TOVA Test of Variable of Attention for ADHD and More

We specialize in attention and executive function assessments with individuals of all ages struggling with focus, organization, or self-regulation. Whether the concerns arise in the classroom, at work, or in daily life, we aim to help clarify the root of those challenges and solutions. One of the key tools we use is the TOVA Test of Variables of Attention. This computerized, research-backed test objectively examines how a person’s attention functions under controlled conditions. Giving the TOVA test online or in person helps us identify patterns related to inattention, impulsivity, or processing speed that might otherwise go unnoticed, particularly in people who have never been formally diagnosed but have lived with symptoms for years. This post goes over the TOVA test for ADHD and other executive functions and other selective attention test measures.

Dr. Lawrence Greenberg developed the TOVA in the 1960s, and it has since been updated and validated with various normative data sets. It is commonly used with a range of neuropsychological assessments to understand each person’s cognitive profile comprehensively.

Tova Test of Variables of Attention Overview

The TOVA Test of Variables of Attention is a computerized neuropsychological assessment designed to objectively measure a person’s attention and impulsivity. It’s often used in the diagnosis of ADHD and to evaluate attention-related concerns. Here’s a breakdown:

What the TOVA Test of Variables of Attention Measures

• Sustained Attention: Ability to maintain focus over time.
• Response Time: How quickly and consistently a person responds.
• Impulsivity: Measured by commission errors (responding when one shouldn’t).
• Inattention: Measured by omission errors (failing to respond when one should).
• Drowsiness or Sluggishness: Response time variability and slow reaction times.

How the Tova Test Works

• It’s a boring, repetitive task (intentionally) that lasts about 21.6 minutes (for children) or about 22 minutes for adults.
• You respond (usually by pressing a button) to specific visual or auditory stimuli.
• There are two parts:
  1. Low Stimulus (rare targets – innatention and selective attention test).
  2. High Stimulus (frequent targets – assesses for impulsivity).

Results & Scoring

• The TOVA Test of Variables of Attention compares your performance to a normative sample based on your age and gender.
• The results can show patterns typical of ADHD, but TOVA testing is not diagnostic on its own.
• TOVA testing is often used alongside clinical interviews, rating scales, and other assessments.

Tova Test of Variables of Attention Pros & Cons

Pros:

• Objective (not self-reported).
• FDA-cleared for helping assess ADHD.
• We can give the TOVA test online

Cons:

• The TOVA Test of Variables of Attention can be influenced by fatigue, anxiety, or medication.
• TOVA testing doesn’t capture all aspects of executive functioning.
• The TOVA Test online may not allow us to observe your performance as closely.

Tova Testing

Structure of the Tova Test Online or In-Person

1. Stimulus Presentation

The TOVA Test online or in person usually consists of two main conditions lasting approximately 11 minutes each:

Low-stimulus (Infrequent Targets)

• Target appears 22% of the time.
• The person must respond only when the target appears.
• Designed as an inattention and selective attention test.
• It can feel tedious—challenging for people with ADHD-inattentive types.

High-Stimulus (Frequent Targets)

• Target appears 77% of the time.
• Much faster-paced.
• Designed to measure impulsivity (difficulty inhibiting response when it’s not appropriate).

Response Type

The participant is usually asked to press a button:

• When they see a specific visual symbol (like a square at the top of the screen).
• Or not press when a different symbol appears (like the same square at the bottom).

There is also an auditory version where tones are used instead of visual symbols.

What It Measures (Key Metrics)

Interpreting the Results

The TOVA test online or in person gives standard scores based on a normative sample by age and sex, with a mean of 100 and standard deviation of 15.

• TOVA Test of Variables of Attention scores below 85 are typically flagged as clinically significant.
• It generates a “cognitive profile” that can align with common ADHD subtypes:
  • Inattentive (e.g., more omission errors, slow RT).
  • Hyperactive-Impulsive (e.g., high commission errors, anticipatory responses).
  • Combined (errors and RT variability across both conditions).

But: It does not diagnose ADHD by itself. TOVA Test of Variables of Attention results are just one piece of the puzzle and need to be interpreted in context with:

• Clinical interviews
• Behavior checklists
• Developmental history

Using the Tova Test for ADHD

Administering the TOVA test for ADHD is most helpful when:

• There is uncertainty in a diagnosis, and objective data is needed.
• You’re evaluating medication effects (can be repeated before and after).
• It’s part of a full neuropsychological evaluation.

However, the TOVA Test for ADHD can give false positives and false negatives:

• Anxiety, depression, sleep deprivation, or anxiety can mimic the diagnosis.
• High-functioning individuals may compensate well and pass.

The TOVA Test for ADHD is one of the more objective tools clinicians use to evaluate attention and impulse control, especially when this diagnosis is suspected.

Why the TOVA for ADHD?

TOVA testing is widely used to help assess for ADHD, particularly in both children and adults. It doesn’t diagnose ADHD by itself, but it provides measurable behavioral evidence that supports or challenges a diagnosis.

ADHD symptoms like:

• Inattention (e.g., losing focus, daydreaming, disorganization),
• Hyperactivity (e.g., fidgeting, restlessness), and
• Impulsivity (e.g., blurting out, acting without thinking)

are often subjective—based on self-report or observation. The TOVA test for ADHD adds objective, numerical data to the mix by measuring performance under controlled conditions.

What Happens in the TOVA Testing For ADHD?

Task Format:

• You press a button when a specific stimulus appears (e.g., a square at the top of the screen).
• You don’t press for the non-target (e.g., same square at the bottom).
• Two conditions:
  1. Low-frequency targets → Innatention and selective attention test (hard to stay focused).
  2. High-frequency targets → Impulsivity is assessed (hard to inhibit reaction).

What it Measures:

What ADHD Looks Like on TOVA Test of Variables of Attention

People with ADHD (Combined Type) often show:

• High commission errors (impulsivity),
• High omission errors (inattention),
• Inconsistent response times, and
• Poor d-prime scores (trouble distinguishing targets from non-targets).

People with ADHD-Inattentive Type often:

• Miss targets (omission errors),
• Respond slowly,
• Show a flat or sluggish pattern in both parts.

People with ADHD-Hyperactive/Impulsive Type might:

• Respond too fast (anticipatory),
• Make lots of commission errors.

How the Results Are Used

• The TOVA test for ADHD gives standardized scores compared to a normed sample (same age/sex).
• It produces a graph and report with:
  • Scores for each metric
  • Confidence levels
  • A behavioral interpretation (e.g., “suggestive of ADHD-inattentive profile”)

Sometimes, we also assess people on and off medication to see how a stimulant affects performance.

Limitations of the TOVA test for ADHD

• Doesn’t prove or rule out ADHD by itself.
• Stress, anxiety, sleep deprivation, or other conditions can skew results.
• Some high-IQ or highly motivated people with ADHD can “mask” symptoms.

That’s why it’s best used with other tools, like:

• Clinical interviews
• Parent/teacher/self-rating scales (e.g., Conners 3, Vanderbilt, ASRS)
• Developmental and academic history

Other Selective Attention Test Instruments

Several other selective attention test instruments besides the TOVA Test of Variables of Attention that are used in clinical and research settings to assess different aspects of attention, especially selective attention, sustained attention, and impulse control.

Here’s a list of the most commonly used ones, broken down by type and what they’re best at:

Top Selective Attention Test Measures

1. Conners’ Continuous Performance– CPT-3

• What it is: Another computerized CPT, this selective attention test is often used in ADHD evaluations.
• Focus: Selective attention, impulsivity, vigilance.
• How it works: Press a key for every letter except X. Measures errors, reaction time, and variability.
• Good for: ADHD, especially to differentiate inattentive vs impulsive profiles.
• Pros: Widely accepted; more complex than TOVA.

Integrated Visual and Auditory CPT – IVA-2

• What it is: Selective attention CPT that combines visual and auditory tasks simultaneously.
• Focus: Divided attention, response control, processing speed.
• Good for: People who may have multi-modal attention issues (auditory + visual).
• Pros: Unique for assessing both systems together.

d2 Test of Attention

• What it is: A paper-and-pencil selective attention test requiring participants to scan rows of characters and mark specific targets (e.g., the letter “d” with two marks).
• Focus: Selective attention, processing speed, visual scanning.
• Good for: ADHD, TBI, general cognitive load assessment.
• Pros: Fast (8 minutes), simple, and widely validated.

Stroop Color and Word

• What it is: You name the color of the ink a word is printed in, even if the word itself is a different color name (e.g., the word “Blue” written in red ink).
• Focus: Selective attention, inhibition, cognitive flexibility.
• Good for: Executive functioning, ADHD, brain injury, frontal lobe function.
• Pros: Easy to administer; strong inhibitory control measure.

Trail Making (TMT) – Parts A & B

• What it is: Connect numbered circles in sequence (Part A), and alternate numbers/letters in sequence (Part B).
• Focus: Visual attention, task-switching, processing speed.
• Good for: TBI, ADHD, dementia screening.
• Pros: Part B is particularly sensitive to cognitive flexibility and executive function.

Symbol Digit Modalities (SDMT)

• What it is: You match symbols to numbers using a key at the top of the page as fast and accurately as possible.
• Focus: Visual scanning, selective attention, speed.
• Good for: Multiple sclerosis, TBI, ADHD.
• Pros: Quick (~5 minutes), high sensitivity to cognitive slowing.

Go/No-Go Tasks

• What it is: Press a button for a “go” stimulus, and do not press for “no-go.”
• Focus: Response inhibition, impulse control.
• Good for: ADHD, especially impulsive/hyperactive types.
• Often included in: Neuropsych batteries or custom computerized assessments.

Summary: Which Selective Attention Test is Best?

Case Example of the TOVA test for ADHD

Here’s a case example of a young woman who undergoes TOVA testing as part of an ADHD evaluation. The goal is to show how someone without a prior diagnosis might present and how giving the TOVA Test online can reveal patterns consistent with undiagnosed ADHD.

Case Study: “Emma” – Age 24

• 24-year-old woman, recent college graduate.
• Works in a creative job, smart and articulate.
• No history of academic failure — but describes always “just barely getting by”, cramming last-minute, chronic lateness, and procrastination.
• She says she’s “always distracted,” zones out during meetings, and feels like her “brain just won’t cooperate.”
• Never evaluated for ADHD — teachers said she was “bright but spacey.”
• Recently began individual therapy for anxiety and was referred for an ADHD assessment.

TOVA Testing Results:

TOVA test for ADHD Setup

• Visual version of the TOVA test online (22 minutes)
• She is not on any medication
• Well-rested and cooperative

TOVA test for ADHD Results Overview

Performance Pattern

• During the first half (low-stimulation):
  • Lots of missed targets, zoning out.
  • Slow and inconsistent reaction times.
• In the second half (high-stimulation):
  • More errors from reacting too fast or wrongly.
  • Indicates impulsivity creeps in when stimuli increase.

Interpretation of the TOVA Test Online:

Emma’s profile is highly consistent with ADHD – Predominantly Inattentive Type:

• Inattention shows up in omission errors, variable RT, and low d-prime.
• Executive dysfunction is likely present (difficulty sustaining effort, organizing, and completing tasks).
• She was not driven by anxiety (she was calm and focused during TOVA testing).
• Never disruptive in school, so ADHD went undetected — a common scenario for women with ADHD, particularly with inattentive symptoms.

Clinical Impressions:

Meets DSM-5 criteria for ADHD-Inattentive Presentation, based on:

• Lifelong symptoms (childhood onset, per school reports and personal history).
• Functional impairment (career, social, emotional regulation).
• TOVA testing results support real neurocognitive attention deficits.

Next Steps:

• Psychoeducation about ADHD in women
• Possible medication trial (stimulant or non-stimulant)
• Cognitive-behavioral executive functioning coaching
• Workplace accommodations (e.g., time-blocking, visual reminders)
• Emotional support around late diagnosis
• Possible evaluation for an Emotional Support Animal

Why This Matters:

Emma’s story is common:

• Smart, capable women often mask symptoms or develop coping strategies.
• They’re told they’re “just anxious” or “lazy” instead of being evaluated.
• TOVA testing objectively validates the experience of struggling with focus, even in high-functioning people.

Conclusion and Our Work with the TOVA

Our evaluations are never about labeling—they’re about understanding. When someone sees their performance mapped out in concrete, data-driven ways, it can be both validating and illuminating. Whether the outcome supports a diagnosis like ADHD or highlights other areas of executive function difficulty, the information we gather allows for tailored, actionable next steps—including treatment options, workplace or educational accommodations, and self-management strategies.

Ultimately, we aim to help individuals move forward with clarity, confidence, and support—armed with the insight they need to advocate for themselves and thrive in the environments that matter most to them. The TOVA test for ADHD can be an important step and can be supplemented by another selective attention test and other measures for a comprehensive approach.

If you want more information about how to take the TOVA test online or in person, TOVA testing in general, or any of our other services, don’t hesitate to contact us or schedule a consultation anytime.

Dr. Alan Jacobson, Psy.D., MBA Founder and President

Dr. Jacobson is a senior-level licensed clinical psychologist who has been practicing for over 20 years. He founded the Virtual Psychological Testing Group in 2021. He provides psychological and neuropsychological testing for adolescents and adults.

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Psychology Psychological testing Neuropsychological testing