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11  About the T.O.V.A.

11.1  What is the T.O.V.A. ?

See the T.O.V.A. device description (section 8).

11.2  Who uses the T.O.V.A. ?

The T.O.V.A. is used by qualified professionals, such as psychologists, physicians (including psychiatrists, neurologists, pediatricians and family practitioners), physician assistants, researchers, pharmaceutical companies, licensed clinical counselors, nurse practitioners, and clinical nurse specialists.

11.3  What makes the T.O.V.A. unique?

For more information, please see our website at http://www.tovatest.com/.

11.4  How does the T.O.V.A. test work?

It’s quite simple: the visual test flashes stimuli on the screen (or the auditory test beeps stimuli on speakers), and the subject taking the test responds as quickly and as accurately as they can with a small handheld microswitch. This kind of ‘stimulus and response’ test is called a continuous performance test (CPT), and the T.O.V.A. is one of many on the market—the best, we believe!

Both the auditory and visual tests are 21.6 minutes long. (A shorter 10.8-minute visual T.O.V.A. test is administered to subjects ages 4 to 5.5.) The visual test has two simple images that alternately flash on the screen, and the subject presses the button after the correct square. The auditory test has two tones, and the subject presses the button after the higher tone. Both tests are horribly, terribly, inhumanly boring. But this is a good thing because you just can’t fake it with the T.O.V.A. .

The T.O.V.A. takes the subject’s responses and compares them to a study with thousands of ‘normal’ people—that is, people who were screened for attention (and other disorders) and were deemed normal. This is called the T.O.V.A. norming study, and it allows us to figure out where the subject’s responses fall on the ‘bell curve’ of normal. It is critical that the number of people in a norming study is large, and the T.O.V.A. still has the largest norming study of any CPT. The T.O.V.A. also compares the subject’s responses to a study of people diagnosed with ADHD.

These comparisons are not diagnoses! Only a clinician can make a diagnosis. The T.O.V.A. simply aids the clinician with their assessment of attention deficits.

11.5  What does the T.O.V.A. measure?

The T.O.V.A. measures attentional variables—that is, it measures how people respond to a long, boring test. There are over 250 peer-reviewed papers on the T.O.V.A. that show how these variables correspond to attention deficits, and how the T.O.V.A. can be used. See the T.O.V.A. website (http://www.tovatest.com/) for a list of papers published about or using the T.O.V.A. .

In particular, the T.O.V.A. measures these variables (listed in order of importance):

Response Time Variability:
How consistently (or not) a subject responded to the T.O.V.A. stimuli. People without attention deficits respond to the stimuli very consistently, and those who do have an attention deficit tend to not be as consistent.
Response Time:
People with attention deficits tend to respond to stimuli slower than normals.
Commissions:
People with attention deficits tend to make more errors of impulsivity, pressing the button when they shouldn’t.
Omissions:
Most people don’t actually miss any stimuli, although omissions do tend to be higher for those with attention deficits.

11.6  What’s all this about precision timing?

Because response times, and even more importantly, the variability of response times, are the core of any CPT, the T.O.V.A. was designed with very high timing accuracy. Although people respond to stimuli in hundreds of milliseconds, the consistency of response times can be only tens of milliseconds. And because that’s the most sensitive variable in a CPT, it’s crucial that the response timing on a CPT be precise—and reliable.

We like to say that the T.O.V.A. has ‘research-grade’ timing accuracy, because our timing is just that good. But what’s just as important is that the timing is reliable. And so we go out of our way to make sure the T.O.V.A. is a reliable test.

Unfortunately, modern operating systems like Windows, macOS, and most flavors of Linux don’t guarantee reliability when it comes to timing. In fact, they do the opposite: they guarantee that eventually they will introduce latencies and variable delays in timing. Modern operating systems have been designed from the ground up to be reasonably fast for users’ demands, but not to be reliably and consistently fast. Have you ever seen your computer hesitate just a split second before it does what you asked it to do? Happens all the time, right? That hesitation will make any CPT running on these operating systems unreliable.

We realize other people say you can still test in Windows or other modern operating systems, but they’ve never (to our knowledge) objectively measured their timing performance with an external timing validation system. We have. We’ve measured timing reliability under Windows (and Mac OS X), and it stinks.

So how do we get around this timing issue?

The T.O.V.A. has two ways of resolving this:

External Audio/Video (EAV) session
- The T.O.V.A. allows you to run a T.O.V.A. test in your OS, because the timing is managed with precision by the T.O.V.A. hardware. Attach the T.O.V.A. USB device to an external monitor and speakers, and you’ll never have to reboot to run a test!
Precision Test Environment (PTE) session
- The T.O.V.A. reboots to the Precision Test Environment, where you administer the T.O.V.A. test, and then reboots you back to your OS. For many users (for instance, using a laptop without an external monitor), rebooting to the PTE will still be the best solution. See section 34 for more information.

11.7  Why do you charge per test?

We charge per test because we care that you have the very latest in tools to help you improve people’s lives. This may sound like advertising, but we truly do believe it. Your clinical tools should be constantly improving as new research and new ideas comes down the pipeline, and the T.O.V.A. will do this.

So instead of charging you an arm and a leg for the T.O.V.A. and leaving you in the dust as it improves, we instead charge you per test and then give you new versions of the T.O.V.A. for free. Yes, for free. More norms? Free. Improved user interface? Free. New statistics? Free.

Note: There is a charge for the T.O.V.A. hardware–please contact T.O.V.A. customer service for details (section 29).

And we support you like no other testing company can: technical support is free. Whenever you have a question or problem with the T.O.V.A. , contact us and we’ll help you. We’re crazy about supporting our users, so really don’t hesitate to call us if you can’t figure out something about the T.O.V.A. .

And, even more importantly, interpretation support is free. This means we have staff whose job it is to help you interpret T.O.V.A. results. Wondering how to identify malingering? Do you need help understanding how comorbid disorders affect T.O.V.A. performance? Are you baffled by the results of your last subject? Call us! We’ll help you understand it.

So in summary, our per-test charge allows us to provide you with an excellent, constantly evolving test of attention with full customer service. We think that’s a pretty good deal.

11.8  What is the history of the T.O.V.A. ?

The T.O.V.A. has its roots in a 1966 National Institute of Health-funded research project. The equipment that gave that CPT literally took up an entire wall. With the onset of the personal computer, it was ported to the Apple IIe (and called the VIRTEST), then the Macintosh, and finally to DOS and Windows PCs. The T.O.V.A. has over 40 years of ongoing research behind it.

11.9  T.O.V.A. system requirements

11.9.1  Windows installation requirements

11.9.2  Macintosh installation requirements

11.10  What’s in the T.O.V.A. Kit?

The T.O.V.A. kit

The following items should be included in the kit:

Software:
The bootable T.O.V.A. flash drive with T.O.V.A. install and manuals.
Hardware:
The T.O.V.A. USB device , microswitch, and the USB, audio, and video cables.
Manuals:
The T.O.V.A. Installation Guide, the User’s Manual, and the Clinical Manual, in addition to online manuals built into the software.

11.11  How do I use the T.O.V.A. ?

We have a whole section about devoted to Using the T.O.V.A. (section 19).

Here’s where you can find answers to some other general questions:

How do I install the T.O.V.A. ?
See section 11.12.
How do I administer a T.O.V.A. test?
See section 20.
How do I import my old T.O.V.A. data?
See section 24.
How do I view a report?
See section 21.
How do I order T.O.V.A. Test Credits?
See section 22.1.
How do I contact The TOVA Company?
See section 29.

11.12  Other questions?

See our Frequently Asked Questions, section 40.

Between Stimulus and Response there is a space.
In that space is our power to choose that response.
In our response lies our growth and our freedom.
– Viktor Frankl

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