & Monique Ernst, M.D., PhD. (1999). Problems in the Management of Attention-Deficit-Hyperactivity Disorder. The New England Journal Of Medicine. January: pp. 40-48

Conference Presentations

Moore, J.J. , Riccio, C.A., Reynolds, C.R., & Lowe, P.A. (1998). How Drug Use Affects CPT Outcomes: Diagnosis and Misdiagnoses in the Presence of Licit and Illicit Substances. [Abstract]. Presented at the Annual Meeting of the National Association of Neuropsychologists, Washington, DC. pp. 1-8

Continuous Performance Tests (CPT) are used frequently to study the impact of pharmacological treatment on attention and impulsivity. The purpose of this integrated synthesis is to investigate the effects of various medications on attention and impulsiveness as measured by continuous performance tests (CPT) and evaluate the effectiveness of these instruments in monitoring the effects of such treatment. From over 400 studies including CPTs, those focusing on psychopharmacological effects were selected for review. Results varied on the impact or effect of the different drug families on reaction time, and commission and omission errors. Although various versions of the CPT(auditory, visual, or both) were used, the majority of the research supported performance improvements on the CPT with the use of psychostimulants. Many studies also investigated the effectiveness of drugs from the neuroleptics, anti-psychotic, anti-anxiety, anti-depression, and epileptic medication families; some compared the effects of these different drug types with the effects of psychostimulants. Some research supported improved CPT performance with anti-anxiety and anti-depressant drugs. Use of medication from other categories had little to no effect on CPT scores. The effects on attention and impulsivity of various substances such as opiates, marijuana, LSD, nicotine, and caffeine as well as carbohydrate intake also have been investigated. Implications for use of CPTs in evaluating psychopharmacological effects on attention are discussed.

Dupuy, Tammy R. , (1996). The Prevalence of Attention Deficit Disorders in a Sample of At Risk Middle School Students. [Abstract]. Presented at the 16th Annual National Academy of Neuropsychology, New Orleans, La.

This study examined the prevalence of Attention Deficit Disorder (ADD) in a sample of 54 at risk middle school (7th and 8th grade) students. Literature reviewed revealed overlapping symptomology between at risk and ADD populations, with similar academic, behavioral, and affective problems. Subjects (aged 13-15) were administered the Test of Variables of Attention (T.O.V.A. ™) continuous performance test and an Attention Deficit Disorder-Hyperactivity: Comprehensive Teacher Rating Scale (ACTeRS) as a self report. Teachers also rated the subjects behaviors. Only African-American (n=26) and Hispanic (n=20) data was utilized. Results supported gender differences. Classifications of ADD were Teacher rated ACTeRS=24%; T.OV.A.=30%; and Subject rated ACTeRS=43%. High prevalence of ADD in the at risk suggest screening and treatment is essential. Larger studies needed.

Leark, Robert A., (1998) . Assessment of Temporal Stability for the Test of Variables of Attention: Test/Retest Reliability. Paper presented at the Second European Conference on ADHD, Cambridge, England. April.

Bullock, Wesley A., Hogan, Kathleen E., (1996). Utility of a Continuos Performance Task (the T.O.V.A. ™) in Discriminating ADHD in At-Risk Adolescents. Presented May 3,1996 at the Sixty-Eighth Annual Convention of the Mid-American Psychological Association, Chicago, IL.pp 2-12

Mahone, E.M., Hagelthorn, K.M., Cutting, L., Schuerholz, L.J., Pelletier, S.F., Rawlins, C., & Denckla, M.B. (1998) Developmental Course of Executive Function in High Functioning Children with ADHD. Poster presented at the National Academy of Neuropsychology Conference, Washington, DC. November.

Leark, Robert A., Dixon, Dennis, Hoffman, Tiffany, Huynh, Donna. (1999). The Effects of Malingering on the Test of Variables of Attention (T.O.V.A. ™). Poster presentation for the 19th Annual Academy of Neuropsychology Conference, San Antonio, TX. November 10-13th.

Fuchs, Thomas. Aufmerksameit und Neurofeedback (Attention and Neurofeedback). Unpublished Doctoral Dissertation, Tubiggen University, Tubiggen, Germany. Yeates, K.O., Luria, J., Bartkowski, H., Rusin, J., Martin, L., Bigler, E., D. Johnson, S.C., Anderson, C. (1998) Postconcussive symptoms in children with mild closed-head injuries. Symposium, February.


How much does the T.O.V.A. ™ cost?

T.O.V.A. for Windows XP, Vista (all versions), Windows 7 (all versions), and Mac OS   $895.00

Visual & Auditory T.O.V.A. ™ $895.00- comes with 5 free interpretation credits


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New PLAY ATTENTION Edufeedback system - for Attention, Focus, Concentration, Active and Short Term Memory, Hyperactivity Reduction, Reading Comprehension - uses the same feedback science and technology perfected for NASA astronauts and US Air Force pilots. Time payment plan options available.
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Contact Information:

Allied Products/Biofeedback Instrument Corp.
255 W. 98th Street
New York, N.Y. 10025
Tel. (212) 222-5665 (5667 Fax)