ADHD Testing – Attention, Executive Functioning and Memory
Tests of Attention
Testing someone's ability to pay attention is more complicated than it sounds. Attention is composed of four major components: selective attention (the ability to attend to stimuli while ignoring distractions), sustained attention (the ability to maintain attention over an extended period of time), divided attention (multi-tasking; the ability to attend to more than one task simultaneously), and alternating attention (mental flexibility; the ability to shift attention from one task to another without losing focus). Measuring each facet of attention can be extremely helpful in pinpointing specific weak areas, as well as areas of relative strengths. Tests can also indicate methods for dealing with the identified attention problem.
Continuous Performance Tests (CPTs)
Continuous Performance Tests (CPTs) are computer-based tasks (often called Target-Focused Tests) that are often used to test attention, including sustained attention over time. CPTs may be used in conjunction with clinical information to make a diagnosis. In general, CPTs provide an objective method for assessing attention deficits that is not subject to the personal biases that can occur with more subjective assessment techniques, such as self-report questionnaires (i.e., someone may not have an accurate interpretation of their attentional difficulties).
Connors CPT II Continuous Performance Test II Version 5 for Windows
This is a computerized test used for people suspected of having attention problems. Results are delivered immediately by computer following the brief 14 minute administration. Subjects are instructed to press the space bar immediately following the appearance of a specific letter on screen.
Connors Kiddie CPT V.5
The K-CPT is designed for children 4 to 5 years of age. The process involves quick flashes of familiar objects to which the child must respond. This version is designed similarly to the Conners' CPT II, but contains key differences designed for this younger population. For example, the test takes half the time to complete and it uses pictures of objects rather than letters on the computer screen in order to avoid letter recognition problems common in this age group.
Integrated Visual and Auditory Continuous Performance Test (IVA)
This test combines visual images and sounds to assess impulsivity, inattention and hyperactivity in individuals from 5 years of age through adulthood. Clients are instructed to click the mouse when they see or hear a "1", but not when they see or hears a "2". Test scores also provide information about stamina, consistency, speed, attention, focus, motivation, and problems with learning.
Tests of Variable Attention (TOVA)
TOVA is a computerized test that can be used to measure impulsivity, vigilance, and deterioration of attention over time. TOVA can be used to screen for ADHD, as well as predict and monitor medication effects. It takes about 22 minutes to complete and does not require the use of language, right-left discrimination, or letter or number recognition. These qualities make it useful for people of various ages and skill levels.
Trail-Making Test A&B
The Trail-Making Test evaluates visual-motor speed and task-switching skills by assessing someone's ability to follow a simple number sequence (Trails A) and a more complex sequence of alternating numbers and letters (Trails B). Scores are compared to age-, education-, and gender-based information to determine whether someone's performance is impaired.
Attentional Capacity Test (ACT)
This test evaluates the child's selective attention ability. Test results can indicate critical areas of treatment focus.
Kagan Matching Familiar Figures Test (MFFT)
The Matching Familiar Figures Test is used to measure someone's tendency toward reflection versus impulsivity when solving problems. Reflection is the ability to consider alternative options when faced with a complex decision, typically resulting in a correct or successful course of action. In contrast, impulsivity is choosing quickly without weighing options or consequences. Impulsivity often results in errors and is a poor problem-solving style. Each item on the MFFT consists of a picture of a common object and six other similar pictures, only one of which is identical to the standard. Five of the pictures differ vary slightly from the original. The subject is asked to choose the picture that identically matches the standard.
Executive functions, also known as higher order functions, include problem-solving abilities (i.e., reasoning, planning, and organization), flexibility in thinking, and the ability to integrate feedback from others. These abilities are primarily associated with the frontal lobe area of the brain. Tests that evaluate executive functioning attempt to determine the child's ability to manage life tasks and school assignments that involve higher order cognitive abilities.
Wisconsin Card Sort Test (WCST)
The Wisconsin Card Sort Test is an objective neuropsychological test which is used to assess frontal lobe functions, visual skills, working memory (i.e., the ability to hold information in your mind while making a decision about it). The WCST takes about 20 minutes to complete. Four cards are initially presented to the subject with the instruction that there is a strategy (e.g., sort by color) to sorting the cards (the actual strategy is not described). The subject is asked to determine the sorting strategy by a process of trial and error. Across the test, the sorting strategy shifts without explicit warning to the subject. Individuals with frontal lobe damage often make perseverative errors (i.e., they repeat themselves by continuing to sort cards using the same rule that worked in the first series, even though the strategy has changed to a new one).
Memory tests can be used to measure both short and long-term memory skills. The primary goals of memory tests are to evaluate the student's current level of functioning in the areas of visual and auditory memory (i.e, memory for things that you see and hear), delayed memory (i.e., memory across time), distractibility (i.e., the ability to concentrate on things to be remembered), and retrieval from memory. Individuals with ADHD tend to perform more accurately in areas that do not require sustained focus or concentration. The person's pattern of responses can be very useful in identifying strengths and weaknesses and specific problem areas, and to determine the types of interventions needed to address any identified deficits.
California Verbal Learning Test
The California Verbal Learning Test-Children's Version (CVLT-C) assesses the strategies and processes that children between 5 and 16 use in learning and recalling verbal material. The CVLT-C can be used to help diagnose and treat memory impairments related to mild or severe learning disabilities, attention-deficit disorders, and other neurological and/or psychiatric problems. The test measures levels of total recall and recognition (i.e., remembering whether you heard a word previously), rate of learning verbal material, strategies employed to remember material, serial-position effects (i.e.,whether someone tends to remember words that come first or last in a list), consistency; degree of vulnerability to interference (i.e.,can the person screen out irrelevant material); as well as short-term and long-term retention.