Is the Test of Variables of Attention Reliable for the Diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD)?

Abstract

The diagnosis of attention-deficit hyperactivity disorder (ADHD) is occasionally biased by the subjectivity of symptoms and reports of parents and teachers. The advent of continuous performance tests raised expectations that the diagnosis of ADHD will be more standardized and accurate. In this study, the authors looked for the validity of the ADHD scores obtained by the Test of Variables of Attention in 230 children who were referred to their ADHD clinic between 2005 and 2007. Based on clinical evaluations, 179 children were diagnosed with affirmed or suspected ADHD. Among the 179 children with ADHD, the Test of Variables of Attention was suggestive of ADHD in 163 participants (91.1% sensitivity), but it was also suggestive for ADHD in 78.4% of the children without ADHD. With a low specificity of 21.6%, the authors feel that the Test of Variables of Attention is not reliable enough to serve as a screening diagnostic tool for ADHD.

The Four Causes of ADHD: Aristotle in the Classroom

“…The TOVA presents a computerized task which evaluates omissions, commissions, reaction times, variability, and post-commission response times. Apart from the scant ecological validity as a task little representative of daily situations, the biggest problem with the TOVA is its inadequate specificity, leading to false positives and false negatives: children not ADHD who “fail” and ADHD children who do well (Zelnik et al, 2012; Fried et al, 2014). …”

Language Impairment in the Attention-Deficit/Hyperactivity Disorder Context

“…Barkley, 2006). Moderate effect sizes, low specificity, and inadequate reliability associated with neuropsychological indices of attention and executive function continue to compromise their applicability to differential diagnosis of ADHD (Nigg, Willcutt, Doyle, & Sonuga-Barke, 2005;Riccio, Reynolds, & Lowe, 2001;Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005;Willoughby & Blair, 2011;Zelnik, Bennett-Back, Miari, Goez, & Fattal-Valevski, 2012). In their review, Riccio et al (2001) noted that virtually any disorder of childhood, including, but not restricted to, intellectual deficit, affective disorder, conduct disorder, sleep disorder, learning disability, maltreatment, low birth weight, hearing impairment, is a candidate for producing deficits in vigilance, sustained attention, and impulsive responding.…”

Markers, Models, and Measurement Error: Exploring the Links Between Attention Deficits and Language Impairments

“…Relying on behavioral measures of executive function to identify ADHD status in individual cases would result in unacceptably high levels of false-positives and misdiagnoses because children from a variety of clinical populations besides ADHD have also demonstrated limitations in these areas (e.g., intellectual deficits, learning disabilities, sleep disorders, hearing impairments, and cases of maltreatment). Another factor complicating their application to differential diagnosis is that approximately 50% of children with ADHD can be expected to perform within the normal range on executive function measures (Nigg, Willcutt, Doyle, & Sonuga-Barke, 2005;Riccio, Reynolds, & Lowe, 2001;Willcutt et al, 2005;Willoughby & Blair, 2011;Zelnik, Bennett-Back, Miari, Goez, & Fattal-Valevski, 2012). This was true for the participants with ADHD in the Parigger (2012) study.…”