We specialize in comprehensive psychological assessments and neuropsychological evaluations for children, adolescents, and adults. Whether you’re seeking clarity around attention challenges, learning differences, mental health struggles, or cognitive functioning, our performance-based assessments offer meaningful, data-driven insight. Using gold-standard tools like the Tower of London Test and Continuous Performance Test, we help identify how your brain processes information, where support is needed, and what accommodations or strategies can improve day-to-day functioning.
Our mission is to provide answers—not just labels—so you can move forward with confidence, support, and a clear understanding of your strengths and challenges.
Performance Assessments Overview 
A performance test is a psychological or neuropsychological assessment that asks a person to complete specific tasks that measure their cognitive, motor, or emotional functioning in a direct, observable way. They evaluate how well someone can perform a task, usually under standardized conditions, rather than relying on self-report questionnaires or interviews. These assessments give objective data on how the brain processes information or responds to challenges.
What Do Performance Tests Measure?
Depending on the measure, performance tests can assess:
- Attention and focus (e.g., Continuous Performance Test)
- Memory (e.g., Rey Auditory Verbal Learning Test)
- Executive functioning (e.g., Tower of London, Wisconsin Card Sorting)
- Processing speed (e.g., Trail Making Test, Digit Symbol)
- Problem-solving and flexibility
- Motor skills or visual-spatial ability
Examples of Performance Assessments:
| Test | Measures | Common Uses |
| Wisconsin Card Sorting (WCST) | Cognitive flexibility | ADHD, brain injury, executive dysfunction |
| Tower of London Cognitive Test | Planning, sequencing | Frontal lobe function, ADHD |
| Trail Making Test (TMT A & B) | Processing speed, mental flexibility | ADHD, dementia, TBI |
| Stroop Test | Inhibition, selective attention | ADHD, emotional regulation |
| Continuous Performance Test (CPT) | Sustained attention | ADHD diagnosis |
| Grooved Pegboard | Fine motor coordination | Motor disorders, brain injury |
Why Use the Tower of London Cognitive Test and Continuous Performance Test?
- They provide objective data that can’t be easily faked or misinterpreted.
- They’re useful for identifying functional impairments that affect real-life performance.
- They’re especially important in assessments for ADHD, learning disabilities, or brain injury.
Tower of London Test
The Tower of London Cognitive Test (TOL) is a neuropsychological assessment that evaluates executive functioning, especially planning and problem-solving abilities. It’s often used in research and clinical settings, particularly in assessing conditions like ADHD, autism, traumatic brain injury, and frontal lobe damage.
What the Tower of London Cognitive Test Involves:
- The original version of the Tower of London Test involves three pegs and three colored balls.
- The participant is asked to move the balls from a starting configuration to a goal configuration in as few moves as possible, following certain rules:
- Only one ball can be moved at a time.
- A ball can’t be placed anywhere except on a peg.
- Pegs can only hold a limited number of balls.
What the Tower of London Test Measures:
- Planning: Thinking ahead about moves.
- Working memory: Holding steps in mind.
- Inhibition: Not making impulsive or incorrect moves.
- Cognitive flexibility: Adjusting when a strategy doesn’t work.
Clinical Use:
- The Tower of London Test is common in assessments for ADHD, autism spectrum disorders, dementia, Parkinson’s, and brain injuries.
- Some computerized Tower of London Test online versions add time-based metrics and more complex tasks.
Conners Continuous Performance Test (CPT-3)
The Conners Continuous Performance Test (CPT) is a computerized assessment used to measure attention-related problems, especially sustained attention, impulsivity, and vigilance. Continuous performance testing is widely used to help diagnose ADHD but is also used in the context of brain injuries, learning disorders, and other attention-related concerns.
How Continuous Performance Testing Works:
- Continuous performance tests for ADHD last about 14 minutes.
- Participants see letters flash on the screen one at a time.
- They’re told to press a key whenever they see any letter except “X”.
- Continuous performance tests for ADHD vary how quickly letters appear and how frequently targets/non-targets occur to challenge different aspects of attention.
What the Continuous Performance Tests for ADHD Measure:
- Sustained attention: Can you keep focused over time?
- Impulsivity: Do you press when you’re not supposed to (false alarms)?
- Inattention: Do you miss the correct targets (omissions)?
- Reaction time: How fast and consistent are your responses?
- Fatigue effects: Does your performance decline over time?
Continuous Performance Test Metrics:
| Metric | What it Reflects |
| Omissions | Inattention (missed responses) |
| Commissions | Impulsivity (responded when you shouldn’t) |
| Hit Reaction Time | Speed of response |
| Variability | Consistency of response speed |
| Perseverations | Responses made too quickly to be deliberate (often <100 ms) |
| Detectability (d’) | How well you can distinguish between targets and non-targets |
Who Takes the CPT?
- Children and adults
- Often part of a broader ADHD evaluation
- Sometimes used post-TBI or in autism assessments to check for overlapping attentional issues
Continuous Performance Test Versions:
-
- CPT 3 is the current standard version.
- There’s also a Conners Kiddie CPT for children aged 4–7.
Case example: Continuous Performance Test for ADHD College Accommodations
Here’s a case example of an adolescent seeking ADHD accommodations for college. This can be used for educational, clinical, or advocacy purposes and includes how a psychological evaluation, documentation, and planning were involved.
Jordan is a bright, creative 17-year-old student preparing for college. He was diagnosed with ADHD (combined presentation) in middle school and has had a 504 Plan in high school, which included extended test time, use of a quiet testing environment, and access to class notes. With graduation approaching, Jordan and his parents wanted to ensure he’d have the right accommodations in college.
Initial Concerns:
- Jordan was worried about long exams, keeping up with deadlines, and the transition to managing everything independently.
- His parents were concerned that without proper support, he’d struggle academically and emotionally.
IQ, Achievement, and Continuous Performance Testing
To qualify for college accommodations (especially with the Disability Services Office or College Board), Jordan needed current documentation.
We conducted an updated evaluation that included:
- Cognitive assessment (WAIS-IV)
- Academic achievement assessment (e.g., WIAT-4)
- Executive functioning assessments (e.g., BRIEF-2, Continuous Performance Tests for ADHD)
- Clinical interview and behavior ratings from teachers and parents
Findings:
- Jordan had above-average intellectual ability
- Significant weaknesses in sustained attention, task initiation, and working memory
- Evidence supported the ongoing diagnosis of ADHD and the need for accommodations
Documentation Submitted
We provided a comprehensive report with:
- A diagnosis of ADHD (DSM-5 criteria)
- History of academic struggles and academic accommodations
- Specific test data supporting the need for modifications
- Recommendations for college accommodations
- Recommendations for Jordan to pursue therapy, self-help, and holistic interventions
College Accommodations Plan
Jordan’s college disability services office approved the following:
- Time-and-a-half on exams
- Testing in a distraction-reduced room
- Priority registration to manage course load
- Access to lecture recordings
- Weekly academic coaching appointments
- Exam accommodations, including extra time
Outcome:
Jordan started his first semester with his supports in place. He checked in regularly with his academic coach and used campus resources like the writing center. His grades stayed consistent, and he reported less stress, knowing he didn’t have to “hide” his ADHD or struggle silently.
Takeaway:
Early planning, updated documentation, and a willingness to ask for help made Jordan’s college transition much smoother. His case shows that ADHD doesn’t have to be a barrier—with the right support, it can be managed successfully.
Case Example 2: Tower of London Test Online and Work Accommodations
Here’s an example of an adult nurse with ADHD seeking workplace accommodations. This scenario reflects common challenges and practical solutions in a healthcare setting.
Erica has worked as a registered nurse in a busy hospital for over 10 years. She was recently diagnosed with ADHD, inattentive type, after recognizing patterns of forgetfulness, difficulty with time management, and frequent overwhelm during shift transitions. Although highly skilled and compassionate with patients, Erica often felt mentally overloaded, especially during multitasking, documentation, and managing shift changes.
Challenges Erica Faced at Work:
- Difficulty remembering verbal instructions from physicians during busy rounds
- Trouble completing documentation promptly, especially at end of shift
- Distraction in noisy environments like the nurses’ station
- Struggles with time-blindness, leading to rushed or forgotten tasks
- Emotional exhaustion from masking her difficulties
She feared disclosing her diagnosis would be seen as a weakness—but also knew continuing without support could lead to burnout or mistakes.
ADHD Evaluation (Tower of London Test Online and BRIEF)
We conducted:
- A full clinical interview
- Standardized ADHD assessments (e.g., Tower of London Test online, BRIEF-A)
- Cognitive testing (WAIS-IV), shows strong verbal comprehension but reduced working memory and processing speed
- Diagnosis: ADHD – Predominantly Inattentive Presentation
She received a written report with accommodation recommendations based on ADA guidelines.
Step 2: Requesting Accommodations
Erica disclosed her diagnosis to her HR department and requested reasonable workplace accommodations under the Americans with Disabilities Act (ADA).
With support from her provider, she formally requested:
- A quiet workspace for documentation
- Written instructions or summaries for verbal orders whenever possible
- Flexible time for charting, such as protected blocks during less busy parts of her shift
- Permission to use noise-canceling headphones or white noise apps when off the floor
- A visual planner at her workstation to help track time-sensitive tasks
Accommodations Granted:
Her supervisor and HR worked with her to implement changes:
- She was assigned a quieter desk area for end-of-shift documentation
- Charge nurses were informed (with Erica’s consent) to provide brief written or texted follow-ups to verbal orders
- She received a personal time-management coach via Employee Assistance Program (EAP)
- Erica also began using ADHD-friendly tools like color-coded task lists and timers
Outcome:
Within three months, Erica’s stress levels had dropped significantly. She was meeting documentation deadlines, feeling more focused, and experiencing fewer errors. Her colleagues noticed her confidence had grown, and she no longer dreaded shift handovers.
Takeaway:
Erica’s case highlights how diagnosis through the BRIEF and Tower of London Test online, advocacy, and tailored accommodations can empower professionals with ADHD to thrive in high-pressure roles. With support, Erica turned her self-doubt into self-management—without compromising her clinical excellence.
Case Example 3: Continuous Performance Test and Others for Self-Improvement
Here’s a case example of a graduate student seeking insight and self-understanding before entering the workforce—particularly relevant for young adults navigating ADHD, neurodivergence, or emotional patterns that affect career readiness.
Maya is a 26-year-old student completing her master’s degree in public health. As she approached graduation, Maya began experiencing anxiety, procrastination, and difficulty focusing, especially during her capstone project and job interviews. Although she had done well academically, she often felt like she was “masking”—putting on a competent front while struggling internally with self-doubt, scattered thoughts, and burnout.
Maya wasn’t sure if she had ADHD, anxiety, or something else. She wanted to understand herself better before stepping into a demanding career and avoid repeating overworking and shutdown cycles.
Why She Sought Help:
- “I want to know why I work the way I do.”
- “I feel like I keep running into the same wall—especially when I’m overwhelmed.”
- “I’m scared I’ll crash once I start working full-time.”
Comprehensive Psychological Evaluation
Maya worked with a psychologist who recommended a comprehensive assessment for self-understanding—not just for diagnosis. The testing included:
- Cognitive assessment (WAIS-IV): Maya had high verbal reasoning but low processing speed
- Executive functioning assessments (e.g., BRIEF-A, Continuous performance tests for ADHD, Tower of London Test): Showed issues with working memory, sustained attention, and task initiation
- Emotional and personality inventories (e.g., MMPI-2-RF, Beck Anxiety Inventory): Mild anxiety, moderate emotional sensitivity
- Clinical interviews exploring family dynamics, past academic strategies, and masking behaviors
Findings & Insights:
- Maya met criteria for ADHD – Predominantly Inattentive Type, with traits often overlooked in women (e.g., internal distraction, overcompensation through perfectionism)
- She also showed traits of high sensitivity and emotional intensity, contributing to cycles of overachievement and burnout
- Her anxiety was situational, tied to transition stress and lack of self-trust—not a generalized anxiety disorder
How It Helped:
- Maya learned her challenges weren’t laziness—they were neurological and emotional patterns that could be supported
- She was able to reframe her inner critic and understand why she freezes under pressure
- Her psychologist provided her with tools and strategies (e.g., body doubling, external structure, breaks before burnout) tailored to her neurodivergence
Outcome:
Maya graduated on time and entered the workforce with a better understanding of:
- Her brain’s natural rhythms
- When and how to ask for accommodations (e.g., structured onboarding, project timelines with mini-deadlines)
- How to set emotional and energetic boundaries to prevent masking and overload
She also began working with a therapist long-term to maintain insight and avoid falling into old patterns.
Takeaway:
Maya’s story shows that psychological testing and counseling aren’t just for diagnosing disorders—they’re powerful tools for personal growth, self-advocacy, and career readiness. Maya built a path that honored her intelligence and limits by understanding her mind through continuous performance testing and others.
Conclusion and Our Work
If you’re feeling uncertain or stuck or want to understand how your mind works, you’re not alone; some resources can help. Our team is here to help you take the next step through evidence-based testing and compassionate, personalized care. Whether you’re preparing for school, work, or a major life transition, we’re committed to giving you the tools and knowledge you need to thrive. Continuous performance testing and the Tower of London Cognitive Test online can be important steps.
If you have any questions about continuous performance tests for ADHD or the TOL, please contact us or schedule a consultation anytime.
