An annotated bibliography of research studies using the T.O.V.A.
Aggarwal, A., & Lillystone, D. (2000). A follow-up pilot study of objective measures in children with attention deficit hyperactivity disorder. Journal of Paediatrics & Child Health, 36(2), 134-138. OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a common childhood problem requiring stimulant medications in a significant proportion of cases. The aim of this pilot study was to assess the effects of prolonged stimulant medication therapy on a continuous performance test, the Test of Variables of Attention (TOVA), which measures objectively features of ADHD. METHODS: Eighteen children aged 8 to 16 years who were diagnosed with ADHD, based on the Diagnostic and Statistical Manual of Mental Disorders 4th edn criteria, were included in the study. Assessment on a continuous performance test (TOVA) was performed initially and the children were administered stimulant medications for at least 12 months. The medications were stopped for 1 week, followed by a repeat TOVA assessment which was compared to the initial TOVA assessment. RESULTS: Follow up TOVA scores showed a significant improvement in mean commission errors (impulsivity) after the stimulant medication therapy. No significant improvement was found in omission errors (inattention), response time and variability. There was a significant positive correlation between commission and omission scores (P value 0.0001). CONCLUSIONS: The results of this pilot study indicate that there is objective improvement in impulsivity in children with ADHD after a prolonged period of stimulant medication therapy. The study suggests that it would be useful to perform formal studies to investigate this further and also to assess the role of continuous performance test (TOVA) as a method for monitoring the need for ongoing therapy.
Alhambra, M. A., Fowler, T. P., & Alhambra, A. A. (1995). EEG biofeedback: A new treatment option for ADD/ADHD. Journal of Neurotherapy, 1(2), 39-43. Explored the effectiveness of EEG biofeedback as an alternative to pharmacological treatments for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD). 36 Ss with ADD/ADHD (aged 6-17 yrs) who completed at least 30 sessions of EEG biofeedback treatment were evaluated using observation of behavioral changes through parental questionnaires, measures of quantitative EEG (QEEG) changes, and a comparison of Test of Variables Assessment (TOVA) scores taken before training and after 20 sessions. 30 Ss showed some significant overall improvement in their condition upon completion of the EEG biofeedback treatment. Results indicate a good correlation between TOVA score improvement and changes in QEEG parameters. Of the 24 patients on medication for their ADD/ADHD condition, 5 Ss were able to be removed completely from their medication after the treatment. 11 Ss showed a decreased dependence on their medication in that their dosage was able to be reduced. The remaining 8 Ss initially on medication showed no change. However, 4 of these 8 Ss showed overall improvement, implying that this same dosage of drug was more effective. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Avior, G., Fishman, G., Leor, A., Sivan, Y., Kaysar, N., & Derowe, A. (2004). The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the test of variables of attention (TOVA) in children with obstructive sleep apnea syndrome. Otolaryngology - Head & Neck Surgery, 131(4), 367-371. OBJECTIVE: To evaluate children with obstructive sleep apnea syndrome (OSAS) for features of attention deficit disorder (ADD) using an objective test of inattention and impulsivity: Test of Variables of Attention (TOVA) and then to determine whether tonsillectomy and adenoidectomy (T+A) results in an improvement in TOVA scores. STUDY DESIGN AND SETTING: This study was a prospective interventional comparative trial in a tertiary care children's hospital. Nineteen children ages 5 to 14 years with OSAS, and otherwise healthy, with a clinical indication for T+A. Preoperative and 2 months postoperative OSA-18, CBCL questionnaires, and TOVA scores were evaluated. RESULTS: The preoperative TOVA scores were in the abnormal range in 12/19 (63%) of the children. The mean preoperative TOVA score was -2.9 (+/- 3.1). The mean postoperative TOVA score was -0.4 (+/-2.8). The improvement in the TOVA scores was significant ( P < 0.0001, t -test). CONCLUSION: This preliminary data suggests that treatment of OSAS with T+A results in significant improvement in objective parameters of inattention and impulsivity. Significance These findings may be important in understanding the impact of OSAS and therapeutic interventions on behavioral problems in children.
Baker, L. B., Conroy, D. E., & Kenney, W. L. (2007). Dehydration impairs vigilance-related attention in male basketball players. Medicine & Science in Sports & Exercise, 39(6), 976-983. PURPOSE: To determine the effects of dehydration (DEH) on attentional vigilance in male basketball players. METHODS: The Test of Variables of Attention (TOVA; Universal Attention Disorders) was administered to 11 male basketball players (17-28 yr) at baseline (test 1), after walking (50% V O2max) in the heat (40 degrees C and 20% relative humidity) (test 2), and then after a simulated basketball game (test 3). Tests 2 and 3 were performed while subjects were either DEH (1-4%) or euhydrated (EUH). The TOVA consisted of target-infrequent and target-frequent conditions, simulating static and dynamic (such as a basketball game) environments, respectively. TOVA measures included errors of omission (OE) and commission (CE), response time (RT), and sensitivity. RESULTS: During the target-infrequent half of test 3, EUH resulted in significantly better sensitivity (+0.4+/-1.2 vs -0.9+/-1.3), faster RT (-8+/-20 vs +16+/-28), and fewer OE (-0.4+/-0.7 vs +1.3+/-2.4) compared with DEH. During the target-frequent half, EUH resulted in significantly fewer OE (-4+/-15 vs +5+/-7) and CE (-1.9+/-3.2 vs 0.6+/-1.4) in test 2 and greater sensitivity (+0.7+/-2.6 vs -0.7+/-1.1) and faster RT (-21+/-28 vs +5+/-31) than DEH in test 3. CONCLUSION: Vigilance-related attention of male basketball players was impaired by DEH, especially during the target-frequent condition of the TOVA. These results suggest that fluid replacement is essential to prevent the decline in vigilance that occurs with DEH in highly dynamic environments. Therefore, basketball players should be advised to maintain EUH for optimal concentration and attentional skills during competition.
Bandstra, E. S., Morrow, C. E., Anthony, J. C., Accornero, V. H., & Fried, P. A. (2001). Longitudinal investigation of task persistence and sustained attention in children with prenatal cocaine exposure. Neurotoxicology & Teratology, 23(6), 545-559. The present study estimates the longitudinal effects of prenatal cocaine exposure on indicators of sustained attention processing at 3, 5 and 7 years of age in an urban sample of full-term African-American children (235 cocaine-exposed, 207 noncocaine-exposed). The sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview, urine and meconium toxicology assays. Sustained attention was measured at age 3 years using a standardized measure of task persistence during a challenging task [G.A. Morgan, N.A. Busch-Rossnagel, C.A. Maslin-Cole and R.J. Harmon, Individualized Assessment of Mastery Motivation: Manual for 15-36 Month Old Children, 1992.], and at ages 5 and 7 years using omission error scores from computerized continuous performance tasks (CPT) [L. Greenberg, R. Leark, T. Dupuy, C. Corman, C. Kindschi, M. Cenedela, Test of Variables of Attention (T.O.V.A. and T.O.V.A.-A.), 22, Universal Attention Disorders, Los Alamitos, CA, 1996; C.K. Conners, Conners' Continuous Performance Test (CPT), second ed., Multi-Health Systems, Canada, 1995.]. Findings from longitudinal GLM/GEE analyses of the three measured time points support a stable influence of prenatal cocaine exposure on indicators of sustained attention, after controlling for prenatal exposure to alcohol, marijuana, tobacco and over 20 additional medical and social-demographic covariates drawn from potentially confounding influences assessed at birth and later assessment visits (D=0.21; 95% CI=0.04, 0.38; P=.017). This effect was not mediated by fetal growth or gestational age and remained highly stable with increasing levels of covariate control. Separately, using the age 7 data, a structural equations model (SEM) was constructed combining all available self-report and bioassay data to measure magnitude of cocaine exposure in relationship to attention task performance. Results indicated a gradient of influence, with each standard deviation increase in the level of prenatal cocaine exposure relating to a 16% standard deviation increase in omission error scores at age 7. Overall findings support a stable cocaine-specific effect on indicators of sustained attention processing during the early childhood years. Results are discussed within the context of neurobiological and behavioral research linking prenatal cocaine exposure to long-lasting disruption of the brain systems subserving arousal and attention.
Bernstein, G. A., Carroll, M. E., Crosby, R. D., Perwien, A. R., Go, F. S., & Benowitz, N. L. (1994). Caffeine effects on learning, performance, and anxiety in normal school-age children. Journal of the American Academy of Child & Adolescent Psychiatry, 33(3), 407-415. OBJECTIVE: The purpose of this investigation was to study the acute effects of caffeine on learning, performance, and anxiety in normal prepubertal children. METHOD: 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. Subjects were randomized to order of placebo and the two dosages of 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. RESULTS: 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 on a visual analogue measure of anxiety. Children reported feeling significantly less "sluggish" after caffeine ingestion than after placebo ingestion. CONCLUSIONS: In a small sample size, there was indication that caffeine enhanced performance on a test of attention and on a motor task. Children also reported feeling less "sluggish" but somewhat more anxious. Because caffeine is so widely available and frequently consumed by children, these results are important and need replication.
Bernstein, G. A., Carroll, M. E., Dean, N. W., Crosby, R. D., Perwien, A. R., & Benowitz, N. L. (1998). Caffeine withdrawal in normal school-age children. Journal of the American Academy of Child & Adolescent Psychiatry, 37(8), 858-865. Examined whether children manifest withdrawal effects after cessation of caffeine intake. 30 normal 8-12 yr olds completed the single-blind, within-subjects, repeated-measures study with weekly sessions. Ss were tested 4 times: (1) baseline (on regular caffeine diet consisting of an average of 20 mg/day); (2) on caffeine (approximately 120 to 145 mg/day); (3) during withdrawal (24 hrs after discontinuation of caffeine taken for 13 consecutive days); and (4) at return to baseline. Ss were evaluated with self-report measures of symptoms and objective measures of attention, motor performance, processing speed, and memory. Tests included the Caffeine Rating Scale, the Finger Tapping Test, and the Test of Variables of Attention. During caffeine withdrawal, there was a significant deterioration on response time, which persisted for 1 wk, on a visual continuous performance test of attention. This finding is consistent with caffeine withdrawal. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Blaskovic, D., & Albrecht, P. (1963). [TICK-BORNE ENCEPHALITIS AS A MODEL OF ARBORVIRUS ENCEPHALITIS.]. [Klie S Tov'a Encefalit'ida Ako Model Arbov'irusov'ych Encefalit'id.] Lekarsky Obzor, 12, 527-537.
Boivin, M. J. (2002). Effects of early cerebral malaria on cognitive ability in senegalese children. Journal of Developmental & Behavioral Pediatrics, 23(5), 353-364. Twenty-nine Senegalese children with a history of cerebral malaria (CM) performed more poorly on the Kaufman Assessment Battery for Children (K-ABC) Simultaneous Processing domain and on the Test of Variables of Attention (TOVA) attention capacity indicators in comparison with a matched control group. Thus, CM can disrupt neuropsychological integration during critical developmental periods, impacting on global neurological integrity, attentional vigilance, perceptual acuity, and subsequent development of visual-spatial processing and memory foundational to global cognitive ability. A subsequent structural equation model confirmed that rural children are at greater risk for CM, subsequent attention deficits, and other developmental risk factors in addition to the CM impact on K-ABC performance. We document CM as one of a host of developmental risk factors within the complex web of poverty in sub-Saharan Africa, which limit children's ability to achieve their full intellectual potential and, thus, extend the human cost of the disease beyond general measures of mortality and morbidity.
Boivin, M. J., Bangirana, P., Byarugaba, J., Opoka, R. O., Idro, R., Jurek, A. M., et al. (2007). Cognitive impairment after cerebral malaria in children: A prospective study. Pediatrics, 119(2), e360-6. OBJECTIVE: This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria. METHODS: Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later. RESULTS: Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits. CONCLUSIONS: Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.
Boivin, M. J., Giordani, B., Crist, C. L., Chounramany, C., Xaisada, S., Choulamountry, L., et al. (1996). Validating a cognitive ability testing protocol with lao children for community development applications. Neuropsychology, 10(4), 588-599. The emergence of the sociocultural perspective in cross-cultural psychology has discouraged the adaptation of standardized tests in nonindustrialized settings. Yet, cognitive assessments are needed for monitoring the effects of nutritional, health, and educational interventions. Forty-seven Lao children 5 to 12 years of age completed the Kaufman Assessment Battery for Children (K-ABC), the Tactual Performance Test (TPT), and the computerized Tests of Variables of Attention (TOVA). TPT performance measures were related to physical (nutritional) development, whereas the K-ABC global cognitive ability indicators were sensitive to parental education and quality of home environment. TOVA performance was related to K-ABC global performance and TPT memory, suggesting that these measures are at least partially undergirded by attentional ability. Sociocultural concerns aside, these finding suggest that validated neuropsychological and cognitive assessments can be adapted that effectively tap basic and universal brain-behavior traits.
Boyd, W. D., & Campbell, S. E. (1998). EEG biofeedback in the schools: The use of EEG biofeedback to treat ADHD in a school setting. Journal of Neurotherapy, 2(4), 65-71. Six middle school students (aged 13-15 yrs) diagnosed with attention deficit hyperactivity disorder (ADHD) were selected for sensorimotor rhythm training with EEG biofeedback. Ss were evaluated following a 72-hr drug-free period with the Wechsler Intelligence Scale for Children (WISC) Digit Span subtest and the Test of Variables of Attention (TOVA). Five of the Ss received 20 sessions of EEG biofeedback and one of the Ss received 9 sessions of EEG biofeedback. Ss were evaluated again following a 72-hr drug-free period. Five of the 6 Ss improved on their combined WISC Digit Span, TOVA Inattention, and TOVA Impulsivity scores. These results support previous findings that EEG biofeedback can be effective in the treatment of ADHD (S. Othmer et al, 1991). More importantly, this study demonstrated that EEG biofeedback could be used in an actual school setting. Recommendations for implementing an EEG biofeedback program in the schools are provided. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Braverman, E. R., Chen, T. J., Schoolfield, J., Martinez-Pons, M., Arcuri, V., Varshavskiy, M., et al. (2006). Delayed P300 latency correlates with abnormal test of variables of attention (TOVA) in adults and predicts early cognitive decline in a clinical setting. Advances in Therapy, 23(4), 582-600. Delayed P300 latency identifies dementia better than the Mini-Mental Status Exam and, in some cases, the Wechsler Memory Scale (WMS-III). The purpose of this study was to determine whether the outcome of an objective Test of Variables of Attention (TOVA) correlates with the findings of an electrophysiologic test-P300 latency-in patients 40 y of age or older. Adult attention deficit disorder may be an important premorbid marker of memory dysfunction or dementia. In males, the means for P300 latency and age-adjusted P300 latency were significantly greater for patients classified as SD-BL (significantly deviant or borderline: TOVA2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with males who had 0 SD-BL quarters (P2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with males who had 0 SD-BL quarters (P2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with males who had 0 SD-BL quarters (P2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with males who had 0 SD-BL quarters (P2 SD-BL quarters had significantly delayed P300 latency and age-adjusted P300 latency compared with females who had 0 SD-BL quarters (P<.005) and 1 SD-BL quarter (P<.010). Results suggest that TOVA abnormalities may be an indicator of delayed P300 and attention disorder. Recent research correlates TOVA abnormalities with impaired WMS scores of early dementia. Coupling of TOVA assessment findings with results of P300, Mini-Mental Status Exam, and WMS-III may allow for enhanced accuracy in the diagnosis and evaluation of the complex pathway of failing attention, memory, and cognition that leads to dementia.
Brewis, A. (2002). Social and biological measures of hyperactivity and inattention: Are they describing similar underlying constructs of child behavior?. Social biology, 49(1-2), 99-115. The relationship between 27 different measures of hyperactive, impulsive, and inattentive behavior, including those considered to be more objective and those considered more influenced by social factors, is examined using a normal sample of 219 Mexican children, ages 6 to 12. Measures were based on activity monitoring by accelerometry, ethological observation of attentional and movements states in the classroom, cognitive testing using the TOVA continuous performance test (CPT), and parents' and teachers' reports on ratings scales and symptom checklists. Factor analysis was used to examine to what degree these different measures are reporting similar underlying constructs (factors) of hyperactivity and inattention. Parent and teacher ratings appear to be describing underlying constructs that are distinct from those described by the other measures, but measures based on CPT, observation, and activity monitoring did not factor together either, nor more highly correlate to each other. Analysis combining all the measures showed that parent and teacher ratings factored together based on who was reporting the behavior, rather than the behavior being reported. The findings underscore that each type of measurement of hyperactivity, impulsivity, and inattention measures a different aspect of a complex behavioral phenomenon, rather than some better measuring than others the same underlying factor.
Byas-Smith, M. G., Chapman, S. L., Reed, B., & Cotsonis, G. (2005). The effect of opioids on driving and psychomotor performance in patients with chronic pain. Clinical Journal of Pain, 21(4), 345-352. OBJECTIVES: This study compared the psychomotor performance and driving ability of patients with chronic pain managed with stable regimens of opioid analgesics with that of normal healthy volunteers. The hypothesis was that patients with chronic pain on stable opioid analgesic regimens operate their automobiles safely with proficiency equal to normal volunteer controls. METHODS: Patients were evaluated for errors while driving their own automobile through a predetermined route in the community, including variable residential and highway conditions, and for speed and accuracy on repeated trials through a 5-station obstacle course that evaluated forward and reverse driving, turning, and parallel parking. Patients also completed the Test of Variables of Attention and the Digit Symbol Substitution Test. RESULTS: No significant differences were observed among groups in driving performance in the community and on the obstacle course or on the Test of Variables of Attention. Results on dependent measures within the opioid group generally were not correlated with morphine equivalent daily opioid doses, which averaged 118 mg (median 40 mg). CONCLUSIONS: Many patients with chronic pain, even if treated with potent analgesics such as morphine and hydromorphone, show comparable driving ability as normals.
Cantor, S. R. (1999). The effect of sleep loss on nighttime sleep, daytime sleepiness, and cognitive functioning in children with attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60 (1-B), 0360. The purpose of this investigation was to define groups of ADHD and Non-ADHD prepubertal children, and assess the impact of sleep loss on sleep, daytime sleepiness, and performance on a continuous performance task, the Test of Variables of Attention (T.O.V.A.-super(TM)). 20 children (11 ADHD and 9 non-ADHD) were evaluated in the CCNY Sleep Disorders Center. Participants who met inclusion criteria returned to begin a two night, two day study in which their sleep and levels of daytime alertness were electronically recorded. To partially sleep deprive participants, they went to bed two hours later on Night 2. Levels of daytime alertness/sleepiness were assessed with the Multiple Sleep Latency Test. Post sleep loss dependent variables included: (1) Night 2 of sleep, (2) Day 2 MSLTs, and (3) T.O.V.A-super(TM) performance. One significant interaction effect was found for sleep. ADHD children had a significantly higher percentage of transitional, lighter Stage 1 sleep after sleep loss, in contrast to the non-ADHD group, who had lower Stage 1% on Night 2, a more expectable response. Parent reports on the questionnaire of children's sleep correlated somewhat with empirical recordings. Items seem to be useful in identifying children with sleep difficulties. ADHD children did not become sleepier than non-ADHD children from mild sleep loss: there was no difference found between the groups on the MSLT. However, all participants, had statistically significantly lower Sleep Latency means on MSLT 2, suggesting that just two hours of sleep loss can have some impact on the high levels of alertness seen in most participants the first day. ADHD group T.O.V.A.-super( TM) means, before and after sleep loss, were not different. ADHD group's T.O.V.A.-super(TM) performance did not show more severe decrements than controls after the sleep loss condition. Preliminary findings showed non-ADHD children made more errors on the T.O.V.A.-super(TM) after mild sleep deprivation. Further research is indicated to follow up investigating the group differences and relationships suggested by this study between sleep loss and nocturnal sleep, decrements in diurnal alertness, and T.O.V.A.-super( Tm) performance in ADHD and non-ADHD children. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Carmody, D. P., Radvanski, D. C., Wadhwani, S., Sabo, M. J., & Vergara, L. (2001). EEG biofeedback training and attention-deficit/hyperactivity disorder in an elementary school setting. Journal of Neurotherapy, 4(3), 5-27. EEG biofeedback was conducted on site in an elementary school. An experimental group of 8 children (aged 8-10 yrs) completed 35-47 sessions of EEG biofeedback training over a 6-mo period. Four Ss in the experimental group were diagnosed with attention deficit hyperactivity disorder (ADHD) and 4 were not diagnosed with ADHD. Eight children in the waitlist control group were matched to the experimental group on age, grade, teacher, and diagnosis. None of the 16 Ss were medicated for ADHD. Attention abilities as measured by the Test of Variables of Attention showed the experimental group of children with ADHD reduced errors of commission and anticipation, indicating a reduction in impulsivity. Teacher reports using the McCarney Scale indicated improvements in attention but no changes in impulsivity and hyperactivity. It is concluded that several confounds require exploration before attribution of changes are assigned to neurofeedback. Whether the effects are due to the neurofeedback protocols, attendance at individual sessions away from the classroom, the attention of the technician, or the excitement of a special program cannot be determined with this study. It will be necessary to have a placebo group in order to separate systematically the variables in the training program. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Carter, C. S., Krener, P., Chaderjian, M., Northcutt, C., & Wolfe, V. (1995). Asymmetrical visual-spatial attentional performance in ADHD: Evidence for a right hemispheric deficit. Biological psychiatry, 37(11), 789-797. This study was designed to confirm the presence of a lateralizing deficit in visual-spatial attention in children with ADHD, to further characterize the nature of this deficit and to specify the likely hemispheric locus of dysfunction. Two versions of the covert orienting of attention procedure which evaluated separately endogenous and exogenous cuing effects were administered to 20 unmedicated children aged 9-12 with ADHD and 20 matched controls. Both groups also underwent thorough psychiatric assessment and testing using the TOVA and the Wisconsin Card Sorting Task (WCST). Children with ADHD showed an asymmetrical performance deficit characterized by a loss of costs on controlled (endogenous) attentional orienting to invalidly cured left visual field targets. The degree of cost asymmetry correlated negatively with the number of categories sorted on the WCST. It was concluded that unmedicated children with ADHD show an asymmetrical performance deficit on the covert orienting procedure characterized by a disruption of right hemispheric attentional mechanisms. This deficit may be related to diminished right hemispheric frontal-striatal catecholamine activity.
Chae, P. K., Jung, H. O., & Noh, K. S. (2001). Attention deficit hyperactivty disorder in korean juvenile delinquents. Adolescence, 36(144), 707-725. This study was conducted to identify attention deficit hyperactivity disorder (ADHD) in Korean juvenile delinquents. Intelligence tests (KEDI-WISC, K-WAIS), the Test of Variables of Attention (TOVA), the Teacher Report Form (TRF), the Youth Self-Report (YSR), and the Rosenberg Self-Esteem Scale were administered to 98 incarcerated Korean adolescents (the delinquent group) and 84 adolescent nondelinquents (the control group). The groups were compared, and significant differences were found for ADHD; 42.4% of the adolescents in the delinquent group were identified as having ADHD, in comparison to 11.9% of the adolescents in the control group. Delinquent adolescents and adolescents with ADHD were found to have lower IQ scores, poorer TOVA performance, more severe problem behaviors, and lower self-esteem than nondelinquent adolescents and adolescents without ADHD. Delinquent adolescents with ADHD consistently fared the worst on assessments of intelligence, TOVA performance, problem behaviors, and self-esteem.
Chae, P. K. (1999). Correlation study between WISC-III scores and TOVA performance. Psychology in the Schools, 36(3), 179-185. The Continuous Performance Test (CPT), such as the Test of Variable Attention (TOVA), is widely used in the assessment of attention deficit hyperactivity disorder (ADHD) with other behavioral ratings and observations. Since some clinicians argue that CPTs measure psychomotor speed function rather than sustained attention, a correlation study between Performance IQ (PIQ) of the Wechsler Intelligence Scale for Children-III (WISC-III) and TOVA was conducted to find out if a significant relationship of any kind existed. Forty 6-16 yr old children with ADHD were studied, and the results indicate that there was no correlation between TOVA and PIQ of the WISC-III. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Chae, P. K., Kim, J., & Noh, K. (2003). Diagnosis of ADHD among gifted children in relation to KEDI-WISC and T.O.V.A. performance. Gifted Child Quarterly, 47(3), 192-201. The following study was conducted to evaluate the correlation between intelligence and a Continuous Performance Test (CPT) that assesses Attention-Deficit Hyperactivity Disorder (ADHD) in children. Characteristics of attention in gifted children with ADHD were also investigated. A sample of 177 elementary school students was studied, and their attention was measured with the Test of Variables of Attention (TOVA). About 9.4% of the gifted children were identified with ADHD using the TOVA, Child Behavior Check List (CBCL), and Teacher's Report Form (TRF). Significant positive correlations were found between intelligence (KEDI-WISC) and omission error, commission error, and response time (RT) variability on the TOVA. That is, children with a high level of intelligence made fewer omission and commission errors and responded more consistently on the TOVA. than children with lower intelligence. No significant correlation was found between intelligence and response time. Overall, gifted children performed better on the TOVA. than nongifted children. Specifically, with the exception of response time and response time variability, gifted children with ADHD performed better on tasks of omission error, commission error, and response sensitivity than nongifted children with ADHD... (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Chevreau, L. P. (2005). Neurofeedback and childhood adhd. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66 (5-B), 2870. This was a multiple-case study of neurofeedback (NF) treatments of attention deficit hyperactivity disorder (ADHD) in children. The research investigated the effects on (a) physiological and behavioral functioning, (b) learning and memory, and (c) social and emotional functioning. Quantitative and qualitative methods were used to assess treatment effects for four boys aged 8 to 11. In each, information was obtained from a caretaker and a teacher. All boys had been diagnosed by their physicians and through neurodiagnostic testing. In every case, the boys had comorbid disorders, including sleep disorders, and, in one case, oppositional defiant disorder (ODD). Three boys were taking medication. NF treatments involved 20 sessions, administered by the investigator. Sensors were placed on the boys' scalps to monitor brain electrical activity. The boys responded to visual stimuli they viewed on a computer monitor, which incorporated this EEG (electroencephalographic) activity as feedback. NF helps participants train their brain activity toward better self-regulation. Pretreatment and posttreatment involved the Test of Variables of Attention (TOVA); the Behavior Assessment System for Children (BASC); parent and teacher monitor ratings; physician information; interviews with child, parent, and teacher; and neurotherapist observations. Results were mixed, with the least progress on TOVA scores. BASC ratings reflected greater improvement at school and home, and interviews and observations included even more positive assessments in all areas of investigation. Gains included greater behavior control, attention, organizational skills, homework completion, and overall academic performance; more positive self-esteem; better sleep; and cooperation with parents and teachers. Potential confounding factors included comorbidity, medication changes in certain boys, and behavioral changes due to expectations of the investigator and other adults. Notably, 40 treatments might have shown further gains. This partial success underscores the importance of further study of NF for ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Cooper, J., Tyler, L., Wallace, I., & Burgess, K. R. (2004). No evidence of sleep apnea in children with attention deficit hyperactivity disorder. Clinical pediatrics, 43(7), 609-614. Children with attention deficit hyperactivity disorder (ADHD) may have a component of sleep apnea causing arousal and contributing to ADHD behavior during the day. Twenty non-ADHD children between 4 and 16 years of age were compared with 18 children with ADHD with use of nocturnal polysomnography (PSG) and psychometric tests. The psychometric testing confirmed that the control group were normal and that the ADHD children fulfilled the diagnostic criteria for ADHD. The PSG showed normal arousal indexes for the ADHD group (9.8 +/- 3.9/hr) and controls (10.2 +/- 3.1/hr), and normal apnea/hypnea indexes for the ADHD group (1.0 +/- 2.4/hr) and controls (0.6 +/- 0.9/hr). The sleep architecture was not significantly different between groups. There were no sleep abnormalities in the ADHD children that could be responsible for, or contributing to, the disorder.
Cotman, A., & Sandman, C. (1997). Cognitive deficits and their remediation in the homeless. Journal of Cognitive Rehabilitation, 15(1), 16-23.
Craw, M. J. (1998). Race and ethnic differences on the test of variables of attention. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (9-B), 5111. To assess the relationship between the Test of Variables of Attention (TOVA) and race/ethnicity, 40 Caucasian, 40 Asian, and 20 Hispanic children between the ages of 8 and 10, were administered the TOVA and the attention factor from the Child Behavior Checklist (CBCL). Gross annual income and years of parent education were used as covariates to partial out variance due to socioeconomic status. All of the children who were participants in the study attended the same elementary school and lived in the same neighborhood. Consent forms were given to all of the children in the 2nd, 3rd, and 4th grades and those parents who agreed to participate were then included in the study and assigned to the appropriate race/ethnic group. Results indicated that there was a significant difference between the three groups on total percentage of omission errors (inattention). Post hoc analysis indicated that the Hispanic group made significantly more errors of omission than the Caucasian group and significantly more errors of omission than the Asian group. This difference remained even after the covariates representing socioeconomic status were removed. There was a significant difference between groups on variability (a measure of consistency), but the difference did not remain after inclusion of the covariates. However, the covariates removed a negligible amount of variance, and a loss of power was seen as responsible for not achieving significant differences between groups on variability. There were no significant differences between groups on commission errors, response time, or the attention factor on the CBCL. In the current study there was evidence that the TOVA may not measure attention in the same way for different race/ethnic groups. The Hispanic group was shown to be less attentive, as defined by increased omission errors on the TOVA, compared to the Asian group and the Caucasian group. There was also evidence that the three groups differed in terms of consistency in responding. Thus, the current study provides the first empirical evidence that the TOVA cannot be assumed to be a culture free test. The results were further explained using tenets from the philosophy of science known as constructionism. It is asserted that attention is a hypothetical construct that cannot be dispassionately observed. Thus, any operational definition of attention, like the TOVA, is created within subsystems of culture, values, economy, and politics that guide the scientific process. In this way, no single measure of attention, however objective it may appear, can accurately measure attention for individuals across various culture and ethnic groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
David, H. P. (1981). Review of women in eastern europe and the soviet union. PsycCRITIQUES.Vol 26 (12), Dec, 1981, Originally published in Contemporary Psychology: APA Review of Books, 1981, Vol 26(12), 967-968. Reviews the book, Women in Eastern Europe and the Soviet Union by Tova Yedlin (Ed.) (1980). This is a unique collection of 14 papers originally presented at the Conference on Women in Eastern Europe and the Soviet Union, convened at the University of Alberta in October 1978. Particularly useful is the critical examination by Alena Heitlinger of "Marxism, Feminism, and Sex Equality." Although "female labor-force participation is a prerequisite of emancipation, a state socialist transformation is insufficient to bring about the liberation of women." Without a social and political climate favoring socialization of housework and child care, "women can hardly hope to play equal roles in society." Although the variety of topics and approaches renders generalization hazardous, the editor suggests that "the question of full equality for women under socialism remains a thing of the future." (PsycINFO Database Record (c) 2007 APA, all rights reserved)
De Jong, M. D. (2001). A comparison of EEG activity in adults with attention deficit hyperactivity disorder and normal controls while performing tasks that require attention. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62 (2-B), 1072. Children with Attention Deficit Hyperactivity Disorder (ADHD) have been reported to have electroencephalographic (EEG) abnormalities in the form of increased levels of theta band activity and lower than normal levels of beta band activity. The purpose of the present study was to determine if these abnormalities can also be observed in adults with ADHD. There were 32 control subjects, 25 subjects with ADHD of the primarily hyperactive type (ADHDhy), and 17 subjects with ADHD of the primarily inattentive type (ADHDpi). For the purposes of analysis, the ADHDhy and ADHDpi groups were combined to form a CLINICAL group. The subjects were right handed males and females between the ages of 20 and 50 years of age. During the study, EEG activity was recorded from 19 electrode sites while subjects sat with their eyes open and eyes closed, and while they performed a variety of tasks including: the Tests of Variability of Attention (TOVA), a reading task, a mental rotation task, a selective attention task, and a listening task. The results of the discriminant function analyses produced functions that correctly classified an average of 60 out of 74 of the control and ADHD subjects during the TOVA, listening, and selective attention tasks (p < .0005). An ANOVA of inter-hemispheric activity revealed that only the ADHDpi group were significantly different from the control group with more right than left hemispheric activity in the delta band during the mental rotation task (p < .006). A paired t-test analysis of inter-hemispheric activity showed that both the ADHDhy and ADHDpi groups had different percentage levels of right and left hemispheric activity (p < .005) during the performance of the eyes closed, T.O.V.A., mental rotation, and reading tasks; there were no significant differences in the control group in any of these comparisons. A MANOVA of regional (frontal, central, posterior, left temporal, and right temporal) activity revealed statistically significant differences in the theta/beta ratio during the eyes closed condition for the ADHDhy group with a higher ratio in the frontal region and right temporal area (p < .006). The results suggest that the differences between normal and ADHD children continues into adulthood but that the magnitude of the differences is reduced. A dysfunction in EEG activity caused by a maturational lag is supported by the results of this study. Based on the results of the analyses, recommendations are made as to which frequency bands and electrode sites should be targeted for use in neurotherapy. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
DeBaun, M. R., Schatz, J., Siegel, M. J., Koby, M., Craft, S., Resar, L., et al. (1998). Cognitive screening examinations for silent cerebral infarcts in sickle cell disease. Neurology, 50(6), 1678-1682. OBJECTIVE: In children with sickle cell disease (SCD), silent cerebral infarcts are the most frequent cause of neurologic injury. We determined the sensitivity and specificity of selective neurocognitive measures when separating children with silent cerebral infarcts and SCD from sibling controls. Additionally, we tested the validity of the same cognitive measures to identify patients with overt strokes. METHODS: We examined performance on a neuropsychologic battery containing measures of attention/executive, spatial, language, memory, and motor functioning for seven children with SCD and silent cerebral infarct, 21 children with SCD and overt stroke, and 17 normal siblings. Diagnosis of cerebral infarct was based on results of MRI. RESULTS: Measures from the attention and executive domains were the most useful for identifying children with silent cerebral infarct. The Test of Variables of Attention was the most robust measure and yielded a sensitivity rate of 86% and a specificity rate of 81%. This measure also showed a sensitivity rate of 95% in identifying overt stroke. CONCLUSIONS: Brief cognitive screening measures, if properly constructed, may be an effective means of identifying children with silent cerebral infarct. Future prospective studies should be pursued to assess the utility of cognitive screening for silent cerebral infarcts in SCD.
Denzin, N. K. (Ed.). (2004). Studies in symbolic interaction, vol 27(2004). Studies in symbolic interaction, Vol 27. xi, 346 pp. US: Elsevier Science/JAI Press.(create) This latest volume continues the series focus on symbolic interaction and communication. Structurally, the text is divided into four sections. Part One honors the contributions of Laurel Richardson to the field. Part Two, which presents two papers from the Peter M. Hall Lecture Series, covers the the topics of symbolic interaction and its relationship to sociology and the changing society; and the stigmatization of certain occupations (the real-estate developer in particular). Part Three explores the most recent developments in interactionist theory and practice. Finally, Part Four presents a collection of creative writings entitled "Border Crossings/Border Performances". (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Deredzhian, A., & Damianov, D. (1974). [Patients with cancer of the cecum previously subjected to surgery for appendicitis]. [Nashi nabliudeniia vurkhu bolni s rak na sliapoto chervo, operirani predi tova za apenditsit] Khirurgiia, 27(4), 278-282.
Dobrusin, S. J. (2000). Determining the diagnostic capabilities of computer performance tests for adults with attention deficit disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61 (1-B), 583. Testing for ADHD in the adults is difficult. Questionnaire data (self-repor ts) are used by mental health professionals to diagnose this condition. Other fa mily members may also complete questionnaires and a thorough developmental histo ry is obtained verifying childhood symptoms for the ADHD adult, but this informa tion is subjective. Objective laboratory measures, such as continuous performanc e tests (CPTs), are available to aid in the diagnosis. The present study examin ed the use of two CPTs, the Gordon Diagnostic System (GDS) (Gordon, 1987) and th e Test of Variables of Attention (TOVA) (Greenberg, 1991), in diagnosing adults with ADHD. The results of the two CPTs were compared between adults with a preli minary diagnosis of ADHD and a control group who had no ADHD symptoms. To determ ine if differences existed in patterns of results between the two groups and in outcomes between the CPTs for either group. The findings showed that the ADHD ( n = 60) and nonADHD (n = 30) groups differed on the TOVA, but no differences wer e found between the two groups on the Gordon. When the two tests were compared r egarding their ability to diagnose ADHD, no differences were found between the T OVA and GDS. The discriminant function analysis showed that TOVA scores includin g response time standard scores, TOVA scores for ADHD, response time variability were stronger predictors of ADHD than individual scores on the GIDS. The WAIS-R vocabulary score was a stronger predictor of ADHD than the block design. Ancill ary findings were also reported on the sensitivity and specificity of the two CP Ts based on their outcomes. It appeared that the GDS had better sensitivity than the TOVA, while the specificity levels appeared to be similar. The lack of a g old standard for diagnosing ADHD provides a cautionary note in the use of CPTs. Mental health professionals who work with ADHD adults should consider using the CPT as part of their diagnostic protocol, but should not rely on their results t o provide a basis for diagnosis. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Downey, K. K., Stelson, F. W., Pomerleau, O. F., & Giordani, B. (1997). Adult attention deficit hyperactivity disorder: Psychological test profiles in a clinical population. Journal of Nervous and Mental Disease, 185(1), 32-38. Used established tests with age-corrected norms to report the battery of psychological and neuropsychological tests conducted on 78 outpatients admitted to an attention deficit hyperactivity disorder (ADHD) clinic. ADHD Ss scored significantly higher than norms on the tridimensional personality questionnaire novelty seeking and harm avoidance scales and Minnesota Multiphasic Personality Inventory-2 scales F, 2, 4, 7, and 8. Further, these Ss were impaired on the California verbal learning test, the attentional capacity test, and the omissions and variability subtests of the test of variables of attention. Adult ADHD Ss had high comorbidity with current depressive disorder, antisocial personality disorder, and alcohol and drug abuse/dependence. High correlations were found between Ss' and independent observers' reports of ADHD symptom severity. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Drozd, J. S. (1997). A comparative study of continuous performance test (cpt) profiles, of a stratified random sample of ethnically diverse urban public school eight and nine-year-olds, with the standardization sample of anglo suburban public school students. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57 (12-B), 7770. Continuous performance tests are instruments which require the test subjects to be, at all times or continuously, attentive to the task presented. In this way lapses or gaps in attention, which can detrimentally affect learning, can be quantified against some standard or norming group. Continuous performance tests (CPT) have been utilized for forty (40) years. Only within the past fifteen (15) years have the format, administration, scoring and norms been standardized as the result of the advancement in computer technology. None of the three commercially produced CPT's include ethnic or socio-economic status information in their normative data. No significant information with regard to possible ethnic or cultural differences in CPT performance is currently available. As the application of CPT's moves from the research lab to clinics, hospitals, and schools, its potential impact on children, especially minorities, also increases. This research involves the statistical comparison of the original suburban Anglo norming of a commercially available CPT, the Tests of Variables of Attention (T.O.V.A.), with a stratified random sampling of an ethnically diverse urban population. Forty (40) boys and forty-three (43) girls between the ages of 8 years 0 months, to 9 years 11 months, were selected from Florida's Dade County Public Schools for inclusion in this study. Results suggest no significant differences in the performance profile of the current research population relative to the original standardization sample. A discussion of minor incongruencies and possible causative factors is included. These findings support the use of the T.O.V.A. as a school based screening instrument, and as part of a multimodal learning problem assessment battery in ethnically diverse urban settings. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Fernandez, T., Herrera, W., Harmony, T., Diaz-Comas, L., Santiago, E., Sanchez, L., et al. (2003). EEG and behavioral changes following neurofeedback treatment in learning disabled children. Clinical Electroencephalography, 34(3), 145-152. Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.
Fitzgerald, R. L. (2001). Statistical reliability of the T.O.V.A.RTM test of variables of attention. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61 (7-B), 3895. ?The problem. The purpose of this study was to measure the temporal reliability of the Test of Variables of Attention (T.O.V.A.). The T.O.V.A. is a continuous performance test (CPT) used to assess attention in neuropsychological and neuropsychiatric evaluations. A problem that physicians, clinicians, and researchers face is the lack of reliable instruments that objectively screen for disorders of attention, for medication titration, and for monitoring treatment of symptoms of Attention Deficit-Hyperactivity Disorder (ADHD) over time. Method. Reliability of the T.O.V.A. was examined using a test-retest reliability correlation approach to report the degree to which the scores for omission, commission, response time, and response time variability obtained by the T.O.V.A. (Visual Version) over a 7-day (+2) period were correlated. The test subjects were 33 school-aged children from the Orange County, California, area. To answer the research questions, 4 null hypotheses were generated: that the scores for omission, commission, response time, and response time variability will not be significantly correlated over a 7-day (+2) period. Results. Analysis of the data revealed a positive correlation of omission, commission, response time, and response time variability scores of .86, .74, .81, and .87, respectively. There were no significant differences between males and females regarding obtained T.O.V.A. scores. A correlated t test was used to determine if a significant difference exists between Test 1 and Test 2 on the omission, commission, response time, and response time variability scores. T test results on the omission, response time, and response time variability scores did not find a significant difference. A significant difference did exist on the commission scores. Data analysis suggests that the T.O.V.A. is a reliable, clinic-based assessment instrument that can be used as a tool for evaluating children referred for ADHD assessment. In addition, the T.O.V.A. can be used for possible diagnosis considerations, medication, and treatment effects. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Flint, R. W.,Jr, & Turek, C. (2003). Glucose effects on a continuous performance test of attention in adults. Behavioural brain research, 142(1-2), 217-228. Increases in plasma blood glucose levels modulate memory, mood, and, to some extent, attention in adults. Participants in the present study were administered glucose (10, 100, and 500 mg/kg, or 50 g) or placebo (23.7 mg saccharin) shortly prior to completing the test of variables of attention (TOVA), a continuous performance test (CPT) commonly used to assess attention for diagnostic purposes. There were significant increases in blood glucose levels for the 500 mg/kg and 50 g groups, but only the 100 mg/kg group showed significant changes in behavior in comparison to the saccharin group. Specifically, the 100 mg/kg group performed worse on measures of commission errors, post-commission responses, and post-commission response time variability. There were no differences among the groups on other major variables of attention, including omission errors, response time, and response time variability. The results of this study demonstrate that large doses of glucose which increase blood glucose levels do not influence attention, but that a moderate dose (100 mg/kg) selectively impairs measures of impulsivity or disinhibition. Practitioners and researchers should maintain an awareness of dietary effects on attention and continue to examine micronutrients as potential confounds on diagnostic tests of cognition and behavior.
Foks, M. (2005). Neurofeedback training as an educational intervention in a school setting: How the regulation of arousal states can lead to improved attention and behaviour in children with special needs. Educational and Child Psychology, 22(3), 67-77. The current choice of treatment for the remediation of attentional and behavioural difficulties among primary school children with special educational needs (SEN) is, increasingly, pharmacological. If-neurofeedback can regulate brain arousal states and thereby improve attention, behaviour and readiness to learn, there may be a case for incorporating it into the special needs provision of mainstream primary schools, thus avoiding the use of potentially damaging stimulant medication as a means of controlling behaviour and promoting inclusion. An experimental design was used, employing the TOVA test as a pre-/post-test measure of attention and the TOVA rating scale as parental pre/post measure of behaviour, plus qualitative feedback as a post-treatment measure of attention/behaviour. Results indicate that neurofeedback may make an important impact on emotions and affect of the SEN individual, leading to improved behaviour and improved attentional capability; quality time spent on a no-failure task of any kind on a one-to-one basis may be beneficial to children with SEN, affecting their personal belief system and behaviour; incorporating neurofeedback as part of the school-based special needs provision is feasible and practicable. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Forbes, G. B. (1998). Clinical utility of the test of variables of attention (TOVA) in the diagnosis of attention-deficit/hyperactivity disorder. Journal of clinical psychology, 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 in 146 children (aged 6-12.11 yrs). Ss, their parents, and/or their teachers completed measures concerning behavioral assessments, educational history, development and behavioral history, and the Ss' cognitive learning style. Results show that 117 Ss were placed into the ADHD group and 29 Ss were placed in the OTHER group. Results show that there were large differences between the ADHD group on teacher ratings of activity and inattention. Analysis of the TOVA variables indicated the ADHD group exceeded the OTHER group on omission errors, response time, variability, and the number of multiple responses. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Friedman, D. H. (1998). Social skills and problem behaviors of adolescents with learning disabilities with and without attention/impulsivity problems: A comparison of teacher and student perceptions. Dissertation Abstracts International Section A: Humanities and Social Sciences, 59 (5-A), 1525. The purpose of this study was to compare teacher and student perceptions of social skills and problem behaviors in subgroups of adolescents with LD. The Test of Variables of Attention--T.O.V.A. was administered to all students in the sample in order to form four subgroups: (a) students with learning disabilities and elevated levels of inattention/impulsivity (LD/ADD), (b) students with learning disabilities and average levels of attention/impulsivity (LD/nADD), (c) normally-achieving students with elevated levels of inattention/impulsivity (NA/ADD), and (d) normally-achieving students with average levels of attention/impulsivity (NA/nADD). The Social Skills Rating System--SSRS-T was used to measure teacher-perceptions of Social Skills, Problem Behaviors, and Academic Competence of all students in the sample (N=87). Separate 2 x 2 MANOVAS, with ADD (ADD, nADD) and ED (LD, NA) representing group types were performed for Social Skills and Problem Behaviors. Results of Social Skills showed that students with ADD received significantly lower ratings than the nADD students on cooperation and self-control. Students with LD were rated significantly lower than their NA peers on all three dependent variables: cooperation, assertion, and self-control Results of Problem Behaviors revealed that the ADD groups exhibited more externalizing problem behaviors than the nADD groups; the students with LD exhibited more externalizing and internalizing problem behaviors than their NA peers. On Academic Competence, results of a 2 x 2 ANOVA indicated that students with ADD and students with LD were seen as less academically competent than the N/ADD and NA groups respectively. The Social Skills Rating System--SSRS-S was administered to all students to measure self-perceptions of their social skills. Self-ratings only differentiated students with ADD from those with nADD on one factor: cooperation. Discrepancies in perceptions between members of each group type (ADD, ED) and their teachers were found utilizing two separate 2 x 2 ANOVAS. The largest discrepancy existed between students with LD and their teachers. The finding that students with LD do not match the social skills behaviors that their regular education teachers expect of them is discussed for current mainstreaming practices. Also discussed is the confounding nature of achievement on social skills functioning. Future research utilizing other assessment methods, multiple settings, and different age-levels is suggested. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28(1), 1-12. Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and beta1 activity (15-18 Hz) with stimulant medication. Participants were N = 34 children aged 8-12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment."
Gillen, W. G. (2003). The tova: Discriminant validity for adhd and depression. Dissertation Abstracts International: Section B: The Sciences and Engineering, 64 (3-B), 1491. The purpose of this study was to investigate the differential diagnostic aspects of ADHD, depression, and normality in samples of the adult population using a continuous performance test (CPT). This study examined the Test of Variables of Attention (TOVA) for accuracy of classification among three samples of adults. Participants ranged from 19-59 years of age and were taking no psychotropic medication. Structured interviews classified 30 participants as meeting the criteria for ADHD and 30 as meeting the criteria for depression. The TOVA developers supplied the baseline data for 30 adult participants with no psychiatric diagnosis. The group with ADHD and the group with depression were given TOVAs and the variable scores were compared among the three groups. A discriminate function analysis determined that the TOVA accurately classified both 63% of the participants diagnosed with ADHD and 63% of the participants with no diagnosis. The TOVA correctly classified 33-40% of the participants with depression. The TOVA variables of (a) variability of response and (b) response time were the only predictor variables significantly contributing to the classification. Thus in adults, the TOVA does not totally discriminate between ADHD and no diagnosis. Further, the randomness of classification for depression (33-40%) suggests that the TOVA not only fails to empirically identify this disorder, but fails to significantly mistake depression for ADHD. Adaptive strategies for adults with ADHD are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Goldstein, S. (2005). Review of clinical applications of continuous performance tests: Measuring attention and impulsive responding in children and adults. Archives of Clinical Neuropsychology, 20(4), 559-560. Reviews the book "Clinical Applications of Continuous Performance Tests: Measuring Attention and Impulsive Responding in Children and Adults," (see record 2001-06202-000) by Cynthia A. Riccio, Cecil R. Reynolds and Patricia A. Lowe. The authors review over 300 studies utilizing CPT paradigms. This volume begins with a cogent review of the neurobiology of attention and executive control. Chapter Two offers an overview of the development of CPT paradigms and the theoretical construct that tasks requiring continuous performance over time can be used as sensitive, neuropsychological measures. Chapter Three provides an extensive overview of common CPTs in clinical use, including the Conners, Gordon Diagnostic System, the Integrative Visual and Auditory Continuous Performance Test and the Test of Variables of Attention. Chapter Four begins a series of chapters examining the relationship of CPTs to a variety of phenomena; including cognitive and behavioral measures, brain function, diagnostic efficacy and treatment response. Finally, Chapter Ten concludes with a thoughtful summary of the book and the authors' suggestions for clinicians and future research. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Greenberg, L. M. (1998). Test of variables of attention. Journal of clinical psychology, 54, 461-476.
Greenberg, L. M. (2002). Test of variables of attention. Journal of learning disabilities, 35, 114-120.
Greenberg, L. M., & Dupuy, T. R. Test of variables of attention.
Greenberg, L. M., & Dupuy, T. R. (2000). Test of variables of attention. Journal of paediatrics and child health, 36, 134-138.
Greenberg, L. M., & Dupuy, T. R. (2001). Test of variables of attention. Neuropsychology, 15, 136-144.
Greenberg, L. M., & Waldman, I. D. (1993). Developmental normative data on the test of variables of attention (T.O.V.A.). Journal of Child Psychology and Psychiatry, 34(6), 1019-1030. Presents developmental normative data for 377 boys and 398 girls (aged 6-16 yrs) for the TOVA, a 23-min fixed interval (FI) visual continuous performance test with minimal language demands and no left-right discrimination. The target is presented on 22.5% and 77.5% of the trials during the 1st and 2nd halves, respectively. TOVA indices include omission and commission errors, response time means and standard deviations, and anticipatory responses. Attention and impulse control developed in a nonlinear manner, changing rapidly in early childhood and leveling off during later childhood and adolescence. Males made more omission, commission, and anticipatory errors and had faster mean reaction time (RT) than females. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Grin'Yatsenko, V. A., Kropotov, Y. D., Ponomarev, V. A., Chutko, L. S., & Yakovenko, E. A. (2001). Effect of biofeedback training of sensorimotor and beta -sub-1EEG rhythms on attention parameters. Human physiology, 27(3), 259-266. The effects of the electroencephalogram (EEG)-biofeedback (EEG-BFB) procedure, aimed at increasing the sensorimotor (12-15 Hz) and beta -sub-1(15-18 Hz) rhythms on the psychological and electrophysiological parameters of attention, were studied using the methods of scalp recording of evoked potentials in the bistimulus paradigm Go/No-Go and a psychological attention test (Test of Variables of Attention; TOVA). 25 children (mean age 11.4 yrs) with %ADHD symtoms were included in the study. EEG-BFB sessions significantly improved the attention, behavior, and school study results in 19 (76%) children. In these cases, a significant increase in the amplitude of the inhibitory component in the frontocentral leads and improvement of the TOVA parameters were found. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Grisanzio, W. R. (2001). Evaluation of the effectiveness of an attention enhancement program for children diagnosed with ADHD administered in the school setting. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61 (9-B), 5043. Attention-Deficit Hyperactivity disorder (ADHD), a persistent pattern of inattention and or hyperactivity-impulsivity, is a growing concern in many school districts because it is estimated to affect as much as 3 percent to 5 percent of the school age population (APA, 1994). The problem is that regardless of the currently accepted methods of treatment such as parent training, family therapy, classroom management, social skills training, and medication therapy, the symptoms of ADHD persist into adolescence at an alarming rate. Children with disorders of behavior exhibit excessive theta brainwave activity compared to normal children (Lubar, 1991). The present study administered a changing criterion treatment protocol, which integrated components of neurofeedback, meditation, and control theory, in order to decrease theta brainwave activity. The purpose of the present study was to explore whether a school system could identify specific profiles of attention with a computerized continuous performance test (CPT), administer an attention enhancement program, and remedy those deficits identified by the CPT. The subjects were 5 male children between the ages of 8 and 10 years who were diagnosed ADHD by their family physicians. Subjects were selected according to their performance on the Test of Variables of Attention (T.O.V.A.), a computerized continuous performance test. Subjects received between 18 and 26 attention enhancement sessions over a four month period during their regular school day. Although the T.O.V.A. showed moderate ability to identify specific profiles of attention, as supported by moderate Pearson correlations between T.O.V.A. impulsivity and ADHDT impulsivity (r = -.58, P < .05) and T.O.V.A. inattention and ADHDT inattention (r = -.63, P < .05), T.O.V.A. performance did not consistently improve after attention training. Although the attention enhancement program was completed within the school, there were many unforseen difficulties and impediments to its successful administration. Secondary dependent measures included the Stroop Color and Word Test, Attention-Deficit Hyperactivity Disorder Test (ADHDT), EEG measures, Parenting Stress Index, and Behavior Rating Profile. The results of these measures were equivocal. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Grooms, S. P. (1996). Within test variance for omission and commission scores for the test of variables of attention (TOVA). Dissertation Abstracts International: Section B: The Sciences and Engineering, 56 (9-B), 5194. The problem. The major purpose of this study was to examine the differences between children who had been diagnosed as having Attention-Deficit Hyperactivity Disorder (ADHD), and those who had not been diagnosed, with regard to their level of performance variability on the Test of Variables of Attention (TOVA) relating to scores of omission and commission. The objectives of this study were: (1) to determine whether a difference existed between the two groups, and (2) to determine whether the variability scores implemented for the TOVA were sufficiently sensitive to detect any significant differences between normals and non-normals. Method. The subjects' scores were extracted from the original norming data for the TOVA published by Greenberg and Waldman (1993) in The Journal of Child Psychology and Psychiatry (data were used with permission). The experimental group included 106 subjects with an average age of 9.96 years and a Standard Deviation (SD) of 2.24 (boys and girls who had been diagnosed as having ADHD and UADD). The non-disordered comparison group consisted of 769 children with an average age of 10.3 years and a SD of 2.75, both groups ranging in age from 6 years to 15 years. Results. Significant differences were found to exist between the two groups for commission and omission within test variance scores. The TOVA within test variance for omission and commission supported the test's sensitivity to ADHD children, demonstrating an ability to accurately predict normals from non-normals. In this study there were significant statistical differences obtained for both hypotheses. Significance was found when employing both the MANOVA and the Univariate F-test to the TOVA within test variance scores. This significance indicates that the two groups being studied were different in their TOVA within test variances for omission and commission errors. The results of this study indicate that both groups are heterogeneous with regard to within test variance as a predicto (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Gross-Tsur, V., Goldzweig, G., Landau, Y. E., Berger, I., Shmueli, D., & Shalev, R. S. (2006). The impact of sex and subtypes on cognitive and psychosocial aspects of ADHD. Developmental Medicine & Child Neurology, 48(11), 901-905. We compared the effect of sex and attention-deficit-hyperactivity disorder (ADHD) subtyping in groups of females and males. One hundred and one females with ADHD (mean age 10y 4mo [SD 2y 8mo]; range 5y-18y) were classified according to subtype by Diagnostic and Statistical Manual of Mental Disorders (4th edn) criteria (inattentive [ADHD-I]; combined [ADHD-C]) and balanced by subtype to 101 males (mean age 10y 5mo [SD 2y 9mo]; range 5y 4mo-17y 6mo). All children underwent IQ and reading assessment, and 109 underwent the continuous performance task (Test Of Variables of Attention [TOVA]). Parents completed the Conners' Abbreviated Rating Scale (ABRS), the Child Behavior Checklist (CBCL), learning disability questionnaires, and reported use and efficacy of methylphenidate. Teachers completed the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) rating scale. Sex differences were found only on the CBCL; females were more impaired on the attention (p<0.001) and somatization (p=0.028) subscales but not for IQ, other questionnaires, TOVA scores, methylphenidate treatment, or demographics. Females with ADHD-C, but not males, had significantly higher T-scores than females with ADHD-I on social, attention, delinquent, and aggressive behaviours. Regardless of sex, children with ADHD-C had higher scores on all CBCL subscales (p=0.047), ABRS (p<0.001), and SKAMP (p=0.03) than children with ADHD-I. The results support the supposition that ADHD in females is the same disorder as in males. ADHD subtyping was the important determinant of ADHD core symptoms; females with ADHD were found to have significant risk of psychopathology.
Hansen, L. M., Trudeau, D. L., & Grace, D. L. (1996). Neurotherapy and drug therapy in combination for adult ADHD, personality disorder, and seizure disorder: A case report. Journal of Neurotherapy, 2(1), 6-14. Presents a case report of a 36-yr-old female patient with attention deficit hyperactivity disorder (ADHD), temporal seizure disorder, and borderline personality disorder treated with 30-weekly sessions of sensorimotor rhythm neurofeedback and carbamazepine. Posttreatment measures showed improvements in Test of Variables of Attention (L. M. Greenberg and I. W. Woldman, 1993), self-reports, and quantitative EEG. Both neurofeedback and carbamazepine showed the most effect in early treatment. Progress continued after discontinuance of the drug. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Hardy, P., Collet, J., Goldberg, J., Ducruet, T., Vanasse, M., Lambert, J., et al. (2002). Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy. Developmental Medicine & Child Neurology, 44(7), 436-446. We conducted a double-blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2-month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self-control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners' Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.
Harris, E. L., Schuerholz, L. J., Singer, H. S., & Reader, M. J. (1995). Executive function in children with tourette syndrome and/or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society, 1(6), 511-516. Examined the extent to which executive function (EF) is impaired in Tourette Syndrome (TS), and whether these deficits can be attributed to comorbid attention deficit hyperactivity disorder (ADHD) in children (aged 6-14 yr olds), 10 with TS-only, 48 with ADHD-only, and 32 with TS and ADHD. Ss completed the Diagnostic Interview for Children and Adolescents, Test of Variables of Attention, Wisconsin Card Sorting Test, and the Complex Figure Test. Ss in all groups could not efficiently produce output on a timed continuous performance task. TS-only Ss appeared to have fewer EF impairments and significantly higher perceptual organization scores than TS and ADHD or ADHD-only Ss. Findings suggest that deficiencies in choice reaction time and consistency of timed responses are common to all 3 groups, but TS-only Ss have relatively less EF impairment than TS and ADHD or ADHD-only Ss. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Hemme, J. M. (2004). Comparison of neuropsychological and behavioral correlates in children with TBI and ADHD. Dissertation Abstracts International: Section B: The Sciences and Engineering, 65 (5-B), 2629. Recent findings suggest that traumatic brain injury (TBI) entails risk for acquired Attention-Deficit/Hyperactivity Disorder (ADHD) symptomatology, yet there are indications that the nature of attentional impairments in children with TBI and ADHD may differ. In addition, previous research has found that inhibitory deficits were related to activity levels in children with TBI and ADHD. Thus, this study compared the attentional profiles and ADHD symptomatology in groups of children with history of TBI or ADHD. It was hypothesized that children with TBI and ADHD would differ in their performances within several domains of attention including: sustained attention, focused/selective attention, working memory, and processing speed. It was also expected that groups would differ in hyperkinesis but not in attention deficit symptoms, with the group of children with ADHD being significantly more hyperactive. Fifty-six participants were identified retrospectively from medical records of a university-affiliated children's hospital. Children who sustained a moderate to severe TBI (n = 24) were compared to children diagnosed with ADHD (n = 32). Both groups of children were evaluated with the following measures: Test of Everyday Attention for Children (TEACh; Manly, Robertson, Anderson, & Nimmo-Smith, 1999), Test of Variables of Attention (TOVA; Greenberg & Dupuy, 1993), Wechsler Intelligence Scale for Children-III (WISC-III; Wechsler, 1994), and the Conners' Parent Rating Scale-Revised (CPRS-R:L; Conners, 1997; completed by caregivers). As expected, children with ADHD were rated as more hyperactive than children with TBI, but contrary to my hypothesis both groups demonstrated elevated levels of inattention. Consistent with previous research, 18% of the TBI sample scored in the range suggestive of ADHD-Predominantly Inattentive Type according to strict cut-off scores from the CPRS-R:L. The hypotheses of this study suggesting that children with TBI would perform more poorly than children with ADHD on focused/selective attention, working memory, and processing speed tasks were not supported. Children with ADHD also did not differ from children with TBI on sustained attention tasks. Finally, the neurobehavioral correlates of attention did not differ between the two groups. Findings from this study underscore the importance of developing specific interventions for children with TBI and ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Henry, G. K. (2005). Probable malingering and performance on the test of variables of attention. Clinical Neuropsychologist, 19(1), 121-129. Fifty subjects with mild head injury involved in personal injury litigation and 2 subjects referred for evaluation of their disability status underwent comprehensive neuropsychological examination including the Test of Variables of Attention (TOVA). Group status was determined by performance on symptom validity testing. Twenty-six subjects who failed symptom validity testing formed the probable malingering (PM) group, while 26 subjects who passed symptom validity testing comprised the not malingering (NM) group. Subjects in the PM group performed significantly worse on all TOVA variables relative to subjects in the NM group. Discriminant function analyses revealed that TOVA omission errors >/=3 errors was the best predictor of group status. Malingering research employing a group of probable clinical malingerers has direct generalizability to real-world settings.
Herod, L. A. (1999). Auditory and visual continuous performance tests in ADHD: A comparison of sensory modalities, age, and response to methylphenidate. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60 (2-B), 0831. Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral disorder characterized by developmentally inappropriate levels of inattention, impulsivity, and/or hyperactivity. Interviews, behavior rating scales, behavioral observation, and laboratory tasks have been employed to evaluate the presence of ADHD symptoms. The continuous performance test (CPT) is a laboratory test commonly used in clinical and research settings with individuals suspected of having ADHD. The CPT is a type of vigilance task that requires monitoring for a particular stimulus embedded in a series of stimuli. Typically, CPTs are presented visually. Little research exists that compares performance between the auditory and visual modalities. This study was designed to determine if there are differences in CPT performance based on modality of presentation. Fifty-three ADHD subjects between the ages of 6 and 15 participated in the study. Each child completed two standardized and normed CPTs, with an auditory and visual version. Total correct and commission errors were compared across modalities and tests (the Gordon Diagnostic System and the Test of Variables of Attention) using Z-scores which were adjusted for the child's age. ADHD children obtained significantly more correct on the two auditory CPTs, relative to the visual CPTs. Commission errors were significantly lower only on the auditory Test of Variables of Attention, relative to the other measures. The effect of age and medication on performance was also investigated. Normal children display a developmental trend in performance, with older subjects detecting more targets and committing fewer errors. Similar to normal children, performance in this sample of ADHD children improved with age. With the exception of the Test of Variables of Attention commissions, there were significant improvements with age. Results suggest that the CPTs employed in this study may have limited utility when assessing adolescents for ADHD, due to the finding that this group detected a high number of correct targets with few errors. Methylphenidate is a commonly prescribed stimulant used to treat the symptoms of ADHD. Medication has been demonstrated to improve both auditory and visual CPT performance. To determine whether methylphenidate improves performance similarly across modality, thirty-two subjects were recruited to participate twice, once while taking a placebo and once while taking methylphenidate. Methylphenidate was found to enhance performance equally across modality. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Hinds, P. L. (2000). Correlation of continuous performance test variables with teacher ratings of behavior among referred and nonreferred students. Dissertation Abstracts International Section A: Humanities and Social Sciences, 60 (11-A), 3978. The purpose of this study was to explore the nature of the relationship between a continuous performance test (CPT) and teachers' ratings of behavior. Assessment data were archival in nature. one hundred-one children from one rural, middle-class, predominately Caucasian school district in a Midwestern state were selected who had taken the Test of Variables of Attention (TOVA) and whose teachers had completed the Attention Deficit Disorders Evaluation Scale-School Version (ADDES) and the Child Behavior Checklist-Teacher Report Form (TRF). of this group 46 had been referred for Attention-Deficit/Hyperactivity Disorder (ADHD) and/or learning difficulties and 55 had participated in a local norming project for the TOVA. Descriptive statistics were found for CPT variables and teachers' ratings of behavior for all participants, boys and girls separately, and referred and nonreferred separately. The research question was investigated using a matrix of partial correlations controlled for age. TOVA variables included Omissions, Commissions, Response Time, Response Time Variability, Anticipatory Responses, and Multiple Responses. Teacher's rating scale variables included the ADDES Total and subscales Inattention, Impulsive, and Hyperactive as well as the TRF Attention Problems, and Aggressive Behavior. Research provided support that TOVA Omissions and Commissions are valid indicators of ADHD as measured by teachers' ratings of behavior. Response Time Variability and Multiple Responses may be valid indicators of generalized behavior dysfunction as measured by teachers, ratings of behavior. Anticipatory Responses and Response Time may aid in distinguishing ADHD with and without hyperactivity but further research is recommended. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Hong, H. J., Shin, D. W., Lee, E. H., Oh, Y. H., & Noh, K. S. (2003). Hypothalamic-pituitary-adrenal reactivity in boys with attention deficit hyperactivity disorder. Yonsei medical journal, 44(4), 608-614. The hypothesis 'whether subjects with attention-deficit/ hyperactivity disorder (ADHD), who showed under-reactivity of the hypothalamic-pituitary-adrenal (HPA) axis to stress, would make more commission errors in attention tasks', was examined. Forty-three boys, with ADHD, who visited the psychiatric outpatient clinic, at Kangbuk Samsung Hospital, were the subjects of this study. Both pre- and post-test morning saliva samples were collected from the patients at the Korean Educational Development Institute-Wechsler Intelligence Scale for Children (KEDI-WISC), and Tests of Variables of Attention (T.O.V.A.) performed. The Standard scores of the T.O.V.A. were compared between the patients with decreases, or increases, in the salivary cortisol levels after the test. Decreases, or increases in the salivary cortisol levels after the test were shown in 28 and 15 patients, respectively. The patients with decreased cortisol levels after the test tended to make more commission errors in compared with those with increased cortisol levels. The patients with the decreased cortisol levels after test had more omission errors in the first quarter of the test, and more commission errors in the second half of the test compared to those with the increased cotisol levels. Subjects who show decreased salivary cortisol levels after stress make more commission errors in attention tests. This suggests that the blunted HPA axis response to stress is related to the impulsivity in patients with ADHD.
Horesh, N. (2001). Self-report vs. computerized measures of impulsivity as a correlate of suicidal behavior. Crisis: Journal of Crisis Intervention & Suicide, 22(1), 27-31. OBJECTIVES: To compare the use of a self-report form of impulsivity versus a computerized test of impulsivity in the assessment of suicidal adolescent psychiatric inpatients. METHODS: Sixty consecutive admissions to an adolescent in patient unit were examined. The severity of suicidal behavior was measured with the Childhood Suicide Potential Scale (CSPS), and impulse control was measured with the self report Plutchik Impulse Control Scale (ICS) and with the Test of Variables of Attention (T.O.V.A.), a continuous performance test (CPT). The T.O.V.A. is used to diagnose adolescents with attention deficit disorder. RESULTS: There was a significant but low correlation between the two measures of impulsivity. Only the TOVA commission and omission errors differentiated between adolescent suicide attempters and nonattempters. CONCLUSIONS: Computerized measures of impulsivity may be a useful way to measure impulsivity in adolescent suicide attempters. Impulsivity appears to play a small role only in nondepressed suicidal adolescents, especially boys.
Huang, Y. S., Chao, C. C., Wu, Y. Y., Chen, Y. Y., & Chen, C. K. (2007). Acute effects of methylphenidate on performance during the test of variables of attention in children with attention deficit/hyperactivity disorder. Psychiatry & Clinical Neurosciences, 61(3), 219-225. This study attempted to determine the acute effects of methylphenidate (MPH) on cognitive performance using the Test of Variables of Attention (TOVA) in children with attention deficit/hyperactivity disorder (ADHD). The study subjects comprised 57 children diagnosed with ADHD aged 6-13 years. Diagnoses of ADHD and other comorbid psychiatric disorders were based on Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria following a standard interview with the Schedule for Affective Disorder and Schizophrenia for School-Age Children, epidemiologic version. The subjects' performance on the TOVA was compared before and 1 h after administration of MPH. After administration of MPH, commission scores, response time and ADHD scores improved significantly, however, there were no significant changes in omission scores, response time variability or response sensitivity. The authors concluded that administration of one dose of MPH (0.5-1.0 mg/kg) produced more effects on impulsivity than on attention deficiency in children with ADHD, and that the second half section of the TOVA could be more sensitive than the first half in determining the acute effects of MPH therapy in children with ADHD. However, the effects of different MPH doses on the TOVA results need further investigation.
Huang, Y. S., Chen, N. H., Li, H. Y., Wu, Y. Y., Chao, C. C., & Guilleminault, C. (2004). Sleep disorders in taiwanese children with attention deficit/hyperactivity disorder. Journal of sleep research, 13(3), 269-277. To assess obstructive sleep apnea syndrome (OSAS) and periodic limb movement disorder (PLMD) in children with attention deficit/hyperactivity disorder (ADHD) compared with a control group. The ADHD was diagnosed based on Diagnostic and Statistical Manual, version IV (DSM-IV) criteria on successively seen elementary school children aged 6-12 years referred to a psychiatric clinic for suspected ADHD. A standardized interview (Kiddie-SADS-E), parents and teacher questionnaires, neuropsychological testing, and nocturnal polysomnography were completed for each child. Eighty-eight children (77 boys) with ADHD and 27 controls were involved in the study. Fifty children with ADHD (56.8%) had an apnea-hypopnea index (AHI) >1 event h(-1) and 17 (19.3%) had an AHI >5 event h(-1). Nine children (10.2%) had a periodic limb movement index (PLMI) >5 events h(-1). There is one child with AHI >1 and none with a PLMI > 5 in the control group. In the test of variables of attention (TOVA), the response time was significantly worse in ADHD with sleep disorders than those without them. The child behavior checklist (CBCL) showed a significant difference between groups in the hyperactivity subscale. The diagnostic criteria for ADHD based on DSM-IV do not differentiate between children with or without sleep disorders. Evaluation of sleep disorders should be considered before starting drug treatment for ADHD.
Huang, Y. S., Guilleminault, C., Li, H. Y., Yang, C. M., Wu, Y. Y., & Chen, N. H. (2007). Attention-deficit/hyperactivity disorder with obstructive sleep apnea: A treatment outcome study. Sleep medicine, 8(1), 18-30. BACKGROUND: Children diagnosed with attention-deficit/hyperactivity disorder (ADHD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria, may also have obstructive sleep apnea (OSA), but it is unclear whether treating OSA has similar results as methylphenidate (MPH), a commonly used treatment for ADHD. METHODS: This study enrolled 66 school-age children, referred for and diagnosed with ADHD, and 20 healthy controls. Polysomnography (PSG) performed after ADHD diagnosis showed the presence of mild OSA. After otolaryngological evaluation, parents and referring physicians of the children could select treatment of ADHD with MPH, treatment of OSA with adenotonsillectomy or no treatment. Systematic follow-up was performed six months after initiation of treatment, or diagnosis if no treatment. All children had pre- and post-clinical interviews; pediatric, neurologic, psychiatric and neurocognitive evaluation; PSG; ADHD rating scale, child behavior checklist (CBCL) filled out by parents and teacher; test of variables of attention (TOVA); and the quality of life in children with obstructive sleep disorder questionnaire (OSA-18). RESULTS: ADHD children had an apnea-hypopnea index (AHI)>11 considered abnormal is detrimental to children with ADHD. Recognition and surgical treatment of underlying mild sleep-disordered breathing (SDB) in children with ADHD may prevent unnecessary long-term MPH usage and the potential side effects associated with drug intake.
HuangStorms, L., BodenhamerDavis, E., Davis, R., & Dunn, J. (2007). QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10(4), 3-16. Background: Poor self-regulation of arousal is central to the behavioral difficulties experienced by children with traumatic caretaker attachment histories. EEG biofeedback teaches children to self-regulate brain rhythmicity, which may in turn affect global improvements in the areas of attention, aggression, impulse control, and trust formation. Research literature reports successful use of neurofeedback for children with ADHD, autism, asthma, stroke, and migraine. This study extends current research by investigating the effectiveness of neurofeedback in reducing behavioral problems commonly observed in abused/neglected children. Methods: Treatment records of twenty adopted children with histories of removal from their biological home by Child Protective Services were obtained from a private neurofeedback practice. All of the children were assessed prior to treatment using the Child Behavior Checklist (CBCL) and the Test of Variables of Attention (TOVA) and again after 30 sessions of individualized, qEEG-guided neurofeedback. Results: T-test analysis of pre- and post-scores on the CBCL showed significant changes in the areas of externalizing problems, internalizing problems, social problems, aggressive behavior, thought problems, delinquent behavior, anxiety/depression, and attention problems (p < .05). TOVA omission error, commission error, and variability scores also improved significantly following neurofeedback training (p < .05). Some pre-treatment qEEG patterns common to this group of children were identified. Conclusions: The CBCL and TOVA score improvements observed in this study indicate that neurofeedback is effective in reducing behavioral, emotional, social, and cognitive problems in children with histories of neglect and/or abuse. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Hyman, S. L., Shores, A., & North, K. N. (2005). The nature and frequency of cognitive deficits in children with neurofibromatosis type 1. Neurology, 65(7), 1037-1044. OBJECTIVE: To assess the frequency and severity of specific cognitive deficits in children with neurofibromatosis type 1 (NF1) in a large unbiased cohort. METHODS: Extensive cognitive assessments were performed in 81 children with NF1 ages 8 to 16 years and their performance was compared with that of 49 unaffected sibling controls. RESULTS: Eighty-one percent of the children with NF1 had moderate to severe impairment in one or more areas of cognitive functioning. Although 51% of children with NF1 performed poorly on tasks of reading, spelling, and mathematics, specific learning disabilities (as defined by IQ-achievement discrepancies) were present in only 20% of the children. Sustained attention difficulties were present in 63% of children with NF1, with 38% of children with NF1 fulfilling the diagnostic criteria for attention deficit-hyperactivity disorder. The NF1 neuropsychological profile is characterized by deficits in perceptual skills (visuospatial and visuoperceptual), executive functioning (planning and abstract concept formation), and attention (sustained and switching). Interestingly, both verbal and visual memory was unaffected in NF1 children, and their memory skills were in general stronger than their level of general intellectual function. Although both expressive and receptive language skills were significantly impaired in NF1 children, they appeared to be relatively better preserved than visuospatial abilities once IQ is taken into account. CONCLUSION: There is an extremely high frequency of cognitive problems in children with neurofibromatosis type 1, making cognitive dysfunction the most common complication to affect quality of life in these children.
Jensen, P. S., & Kenny, D. T. (2004). The effects of yoga on the attention and behavior of boys with attention-deficit/ hyperactivity disorder (ADHD). Journal of Attention Disorders, 7(4), 205-216. Boys diagnosed with ADHD by specialist pediatricians and stabilized on medication were randomly assigned to a 20-session yoga group (n = 11) or a control group (cooperative activities; n = 8). Boys were assessed pre- and post-intervention on the Conners' Parent and Teacher Rating Scales-Revised: Long (CPRS-R:L & CTRS-R:L; Conners, 1997), the Test of Variables of Attention (TOVA; Greenberg, Cormna, & Kindschi, 1997), and the Motion Logger Actigraph. Data were analyzed using one-way repeated measures analysis of variance (ANOVA). Significant improvements from pre-test to post-test were found for the yoga, but not for the control group on five subscales of the Conners' Parents Rating Scales (CPRS): Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive and ADHD Index. Significant improvements from pre-test to post-test were found for the control group, but not the yoga group on three CPRS subscales: Hyperactivity, Anxious/Shy, and Social Problems. Both groups improved significantly on CPRS Perfectionism, DSM-IV Hyperactive/ Impulsive, and DSM-IV Total. For the yoga group, positive change from pre- to post-test on the Conners' Teacher Rating Scales (CTRS) was associated with the number of sessions attended on the DSM-IV Hyperactive-Impulsive subscale and with a trend on DSM-IV Inattentive subscale. Those in the yoga group who engaged in more home practice showed a significant improvement on TOVA Response Time Variability with a trend on the ADHD score, and greater improvements on the CTRS Global Emotional Lability subscale. Results from the Motion Logger Actigraph were inconclusive. Although these data do not provide strong support for the use of yoga for ADHD, partly because the study was under-powered, they do suggest that yoga may have merit as a complementary treatment for boys with ADHD already stabilized on medication, particularly for its evening effect when medication effects are absent. Yoga remains an investigational treatment, but this study supports further research into its possible uses for this population. These findings need to be replicated on larger groups with a more intensive supervised practice program.
Jondeau, G. (2005). [The best of cardiac failure in 2004]. [L'essentiel de 2004 en insuffisance cardiaque.] Archives des Maladies du Coeur et des Vaisseaux, 98 Spec No 1(Spec 1), 23-32. Regarding cardiac failure, the year 2004 was notable for the dissemination of indications for the use of medical devices in heart failure: indications for cardioversion with the long awaited publication of the COMPANION study, advancement of the concept of intra-ventricular asynchronism, and studies of defibrillators in non-ischaemic cardiac failure (COMPANION, DEFINITE, SCD-HeFT, TOVA). Furthermore, pragmatic clinical studies allowed refinement of the uses of BNP (diagnostic and prognostic), underlining the importance of renal function and its progression during hospitalisation, and the risks of using strong, modern therapy in populations without "ad hoc" surveillance which do not correspond with study populations (aldactone in Canada). Just as in coronary patients, it appears to be important to commence full medical treatment prior to hospital discharge, because treatment is rarely changed thereafter. The management of seriously ill patients is evolving with several therapeutic advances: the methods of selecting patients for heart transplants have changed, with the advancement of opportunities for circulatory assistance. Attention has also been turned to the significant group, still poorly understood, of patients with diastolic heart failure, for whom diagnostic methods have been defined, as well as their clinical characteristics. Lastly the medication studies: new drugs in acute cardiac failure (preliminary results for vasopressin antagonists), wider indications for betablockers in elderly subjects (SENIORS), and advances in cellular cardiomyoplasty (using haemopoietic stem cells especially this year). It has been a fruitful year, difficult to summarise in a few lines, or even several pages.... [References: 39]
Joyce, M., & Siever, D. (2000). Audio-visual entrainment program as a treatment for behavior disorders in a school setting. Journal of Neurotherapy, 4(2), 9-25. ADHD children produce higher amounts of theta (5-7 Hz) and less beta (13-21 Hz) brain wave activity than normals. Many researchers are testing the therapeutic effectiveness of Audio-Visual Entrainment (AVE) as a treatment for a variety of low arousal brain disorders. AVE is the repetitive and intermittent presentation of light and sound. AVE affects EEG output in that brain wave output can be suppressed or enhanced at specific frequencies. 34 elementary students from two different schools were given AVE over the course of 7 wks. Ss were given the Test of Variables of Attention (TOVA) before and after participation. A second group of 8 Ss were in a special reading (SPALDING) class. All of the students in this class received the Standardized Test for the Assessment of Reading (STAR) and were compared with a control group. Overall inattention, impulsivity and variability as rated by the TOVA improved significantly. The 8 Ss from the SPALDING reading program who received AVE improved their reading scores more than their control classmates. The results included normalization as recorded on the TOVA, substantial improvements in reading as recorded on the STAR, and improvements in general behavior as noted by teachers and parents. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Kaiser, D. A., & Othmer, S. (2000). Effect of neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 4(1), 5-15. Neurofeedback studies have been criticized for including small numbers of subjects. The effect of sensorimotor-beta neurofeedback training on the Test of Variables of Attention was evaluated in 1,089 Ss (aged 5-67 yrs) from 32 clinics. Ss underwent 20 or more sessions of SMR-beta neurofeedback training for attentional and behavioral complaints at thirty-two clinical settings affiliated with EEG Spectrum, Inc. Ss were evaluated prior to training and at training completion. 157 Ss who elected extensive training (40 sessions or more) were tested after both 20 and 40 training sessions. Results indicated that neurofeedback training produced significant improvement in attentiveness, impulse control, and response variability. Significant clinical improvement in one or more measures was seen in 85% of those Ss with moderate pre-training deficits. It is concluded that neurofeedback training is effective in remediating attentional dysfunction. Nevertheless, large-scale studies with greater control (e.g., wait-list designs) are needed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Kennel, S. E. (2005). The effect of binaural auditory beats on inattention in children and adolescents with attention-deficit hyperactivity disorder. (Ph.D., University of Virginia). , 148. Purpose. The purpose of this investigation was to determine the effectiveness of binaural auditory beat stimulation in reducing the symptom of inattention in children and adolescents with Attention-Deficit Hyperactivity Disorder (ADHD). Methods. This study was a randomized, double-blind, placebo-controlled clinical investigation to determine the effectiveness of binaural auditory beats on the symptom of inattention in children with ADHD. Participants were randomly assigned to listen to a CD that contained binaural auditory beats or a sham CD, three times a week for three weeks while completing homework assignments. Sample. The sample was comprised of 20 children and adolescents, eight to twenty-one years of age. Participants were recruited from Charlottesville, Virginia and the surrounding counties via newspaper advertisements, brochures and flyers that were posted in the Primary Care Clinic at the University of Virginia's Health Center and local pediatrician's offices. Measures. The Children's Color Trails Test, The Color Trails Test and the Test of Variables of Attention (TOVA) were used to measure changes in inattention pre and post intervention. The Homework Problem Checklist was used to measure changes in homework behaviors during the three week study. Results. Repeated measures ANOVA were used to analyze pre and post intervention scores on the Color Trails Tests. Analysis of Covariance (ANCOVA) was used to analyze pre and post intervention scores on the TOVA. The effect of time was significant on the Color Trails Test. However, there were no significant group differences on this measure. In addition, there were no significant group differences on the TOVA when pre and post-intervention scores were compared. Repeated measures ANOVA were used to evaluate changes on the Homework Problem Checklist over three week intervention. Homework problems significantly decreased in both groups; however, group differences were not significant. Conclusion. The results from the present study suggest that BABS did not significantly reduce the symptom of inattention in children and adolescents affected with Attention Deficit Hyperactivity Disorder. This may be attributable to the small sample size. Therefore, this modality should be studied using a sufficient sample to determine its effectiveness to reduce the symptom of inattention in those diagnosed with ADHD.
Kiger, N. C. (1998). An evaluation of parent and teacher rating scales as predictors of the T.O.V.A. measures of inattention, impulsivity, response time and variability. Dissertation Abstracts International Section A: Humanities and Social Sciences, 58 (9-A), 3417. This study evaluated the relationship of six parent and eight teacher rating scales to the T.O.V.A. measures of Inattention, Impulsivity, Response Time and Variability. Subjects consisted of 88 children 6 through 14 years of age, referred by teachers and parents to a school psychologist in a small midwestern community for evaluation of ADHD symptomatology. These students attended school at four public elementary schools and three private religious elementary schools. Sixty-eight subjects were males and twenty subjects were females. Each child was administered the T.O.V.A. by a school psychologist. Parents filled out the BASC:PRS, CPRS-48, and the ADHD Rating Scale. Teachers completed the BASC:TRS, CTRS-28, the ADHD Rating Scale and the APRS. Results from correlational analyses of parent rating scales, teacher rating scales and the four T.O.V.A. variables are presented and discussed. Multiple regression analyses were used to evaluate sets of parent and teacher rating scales as predictors of the four T.O.V.A. variables. On the basis of the study it was concluded that the combination of the sets of parent and teacher rating scales accounted for approximately one-sixth of the variance of the T.O.V.A. Impulsivity measure. The combination of the sets of parent and teacher rating scales did not explain an important part of the variance of the T.O.V.A. Inattention, Response Time or Variability measures. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
King, A., Herron, S., McKinstry, R., Bacak, S., Armstrong, M., White, D., et al. (2006). A multidisciplinary health care team's efforts to improve educational attainment in children with sickle-cell anemia and cerebral infarcts. Journal of School Health, 76(1), 33-37. The primary objective of this study was to improve the educational success of children with sickle-cell disease (SCD) and cerebral infarcts. A prospective intervention trial was conducted; a multidisciplinary team was created to maximize educational resources for children with SCD and cerebral infarcts. Students were evaluated systematically before and after the intervention. A baseline evaluation was completed assessing the presence of an Individualized Education Plan (IEP), grade retention in school, and days absent from school in the year preceding the intervention. A postintervention assessment occurred 2 years later for these same measurements. At baseline, 74% (17 of 23) of the students were receiving IEPs. Two years later, 87% (20 of 23) students received IEPs (p = .34). Despite the intervention, the rate of children retained in their school grade increased from 0.6 per 100 years in school at baseline to 1.7 per 100 years, 95% CI (-3.86, 1.49). The school absenteeism rate did not significantly change after the intervention; the average days absent per student rose from 15.5 to 22.5, (p = .05). The multidisciplinary team effort alone was insufficient to decrease grade retention and absenteeism rate. Further support, from either the parents or school administration, is needed to increase education attainment of students with cerebral infarcts.
Knoblich, D. L. (2001). A controlled study to test the efficacy of eeg-driven stimulation (eds) on attention and memory of adults with attention deficit disorders. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62 (2-B), 1133. This study was designed to assess the clinical efficacy of EEG-Driven Stimulation (EDS) on attention and memory of adults with Attention Deficit Hyperactivity Disorder. Two groups were used in the study, a photic stimulation EDS group (N = 12; mean age = 37.7) and a stimulant medication (MED) group (N = 13; mean age = 45.8). Both groups were similar with respect to age, IQ, an approximate measure of hypnotic ability, gender, and primary and secondary diagnoses. Participants in the MED group were adults already taking stimulant medication. They were off their medication 24 hours prior to and during pretesting. For the remainder of the study and during posttesting, they remained on their medication. Due to the individualized nature of the EDS training protocol, participants in the EDS group were in treatment from 4 to 5 months with a mean number of treatment sessions being 28. The generalized goal of training was to reduce amplitude in delta and alpha bands from 21 scalp locations down to 2-3 microvolts. It was hypothesized that EDS training would be associated with a significant decrease in theta/high beta power ratios along with significant improvements in attention and memory. It was also hypothesized that the EDS group and MED group would demonstrate comparable improvements in attention and memory. The Test of Variables of Attention (TOVA), the Rey Auditory-Verbal Learning Test (RAVLT), and theta/high beta power ratios from 21 scalp locations were used to assess both groups' pre- to posttreatment changes in attention, memory, and EEG activity. Statistically significant results in attention were observed in both treatment groups. For the memory variables, only the IVIED group yielded statistically significant results. Regarding difference in degree of improvement in attention and memory variables, no statistical significance was found between treatment groups. Though not significant, an overall reduction in theta/high beta power ratios along 21 scalp locations for the EDS group was observed. No difference in power ratios, from nonmediated to medicated conditions was demonstrated in the MED group. Despite the apparent ability of both EEG-driven stimulation and stimulant medication to improve adult attention, the hypothesized mechanism for change, that is, reductions in theta/high beta power ratios, was not found to be a correlate of change, nor was hypnotic ability or suggestibility found to be a factor. These clinical findings suggest that physiological and psychological mechanisms may have had only a limited impact on change. Further research is needed to assess the influence of proposed mechanisms of change as well as nonspecific effects. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Lavi, U., Lahav, E., Genizi, A., Degani, C., Gazit, S.,Hillel, J. (1991). Quantitative genetic analysis of traits in avocado cultivars. Plant Breeding, 106(2), 149-160. Quantitative genetic analysis of several avocado traits was evaluated from progenies of crosses between and within avocado cv. Parenthood was determined by isozymes and the seedling progenies were assessed for 8 traits (tree size, flowering intensity, fruit density, fruit wt., inflorescence length, seed size, fruit softening time and harvest duration). A biometrical genetic approach for analysis of this breeding project is presented. Genetic profiles of the traits and cv. were detailed by several characteristics. 5 avocado cv. Fuerte, Hass, Ettinger, Tova and Rosh-Hanikra were characterized separately for each trait. Practical conclusions for the breeder with respect to economically important quantitative traits are discussed.
Leark, R. A., Wallace, D. R., & Fitzgerald, R. (2004). Test-retest reliability and standard error of measurement for the test of variables of attention (T.O.V.A.) with healthy school-age children. Assessment, 11(4), 285-289. Test-retest reliability of the Test of Variables of Attention (T.O.V.A.) was investigated in two studies using two different time intervals: 90 min and 1 week (2 days). To investigate the 90-min reliability, 31 school-age children (M = 10 years, SD = 2.66) were administered the T.O.V.A. then read ministered the test 90 min afterward. Significant reliability coefficients were obtained across omission (.70), commission (.78), response time (.84), and response time variability (.87). For the second study, a different sample of 33 school-age children (M = 10.01 years, SD = 2.59) were administered the test then read ministered the test 1 week later. Significant reliability coefficients were obtained for omission (.86), commission (.74), response time (.79), and response time variability (.87). Standard error of measurement statistics were calculated using the obtained coefficients. Commission scores were significantly higher on second trials for each retest interval.
Leark, R. A., Dixon, D., Hoffman, T., & Huynh, D. (2002). Fake bad test response bias effects on the test of variables of attention. Archives of Clinical Neuropsychology, 17(4), 335-342. This study investigated the effects of faking bad (FB) on the Test Of Variables of Attention (TOVA) using 36 Ss (mean age 22.38 yrs) randomly placed into 2 groups. Ss in Group 1 took the TOVA under normal conditions (NQ first; they were then requested to subtly fake bad. Group 2 Ss took the TOVA under the same fake bad instructions first, then took the test under normal conditions the second time. An analysis of the effects of test order yielded non-significant differences for basic TOVA variables across all 4 quarters, both halves and the total score. An analysis for group mean differences between the NC and the FB instructions yielded significant differences across the basic TOVA variables across the 4 quarters, 2 halves and total score. The FB group had excessive amounts of omission and commission errors, a greater response time mean (i.e., slower to respond) and had greater variance around their mean response time. The study affirms that the professional using the TOVA needs to carefully eliminate a fake bad test-taking bias when Ss produce excessive test results. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Lee, K. T., Mattson, S. N., & Riley, E. P. (2004). Classifying children with heavy prenatal alcohol exposure using measures of attention. Journal of the International Neuropsychological Society, 10(2), 271-277. Deficits in attention are a hallmark of the effects of heavy prenatal alcohol exposure but although such deficits have been described in the literature, no attempt to use measures of attention to classify children with such exposure has been described. Thus, the current study attempted to classify children with heavy prenatal alcohol exposure (ALC) and non-exposed controls (CON), using four measures of attentional functioning: the Freedom from Distractibility index from the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), the Attention Problems scale from the Child Behavior Checklist (CBCL), and omission and commission error scores from the Test of Variables of Attention (TOVA). Data from two groups of children were analyzed: children with heavy prenatal alcohol exposure and non-exposed controls. Children in the alcohol-exposed group included both children with or without fetal alcohol syndrome. Groups were matched on age, sex, ethnicity, and social class. Data were analyzed using backward logistic regression. The final model included the Freedom from Distractibility index from the WISC-III and the Attention Problems scale from the CBCL. The TOVA variables were not retained in the final model. Classification accuracy was 91.7% overall. Specifically, 93.3% of the alcohol-exposed children and 90% of the control children were accurately classified. These data indicate that children with heavy prenatal alcohol exposure can be distinguished from non-exposed controls with a high degree of accuracy using 2 commonly used measures of attention.
Li, H., Huang, Y., Chen, N., Fang, T., & Lee, L. (2006). Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing. Laryngoscope, 116(7), 1142-1147.
Li, X., & Wang, Y. (2000). A preliminary application of the test of variables of attention (TOVA) in china. [chinese]. Chinese Mental Health Journal, 14(3), 149-152. Studied the application of the TOVA in children with attention deficit hyperactivity disorder (ADHD) in China. 56 children with ADHD (aged 8-13 yrs) (matching the criteria of the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) and Ss' IQ <= 75) and 16 normal children (aged 8-13 yrs) in Beijing were tested with the visual software of the TOVA. Ss' reaction time (RT), mistakes, and missing errors were compared between ADHD Ss and the normals. ADHD Ss received medication and were tested and retested before and after; the test results were compared with the results of the Conner's Parent Rating Scale. It is reported that significant difference in each variable of the TOVA was found between the ADHD Ss and the normals; and that the sensitivity and speciality of diagnosis of the TOVA were 85.7% and 87.5% respectively compared to the clinical standards. The ADHD Ss also improved significantly after medication. The results of the TOVA reflect the pathological characteristics of ADHD and demonstrate sensitivity to treatment efficacy. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Llorente, A. M., Voigt, R. G., Jensen, C. L., Berretta, M. C., Kennard Fraley, J., & Heird, W. C. (2006). Performance on a visual sustained attention and discrimination task is associated with urinary excretion of norepineprhine metabolite in children with attention-deficit/hyperactivity disorder (AD/HD). Clinical Neuropsychologist, 20(1), 133-144. The degree of association between performance on a sustained attention task requiring visual discrimination and urinary excretion of catecholamine metabolites was examined in a cohort of 6- to 12-year-old children (n = 31) strictly selected and diagnosed with attention-deficit/hyperactivity disorder (AD/HD) according to DSM-IV and other strict criteria. Sustained visual attention and discrimination were measured using the Test of Variables of Attention (T.O.V.A.). Urinary excretion of dopamine (DA) and norepinephrine (NE) metabolites was measured by reversed high-pressure liquid chromatography (HPLC). Pearson product-moment correlations were used to investigate the relationship between T.O.V.A. errors of omission (OMM), errors of commission (COM), response time (RT), and response time variability (RTV) and catecholamine metabolites of DA and NE. All T.O.V.A. indexes under investigation were significantly correlated with urinary excretion of NE metabolites, but correlations were low-to-moderate in magnitude (.37-.50). In contrast, there were no statistically significant correlations between T.O.V.A. indices and DA metabolites. These findings and their concordance with past research in human adults and animals, as well as theoretical issues associated with the present results, are discussed.
Llorente, A. M., Amado, A. J., Voigt, R. G., Berretta, M. C., Fraley, J. K., Jensen, C. L., et al. (2001). Internal consistency, temporal stability, and reproducibility of individual index scores of the test of variables of attention in children with attention-deficit/hyperactivity disorder. Archives of Clinical Neuropsychology, 16(6), 535-546. Psychometric properties of the Test of Variables of Attention (TOVA) were examined in a cohort of 63 children strictly diagnosed with attention deficit hyperactivity disorder (ADHD). Internal consistency was assessed via correlational analyses to determine the degree of agreement among various test portions. The temporal stability of errors of omission, errors of commission, response time, and response time variability was evaluated using test-retest reliability. Reproducibility of individual scores for the same indices was assessed using the Bland-Altman procedure. Select TOVA index scores exhibited high internal consistency in this cohort. Although the temporal stability of group scores (test-retest reliability) was satisfactory, individual test scores were less reproducible. Temporal stability and individual test-retest score agreement were greater for response time and spouse time variability than for errors of omission and errors of commission. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Lou, H. C., Rosa, P., Pryds, O., Karrebaek, H., Lunding, J., Cumming, P., et al. (2004). ADHD: Increased dopamine receptor availability linked to attention deficit and low neonatal cerebral blood flow. Developmental Medicine & Child Neurology, 46(3), 179-183. Attention-deficit-hyperactivity disorder (ADHD), while largely thought to be a genetic disorder, has environmental factors that appear to contribute significantly to the aetiopathogenesis of the disorder. One such factor is pretern birth with vulnerable cerebrovascular homeostasis. We hypothesised that cerebral ischaemia at birth could contribute to persistent deficient dopaminergic neurotransmission, which is thought to be the pathophysiological basis of the disorder. We examined dopamine D-sub(2/3) receptor binding with positron emission tomography (PET) using [superscript 1superscript 1C] raclopride as a tracer, and continuous reaction times (RT) with a computerized test of variables (TOVA) in six adolescents (12-14 years of age, one female) who had been examined with cerebral blood flow (CBF) measurements at preterm birth and had a subsequent history of attention deficit. We found that high dopamine receptor availability ('empty receptors') was linked with increased RT and RT variability, supporting the concept of a dopaminergic role in symptomatology. High dopamine receptor availability was predicted by low neonatal CBF, supporting the hypothesis of cerebral ischaemia as a contributing factor in infants susceptible to ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O'Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC--R performance. Biofeedback & Self Regulation, 20(1), 83-99. Assessed the effectiveness of neurofeedback treatment for children and adolescents (aged 8-19 yrs old) with attention deficit hyperactivity disorder (ADHD) on both objective and subjective measures. Exp 1, with 19 Ss, indicated that Ss who successfully decreased theta activity showed significant improvement in the Test of Variables of Attention performance. Exp 2, with 13 Ss, revealed significant improvement in parent evaluations on the Attention Deficit Disorders Evaluation Scale following neurofeedback training. Exp 3, with 10 Ss, indicated significant increases in Wechsler Intelligence Scale for Children--Revised (WISC--R) scores following neurofeedback training. Findings indicate that neurofeedback training can be an appropriate and efficacious treatment for children with ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Mann, J. B. (1997). Assessment of ADHD: Does the addition of continuous performance tests, memory tests, and direct behavioral observations enhance informants' ratings of the child? Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (5-B), 2688. Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder of unknown etiology. ADHD is estimated to affect 5 to 30 percent of the school age population (Barkley, 1990; Shaywitz & Shaywitz, 1991; Taylor, Sandberg, Thorley & Giles, 1990). Despite the fact that it is one of the most extensively studied childhood psychiatric disorders, few researchers have conducted the kinds of thorough evaluations necessary to gain broad and varied amounts of information about a child suspected of having ADHD. In addition, it is common for clinicians to diagnose a child based on a brief clinic visit and information from one persons' perspective of the child's behavior. A total of 56 children participated in this study to further the understanding of assessing children for ADHD. The children were referred for behavioral and/or attentional problems. There were 30 children in the ADHD group and 26 children in the Non-ADHD group. The researcher examined whether multiple raters, settings, and measures are necessary to accurately distinguish ADHD children from a group of referred children who did not have ADHD. Specifically, this study's purpose was to investigate whether children who met DSM-IV criteria for ADHD could be accurately and independently diagnosed as having attentional impairment through parent and teacher behavioral questionnaires. In addition, this study examined the efficacy of including direct observations of behavior and theoretically relevant measures of cognitive and motor disinhibition in parent and teacher observations of ADHD. Dr. Russel Barkley's (1994) theoretical model of ADHD as a deficit in behavioral inhibition was employed as the theoretical rationale for employing the additional measures that included actual behavioral observations along with laboratory tests of attention and clinical tests of complex memory. It was of interest to determine if direct measurement of the child added significantly to the discrimination that is obtained solely from the observations of informants. Results from this study suggest that both multiple raters and settings are important in the diagnosis of ADHD. The child's parent, teacher, and clinician are valuable informants' of the child's behavior. Likewise, observing the child in various settings such as his or her home and school add information to aid in the diagnosis of ADHD. In regards to measures, the results suggest that the observations or perceptions from others such as the DISC-P structured interview, CBCL-parent and teacher rating scales, and the BASC-SOS, help add to the prediction of ADHD. However, direct measures of performance such as the TOVA continuous performance test and complex memory tasks (K-ABC-Word Order & Hand Movements subtests and the McCarthy Tapping Sequence subtest) do not aid in the prediction of ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Manor, I., Corbex, M., Eisenberg, J., Gritsenkso, I., Bachner-Melman, R., Tyano, S., et al. (2004). Association of the dopamine D5 receptor with attention deficit hyperactivity disorder (ADHD) and scores on a continuous performance test (TOVA). American Journal of Medical Genetics.Part B, Neuropsychiatric Genetics: the Official Publication of the International Society of Psychiatric Genetics, 127(1), 73-77. Towards further clarifying the role of dopamine D5 receptor (DRD5) microsatellite polymorphism in the etiology of ADHD, we used a robust family based strategy to test for association between DRD5 and this disorder. Additionally, a neuropsychological mechanism by which this allele may confer risk was explored by examining the relationship between DRD5 genotype and scores on a continuous performance test. DNA was obtained from 164 probands and their parents. Additionally, the majority of these probands were administered a computerized continuous performance test, the Test Of Variables of Attention (TOVA). We first confirmed preferential transmission (TDT chi(2) = 7.02, P = 0.008) of the 148 base pair allele in 155 informative transmissions (94 transmitted and 61 non-transmitted 148 bp allele). Additionally, we used a family-based association test (FBAT) and observed significant multivariate association using FBAT between TOVA scores before methylphenidate administration and the DRD5 microsatellite polymorphism across all four TOVA variables: multi-allelic, multivariate test chi(2) = 16.32, P = 0.037 when the 148 bp allele was compared to all others (collapsed genotype) that was also significant (chi(2) = 59.20, P = 0.025) when all 14 alleles (full genotype) were analyzed. Following methylphenidate, no significant association was observed (chi(2) = 12.08, P = 0.147 for 148 bp versus all others) and, similarly, for all 14 alleles (chi(2) = 47.18, P = 0.343). In summary, the main finding of this report is that the DRD5 repeat polymorphism confers a small but significant risk for ADHD consistent with previous reports. Provisional results in this single investigation suggest that the DRD5 microsatellite also affects performance scores on the TOVA. Copyright 2004 Wiley-Liss, Inc.
Manor, I., Sever, Y., & Weizman, A. (1999). [Computerized test as a diagnostic auxiliary--TOVA--another tool in the diagnosis off attention deficit disorders (ADHD)]. Harefuah, 136(10), 812-815.
Manor, I., Tyano, S., Eisenberg, J., BachnerMelman, R., Kotler, M., & Ebstein, R. P. (2002). The short DRD4 repeats confer risk to attention deficit hyperactivity disorder in a family-based design and impair performance on a continuous performance test (TOVA). Molecular psychiatry, 7(7), 790-794. One particular candidate gene, the dopamine D4 receptor (DRD4), has been the focus of intense study regarding ADHD since the original investigation by La Hoste et al, an observation confirmed by a recent metaanalysis. However, two previous studies from Israel failed to observe this association. We have now recruited an additional sample and, overall, in the combined sample of 178 triads we observe using the transmission disequilibrium test, preferential transmission of the short allele. Additionally, we now report the effect of the DRD4 repeat region on the Test Of Variables of Attention (TOVA), a widely used computerized continuous performance test. Probands with the short exon III repeat performed significantly worse on the TOVA measured both by errors of commission and response time variable. Intriguingly, a 'dose effect' was observed. Increasing repeat size is accompanied by a reduced number of errors of commission and a significant difference is observed between the 2 vs 7 repeats. On the whole, our results lend credence to the notion that the relationship between the DRD4 receptor and ADHD is complex and may be reflecting linkage disequilibrium between the 7 or long DRD4 exon III repeats and a 'true' risk allele in this gene or a neighboring locus. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Manor, I., Tyano, S., Mel, E., Eisenberg, J., Bachner-Melman, R., Kotler, M., et al. (2002). Family-based and association studies of monoamine oxidase A and attention deficit hyperactivity disorder (ADHD): Preferential transmission of the long promoter-region repeat and its association with impaired performance on a continuous performance test (TOVA). Molecular psychiatry, 7(6), 626-632. Monoamine oxidase A (MAO A) is located on the X chromosome and metabolizes biogenic amines including dopamine, norepinephrine and serotonin. A functional promoter-region polymorphism of this gene has been described that has been studied in a number of mental illnesses but not in attention deficit hyperactivity disorder (ADHD). In the current study, we examined the MAO A promoter-region polymorphism initially in 133 triads and observed preferential transmission of the long alleles from 74 heterozygote mothers to ADHD probands (chi(2) = 4.37, P = 0.036, df = 1). We also examined the role of this polymorphism in a computerized continuous performance test, the TOVA. Significant differences were observed on errors of commission (chi(2) = 7.021, P = 0.008) and patients carrying the long MAO A allele made significantly more such errors. Errors of commission are a measure of impulsivity. However, following Ritalin (methylphenidate) administration the association between this polymorphism and errors of commission was markedly attenuated and no longer significant at the P < 0.05 level. We also analyzed the provisional association by the case-control design. A significant difference in allele frequency was observed between 110 male probands vs 202 male controls (Pearson chi(2) = 7.94, P = 0.047). Similarly results were obtained when 19 female probands were compared to female controls (genotype chi(2) = 21.28; P = 0.0032, 3 df and allele chi(2) = 30.88, P= 0.0007, 2 df). All three complementary approaches employed (family-based, case-control and quantitative trait design) suggest a role for the MAO A promoter-region polymorphism in conferring risk for ADHD in our patient population.
Mansfield, L., Mendoza, C., Flores, J., & Meeves, S. G. (2003). Effects of fexofenadine, diphenhydramine, and placebo on performance of the test of variables of attention (TOVA) [corrected] [published erratum appears in ANN ALLERGY ASTHMA IMMUNOL 2003 aug;91(2):167]. Annals of Allergy, Asthma, & Immunology, 90(5), 554-559. OBJECTIVE: To determine the effects of diphenhydramine 50 mg and fexofenadine 180 mg on cognitive performance using the Test of Variables of Attention (TOVA), and to ascertain whether the TOVA was sufficiently sensitive to differentiate between the effects of these first- and second-generation H1-receptor antagonists on performance. STUDY DESIGN: The study used a double-blind, placebo-controlled, randomized, crossover design. Forty-two subjects completed four separate TOVA tests: at baseline and after administration of placebo, diphenhydramine 50 mg, and fexofenadine 180 mg. On each occasion, subjects rated subjective feelings of drowsiness on a visual analog scale (VAS) before taking the TOVA. RESULTS: Compared with placebo, diphenhydramine caused an increased response time (P = 0.0230) and more omission errors (P = 0.0398). Diphenhydramine was also associated with increased drowsiness VAS ratings (P = 0.0065) compared with placebo. Diphenhydramine caused significantly more commission errors than fexofenadine (P = 0.0354). Neither placebonor fexofenadine 180 mg caused significant changes in any TOVA or VAS measurements compared with baseline. Fexofenadine was not statistically different from placebo for any evaluation. CONCLUSIONS: The TOVA was sufficiently sensitive to differentiate between the central nervous system effects of fexofenadine and diphenhydramine. Fexofenadine 180 mg had no significant effect on the TOVA measures of performance or on self-reported drowsiness compared with placebo. In contrast, diphenhydramine 50 mg caused significant increases in omission errors and response time on the TOVA and increases in self-reported drowsiness compared with placebo [corrected].
Mautner, V., Kluwe, L., Thakker, S. D., & Leark, R. A. (2002). Treatment of ADHD in neurofibromatosis type 1. Developmental Medicine & Child Neurology, 44(3), 164-170. Forty-six of 93 children with neurofibromatosis type 1 (NF1) were found to satisfy the diagnostic criteria for attention deficit hyperactivity disorder (ADHD). Detailed comparisons were made among 20 children with NF1 and ADHD (12 males, 8 females; mean age 10.7 years, SD 2.2), 26 control children with NF1 (15 males, 11 females; mean age 11.3 years, SD 2.3), 14 control children with ADHD (7 males; mean age 9.9 years, SD 1.9), and 14 normally developing control children (7 males; mean age 11.2 years, SD 2.8). Children with NF1 and ADHD had the lowest IQ scores among the four groups. Test of Variables of Attention (TOVA) scores were poorer in the NF1-ADHD and ADHD control groups than in the two non-ADHD groups. Those with NF1 and ADHD were rated significantly poorer on the Child Behavior Checklist (CBCL) than were the NF1 control group. By administering low doses (5 to 15 mg) of methylphenidate to the NF1-ADHD group, significantly improved TOVA scores were obtained. One-year follow-up yielded significantly improved CBCL scores. Our results show a high incidence of ADHD in NF1 and support an association between ADHD and learning and social problems in children with NF1. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
McAdams, D. P., Josselson, R., & Lieblich, A. (Eds.). (2006). Identity and story: Creating self in narrative(2006). Identity and story: Creating self in narrative. x, 284 pp. Washington, DC, US: American Psychological Association.(from the cover) In Identity and Story: Creating Self in Narrative, the fourth volume in the Narrative Study of Lives series, Dan P. McAdams, Ruthellen Josselson, and Amia Lieblich (2006) bring together an interdisciplinary and international group of creative researchers and theorists to examine how the stories we tell create our identities. An increasing number of psychologists argue that people give meaning to their lives by constructing and internalizing self-defining stories. The contributors to this volume explore how, beginning in adolescence and young adulthood, our narrative identities become the stories we live by. This volume addresses the most important and difficult issues in the study of narrative identity, including questions of unity and multiplicity in stories, the controversy over individual versus societal authorship of stories, and the extent to which stories typically show stability or growth in the narrator. The detailed examination of excerpts from stories told to researchers and the analysis of published memoirs, together with the contributors' insights into narrative psychology, make this provocative volume a rich, research-based exploration into how our lives may be the product of the stories we tell. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Mcaleer, E. (2007). Evaluating differences on a continuous performance test for father/son pairings with and without attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68 (1-B), 628. Previous research has demonstrated that fathers of sons with Attention Deficit Hyperactivity Disorder (ADHD) often have their own attention problems (e.g., Epstein et al., 2000). These studies generally employed self-report measures and behavior checklist to measure attention problems. The current study looked at the relationship between fathers' and sons' attention problems with the Test of Variables of Attention (TOVA). Forty-five father/son pairs completed the TOVA. Father/son pairings formed three groups: a clinic-referred control group, a group with sons diagnosed with ADHD-Primarily Inattentive type, and a group composed of sons diagnosed with ADHD-primarily Hyperactive type and ADHD Combined type. All boys were between the ages of 7 and 16 years old. Participants had either been referred to a college-based testing facility for the purpose of obtaining a complete psychological evaluation, or were being treated by a clinical psychologist in private practice. Analyses showed TOVA scores on the four outcome measures were significantly lower for boys diagnosed with ADHD than boys without ADHD, indicating greater attention problems. The comparison of the fathers indicated fathers of sons with ADHD had significantly more variability in response time and that more were indicated as having an attention problem on the TOVA. Results detected no significant effect for ADHD subtype on the outcome measures for either the boys or their fathers. A significant positive relationship was found for three of the outcome measures for fathers and sons in the control group, and a significant positive relationship was found for fathers and sons in the ADHD-PI group for variability in response time. Overall, the results provided further evidence that boys diagnosed with ADHD have fathers who suffer from attention problems as well. Although this is not necessarily a new finding, demonstrating it with an objective measure of attention is novel. Future studies should include a behavioral analysis of participants during the administration of the TOVA, since it appeared that behaviors such as verbal responses and on task behaviors fluctuated greatly between groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
McCarney, D., & Greenberg, L. M. (1992). Test of variables of attention. Neuropsychology review, 3, 1-117.
Mcdowell, S. K. (2005). The temporal reliability of the test of variables of attention - auditory (T.O.V.A. - A.RTM). Dissertation Abstracts International: Section B: The Sciences and Engineering, 65 (10-B), 5456. The test-retest reliability of the Test of Variables of Attention - Auditory (T.O.V.A. - A.) was evaluated in a normal population of school-aged children (n = 42). Positive and significant correlations were found over the two testing trials (7 + 2 days apart) on four T.O.V.A. - A. indices including omission errors, commission errors, response time, and response time variability. Reliability estimates were moderate and lower than expected (ranging from .58 to .71). Correlated samples t tests revealed significant differences in scores from Time 1 to Time 2 for response time, but not for any of the other indices. Implications of these findings for the future use of the T.O.V.A. - A. with clinical populations are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Michaels, K. L. (1996). Differentiating attentional functions in children with ADHD, anxiety, and depression. Dissertation Abstracts International Section A: Humanities and Social Sciences, 57 (3-A), 1018. Research has consistently demonstrated that attentional disturbances frequently occur, not only among children diagnosed with Attention Deficit Hyperactivity Disorder, but also among depressed children and among anxious children. Given the symptom overlap and high comorbidity of ADHD with other disorders, the frequency of attention-related referrals to clinical practices, and often similar clinical presentations, this study sought to address whether performance on a measure of sustained attention could provide data for differential diagnostic assessment as well as predict group membership. The Test of Variables of Attention (T.O.V.A.) was employed with children ages six through sixteen diagnosed with ADHD, a mood disorder, or an anxiety disorder. Numerous variables were analyzed, including first half omission scores, total test omission scores, second half commission scores, total test commission scores, total test response time, and total test variability scores. Also discussed is the concept of a performance decrement, which is typically observed among ADHD children on CPT measures. Results from this study indicated that children diagnosed with ADHD obtained significantly poorer first half omission scores than depressed and anxiety disordered subjects, suggesting poorer vigilance among the ADHD population. This finding is consistent with previous research demonstrating poor and even impaired vigilance on CPT measures among ADHD populations. However, no other significant differences emerged among the remaining variables analyzed. With regard to a performance decrement, results were inconsistent, with the ADHD group demonstrating decreased performance during the second quarter but improved performance during other quarters. Results from predictive discriminant analysis suggest that a model based on first half omission errors may be clinically useful, although not overwhelmingly predictive of group membership: the T.O.V.A. was able to accurately identify approximatel (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Monastra, V. J., Lubar, J. F., & Linden, M. (2001). The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: Reliability and validity studies. Neuropsychology, 15(1), 136-144. The development of a quantitative electroencephalographic (QEEG)-based procedure for use in the assessment of attention deficit-hyperactivity disorder (ADHD) was examined through a series of studies investigating test reliability and validation issues. This process, involving a spectral analysis of the electrophysiological power output from a single, midline, central location (the vertex), was conducted in 469 participants, 6 to 20 years of age, classified as ADHD, inattentive type; ADHD, combined type; or control. The results indicated that the QEEG scanning procedure was reliable (r = .96), was consistent with the Attention Deficit Disorders Evaluation Scale (S. B. McCarney, 1995) and the Test of Variables of Attention (L. M. Greenberg, 1994; chi-square, p < .01), and differentiated participants with ADHD from a nonclinical control group (p < .001). The sensitivity of the QEEG-derived attentional index was 90%; the specificity was 94%.
Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27(4), 231-249. 100 children (83 males and 17 females, aged 6-19 yrs) who were diagnosed with attention-deficit/hyperactivity disorder (ADHD) participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Murphy, H. E. (2007). A comparison of the continuous performance test - test of variables of attention and the conners' rating scales - revised in the clinical diagnosis of attention deficit-hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67 (12-B), 7385. Scope and method of study. The purpose of the this study was to examine the relationship and consistency between the Test of Variables of Attention (TOVA) and the Test of Variables of Attention - Auditory (TOVA-A) and the Conners' Parent Rating Scale - Revised: Long Form (CPRS-R: L) and the Conners' Teacher Rating Scale - Revised: Long Form (CTRS-R: L). Participants in the study were a group of nonreferred children between the ages of 6 and 12. Children completed the TOVA and TOVA-A CPTs. The CPRS-R: L and CTRS-R: L scales were completed by the participant's parent and teacher. Pearson Product correlations, multiple regression and chi-square analyses were utilized to determine the relationship and consistency between the TOVA and TOVA-A measures and the scales of the CPRS-R: L and CTRS-R: L. Findings and conclusions. The TOVA and TOVA-A D-Prime was consistently correlated with the Cognitive Problems/Inattention scale, the Conners' ADHD Index, and the DSM-IV: Inattentive scale and the DSM-IV: Total scale of the CPRS-R: L and the CTRS-R: L; and the Social Problems scale of the CTRS-R: L. The RTV also showed a statistical relationship among these scales, although not as consistent a pattern. The ADHD score of the TOVA was consistently correlated with the CPRS-R: L and CTRS-R: L DSM-IV: Hyperactive-Impulsive scale. Multiple regression analyses found that the TOVA and TOVA-A D-Prime, Omission Errors, and RTV scores would more likely to predict parent and teacher rating scales measuring inattention, while the TOVA and TOVA-A D-Prime or the TOVA ADHD score would be more likely to predict parent and teacher scales measuring hyperactivity and/or impulsivity. Chi-square analyses suggested that there are no differences in the proportion of children identified as normal or abnormal by the variables of the TOVA/TOVA-A and the scales of the CPRS-R: L and CTRS-R: L. These findings indicate that the TOVA and TOVA-A are measuring similar aspects of inattention, hyperactivity, and impulsivity as the CPRS-R: L and the CTRS-R: L. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Mutschler, K. A. (1997). Neuropsychological correlates of violence: Attention deficits and incarcerated men. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57 (10-B), 6639. There is an extensive body of literature which examines violence and its relationship to abnormalities in brain functioning. While there seems to be little dispute regarding existence of the relationship, methodological limitations make research in this area complicated. Early neuropsychological studies of brain functioning have indicated significant organic abnormalities in violent adults and adolescents. Current research has replicated earlier studies although data analysis is often controversial. While contemporary studies continue to focus on risk assessment and the interplay of genetic, biological, and environmental conditions, this study explored possible connections between neuropsychological functioning and violent behavior, with a specific concentration on attention. The study focused on neuropsychological functioning of incarcerated males in the state prison complex in Ionia, Michigan. Sixty-one subjects were assigned to one of two groups based on their classification (high risk versus low risk) as determined by the Michigan Department of Corrections' Assaultive Risk Screening sheet. The subjects ranged in ages from 18 to 30. Individuals with diagnosed mental retardation, mental illness, a history of head injury or a reading level below fifth grade were excluded from the study. Tests used for the battery were the Stroop Color and Word Test, Trail Making Test (A and B), Digit Span (WAIS-R), Arithmetic (WAIS-R), The Wisconsin Card Sort, Peabody Picture Vocabulary Test-Revised, Tests of Variables of Attention (T.O.V.A.) and Symbol Digit Modalities Test. Four elements of attention--focus-execute, shift, sustain, and encode, were examined. The purpose of this study was to investigate brain-behavioral patterns and statistically significant differences and similarities in neuropsychological functioning (particularly in the areas of attention) of individuals who are at high and low risk for future violent behavior. The hypotheses of the study stated that there would be significant abnormalities in neurological functioning (specifically attention) of adult offenders who were classified as high risk. The test results did not discriminate differences between high and low risk, but identified twenty-two out of sixty individuals (38%) as having attentional deficits in the sustain element of attention. The findings of this study were consistent with the literature on the incidence of attentional disorders in incarcerated populations. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Norris, S. L., Lee, C., Burshteyn, D., & CeaAravena, J. (2001). The effects of performance enhancement training on hypertension, human attention, stress, and brain wave patterns: A case study. Journal of Neurotherapy, 4(3), 29-44. Evaluated the effects of alpha increase neurofeedback training (Performance Enhancement Training) on blood pressure, stress reduction, attention, and observed changes in brainwave patterns. A 49-yr-old male college student diagnosed with essential hypertension controlled by medication had undergone 26 sessions of alpha-increase biofeedback (8-13 Hz) at PZ electrode site for a period of 15 wks. Pre- and postblood pressure measurements were taken for every session. At the beginning of week number 8, the S discontinued his medication as advised by his physician. Pre- and postvisual Test of Variables of Attention CPT test was administered to assess the changes in accuracy, reaction time (RT), and RT variability. Osterkamp and Press Self-Assessment Stress Inventory was administered before and after training to assess the level of stress. QEEG evaluation was conducted prior, as well as upon completion of the study. Mean Arterial Blood Pressure yielded significant results between pre- and postsessions within S blood pressure measurements. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Norris, S. L., Lee, C., Cea, J., & Burshteyn, D. (1998). Performance enhancement training effects on attention: A case study. Journal of Neurotherapy, 3(1), 19-25. This case study evaluated the effects of alpha-increase biofeedback training on attention in a healthy 23-yr-old male. The S underwent 23 sessions of alpha-increase biofeedback (8-13 Hz) at PZ electrode site over 11 wks. The Test of Variables of Attention (TOVA) test was administered pre- and posttreatment to assess changes in reaction time (RT) and RT variability. QEEG evaluation was conducted prior to and on completion of the study. Results of the TOVA test indicate an improvement in the S's RT and the RT variability. Statistical analysis shows that before and after QEEG evaluations were within normal limits. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Oh, K. S., Shin, D. W., Oh, G. T., & Noh, K. S. (2003). Dopamine transporter genotype influences the attention deficit in korean boys with ADHD. Yonsei medical journal, 44(5), 787-792. Attention appears to be inheritable, stable and influenced by genetic factors. The use of the Continuous Performance Test (CPT), as an endophenotypic measure, is valuable for genetic studies because it may show increased sensitivity to specific dimensions in attention deficit hyperactivity disorder. However, few studies have been designed to examine the influence of the genotype on attention level measured by CPT in ADHD patients. This study examinee the difference between 10/10 and 10/ genotype in the attention deficits measured by the CPT in ADHD patients. Forty-four unrelated ADHD patients were recruited from the psychiatric outpatients' clinic at Kangbuk Samsung Hospital. Two child psychiatrists made the diagnoses of ADHD using the DSM- IV diagnostic criteria. The genomic DNA was extracted from the blood, and analyzed to determine the genotype. A 40- base pair variable number of tandem repeats (VNTR) polymorphism in the 3' untranslated region was amplified. The attention deficits were measured by the test of variables of attention (T.O.V.A.). Between the 10/10 genotype and 10/ genotype, standard scores of the T.O.V.A. were compared using a Mann-Whiney test. A comparison with the 10/10 genotype and 10/* genotype showed that those patients with the 10/10 genotype made less omission errors in the first quarter of the test (p < 0.05, by Mann-Whiney test). No significant differences were observed in the errors of commission, response time, variability. This study found that the 10/10 genotype made less omission errors on the T.O.V.A. This suggests that the dopamine transporter genotype influences the attention deficits measured by T.O.V.A.
Ossmann, J. M., & Mulligan, N. W. (2003). Inhibition and attention deficit hyperactivity disorder in adults. American Journal of Psychology, 116(1), 35-50. The inhibitory account of attention deficit hyperactivity disorder (ADHD) was tested by examining the performance of college-aged adults on a variety of inhibitory tasks, including the stop signal task, the negative priming task, a measure of working memory capacity, and the Test of Variables of Attention. 24 undergraduates with ADHD (mean age 19.21 yrs) and 24 undergraduates without ADHD (mean age 19.42 yrs) participated. The poorer performance of adults with ADHD compared with controls on negative priming, stopping, and continuous performance tasks, combined with similar group performances on a test of working memory capacity, indicates a specific inhibitory deficit as opposed to a general limitation in attentional capacity. Overall results provide evidence for extending the inhibitory deficit hypothesis to adult ADHD, not only for mechanisms of response (or motor) inhibition but also for mechanisms of cognitive inhibition. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Otka, J. E., Mercadante, M. T., Scahill, L., & Leckman, J. F. (2001). Reboxetine as a potentially effective treatment for attention deficit hyperactivity disorder. Journal of child and adolescent psychopharmacology, 11(2), 203-204. Presents the case of a 33-yr-old man with attention deficit hyperactivity disorder (ADHD) who showed a positive response to reboxetine. After beginning reboxetine, the S was better able to concentrate and was able to read for pleasure. Job functioning also improved, as evidenced by a self-reported increase in sustained attention at work from 10 min to 45 min posttreatment. He also showed a dramatic improvement on the Test of Variables of Attention. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Page, R. H. (2003). Analysis of specific attentional functions in attention-deficit/hyperactivity disorder (ADHD): Implications for ADHD subtyping theory. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63 (11-B), 5552. It is important to understand the neurobiological, cognitive, and behavioral factors that underlie ADHD and the ADHD subtypes. It has often been hypothesized that the ADHD-Combined Type (ADHD-CT) and ADHD-Predominantly Inattentive Type (ADHD-PI) subtypes may be the result of different underlying factors and may be associated with different types of attentional deficits. The current study compared 30 children with ADHD-CT and 35 children with ADHD-PI on several neuropsychological variables associated with various aspects of attentional processing. However, it is important to note that only 47 (22 with ADHD-CT and 25 with ADHD-PI) of the participants were assessed with some of the experimental measures. All participants were between the ages of 6 years, 0 months and 12 years, 11 months. Participants were evaluated using several neuropsychological measures associated with various aspects of attentional processing in order to test five hypotheses regarding possible subtype differences in specific types of attention. The attentional processes of interest included response activation, sustained attention, encoding/working memory, the focus/execute aspect of attention, and attentional stability. These constructs were taken from the theories of Tucker and Williamson (1984) and Mirsky and Colleagues (1999). The attentional measures used in this study were taken from the Test of Variables of Attention (TOVA), the Children's Memory Scale (CMS), and the Wechsler Intelligence Test for Children-Third Edition (WISC-III). Analysis of possible subtype differences in the occurrence rate of reading disabilities was also conducted. Finally, post hoc analyses were conducted in order to test the hypothesis that specific attentional processes might impact other specific aspects of the neuropsychological functioning of children with ADHD. The attentional processes of interest were response activation and attentional stability. The dependent variables for the post hoc analyses included measures of language ability as well as behavioral ratings of attention and hyperactivity. No statistically significant group differences were found for any of the variables reflecting the five aspects of attentional processing. Nor were any significant subtype differences in the occurrence rate of reading disabilities or the post hoc analyses. The post hoc analyses did not yield statistically significant results either. Finally, weaknesses of the current study as well as future directions for ADHD research were discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Pancner, P. L. (2006). The utility of the personality assessment inventory as an indicator of attention deficit/hyperactivity disorder with an adult clinical population. Dissertation Abstracts International: Section B: The Sciences and Engineering, 67 (6-B), 3461. This study examined whether a subscale of the Personality Assessment Inventory (PAI) was able to function as an identifying marker for Attention Deficit/Hyperactivity Disorder (ADHD) in adults. Consisting of a group of non-ADHD subjects who had other mental disorders and a group of ADHD subjects, the study examined the Schizophrenia-Thought Disorder subscale (SCZ-T) raw scores by comparing the means from each group. The subjects ranged in age from 18 to 75 years and were from an outpatient psychiatric private practice. The total sample (N = 82) consisted of an equal number of male and female participants who were mostly Caucasian. This study utilized the Test of Variables of Attention (TOVA) to distinguish between non-ADHD subjects and ADHD subjects. This study found that the SCZ-T subscale of the PAI discriminated between non-ADHD and ADHD subjects, which suggest that this subscale is capable of serving as an identifying marker for ADHD in adults. Furthermore, this study demonstrates that the PAI is clinically beneficial in the assessment of ADHD in adults. Although the findings do not suggest that the PAI is able to diagnose a mental disorder apart from other clinical information, the findings indicate that the subscale can improve symptom identification and diagnostic accuracy. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Parasnis, I., Samar, V. J., & Berent, G. P. (2003). Deaf adults without attention deficit hyperactivity disorder display reduced perceptual sensitivity and elevated impulsivity on the test of variables of attention (T.O.V.A.). Journal of Speech, Language, and Hearing Research, 46(5), 1166-1183. The Test of Variables of Attention is a continuous performance test used widely to help diagnose attention deficit hyperactivity disorder in both hearing and deaf people. The T.O.V.A. performance of 38 prelingually and profoundly deaf young adults and 34 hearing young adults was examined in this study. Deaf participants had significantly lower d' scores than hearing participants, indicating reduced perceptual sensitivity to the distinction between target and distractor stimuli. Consistent with the existing literature on attentional reorganization in the deaf population, this result was interpreted as indicating a deafness-related reduction in attention to centrally presented stimuli. Deaf participants also showed 2 to 3 times more commission errors than hearing participants and displayed a higher incidence of anticipatory errors. Beta score analysis confirmed that deaf participants adopted an overall less conservative response criterion that contributed to their total elevated commission errors. However, a portion of the commission errors was secondary to their reduced d', not to increased behavioral impulsivity. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Patrick, G. J. (1994). Neuronal regulation and attention deficit disorder: An application of photic driven EEG neurotherapy. (PH.D., University of Washington). , 202. The primary aim of this nursing clinical research dissertation was to test a photic driven electroencephalograph (EEG) neural training procedure designed to enhance the regulation of brain wave activity and thus improve cognitive functioning in ADHD children. The outcome measures used were a combination of psychometric test scores, behavior profiles, computerized performance test scores and EEG measures. A related goal was to describe the associated changes in dynamic EEG patterns in order to evolve a theoretical basis for the EEG treatment. The study subjects were 8-14 year old children of intact families referred from a number of sources and were screened by a developmental pediatrician for other concurrent DSM-3-R diagnoses and medical conditions. Some of the subjects were medicated and some were not. A quasi-experimental waiting control group design was used with repeated tests consisting of the Wechsler Intelligence Scale for Children Third Edition (WISC-3), Raven Progressive Matrices (RPM), Wechsler Individual Achievement Test (WIAT), Achenbach Child Behavior Checklist and Profiles (CBCL-P), and Test of Variables of Attention (TOVA). Electroencephalograph (EEG) measures were also used to identify changes due to treatment. No significant changes were noted in any of the waiting period control group tests. Experimental results revealed significant improvement in WISC-3 processing speed (impulsivity), freedom from distractibility (attention), and improvement in the CBCL-P parent and youth self-report form attention problem profiles. Significant changes were not found in the Raven (attention) scores. The TOVA test scores showed significant post-treatment reduction in impulsivity as measured by errors of commission; however, changes in omission errors did not reach significance at the.05 level. Follow-up WIAT testing is incomplete, however the 11 evaluated so far have shown systematic improvements. Unfortunately, there were no significant descriptive changes discernible in the identified EEG measures. This was possibly due to problems with data procurement procedures. The results of this preliminary study are encouraging. The primary goal of the study was accomplished and the study hypothesis is supported by the data. Further study is indicated to explore the effects of longer treatment courses, different training goals, and better data procurement procedures with larger and more homogenous samples.
Patrick, G. J. (1995). Neuronal regulation and attention deficit disorder: An application of photic driven EEG neurotherapy. Dissertation Abstracts International: Section B: The Sciences and Engineering, 56 (3-B), 1347. The primary aim of this nursing clinical research dissertation was to test a photic driven electroencephalograph (EEG) neural training procedure designed to enhance the regulation of brain wave activity and thus improve cognitive functioning in ADHD children. The outcome measures used were a combination of psychometric test scores, behavior profiles, computerized performance test scores and EEG measures. A related goal was to describe the associated changes in dynamic EEG patterns in order to evolve a theoretical basis for the EEG treatment. The study subjects were 8-14 year old children of intact families referred from a number of sources and were screened by a developmental pediatrician for other concurrent DSM-3-R diagnoses and medical conditions. Some of the subjects were medicated and some were not. A quasi-experimental waiting control group design was used with repeated tests consisting of the Wechsler Intelligence Scale for Children Third Edition (WISC-3), Raven Progressive Matrices (RPM), Wechsler Individual Achievement Test (WIAT), Achenbach Child Behavior Checklist and Profiles (CBCL-P), and Test of Variables of Attention (TOVA). Electroencephalograph (EEG) measures were also used to identify changes due to treatment. No significant changes were noted in any of the waiting period control group tests. Experimental results revealed significant improvement in WISC-3 processing speed (impulsivity), freedom from distractibility (attention), and improvement in the CBCL-P parent and youth self-report form attention problem profiles. Significant changes were not found in the Raven (attention) scores. The TOVA test scores showed significant post-treatment reduction in impulsivity as measured by errors of commission; however, changes in omission errors did not reach significance at the.05 level. Follow-up WIAT testing is incomplete, however the 11 evaluated so far have shown systematic improvements. Unfortunately, there were no significant descriptive changes discer (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Patrick, G. J. (1996). Improved neuronal regulation in ADHD: An application of fifteen sessions of photic-driven EEG neurotherapy. Journal of Neurotherapy, 1(4), 27-36. Investigated a 15-session EEG driven photic stimulation neural training procedure designed to enhance the regulation of brain wave activity and thus improve cognitive functioning in 25 8-14 yr olds with attention deficit hyperactivity disorder (ADHD) (14 medicated). A quasi-experimental waiting control group design was used with repeated psychometric tests consisting of the Wechsler Intelligence Scale for Children - IIIrd Edition (WISC--III), Raven Progressive Matrices, Wechsler Individual Achievement Test (WIAT), Child Behavior Checklist and Profiles (CBCL-P), a computerized performance test of variables of attention, and 2 separate EEG measures. No significant changes were noted in any waiting period control group tests. Results reveal highly significant EEG changes, improvements in the WISC processing speed and freedom from distractibility scales, WIAT, CBCL-P, and 4th quarter commission error test scores. Further study is indicated to explore the effects of longer treatment courses, different training goals, and better data procurement procedures using outcome measures of EEG variability coupled with successful psychometric performance. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Pina, J. (2001). He measurement of sustained attention in children with and without attention deficits. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61 (10-B), 5577. The clinical use of computerized Continuous Performance Tests (CPTs) with children with Attention Deficit-Hyperactivity Disorder (ADHD) presents several complex issues relating to diagnosis and construct validity. Moreover, these tests have not typically provided adequate measures of "sustained" attention-that is, subject performance over time, otherwise known as "vigilance". Those studies which sought to measure sustained attention decrements over time provided mixed results, and therefore different methodological approaches may better tap the vigilance decrement hypothesized in attention deficits. Overall, accurate measures of vigilance, such as signal detection measures, may improve current construct validity of CPTs. This program of research, composed of two studies, used the Test of Variables of Attention (TOVA) in a group of children with and without ADHD, as diagnosed by ADHD rating scales. Study 1, using 134 male subjects, utilized regression analyses to test the efficacy of a new multivariate measure, the Decrement Over Time (DOT), in its sensitivity to the Inattentive (IA) subtype of ADHD. Study 2 re-tested a sample of 67 children drawn from the study 1 sample at least one year later, to test the superiority of the DOT model when compared to traditional CPT measures of omission and commission errors, response time, and response variability, as well as the TOVA ADHD Score, when assessing inattention. Also, behavioral ratings were recorded during TOVA performance, and it was hypothesized that these would increase the construct validity of the TOVA measures. Results suggested that the DOT model was significantly related to external ratings of inattention, above and beyond the TOVA measures and ADHD Score. The hypothesis that behavioral ratings would supplement the TOVA measures was not substantiated, although the behavior ratings did improve the ability of the DOT model in assessing ADHD subtypes. Study 2 also sought to investigate the effects of maturation and motivation, but these hypotheses were not confirmed in this study. The implications and applications of the use of the DOT model in CPT assessment of sustained attention deficits are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Pinter, C. A. (2000). Assessment of cognitive and executive functioning in adults with suspected attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 61 (5-B), 2777. A multidimensional model of attention deficits is proposed for assessing ADHD in adults. The model is based on cognitive and executive function deficits and incorporates selected subtests from the WAIS-R, WMS-R, TOVA, Trails A and B, Stroop Color-Word Interference Test, and WRAT. Using ANOVA procedures, results on 58 adult outpatients indicate the model is capable of distinguishing adults with ADHD from those without (p < .05). The author discusses utilizing the proposed model for increasing diagnostic accuracy and understanding of the cognitive and executive deficits underlying the psychosocial deficits associated with this disorder. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Preston, A. S., Fennell, E. B., & Bussing, R. (2005). Utility of a CPT in diagnosing ADHD among a representative sample of high-risk children: A cautionary study. Child Neuropsychology, 11(5), 459-469. Continuous performance tests (CPTs) are widely used in the assessment and study of attention deficit hyperactivity disorder (ADHD). Although CPTs have reliably found differences between children with ADHD and normal controls, discriminating between children with ADHD and children with subclinical levels of behavioral or cognitive problems is a more clinically relevant and difficult endeavor. Additionally, most studies use convenience samples from clinical care settings that may not represent the ADHD population as a whole. The current study assessed the utility of a clinically used CPT, the Test of Variables of Attention (TOVA), in distinguishing between children with ADHD and children with subclinical levels of attention/behavior problems. Participants constituted a representative sample of elementary school students at high risk for ADHD, including 116 children with ADHD and 51 subclinical controls. Results found no significant differences between the ADHD and subclinical group on CPT variables, and CPT performance did not reliably predict group membership. Implications of the findings are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Putman, J. A., Othmer, S. F., Othmer, S., & Pollock, V. E. (2005). TOVA results following inter-hemispheric bipolar EEG training. Journal of Neurotherapy, 9(1), 37-52. Introduction: This study examines recovery of attentional measures among a heterogeneous group of clients in a pre-and post-comparison using inter-hemispheric EEG training at homologous sites. A continuous performance test was used as an outcome measure. The client population was divided into three categories: (a) primarily attentional deficits, (b) primarily psychological complaints, and (c) both. Method: Neurofeedback protocols included T3-T4, Fp1-Fp2, F3-F4, C3-C4 and P3-P4. A wide range of reward frequencies was used, and these were individually selected to optimize the subjective experience of the training. Participants were 44 males and females, 7 to 62 years old, who underwent treatment for a variety of clinical complaints. Dependent variables were derived from a continuous performance test, the Test of Variables of Attention (TOVA), which was administered prior to EEG training and 20 to 25 sessions thereafter. Results: After EEG training a clear trend towards improvement on the impulsivity, inattention, and variability scales of the TOVA was evident. Participants with normal pre-training scores showed no deterioration in their performance, indicating that homologous site inter-hemispheric EEG training had no deleterious effect on attention. In addition reaction time was predominately in the normal range for this population and remained unchanged following training. Conclusion: Normalization of attentional variables was observed following training irrespective of the primary clinical complaint. These results suggest that inter-hemispheric training at homologous sites provides another "generic" EEG biofeedback protocol option for addressing attentional deficits. Inter-hemispheric training likely serves as a general challenge to the regulation of cerebral timing, phase, and coherence relationships. Such a challenge may result in more effective regulation of cerebral networks, irrespective of whether these are involved in attentional or affective regulation. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Ramirez, J. R. (1998). Attentional deficits in youth boxing: Effects of repeated mild closed head injuries. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (9-B), 5138. This study was designed to determine whether lasting attentional deficits result from repeated mild closed head injuries related to participation in youth boxing. Subjects consisted of 10 amateur boxers and 10 basketball players who were participating in tournaments at a youth club. Subjects were matched for age, grade point average, and socioeconomic status. Attentional disruptions were measured by four variables of the Test of Variable Attention (TOVA): Omission errors, a measure of attention; commission errors, a measure of response inhibition and impulsivity; response time, a measure of information processing and motor response speed; and variability of response time, a measure of consistency of attention. The boxers were tested 1 hour after the completion of the boxing tournament and again 8 weeks later. The basketball players were tested once while their tournament was in progress. The results of the study indicate that the cumulative effects of head blows sustained during the boxing season did not have a significant effect on TOVA measures of inattention, inhibition/impulsivity, or information processing and motor response speed. Variability was the only index for which the mean score of the boxers differed significantly from the norm. Consistency of attention was inconsistent and varied at the end of the boxing season and appears to be the only variable affected by the purported head blows. The hypothesis that there would be significant differences between boxers' mean TOVA scores obtained 1 hour after the last match of the tournament and those obtained 8 weeks later was partially supported. The mean scores of the boxers for commission errors and consistency of attention improved significantly between the two testing conditions although their reaction-time score decreased. The hypothesis that the mean TOVA scores of the boxers obtained 1 hour after the last match of their tournament would differ from those of basketball players was supported. The basketball players' reaction time was significantly faster than that of the boxers at the end of the season as well as 8 weeks later. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Reeve, D. (1998). Dana reeve: Caregiver, activist, and superwoman. interview by tova navarra. Nursing Spectrum (D.C./Baltimore Metro Edition), 8(24), 6-7.
Reinecke, M. A., Beebe, D. W., & Stein, M. A. (1999). The third factor of the WISC-III: It's (probably) not freedom from distractibility. Journal of the American Academy of Child & Adolescent Psychiatry, 38(3), 322-328. Examined the ecological validity, construct validity, and diagnostic utility of the 3rd factor of the Wechsler Intelligence Scale for Children-III (WISC-III), heuristically labeled Freedom From Distractibility (FFD). 200 children, aged 6-11 yrs, with attention-deficit hyperactivity disorder (ADHD), completed the WISC-III, the Wide Range Achievement Test--Revised, and the Test of Variables of Attention. Objective parent and teacher report measures of attention and hyperactivity were completed. Mean FFD scores were significantly lower than other WISC-III factor scores. The diagnostic utility of FFD is limited, however, as the majority of the Ss did not show a significant relative weakness on this index. Correlational analyses failed to support the concurrent, ecological, or construct validity of the FFD. FFD scores were not correlated with a measure of sustained visual attention. Among children with ADHD, a low FFD score may be associated with the presence of a learning disability or poor academic performance. This finding was maintained after level of general intelligence was statistically controlled. FFD may not be reliable or valid as an index of attention or as a diagnostic screening measure for identifying children with ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Riccio, C. A., Reynolds, C. R., & Lowe, P. A. (2001). Clinical applications of continuous performance tests: Measuring attention and impulsive responding in children and adults. (2001).Clinical applications of continuous performance tests: Measuring attention and impulsive responding in children and adults.xii, 396 pp.Hoboken, NJ, US: John Wiley & Sons Inc, (from the cover) This handbook examines the similarities and differences of the numerous Continuous Performance Test (CPT) techniques and their research literature. The four major instruments in use today are thoroughly reviewed (Conners' CPT, Gordon Diagnostic System, Integrated Visual and Auditory CPT, and Test of Variables of Attention/Test of Variables of Attention--Auditory), along with a complete overview of their specific applications. Additional CPTs are discussed in the context of how modifications to the CPT paradigm can affect results and, subsequently, interpretation. Brain-behavior correlates of CPT scores and the use of CPT's for monitoring effectiveness of treatment approaches are also covered in depth. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Romans, S. M., Roeltgen, D. P., Kushner, H., & Ross, J. L. (1997). Executive function in girls with turner's syndrome. Developmental neuropsychology, 13(1), 23-40. Investigated executive function and attention abilities in 105 girls with Turner's syndrome ([TS] aged 7-16.9 yrs) and 153 age-, IQ-, and SES-matched controls. Executive skills included the ability to plan, organize, monitor, and execute multistep problem-solving processes. Three age groups were evaluated in order to assess developmental patterns in executive skills. Data showed that TS Ss performed significantly less well than did controls on measures of attention, including the Freedom From Distractibility factor of the Wechsler Intelligence Scale for Children--Revised (WISC--R) and the Test of Variables of Attention. In the executive function domain, TS Ss performed at levels comparable to controls on the Wisconsin Card Sort Test and on measures of semantic clustering, but they exhibited significant deficits on the Rey-Osterrieth organizational component and the Tower of Hanoi. In summary, girls with TS showed evidence of increased impulsivity, and their performance on tests of executive function with complex spatial demands showed similar impairment at all ages studied. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Rosengren, K. S. (2005). Performance of intellectually gifted children on three measures of attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 65 (12-B), 6672. While there is a growing awareness of the co-occurrence of giftedness and Attention Deficit Hyperactivity Disorder (ADHD), little is known about the clinical presentation of ADHD in intellectually gifted children. Current diagnostic decisions with this subpopulation are made employing procedures and norms developed using a nonexceptional population. However, it is unknown whether this common practice is appropriate. This study explored how intellectually gifted children perform on three commonly used measures of ADHD, specifically: (a) the Test of Variables of Attention (TOVA); (b) the Conners' Teacher Rating Scale, Revised-Long Form (CTS); and (c) the Conners' Parent Rating Scale, Revised-Long Form (CPS). Children who met traditional criteria for giftedness (N = 90) were obtained from nearby public schools. Each was administered the TOVA and their parents and teachers completed a Conners' rating scale. The performance of these children was compared to normative data. It was hypothesized that: (a) gifted children would perform significantly better on the TOVA than normative children, and (b) no differences would be found between the performance of gifted children and the normative sample on both the CTS and CPS. The hypotheses were partially supported by the findings. Gifted children performed better on three of the five TOVA variables, but only for the younger children in the sample. In addition, no evidence of differences in scores was found between the gifted children and the normative sample on the CTS and CPS. The findings do, however, address the underlying clinical question regarding the appropriateness of using the normative data provided for the TOVA, CTS and CPS to assess ADHD in intellectually gifted children. Ultimately, the performance differences found for gifted children on the TOVA suggest that alternate TOVA norms are likely needed for younger ages. A rationale for adjusting the TOVA norms is proposed, and a few simple "rules of thumb" for transforming the age-based are summarized in an Adjustment Matrix. The differences on the CTS and CPS were found mostly for variables unrelated to ADHD and suggest that the normative data for the Conners' Scales can be used when assessing ADHD in gifted children. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Rossiter, T. (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part II. replication. Applied Psychophysiology & Biofeedback, 29(4), 233-243. This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample, expanded age range, and improved statistical analysis. Thirty-one ADIHD patients who chose stimulant drug (MED) treatment were matched with 31 patients who chose a neurofeedback (EEG) treatment program. EEG patients received either office (n = 14) or home (n = 17) neurofeedback. Stimulants for MED patients were titrated using the Test of Variables of Attention (TOVA). EEG (effect size [ES] = 1.01-1.71) and MED (ES = 0.80-1.80) groups showed statistically and clinically significant improvement on TOVA measures of attention, impulse control, processing speed, and variability in attention. The EEG group demonstrated statistically and clinically significant improvement on behavioral measures (Behavior Assessment System for Children, ES = 1.16-1.78, and Brown Attention Deficit Disorder Scales, ES = 1.59). TOVA gain scores for the EEG and MED groups were not significantly different. More importantly, confidence interval and nonequivalence null hypothesis testing confirmed that the neurofeedback program produced patient outcomes equivalent to those obtained with stimulant drugs. An effectiveness research design places some limitations on the conclusions that can be drawn.
Rossiter, T. (2002). Neurofeedback for AD/HD: A ratio feedback case study and tutorial. Journal of Neurotherapy, 6(3), 9-35. Presents the case study of a 13-yr-old male with attention deficit hyperactivity disorder (ADHD) treated with neurofeedback. The case is presented as a tutorial on Ratio feedback. Ratio feedback protocols provided visual and auditory feedback based on the ratio of slow wave activity to be suppressed divided by fast wave activity to be enhanced. The patient demonstrated marked improvement in processing speed and variability on the Test of Variables of Attention-Auditory, a 19-point increase in IQ on the Kaufman Brief Intelligence Test, significant behavioral improvement based on parental (Behavioral Assessment for Children) and patient (Brown ADD Scale) reports, and a 7.5 grade equivalent increase in reading scores. At the 17-mo follow-up parent questionnaires indicated that the patient's behavioral gains had been maintained or were slightly improved. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Rossiter, T. R. (1998). Patient-directed neurofeedback for AD/HD. Journal of Neurotherapy, 2(4), 54-63. Reports on patient-directed neurofeedback for attention deficit hyperactivity disorder (ADHD). Therapist involvement was limited to 10 treatment sessions used to train the patient or parents of younger children to use the equipment, to monitor treatment, and to make changes in the treatment protocol as necessary. The remaining 50 sessions were conducted at home using inexpensive, easy to operate, 1 or 2 channel Lexicor PODs. Results from the initial 6 patients (aged 7-45 yrs) are reported. Thirteen of 24 Test of Variables of Attention (TOVA) measures (e.g., attention, impulsivity, reaction time and variability) were below average at baseline. After 30 neurofeedback sessions, only 5 TOVA variables remained below average. It is concluded that patient-directed neurofeedback may be an effective alternative to therapist-directed treatment for many ADHD patients and can be delivered at substantially less cost. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Rossiter, T. R., & La Vaque, T. J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. Journal of Neurotherapy, 1(1), 48-59. Compared treatment programs with EEG biofeedback or stimulants as their primary components for patients (aged 8-21 yrs) with undifferentiated attention deficit disorder or attention deficit hyperactivity disorder (ADHD). An EEG group (23 Ss) was matched with a stimulant (MED) group (23 Ss) by age, IQ, gender, and diagnosis. The Test of Variables of Attention (TOVA) was administered pre- and posttreatment. EEG and MED groups improved on measures of inattention, impulsivity, information processing, and variability, but did not differ on TOVA change scores. The EEG biofeedback program is an effective alternative to stimulants and may be the treatment of choice when medication is ineffective, has side effects, or compliance is a problem. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Rugino, T. A., & Copley, T. C. (2001). Effects of modafinil in children with attention-deficit/hyperactivity disorder: An open-label study. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 230-235. OBJECTIVE: To examine the effect of once-daily dosing of modafinil, a stimulant that has a long duration of action, on clinical features of attention-deficit/hyperactivity disorder (ADHD) in children. METHOD: An open-label design was used to compare the Conners Parent and Teacher Rating Scale-Revised (L) (CPRS, CTRS), the ADHD Rating Scale-IV, and the Test of Variables of Attention (TOVA), without and with medication, in children with ADHD. Eleven children with ADHD, ranging in age from 5 to 15 years, took modafinil for an average of 4.6 weeks. RESULTS: Average TOVA ADHD scores improved by 2.43 SD (p = .0009). CTRS and CPRS ADHD index T scores improved by an average of 14.1 (p = .0009) and 17.7 points (p = .001), respectively. The mean ADHD Rating Scale-IV scores improved from the 88th percentile to the 75th percentile (p = .047). One subject withdrew from the study because of an adverse event that was resolved completely with medication withdrawal. Other side effects were mild and responded to dose adjustment. No subjects required more than one dose per day. CONCLUSIONS: Modafinil may be a useful once-daily treatment for children with ADHD. Further study using a double-blind, placebo-controlled design is needed.
Rugino, T. A., & Samsock, T. C. (2003). Modafinil in children with attention-deficit hyperactivity disorder. Pediatric neurology, 29(2), 136-142. Previous clinical evidence suggested that modafinil may improve clinical features of children with attention-deficit hyperactivity disorder. To test this hypothesis, a randomized, double-blind, placebo-controlled study design was used. Of 24 children initially randomized into the study, 11 control subjects and 11 treatment patients completed the study, with evaluation before medication and after 5 to 6 weeks. The average Test of Variables of Attention attention-deficit hyperactivity disorder z score improved by 2.53 S.D.s for the modafinil group compared with a decline of 1.02 for control patients (P < or = 0.02). Conners Rating Scales ADHD total t scores for the modafinil group improved from 76.6 to 68.2 compared with improvement from 77.7 to 76.0 for control subjects (P = 0.04). Ten of 11 treatment patients were reported as "significantly" improved, whereas eight of 11 control subjects were reported as manifesting "no" or "slight" improvement (P < 0.001). Adverse effects were few and manageable, with no anorexia. Modafinil may be a useful treatment for children with ADHD, particularly when anorexia limits use of stimulants.
Salerno, J. A. (1997). Neurofeedback in closed head injury: A multiple case design study. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57 (11-B), 7266. The focus of this study was on the clinical application of neurofeedback (electroencephalographic biofeedback) as a treatment strategy for the attention, concentration, short term memory, sleep problems, and emotional difficulties associated with mild to severe closed head injury. The subjects were 4 males and 6 females, ages 30 to 49 with varying degrees of head injury. The time since injury ranged from 13 months to 276 months. The design of the study was a multiple case study design with subjects serving as their own controls. The hypotheses were that EEG training of subjects with mild to severe closed head injury would be associated with a significant decrease in theta and high frequency beta magnitudes and changes in theta/high frequency beta ratios. EEG changes were to have been documented from multiple pretraining and posttraining EEG baseline measurements. It was also hypothesized that neurofeedback training would be associated with improvement in attention, concentration, short term memory, sleep problems, depression, anxiety, irritability, and mood swings. Subjects received pretesting and posttesting with the Micro-Cog Assessment of Cognitive Functioning and Test of Variables of Attention as well as a Symptom Checklist-90-R for assessment of emotional functioning. Each subject also participated in a pretraining and posttraining clinical interview and maintained a weekly symptom report form. Following the administration of the pretests, subjects engaged in a 30 session protocol of EEG biofeedback training. Each session consisted of 30 minutes of individual training in the Cz, C3, and/or C4 cranial areas. The results did not support the expected changes in theta or high frequency beta activity. However, a statistically significant training effect was indicated in the alpha and sensorimotor (12-15hz.) frequencies in the primary area of training (Cz). Although subject report generally indicated improvement in memory, this was not supported by statistically significant test results. Statistically significant improvement was indicated for attention-concentration, sleep problems, and the emotional areas. In regard to memory function, it was possible that the protocol may not have been extensive enough in time or scope to achieve improvements that could be documented with test results. Further research on a larger scale with neurofeedback training and head injury may aid our understanding and ability to treat this often devastating condition. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Schatz, A. M., Ballantyne, A. O., & Trauner, D. A. (2001). Sensitivity and specificity of a computerized test of attention in the diagnosis of attention-Deficit/Hyperactivity disorder. Assessment, 8(4), 357-365. Attention-Deficit/Hyperactivity Disorder (ADHD) is difficult to diagnose due to the subjectivity of its symptoms and lack of specific assessment measures. Computerized tests of attention have recently been used as objective measures that may assist in the diagnosis of the disorder. The present study evaluated consistency between the Conners Parent Rating Scale and the Test of Variables of Attention (TOVA), which is a computerized test of attention designed to identify symptoms associated with ADHD, in children clinically diagnosed with ADHD (n = 28) and controls (n = 20). Our results showed that both the Conners and the TOVA indicated significant problem areas suggestive of an attention deficit in approximately 85% of children who were clinically diagnosed with ADHD. However, the TOVA also found attentional problems in approximately 30% of control children, whereas none of the controls scored abnormally on the Conners. As computerized measures are administered more frequently, there may be a risk of overdiagnosis and treatment of "ADHD" in normal children. A combined approach using questionnaires, clinical evaluation, and computerized tests of attention in the assessment of possible ADHD may provide the most accurate means of diagnosis.
Schatz, A. M., Weimer, A. K., & Trauner, D. A. (2002). Brief report: Attention differences in asperger syndrome. Journal of Autism and Developmental Disorders, 32(4), 333-336. The goal of the present exploratory study was to establish whether a small sample of individuals with Asperger syndrome showed an increased number of attention deficit symptoms. Participants were eight males (aged 9.00-19.92 yrs) clinically diagnosed with Asperger syndrome and eight matched control subjects. The TOVA, a computerized continuous performance test, was administered in a standardized fashion to all participants. Evidence of an attention deficit was seen in a majority of the participants with Asperger syndrome. Only the Variability diagnostic variable was able to differentiate the two groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Schuerholz, L. J., Singer, H. S., & Denckla, M. B. (1998). Gender study of neuropsychological and neuromotor function in children with tourette syndrome with and without attention-deficit hyperactivity disorder. Journal of child neurology, 13(6), 277-282. Neuropsychological and neuromotor functions were compared between boys and girls with Tourette syndrome (TS only), attention-deficit hyperactivity disorder (ADHD only), Tourette syndrome with ADHD (TS+ADHD), and a comparison group, in an age (mean = 10 years) and IQ (Wechsler Full-Scale mean = 111) matched sample (n = 116). There were no timed-task neuromotor differences among the groups. Analyses of variance revealed a group x gender interaction for Letter Word Fluency and the Rapid Automatized Naming test. Girls with ADHD only were faster than boys on both tasks. When data for girls only were analyzed, girls with Tourette syndrome with ADHD had the greatest variability of reaction time on the Test of Variables of Attention, and were slowest on Letter Word Fluency. Girls with TS only were slower than girls in the other three groups on Letter Word Fluency. Poor Letter Word Fluency is explained as a linguistic executive dysfunction involving speed and efficiency of memory search in this bright group of girls with Tourette syndrome, not otherwise at risk for linguistic difficulties.
Scott, D. W., O'Garra, A., Warren, D., & Klaus, G. G. (1987). Lymphoma models for B cell activation and tolerance. VI. reversal of anti-ig-mediated negative signaling by T cell-derived lymphokines. Journal of Immunology, 139(12), 3924-3929. We have recently described three "immature" B cell lymphomas which are exquisitely sensitive to growth inhibition by anti-Ig reagents and may serve as models for tolerance induction in normal B cells. These cells are inhibited from cell cycle progression into S after receiving a negative signal in early G1. In this paper, we demonstrate that the growth inhibition by anti-Ig can be prevented and reversed by the addition of supernatants from T cell lines. One such line, called Tova, produces factors which restore normal levels of DNA synthesis in the presence of concentrations of anti-Fab or anti-kappa immunoglobulins which cause up to a 90% inhibition of thymidine incorporation in a 2- to 3-day culture period. This factor is at least partially effective when added up to 24 hr after anti-Ig to unsynchronized lymphoma cells and it does not alter the growth of control cultures. Studies using synchronized lymphoma cells indicated that the T cell factor permitted cycle progression into S when added during the early G1 exposure to anti-kappa and was less effective when added late in G1. Preliminary characterization suggests that both B cell growth factor II (interleukin 5) and B cell stimulatory factor 1 (interleukin 4) have additive activity in this system, although another unidentified lymphokine may also be involved. The relevance of T cell reversal of Ig receptor-mediated negative signaling to neonatal B cell tolerance is emphasized.
Scott, W. C., Kaiser, D., Othmer, S., & Sideroff, S. I. (2005). Effects of an EEG biofeedback protocol on a mixed substance abusing population. American Journal of Drug & Alcohol Abuse, 31(3), 455-469. This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance abusing inpatient population. METHOD: One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared. RESULTS: Experimental subjects remained in treatment significantly longer than the control group (p <0.005). Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demonstrated significant improvement on the TOVA (p<.005) after an average of 13 beta-SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level. CONCLUSIONS: This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.
Shaffer, R. J., Jacokes, L. E., Cassily, J. F., Greenspan, S. I., Tuchman, R. F., & Stemmer, P. J.,Jr. (2001). Effect of interactive METRONOME training on children with ADHD... including commentary by koomar J, burpee JD, DeJean V, frick S, kawar MJ, fischer DM. American Journal of Occupational Therapy, 55(2), 155-166. Objective. The purpose of this study was to determine the effects of a specific intervention, the Interactive Metronome, on selected aspects of motor and cognitive skills in a group of children with attention deficit hyperactivity disorder (ADHD). Method. The study included 56 boys who were 6 years to 12 years of age and diagnosed before they entered the study as having ADHD. The participants were pretested and randomly assigned to one of three matched groups. A group of 19 participants receiving 15 hr of Interactive Metronome training exercises were compared with a group receiving no intervention and a group receiving training on selected computer video games. Results. A significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronome treatment was found. Additionally, several significant differences were found among the treatment groups and between pretreatment and posttreatment factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior. Conclusion. The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.
Sichel, A. G., Fehmi, L. G., & Goldstein, D. M. (1995). Positive outcome with neurofeedback treatment in a case of mild autism. Journal of Neurotherapy, 1(1), 60-64. Reports the experience of an 8.5-yr-old boy who was diagnosed mildly autistic by several specialists. One specialist claimed that the S was brain damaged and "autistic like" and that there was no hope for improvement. The S's score on a test of variables of attention was consistent with an attention deficit disorder. At the request of the S's mother, neurotherapy diagnosis and treatment was begun. After 31 sessions, the S showed positive changes in all the diagnostic dimensions defining autism in the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Smith, M. L. (1997). Neuropsychological consequences of hypoxia in children with transposition of the great arteries: Memory and learning. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57 (8-B), 5344. This study investigated the neuropsychological consequences of hypoxia in children with transposition of the great arteries (TGA). TGA is a congenital heart defect requiring reparative open heart surgery to improve arterial oxygen saturation. Participants in this study were 56 children with TGA and 34 sibling controls from the Baltimore-Washington metropolitan area. Participants were assessed with neuropsychological measures including: Stanford Binet-IV Intelligence Test, Woodcock Johnson-Revised Test of Academic Achievement Wide Range Assessment of Memory and Learning, California Verbal Learning Test-Children's version, Rey Osterrieth Complex Figure, Test of Variables of Attention, and the Child Behavior Checklist. It was predicted that presence of TGA in children is related to substandard performance on tests of academic achievement and neuropsychological measures of memory and learning. Results indicated that compared to sibling controls, children with TGA performed more poorly on tests of (1) academic achievement, (2) attention, (3) acquisition memory, and (4) organization and planning abilities. Multiple regression analyses revealed that attention and acquisition memory accounted for a significant proportion of the variance in academic achievement of children with TGA. Children with TGA in the current sample were at greater risk for learning disability than learning disability prevalence rates within the normal population. A greater number of children with TGA received special educational assistance at school than sibling controls. It was concluded that chronic hypoxia in children with TGA results in mild generalized cerebral dysfunction. Many children with TGA will require special education services, and are at risk for academic struggles if they do not receive appropriate resources and support. Therefore, developmental, educational, and neuropsychological monitoring of children with a history of hypoxia should continue into the school age years. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Smith, P. N., & Sams, M. W. (2005). Neurofeedback with juvenile offenders: A pilot study in the use of QEEG-based and analog-based remedial neurofeedback training. Journal of Neurotherapy, 9(3), 87-99. Introduction. Atypical EEG and neuropsychological indicators have been observed among offenders. Dangerous offenders treated with a combined program that included neurofeedback (EEG biofeedback) and galvanic skin response (GSR) biofeedback demonstrated reduction in recidivism (Quirk, 1995). This study was designed to further evaluate the EEG findings of youth offenders and to provide an initial report on the effectiveness of a task oriented analog/ QEEG-based remedial neurofeedback training approach. Method. Five offenders with significant psychopathology were referred for treatment. The group was evaluated with attentional testing and analog/QEEG assessment prior to and following neurotherapy. Treatment consisted of 20 or 40 sessions of a task-activated, analog/QEEG-based approach. Another group of thirteen offenders were assessed with attentional testing and provided with neurotherapy following QEEG assessment. Results. For all of the youth trained, in the analog/QEEG group, prevs. post-audio and visual attention testing demonstrated significant improvement within 20 remedial sessions. Three of the five youth showed rapid advancement in a residential grading system. Staff observational ratings suggested behavioral improvement in the QEEG group who in general were in training for a longer period of time. Conclusion. EEG abnormalities and deficits in neuropsychological testing were found among offenders. Neurotherapy as an adjunctive treatment appears to hold promise for improvement in cognitive performance as well as recidivism. It is anticipated that different neurofeedback protocols may enhance outcomes.
Sporn, M. B. (2002). The use of the test of variables of attention to predict attention and behavior problems in deaf adults. Dissertation Abstracts International Section A: Humanities and Social Sciences, 62 (10-A), 3295. Studies indicate that the prevalence of attention difficulties in deaf individuals is greater than that in the general population. Computerized Performance Tests (CPTs) have become a valuable tool in diagnosing attention problems and recent research has demonstrated that deaf individuals perform poorly on CPTs when compared to their hearing peers. The current study attempted to validate the use of the Test of Variables of Attention (T.O.V.A.) for use with deaf adults. In addition, the present paper evaluated the significance of an inattentive or hyperactive performance on the T.O.V.A. In this study 63 deaf undergraduate students were screened with a prorated Performance IQ from The Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Subjects were then administered the Test of Variables of Attention (T.O.V.A.), the Risk-Taking Self-Report Scale, and ADHD Behavior Checklist for Adults. Results from these measures were correlated to the students' current Grade Point Average. Results and implications for the use of the T.O.V.A. as a screening measure of attention difficulties with deaf adults are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Stein, Sarampote, C. S., Waldman, I. D., Robb, A. S., Conlon, C., Pearl, P. L., et al. (2003). A dose-response study of OROS methylphenidate in children with attention-deficit/hyperactivity disorder. Pediatrics, 112(5): Supplement), e404-13. OBJECTIVE: OROS methylphenidate HCL (MPH) is a recently developed long-acting stimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD). This study was conducted to examine dosage effects on ADHD symptoms and stimulant side effects and to explore potential moderating effects of ADHD subtype. METHODS: Children with ADHD combined type (ADHD-CT) or predominantly inattentive type (ADHD-PI; n = 47), ages 5 to 16 years, underwent a placebo-controlled, crossover trial using forced titration with weekly switches at 3 dosage levels. Parent and teacher ratings of ADHD symptoms were used to evaluate efficacy. In addition, vital signs and standardized measures of stimulant side effects were obtained weekly. RESULTS: Parent ratings were more sensitive to treatment effects than teacher ratings. ADHD symptoms and Clinical Global Impressions Severity Index ratings at each dose condition differed significantly from placebo and baseline ratings, which did not differ from one another. For those with ADHD-CT, there was a clear linear dose-response relationship, with clinically significant reductions in ADHD Rating Scale-IV scores occurring in two thirds to three fourths of the subjects during either 36- or 54-mg dose conditions. Children with ADHD-PI, conversely, were more likely to respond optimally to lower doses and derived less benefit from higher doses, with 60% displaying significant improvement on the ADHD Rating Scale-IV at 36 mg or lower. Mild stimulant side effects were reported during placebo and at all dosage levels. With the exception of insomnia and decreased appetite, which were more common at higher doses, parent report of side effects was not related to dose. In addition, younger and smaller children were more likely to display sleep difficulties and decreased appetite at the higher dose levels Although pulse rate increased slightly with increasing dose, there were no dose effects on blood pressure. CONCLUSIONS: In children with ADHD-CT, the most common subtype of ADHD, increasing doses of stimulant medication were associated with increased improvement of inattention and hyperactivity symptoms. In children with ADHD-PI, symptom improvement occurred at lower doses and less benefit was derived from higher doses. In both ADHD subtypes, higher doses were associated with parent ratings of increased insomnia and decreased appetite.
Stewart, G. A., Steffler, D. J., Lemoine, D. E., & Leps, J. D. (2001). Do quantitative EEG measures differentiate hyperactivity in attention deficit/hyperactivity disorder? [references]. Child Study Journal, 31(2), 103-121. Examined the external validity of attention deficit hyperactivity disorder (ADHD) without hyperactivity as a diagnostic category by comparing a group of 9 boys who met the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for ADHD, predominantly inattentive type, to a group of 9 boys who met the criteria for ADHD. Quantitative EEG analysis was used to examine possible differences in brain wave activity of the two subtypes of ADHD while completing the Test of Variables of Attention, a computerized task that measures a variety of constructs associated with attention and impulsivity. Although parent-reported behavioral ratings confirmed differential characteristics of both subtypes of ADHD, EEG findings did not differentiate between ADHD with and without hyperactivity. Implications to cognitive models of ADHD are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Stewart, G. A. (1998). EEG characteristics of attention deficit disorders with and without hyperactivity. Dissertation Abstracts International Section A: Humanities and Social Sciences, 58 (9-A), 3420. The purpose of the study was to examine the external validity for Attention Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive Type, as a separate entity from ADHD, Combined Type. EEG and psychometric data were collected on a group of carefully selected 10 to 12 year old boys who met the criteria for one of these two diagnoses, as well as a group of normal control children. The EEG records were collected during the following three conditions: eyes open, eyes closed, and while completing the Test of Variables of Attention (TOVA). Means and standard deviations were calculated for each EEG variable and change scores were calculated to reflect the shift in EEG activity that occurred between the eyes open and TOVA conditions. An analysis of covariance design using the eyes open condition as covariate was also used to compare the EEG data for the three groups. Both of the clinical groups obtained similar scores on the TOVA and exhibited the presence of excessive slow wave activity and higher mean magnitude when compared to normal subjects. The majority of significant differences emerged between the predominantly inattentive subjects and the control subjects. The results do not provide support for conceptualizing ADHD, Predominantly Inattentive Type, as a distinct clinical entity. The findings are discussed in relation to the theory of optimal stimulation and its possible relevance to understanding the different behavioral presentation of the two clinical groups. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Stierwalt, J. A. G., & Murray, L. L. (2002). Attention impairment following traumatic brain injury. Seminars in speech and language, 23(2), 129-38, 1-7. The incidence of traumatic brain injury (TBI) is approximately 2,000,000 cases annually, and approximately 5.3 million Americans are currently living with some degree of cognitive-linguistic impairment secondary to TBI. One frequent aspect of that impairment is disordered attention. Attention is a complex system comprised of several component skills, each of which may be compromised by TBI and thus must be carefully assessed to design appropriate treatment protocols. Attention treatments for patients with TBI frequently involve implementing environmental controls and designing individualized therapy tasks that vary in terms of information processing demands. This article provides a summary of those attention impairments frequently associated with TBI and outlines assessment and treatment guidelines for clinicians serving TBI patients with attention problems.
Stokes, D. A. (2003). Effectiveness of electroencephalogram biofeedback training for disorders of arousal in a clinical setting as measured by changes in T.O.V.A. scores, mood and symptom ratings. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63 (7-B), 3508. The effects of electroencephalogram (EEG) biofeedback were examined with 10 participants presenting with a variety of psychological and neurological diagnoses related to their level of arousal. These conditions included anxiety, depression, and attentional disorders. Prior to treatment, participants were given the Test of Variables of Attention (T.O.V.A.), a continuous performance test, a Symptom Checklist, and, if they were depressed or anxious, the Beck Depression Inventory or the State Trait Anxiety Inventory. After 20 sessions of neurofeedback participants took the T.O.V.A. again and completed a post-treatment Symptom Checklist and, when appropriate, the depression and anxiety inventories. The 20 neurofeedback sessions involved providing clients with feedback on their brainwave patterns, and through this feedback, training them to increase activity in some frequency bands and decrease activity in other frequency bands. The theory is that this type of training improves cognitive functioning and mood states by facilitating the brain's ability to regulate its own arousal levels. Nonparametric statistical analyses showed statistically significant improvements in TOVA response time variability, the leading indicator of ADD. There were also improvements on the depression and anxiety inventories, although the number of subjects completing these instruments was too small to warrant statistical analyses. The study adds to the small but growing body of research suggesting the effectiveness of neurofeedback for a variety of neurologically based disorders related to arousal level. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Thompson, L., & Thompson, M. (1998). Neurofeedback combined with training in metacognitive strategies: Effectiveness in students with ADD. Applied Psychophysiology & Biofeedback, 23(4), 243-263. A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children. A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended forty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 68), Wide Range Achievement Test (WRAT 3, n = 99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n = 66). Significant improvements (p < .001) were found in ADD symptoms (inattention, impulsivity, and variability of response times on the TOVA), in both the ACID pattern and the full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the WRAT 3. The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs. Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.
Thorpe, T. (1997). EEG biofeedback training in a clinical sample of school age children treated for attention deficit hyperactivity disorder (neurofeedback). Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (3-B), 1550. The present study examined EEG biofeedback efficacy in relation to age, medication status and EEG training protocol for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). A nonrandomized correlational and mixed model factorial design was instituted. Measures from the Test of Variables of Attention (T.O.V.A.; Greenberg, 1987), a computerized performance test, served as dependent variables. Existing clinical data were obtained from 22 offices in which Neurocybernetics EEG biofeedback equipment (EEG Spectrum, Inc., Encino, CA) was utilized. A standardized clinical EEG biofeedback protocol was instituted, including the augmentation of SMR (12-15 Hz) or low beta (15-18 Hz) with concurrent inhibition of theta (4-7 Hz) and high beta (22-30 Hz) EEG spectral bands. The sample consisted of 118 girls and boys, age 5 to 16, who participated in an average of 20 sessions and were diagnosed with ADHD and in about half of the instances with selected comorbid conditions. Analyses were restricted to individuals who had a pre-training deficit (i.e., below 100) on the T.O.V.A. measures of inattention, impulsivity and/or response time variability, resulting in sample sizes of 96, 91 and 113 respectively. A child's age did not correlate significantly with improvement on measures of inattention and impulsivity. For these same measures, no significant differences were found across EEG training protocol conditions yet post-hoc analyses revealed significant differences on variability (p<.05). The findings suggest that a combination of SMR/beta training may be better than either alone in effecting a measure of sustained attention. Results also show no significant effect of gender, comorbid conditions or medication status on inattention or impulsivity measures. Although, for patients showing a deficit in impulsivity, medical management in addition to EEG biofeedback appears to be beneficial. Encouragingly, EEG biofeedback treatment in general resulted in significant improveme (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Topitsch, D., Schober, E., Wurst, E., & Kryspin-Exner, I. (1998). Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus. European journal of pediatrics, 157(10), 802-805. We compared the results of a computerized attention test (TOVA) in 38 children with insulin dependent diabetes mellitus in relation to various spontaneously occurring blood glucose levels. Testing was performed at the following blood glucose levels: 8.3 mmol/1 (hyperglycaemia). The attention (sum of errors and response time) varied significantly with the blood glucose level (P = 0.002). The highest number of errors of omission and the longest response time was observed during the test run with hypoglycaemia. Age, sex, age at manifestation of the disease, metabolic control and the results of the intelligence test had no significant influence on these results. We found that attention in children with diabetes was significantly reduced compared to TOVA norms especially during mild hypoglycaemia (P < 0.001). Irrespective of the blood glucose levels, reaction time and the variability of the reaction time differed significantly between TOVA norms and diabetic children (P < 0.01). CONCLUSION: In children with diabetes mellitus a significant reduction in attention was found at mild hypoglycaemia but as well at low normal blood glucose levels. Attention deficits due to transient lowering of blood glucose may therefore occur in diabetic children even before they are aware of hypoglycaemic symptoms.
Trembach, A. B., Belyaev, M. A., & Lysenko, V. V. (2004). Age-related changes in attention and impulsivity in young schoolchildren. Human physiology, 30(5), 537-544. Normative values of attention, impulsivity, response time, and response time variability were determined for seven- to ten-year-old children with the continuous performance Test of Variables of Attention (TOVA). An age-related increase in attention and a decrease in impulsivity, response time, and its variability were revealed. Differences in TOVA scores were studied for students of gymnasia and schools providing general education. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Vladimirov, I. (2004). [Aromatase inhibitors--is it a new opportunity in the treatment of infertility?]. [Aromataza inkhibitorite--dali tova e nova vzmozhnost za lechenie na infertiliteta?] Akusherstvo i Ginekologiia, 43(2), 50-55. Aromatase P-450 is a key enzyme in the production of estrogens, that is, the conversion of androstenedione and testosterone to estrone and estradiol. Aromatase is a good target for selective inhibition. New aromatase inhibitors provide a good opportunity for successful treatment during infertility management. They have a potential to replace clomiphene citrate (CC) as the first-line treatment for ovulation induction. Applying aromatase inhibitors during assisted reproduction followed: reducing the FSH dose needed to achieve optimum controlled ovarian hyperstimulation (COH); improving ovarian response to FSH in poor responders; terminating positive feedback loop and improving ovarian response to COH in infertile case with endometriosis; improving implantation rates in assisted reproduction technology (ART); reducing estrogen levels to reduce the risk of OHSS during COH. [References: 26]
Voigt, R. G., Llorente, A. M., Jensen, C. L., Fraley, J. K., Berretta, M. C., & Heird, W. C. (2001). A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. Journal of Pediatrics, 139(2), 189-196. OBJECTIVE: To determine whether docosahexaenoic acid (DHA) supplementation for 4 months decreases the symptoms of attention-deficit/hyperactivity disorder (ADHD). STUDY DESIGN: Sixty-three 6- to-12-year-old children with ADHD, all receiving effective maintenance therapy with stimulant medication, were assigned randomly, in a double-blind fashion, to receive DHA supplementation (345 mg/d) or placebo for 4 months. Outcome variables included plasma phospholipid fatty acid patterns, scores on laboratory measures of inattention and impulsivity (Test of Variables of Attention, Children's Color Trails test) while not taking stimulant medication, and scores on parental behavioral rating scales (Child Behavior Checklist, Conners' Rating Scale). Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance, controlling for age, baseline value of each outcome variable, ethnicity, and ADHD subtype. RESULTS: Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group (4.85 +/- 1.35 vs 1.86 +/- 0.87 mol % of total fatty acids; P <.001). Despite this, there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms. CONCLUSION: A 4-month period of DHA supplementation (345 mg/d) does not decrease symptoms of ADHD.
Wada, N., Yamashita, Y., Matsuishi, T., Ohtani, Y., & Kato, H. (2000). The test of variables of attention (TOVA) is useful in the diagnosis of japanese male children with attention deficit hyperactivity disorder. Brain & development, 22(6), 378-382. The purpose of this study was to evaluate the ability of the test of variables of attention (TOVA) to distinguish between 6- to 12-year-old Japanese male children with attention deficit hyperactivity disorder (ADHD group; n = 17) meeting DSM-IV and ICD-10 criteria, and age-matched, normal Japanese male controls (control group; n = 19). The TOVA is a computer-administered, visual continuous performance test that provides measures of attention. The ADHD group had significantly higher means than the control group in all variables: omission errors, commission errors, response time, response time variability, anticipatory responses, and multiple response. Control children exhibited age-related changes in two variables: response time and response-time variability, but no age-related changes were observed in any variables in the ADHD group. This preliminary study indicates that the TOVA makes a useful contribution to the diagnosis of Japanese male children with ADHD. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
Walcutt, D. L. (2001). The efficacy of neurofeedback on migrainous neuralgia. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62 (1-B), 568. ?There are few effective prophylactic measures employed for the treatment of migraines. Pharmacological advances have offered symptomatic or abortive treatment of acute migraines. Unfortunately, medications carry side effect warnings and contraindications. The science of peripheral biofeedback is more than 100 years old and has been effectively used to control migraines since the early 1970s. EEG biofeedback, or neurofeedback, has been utilized for nearly 40 years and is the newest generation of biofeedback. However, instead of training a person to control peripheral measures, the therapist teaches control of brain waves. Migraine headaches are considered to be caused in part by an instability in brain wave frequencies that can be corrected through brain wave training. Whereas pharmacological interventions may bring with them side effects and restrictions, neurofeedback is virtually risk-free. Since the brain is "trained" directly, there is no need for a medication to be metabolized, to cross the blood-brain barrier, or to be secreted by the body. Such traditional treatments can create complications for the patient beyond the targeted headaches. Anecdotal reports have indicated neurofeedback as a useful and safe intervention for migraines, but no empirical research has been published. The purpose of this research is to explore the effectiveness of neurofeedback as a treatment and/or prophylaxis for migraine pain. In this study, experimental and control groups consisted of two adult women each (N = 4), having one or more migraines weekly for 2 years. Subjects maintained migraine headache diaries and received pre-treatment Tests of Variables of Attention (T.O.V.A.) and MMPI-2's. Controls received delayed treatment. Two-tailed t tests compared pre- and post-treatment headache intensity, frequency, and MMPI-2 data. Technical difficulties precluded comparison of T.O.V.A. data. Subject compliance was variable. Although there were no significant differences between pretreatment headache frequency and intensity compared to data after the 7th and 14th treatments, positive trends were evident. There was significant improvement on post-treatment Social Introversion. t (2) = 21.00, p < .05 and Masculinity/Femininity Scales, t (2) = -17.00, p < .05 on experimental group MMPI-2 scores. There were insignificant but positive changes here as well. Future research is expected to provide a larger sample with more exacting measures and requirements. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Warren, K. M. (1996). The use of the TOVA I and TOVA II in the identification of children with attention deficit hyperactivity disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 57 (3-B), 2170. Current assessment devices used in the diagnosis of children with ADHD have been primarily standardized behavior rating scales that are observation-based. The use of continuous performance tests adds a measure that directly accesses the child's impulsivity and ability to attend. The purpose of this investigation was to examine the contributions of two continuous performance tests, the TOVA I and TOVA II in the diagnosis of children with ADHD. Specifically, consideration of how both verbal and auditory forms of stimuli presentation augment accurate detection of ADHD. The predictive and divergent validity of the TOVA I and TOVA II was assessed. The results supported the ability of both tests to identify children with ADHD, with the combined use of both tests being the most effective discriminator. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Webb, N. B. (Ed.). (2004). Mass trauma and violence: Helping families and children cope(2004). Mass trauma and violence: Helping families and children cope. xx, 378 pp. New York, NY, US: Guilford Press.(from the publicity materials) This book describes a range of effective ways to help children and families cope with major traumatic experiences such as community violence, war, and terrorist attacks. Detailed case examples bring to life the complexities of assessment and intervention with children of different ages and cultural backgrounds, including both survivors of one-time traumatic events and those dealing with ongoing stressors like the military deployment of a parent. Expert contributors provide guidelines for setting up and running school- and clinic-based support groups; conducting brief and longer-term interventions with individuals and families; and promoting healing with art, music, and play. This book is grounded in the latest knowledge on stress and coping, bereavement, attachment, and risk and resilience, and includes tips for therapist self-care. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Westby, S. A. (1999). Test of variables of attention (TOVA) utility in differentiating attention Deficit/Hyperactivity disorder subtypes. Dissertation Abstracts International: Section B: The Sciences and Engineering, 60 (2-B), 0846. Research has indicated that Continuous Performance Tests (CPTs) can differentiate Attention-Deficit/Hyperactivity (ADHD) subjects from controls without any psychiatric illness. However, CPTs have neither accurately differentiated ADHD children from those with other psychiatric disorders--nor differentiated subtypes of ADHD from each other. The Test of Variables of Attention (TOVA), a new CPT, has several advantages over its predecessors which may allow the TOVA to be more effective in this differentiation process. Data from ADHD subjects was selected from children who were administered the TOVA as part of their evaluation for ADHD at Lakeland Mental Health Center in Moorhead, MN, the Child Evaluation and Treatment Program in Grand Forks, ND, and the Behavioral Health Clinic at the St. Cloud Hospital in St. Cloud, MN. Learning Disordered subjects' data was obtained from a previous study by Clay et al. (1996). Children with no history of psychiatric illness were recruited by offering research participation credit to University of North Dakota students who agreed to have their children participate in this study. Results were evaluated by using a group (ADHD-C, ADHD-I, Learning Disordered, and non-patient control) by TOVA quartile (1,2,3,4) mixed ANOVA on all TOVA variables (using age-corrected standard scores). In addition, I computed the Positive Predictive Power (PPP), Negative Predictive Power (NPP), and Sensitivity of the TOVA variables in order to determine the diagnostic utility of these measures. Finally, to test a theory that "high consistency" ADHD children might outperform controls, each group was divided into halves based upon the group's response time variability scores (by a simple median split). A group by consistency (high variability vs. low variability) ANOVA was conducted on the remaining TOVA variables (errors of omission, errors of commission, and response time). Results of the PPP/NPP analyses suggested that some TOVA variables are useful in differentiating ADHD children from non-patient controls, but not useful in differentiating ADHD from LD children. Also, TOVA data do not appear to be able to differentiate ADHD subtypes from each other. Finally, the data provided little support for the theory that a subgroup of "high consistency" ADHD children would outperform controls on other TOVA variables. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Wetzler, S., & Sanderson, W. C. (Eds.). (1997). Treatment strategies for patients with psychiatric comorbidity(1997). Treatment strategies for patients with psychiatric comorbidity. xvi, 368 pp. Hoboken, NJ, US: John Wiley & Sons Inc.(from the preface) The primary aim of this book is to describe how comorbid disorders necessitate modifications in standard psychotherapeutic and psychopharmacological treatments. It is divided into 3 sections: an introduction, which considers general issues relevant to comorbidity; a core section on treatment strategies; and a section on related topics. The treatment section has parallel chapters on psychotherapeutic and drug treatments for the most prominent groupings of psychiatric disorders. Each chapter considers treatments for the most common comorbid conditions. This organization is derived from epidemiological research on the most prevalent combinations of psychiatric disorders. /// This book is intended as a practical compendium of clinical advice and recommendations for mental health professionals. It may be read straight through or used as a reference book that the clinician may refer to when faced with difficult clinical problems. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Weyandt, L. L., Mitzlaff, L., & Thomas, L. (2002). The relationship between intelligence and performance on the test of variables of attention (TOVA). Journal of learning disabilities, 35(2), 114-120. The present study explored the relationship between the intelligence of young adults and their performance on the Test of Variables of Attention (TOVA). The study also examined whether significant differences existed between adults with and without attention-deficit/ hyperactivity disorder (ADHD) on TOVA errors of omission, errors of commission, mean correct response time, and variability, as well as on performance on the freedom from distractibility (FD) factor on the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Seventy-nine adults participated in the study, including 17 with ADHD and 62 college students without ADHD. Pearson product-moment correlations indicated that none of the correlations between Full Scale IQ (FSIQ) and TOVA variables were significant. Analysis of variance results revealed that adults with ADHD made more errors of omission on the TOVA than did controls. Between-group differences were not found on the remaining dependent variables.
Weyandt, L. L., Rice, J. A., Linterman, I., Mitzlaff, L., & Emert, E. (1998). Neuropsychological performance of a sample of adults with ADHD, developmental reading disorder, and controls. Developmental neuropsychology, 14(4), 643-656. 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 Progressive Matrices) and several self-report ADHD rating scales. The psychometric properties of three ADHD rating scales were also explored: Wender Utah Rating Scale (M. Ward et al, 1993), Patient Behavior Checklist (R. A. Barley, 1990), and the Adult Rating Scale (L. Weyandt et al, 1995). Ss were 21 individuals (mean age 25.9 yrs) with ADHD, 19 (mean age 21.5 yrs) with DRD, and 24 controls (mean age 23.4 yrs). Results reveal a significant difference between groups, with the DRD group committing more WCST errors (total and perseveration) than the remaining groups. Group differences were also found on the ADHD ratings scales, with the ADHD group reporting higher ratings. Findings support the psychometric properties of all three scales, suggesting they are measuring symptoms specific to ADHD rather than general psychological functioning. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Whang, W., Mittleman, M. A., Rich, D. Q., Wang, P. J., Ruskin, J. N., Tofler, G. H., et al. (2004). Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: Results from the triggers of ventricular arrhythmias (TOVA) study. Circulation, 109(11), 1386-1391. BACKGROUND: Left ventricular ejection fraction (LVEF) predicts device discharges in patients with implantable cardioverter-defibrillators (ICDs). The relationship between severity of congestive heart failure (CHF) and ICD discharges is less clear. METHODS AND RESULTS: We prospectively analyzed the association between CHF and risk of appropriate ICD discharges in the Triggers Of Ventricular Arrhythmias (TOVA) study, a cohort study of ICD patients conducted at 31 centers in the United States. Reported shocks were confirmed for sustained ventricular tachycardia (VT) or fibrillation (VF) by analysis of stored electrograms. Proportional hazards models included CHF categorized by New York Heart Association class. Baseline CHF was present among 502 (44%) of 1140 patients; 170 (34%) had class I, 230 (46%) had class II, 97 (19%) had class III, and only 5 (1%) had class IV symptoms. During median follow-up of 212 days, 92 patients experienced 1 or more appropriate ICD discharges. Class III CHF was associated in a statistically significantly manner with ICD discharge for VT/VF (hazard ratio 2.40, 95% CI 1.16 to 4.98), even with adjustment for LVEF. The combination of LVEF <0.20 and class III symptoms resulted in a particularly high risk of shocks for VT/VF (hazard ratio 3.90, 95% CI 1.28 to 11.92). CONCLUSIONS: Class III CHF, an easily accessible clinical measure, is an independent risk factor, along with LVEF, for ventricular arrhythmias that require shock therapy among ICD patients. Whether patients with class III CHF benefit to a greater degree from ICDs and whether aggressive treatment of CHF in ICD patients may prevent ventricular arrhythmias remains to be determined.
Wilde, D. J. (1998). Arousability in attention deficit disorder: Physiological assessment and respiratory intervention. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58 (11-B), 6250. This study evaluated (1) how autonomic response (e.g., skin conductance, heart rate) can be used to discriminate between subgroups of Attention Deficit Hyperactive Disorder (ADHD) and (2) the effect of teaching breathing retraining on the low arousal subgroup. ADHD behaviors are hypothesized to be the result of patterns of autonomic reaction to attention demanding conditions. The ability to discriminate different arousal patterns between subjects displaying different behaviors, and the dramatic improvement in attention from an autonomic intervention, support the hypothesis. Study One. Thirty five subjects were classified as either pure inattentive, mixed inattentive/impulsive or normal based on the results of the Test of Variables of Attention (T.O.V.A.). Skin conductance and heart rate were evaluated for the three different subgroups during the T.O.V.A., used as a calibrated cognitive challenge. Subjects in the inattentive group showed a statistically significant underarousal response compared to the normal or impulsive group. Subjects in the impulsive group showed a significantly different arousal pattern compared to the normal group. The results support physiological response to challenge as a discriminating measure. Study Two. Respiratory training was given to three subjects for six weeks to ascertain the effect of modification of the abnormal arousal level on attention. Retesting showed the trained subjects had dramatic, clinically and statistically significant improvements, compared to untreated controls, in their T.O.V.A. scores, as well as the Attention Deficit Scales for Adults (ADSA). A six month follow up, with a questionnaire evaluating attention behavior, continued to support the findings. The results show that (1) one can identify an inattentive subpopulation who show underarousal response to challenge, and (2) subjects trained with breathing exercises improve their attention, resulting in dramatic improvement in T.O.V.A. and ADSA scores. This supports the underarousal hypothesis for the inattentive group and suggests that optimal arousal is an important criterion for normal attention. Intervention results support the arousal theory and suggest that behavioral arousal modification may be a powerful treatment methodology for some subgroups. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
Wu, Y. Y., Huang, Y. S., Chen, Y. Y., Chen, C. K., Chang, T. C., & Chao, C. C. (2007). Psychometric study of the test of variables of attention: Preliminary findings on taiwanese children with attention-deficit/hyperactivity disorder. Psychiatry & Clinical Neurosciences, 61(3), 211-218. Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder in children. Unfortunately, reliable means of measuring attention and impulsivity to help with diagnoses are scarce. The test of variables of attention (TOVA) is a computer-administered continuous performance test measuring attention and impulsivity, designed to avoid confounding arising from language processing skills or short-term memory problems. Some evidence has indicated the TOVA can be useful in diagnosing ADHD. This study examines its validity and reliability in helping diagnose Taiwanese ADHD children. The study included 31 ADHD children (24 males, seven females) from a northern Taiwan children's hospital and 30 normal controls (18 males, 12 females) from the local community. The TOVA and the Child Behavior Checklist (CBCL) were administered to all children. TOVA scores for omissions, commissions, response time, response time variability, D' and ADHD scores were analyzed. Results showed a mean internal consistency of 0.81 for all six TOVA variables across conditions, with moderate convergent and discriminant validities. Groups showed significant differences in response time variability, D' and ADHD scores, with the normal group outperforming the ADHD group. Significant group differences were also found in all CBCL subscale scores except somatic complaints. The ADHD group obtained a clinically significant score on the hyperactivity subscale of the CBCL. The findings partially support the usefulness of the TOVA in assessing attention and impulsivity problems for a Taiwanese sample. Future studies should increase the sample size, use multiple measures, and collect behavior ratings from both parents and teachers.
Yeates, K. O., Luria, J., Bartkowski, H., Rusin, J., Martin, L., & Bigler, E. D. (1999). Postconcussive symptoms in children with mild closed head injuries. Journal of Head Trauma Rehabilitation, 14(4), 337-350. OBJECTIVE: To examine the incidence and neuropsychological, behavioral, and neuroimaging correlates of postconcussive symptoms (PCS) in children with mild closed head 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 (ie, within 7 days of injury) and at 3 months postinjury. Parents rated PCS, motivation and affective lability, 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 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. CONCLUSION: 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. Copyright (C) 1999 by Aspen Publishers, Inc.
Zoria, V. G. (1966). [Functional changes in the brain and heart in tetanus and some problems of antispasmodic therapy]. [Izmeneniiata na funktsionalnoto sustoianie na glavniia mozuk i surtseto pri tetanus i niakoi vuprosi na protivogurchovata terapiia na tova zaboliavane.] Khirurgiia, 19(1), 21-28.