Comparison between neurological examination and computerized test of attention for suspected ADHD: Implications for assessment of a common childhood disability

Aim: The aim of this study was to determine the role of the Test of Variables of Attention (TOVA), a computer-based continuous performance test (CPT), in assessing suspected attention-deficit/hyperactivity disorder (ADHD), a pervasive cause of disability in children and adolescents. Methods: One hundred and fifty children and adolescents referred to a community-hospital-based neurology clinic for suspected ADHD underwent a comprehensive clinical evaluation by a pediatric neurologist in addition to the TOVA test. Retrospective chart data were analyzed separately for children aged 6 - 12 years (n = 101) and adolescents (13 - 18 years) (n = 49). Parents and teachers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR, 2000) questionnaires for children 6 - 12 years old. Results: The correlation between the neurologist ' s impression of the presence of attention deficit and the TOVA scores was good in the younger group (r = 0.28, p = 0.001) and weaker in the older group (r = 0.29, p = 0.05). On nonparametric analysis, the neurological evaluation did not distinguish between low and high TOVA scorers in the older group. The neurologist ' s impression correlated more closely with the DSM-IV parents ratings (r = 0.29, p = 0.01) than the teachers ' (r = 0.08, p = 0.05). Conclusions: The TOVA correlated well with clinical assessment of ADHD and has added value in the evaluation of ADHD in adolescents, for whom standardized rating scales are lacking. In younger children, an experienced clinician can usually reach an accurate diagnosis based on accepted clinical criteria, including parent and teacher reports.