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ADHD Testing & Evaluation at Grace Health Services in VA & D.C.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by symptoms of inattention, hyperactivity, and impulsivity. An accurate ADHD diagnosis is important as it allows you to access the appropriate support and treatment to effectively manage your symptoms and improve your quality of life.

The Test of Variables of Attention (TOVA) is a computerized assessment tool commonly used to help diagnose ADHD. By measuring attention-related abilities, such as sustained attention, impulsivity, and response time variability, the TOVA provides objective data that complements other diagnostic information.

ADHD Testing & Evaluation
TOVA test for ADHD

TOVA is a continuous performance test (CPT) used to evaluate attention-related difficulties and symptoms associated with ADHD

By presenting visual stimuli and analyzing your responses, it measures the following:

  • sustained attention (the ability to maintain focus over time)

  • response time variability (consistency of response speed)

  • impulsivity (tendency to respond hastily without proper consideration)

  • overall attention performance


TOVA then generates performance scores that are used to assess attention-related abilities and aid in diagnosing and treating ADHD

TOVA test for ADHD

Format of TOVA

TOVA is typically administered on a computer and involves a series of visual stimuli, usually presented in the form of letters or shapes.

During TOVA, you observe a computer screen where letters or symbols appear. Your task is to press a button when you see a specific letter while refraining from pressing it for other letters. The test measures your reaction time, response consistency, and error rate.

There are several signs that may indicate a child
should be tested for ADHD. These signs include:

  • inattention

  • hyperactivity

  • impulsivity

  • poor academic performance

  • behavioral problems (difficulty following rules, acting out, or being disruptive in social situations)

  • emotional issues (difficulty managing emotions, frequent mood shifts, or impatience)

  • relationship difficulties

Signs your child should be tested for ADHD

TOVA measure

TOVA measures the following skills:

  • Sustained Attention: assesses your ability to maintain focus and attention over an extended period of time

  • Response Time: measures how quickly you react to specific stimuli presented during the test

  • Response Time Variability: evaluates how consistently you’re able to respond at a steady pace

  • Impulsivity: assesses your tendency to respond hastily or impulsively without proper consideration

  • Attention Performance: provides an overall assessment of your attention abilities

The Test of Variables of Attention T.O.V.A

The T.O.V.A. is a medical device that aids in the assessment of, and evaluation of treatment for, attention deficits, including ADHD.

The T.O.V.A. is used by healthcare professionals to measure key variables of attention and inhibitory control that are the building blocks for our ability to focus, think effectively, and develop healthy relationships.

Relation between TOVA & ADHD

TOVA doesn’t directly determine ADHD on its own but rather serves as a diagnostic tool alongside other clinical evaluations. It provides objective data on attention-related abilities like sustained attention and impulsivity.

By combining TOVA results with a comprehensive evaluation that includes clinical interviews, behavioral observations, and medical history, healthcare professionals gain a better understanding of your attention-related skills, leading to a more accurate ADHD assessment.

Relation between TOVA & ADHD

Is TOVA reliable?

TOVA is recognized as a dependable tool for assessment, offering objective, standardized evidence. Studies indicate that individuals with authentic ADHD display distinct responses in Continuous Performance Tests (CPTs) compared to those without ADHD, affirming the validity of these tests. For instance, a 2007 study in Taiwan examined the effectiveness of TOVA in diagnosing ADHD.

It compared the performance of 31 children diagnosed with ADHD against 30 children with typical development, using TOVA alongside the Child Behavior Checklist (CBCL), a widely used psychological survey. The findings revealed that the ADHD group had more variable response times, higher ADHD scores, and increased hyperactivity on the CBCL, leading to the conclusion that TOVA is consistent and offers accurate measures of attention and impulsivity.

Furthermore, a 2019 study investigated the possibility of practice effects with TOVA, which refer to performance improvements due to repeated testing rather than actual attentional changes. This study found no significant score variations over time, indicating that TOVA's measures of attention are reliable and not susceptible to practice effects.


Understanding how T.O.V.A. works is pretty simple and interesting! Imagine this: in the visual part of the test, you see different images popping up on a screen. In the auditory part, you hear beeps coming from speakers. Your job is just to respond as quickly and accurately as you can, using a small, easy-to-handle button.

Here's the deal with the timing: both the visual and auditory tests take about 21.6 minutes. But for the little ones, aged between 4 and 5.5 years, there's a shorter version of the visual test that lasts only 10.8 minutes. It's all about making it comfortable for everyone!

During the visual test, two types of images will show up on the screen, and you need to press the button when you see a specific square. In the auditory test, you'll hear two different sound pitches. Your task is to press the button when you hear the higher pitch.

After you complete the test, T.O.V.A. compares your reactions to what's typical. This helps to understand how your responses fit into the bigger picture. Plus, T.O.V.A. also compares your results with those from people diagnosed with ADHD. But remember, this comparison doesn't mean a diagnosis. Only qualified medical professionals can diagnose ADHD, and they should be the ones looking at your T.O.V.A. results. So, think of T.O.V.A. as a helpful tool in the bigger process of understanding attention and response patterns!

Let’s get you the care you deserve!

​Our certified providers at Grace Health Services in VA & D.C. are dedicated to understanding and treating a variety of mental health challenges. Drawing from both modern research and years of hands-on experience, we aim to provide nothing but the finest care from the moment of diagnosis.

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