Three ADHD Tests Prove Computerized Technology Vital Tool for Clinicians

The National Psychologist

November/December 1995

Larry D. Rosen, Ph.D.


Recent computerized psychological instruments on Attention Deficit/Hyperactivity Disorder (ADHD) provide abundant proof that ever-improving computerized test technology assures a more efficient office for psychologists.

The Connors Continuous Performance Test, the IVA Computerized Visual and Auditory Performance Test, and the Test of Variables of Attention Continuous Performance Test (TOVA) -- three excellent instruments -- are evidence that computerized testing has become an inseparable tool for the contemporary clinician's organization.

While many assessment instruments have reached the market, the computerized ADHD tests indicate clearly how far the technology has advanced. They show that:

The Conners, IVA and TOVA enable clinicians to make judgments about the existence of ADHD. With repeated administrations, they can monitor the effects of medication.

Each of the three programs is a test of continuous performance that requires the patient to press a button when a target figure is presented. The tests examine response time and errors of both omission (failing to respond to a target) and commission (responding when there is no target). From there, the tests differ widely as may be seen in the subsequent alphabetically-ordered descriptions. Each test has demonstrated both high reliability and strong validity.

Conners' Continuous Performance Test

The Conners presents a single letter in the middle of the computer screen. If the letter is an X, the patient does not press the space bar. If it is any letter other than an X the patient is asked to press the space bar.

The program takes 14 minutes to complete and then produces an 11-page report that includes a short interpretation, plus graphs and text comparing the patient to the general population in many easily understood T-scores. The Conners also can compare the patient to a population of ADHD children and adults. Conners' interpretations are generated from comparisons with a database of 520 children and adults from the general population and/or 670 members of a clinical sample of ADHD adults and children. The 110-page plus manual presents summaries of many research studies using the Conners (more than either of the others).

The Connors runs on IBM-Compatible machines with a DOS operating system and costs $495 for unlimited usage. For $35 the clinician can preview the Conners and its manual and use it with five patients. Those who like it you can credit the $35 toward your purchase. (Available through Multi-Health Systems: Customer Service 800-456-3003; Support 800-496-8324).

The IVA Computerized Visual & Auditory Continuous Performance Test

The IVA also requires the patient to press a button (in the IVA you press the mouse button) only for specific characters. The characters are a "1" and a "2" and half are presented visually (on the computer screen) and the other half audible to sound through the computer's speaker for 13 minutes. This addition of the audible dimension makes the IVA unique in being the only one of the three to identify adults and children who have problems with auditory attention.

Since most computers come with a SoundBlaster card, they are ready for the IVA. If you have an older computer you will need a SoundBlaster card (less than $200) or if you plan to use a laptop you will need a Port-Able Sound kit (also less than $200).

The IVA uses a large database of 781 adults and children to identify visual and auditory impulsivity, inattention and hyperactivity. The IVA includes a professional manual with two parts, one showing how to run the IVA and the other how to interpret it. The IVA runs on IBM-Compatible machines (DOS) and costs $598 for the first 25 test administrations and $75 for each additional 25 administrations. For $25 you can purchase a demonstration model that emulates the IVA without needing a sound card. If you like what you see (and hear) you can credit the $25 to your purchase price. Several research studies are included in the price of either the manual or the preview version. (Braintrain 800-822-0538)

Tests of Variables of Attention Continuous Performance Test (TOVA)

The TOVA makes three changes in the strategies of the Conners and the IVA. First, it uses non-language based visual targets and distracters (a large rectangle with a square either at the top or the bottom). Second, it uses two different response sets - one where the target appears infrequently to assess boredom and another where the target appears often to assess inhibition. Third, it is available for IBM-Compatibles and Macintosh computers.

The TOVA is appreciably longer than either of the others (22 minutes) and uses a special microswitch that makes the response times more accurate. The TOVA has normative data on 2,200 adults and children from which it generates a three-to-four page report. Two manuals are provided, one for administration and one for interpretation. The latter includes summaries of studies using the TOVA. The TOVA costs $495 for the software, hardware and the first five tests and $25 each for additional tests. (Universal Attention Disorder 800-729-2886).


So, what distinguishes these tests from one another? Quite honestly, after taking all three myself, they look and feel quite different. The TOVA seemed quite long, taking 22 minutes. The first half dragged -- no surprise for an instrument which measures boredom tolerance -- while the last half flew by (lots of targets, and, unfortunately for me, lots of false positives). However, because of its length, the TOVA report provided different information than either of the others. The IVA and Conners only take 13-14 minutes. The reports also varied quite a bit with each providing very different information. However, all three came to the same conclusions about me. (What they found shall remain a secret, but medication may be in order.)

So, what criterion should you use to choose one of these commendable tests? You have to decide what means the most to you. If price is critical, examine the costs closely, and estimate how many tests you think you will administer. If quality of the report is important, ask to see a copy of a sample report from each company. They should send you one gratis.

Support is a critical feature for any software. To assure satisfaction, try each of the 800 phone numbers and ask to talk to a support staff person about his/her role. The IVA and TOVA are the only products of the companies that distribute them. The Conners is distributed by MHS which publishes numerous assessment measures. As such, the IVA and TOVA support is more personal. IVA support, for example, is provided by either the test developer or his wife. The developer even provides his beeper number (an 800 number, too) for emergency support. TOVA support staff are equally personable and responsive. When I had a question about interpretation of my profile, I left a message and received a quick response. MHS, the Conners distributor, is a much larger company with three technical support staff and one additional support person for nontechnical issues such as interpretation. Incidentally, both MHS and Braintrain are located on the East coast which means live support is on eastern time while Universal Attention Deficit is on the West Coast time.

Each of these measures can be helpful in determining both the existence of ADHD and the effects of medication on reducing its severity. Each test manual cautions the clinician to use at least two additional sources of information including reports from teachers, parents and/or friends; rating scales; and other measurement tools.


Copyright, 1995, The National Psychologist. Reprinted with permission. The National Psychologist is a privately-owned bimonthly newspaper which may be purchased for $30 a year. Write or call: TNP, 6100 Channingway Blvd., Suite 303, Columbus, OH 43232; telephone: 614.861.1999 or fax with Visa or MC to 614.861.1996.