Research Studies on and using the IVA+Plus (IVA) Continuous Performance Test

Angelakis, E., & Lubar, J.F. (2001). The Role of Peak Alpha Frequency in Reading.
Presented at the 32nd Annual Conference of Association for Applied Psychophysiology and Biofeedback, Raleigh-Durham, NC.

Baerwald, J. P. & Tryon, W.W. (1999). Response control and Attention Differentials in Patients with Schizophrenia and Bipolar Disorder. Presented at the APA Convention, Boston, MA.

This study examined hypothesized response control and attention differentials in patients with schizophrenia (SS) and bipolar disorder (BDS). The Integrated Visual and Auditory Continuous Performance Test (IVA) was the primary measure. The subjects were 95 inpatients (SS: n=51; BDS: n=44). Each group displayed clinically intact response control abilities in comparison to impaired attention abilities. Results suggest that impaired attention abilities are not secondary to either slowed motor reaction time or response inhibition. It is suggested that attention impairment in these populations may implicate higher cortical regions responsible for executive function.

Baerwald, J.P., Tryon, W.W. & Sandford, J. (2001). Modal Attention Asymmetry in Patients with Schizophrenia, Bipolar Disorder, as Compared to Normal Controls. Neuropsychology, 15(4), 535-543.

This cross-sectional study examined modal attention asymmetries in patients with schizophrenia (n = 47) and bipolar disorder (n = 42) as contrasted to a matched sample comparison group of normal subjects (n = 89). A test of continuous auditory and visual attention [IVA] was the primary measure. The data were analyzed from two experimental conditions: simple modal responses (auditory and visual) and modal switching responses (ipsimodal and crossmodal switching). In the simple modal condition, patients with schizophrenia demonstrated a visual over auditory asymmetry; patients with bipolar disorder showed no differences. In modal switching conditions, however, patients with bipolar disorder displayed a significant auditory over visual asymmetry. No main effect was detected between medications and attention functioning. Results are discussed in light of differentiating these two populations on basis of modal specificity of attention functioning.

Baerwald, J.P., Tryon, W.W., & Sandford, J.A. (2005). Bimodal response sensitivity and bias in a test of sustained attention contrasting patients with schizophrenia and bipolar disorder to normal comparison group. Archives of Clinical
Neuropsychology, 20(1), 17-32.

This study examined response discrimination (d?) and bias (likelihood ratio) differentials in a computer-generated test of auditory and visual attention functioning. Patients with bipolar disorder (n=42) and schizophrenia (n=47) were contrasted to a normal comparison group (n=89) in two conditions: (a) simple modal responsivity (auditory and visual stimuli) and (b) ipsimodal (auditory/auditory and visual/visual) and crossmodal (auditory/visual and visual/auditory) responding. The results of this study indicated that in the simple modal condition both subject groups showed differential modal preferences but in opposite directions. The schizophrenic group showed a significant visual over auditory preference, committing more auditory commission and omission errors than visual errors. The bipolar group displayed a distinct auditory over visual response preference, committing significantly higher number of visual omission errors. Response bias analysis indicates that both diagnostic groups adopted a more liberal response bias, whereas the comparison group assumed a more conservative approach. For all groups response sensitivity improved as response bias became more neutral.

The modal switching results indicated that all three groups tended to commit more commission errors (false alarms) in the auditory crossmodal switching condition (visual/auditory) by comparison with the other switching conditions. Between group comparisons for this condition showed that the schizophrenic group committed significantly more commission errors than the other groups. No significant medication effects were detected.

Bender, S.D. & Rogers, R. (2004). Detection of Neurocognitive Feigning: Development of a Multi-Strategy Assessment. Archives of Clinical Neuropsychology, 19, 49-60.

Braaten, A. (2001). The Relationship Between Performance on a Continuous Performance Task, Grade Point Average, and Self-Report Scales of Cognitive and Neurological Functioning. Journal of Neurotherapy, 4 (4), 79.

The purpose of this pilot study was to determine if there is a relationship between “self-report” scales and the Integrated Visual and Auditory Continuous Performance Test (IVA). Sixty-five participants, between the ages of 18-50, from general psychology classes at St. Cloud State University completed the Integrated Visual and Auditory (IVA) Continuous Performance Task, the Neuropsychological Impairment Scale (NIS), the Attention-Deficit Scale for Adults (ADSA), the Conners’ Adult ADHD Rating Scale Self-Report: Long Version (CAARS-S:L:), the Western Utah Rating Scale (WURS), and the Attention Deficit Disorders-Evaluation Scale (ADDES).

In preliminary analysis the data suggest no correlation between the self-report scales and the continuous performance task. A further detailed analysis will be performed. Further discussion will focus on which scales can be helpful in diagnosing and measuring outcome after Neurotherapy training.

Braytenbah, A.S. & Harrison J. (1996). The Relationship of Attention and Response Control to Academic Performance. Presented at the C.H.A.D.D. Convention, Chicago, IL.

This study used the Integrated Visual and Auditory (IVA) CPT to collect measures of inattention, impulsivity, choice reaction time, variability of responses and stamina. The purpose of the study was to investigate how attention and response control might relate to successful academic performance as measured by grades in a normal elementary student population. Both auditory response control and visual attention were found to be significantly correlated with performance on most academic subjects as well as with overall GPA. These findings may account in part for the academic problems of children with ADHD, and suggest that interventions which help reduce auditory distractibility and increase visual attentional functioning will improve academic performance.

Corbett, B., Constantine, L. (2006). Autism And Attention Deficit Hyperactivity
Disorder: Assessing Attention And Response Control With The Integrated Visual And
Auditory Continuous Performance Test. Child Neuropsychology, 12, 335 - 348.

This study used the IVA+Plus CPT to compare differences in functioning between autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD). Results show that children with ASD show statistically significant deficits in visual and auditory attention and greater deficits in impulsivity than children with ADHD or typical development.

Demos, J. (2005). Using IVA+Plus to Demonstrate the Efficacy of Neurofeedback.

John N. Demos is a licensed counselor residing in the state of Vermont. The Biofeedback Certification Institute of America (BCIA) has certified him as an EEG-biofeedback practitioner and an accredited didactic trainer (www.bcia.org). The following article discusses his use of the IVA+Plus as a measure of progress to demonstrate the efficacy of Neurofeedback training. Despite a preponderance of evidence supporting neurofeedback, the traditional medical community has not yet embraced neurofeedback. Consequently, each neurofeedback provider, sooner or later, will be called upon to provide data in support of his or her clinical work. Mr. Demos recommends that all neurofeedback providers use the IVA+Plus continuous performance test to help establish both pre and post-test measure of attentional functioning.

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Dumont, R., Tambora, A., & Stone, B. (1995). Continuous Performance Tests: The TOVA, Conners CPT, and IVA. NASP Communique, 24, 3, 22-24.

Three computerized continuous performance tests were reviewed by these authors. The goal of these reviews was to compare the ease of use, computer requirements, normative data, test results and interpretability of these tests for practitioner. “While all three reviewed tests address reliability and validity to some degree and are in the beginning stages of compiling research data, the IVA’s authors did the best job of asking the right questions and are headed in the most compelling direction.”

Edwards, G. (1998). Determining the Role of a New Continuous Performance Test in the Diagnostic Evaluation of ADHD. The ADHD Report, 6(3), 11-13.

This study evaluated the accuracy of the Integrated Visual and Auditory Performance Test (IVA) in comparison to the conventional method of ADHD based on the DSM-IV. The 138 subjects (103 males, 35 females) used in this study were referrals to the ADHD Clinic at the University of Massachusetts Medical Center and were between the ages of five and 18. Using conventional methods of diagnosis, 78% of the patients were diagnosed with ADHD. The comparison study found that the IVA hit rate was clearly superior to Conners when looking at whether either of the global quotient scores was significant. The false positive rate of 36% was almost identical to the false positive rate reported by Barkley on the Conners CPT. The false negative rate of 30% remained consistent with other reports on visual CPTs. This study suggested that it would be critical to look at the predictive power of the IVA test in a more general setting such as a pediatric practice to gain a more realistic impression of its sensitivity where c disorders are less prevalent. The study also found that the auditory component of the IVA provided useful information about differences between auditory and visual functioning experienced by some children.

Erdal, K. (2004), The Effects of Motivation, Coaching, and Knowledge of Neuropsychology on the Simulated Malingering of Head Injury. Archives of Clinical Neuropsychology, 19, 73-88.

Eslinger, P.J. (2002). Neuropsychological Interventions: Clinical Practice and Research. Book Review by Thomas L. Bennett.. New York: Guilford Press.

Golden, C., Espe-Pfeiffer, P., & Wachsler-Ferder, J. (2003). Neuropsychological Interpretations of Objective Psychological Tests. (Book Review).

Gordon, M. (1993). Do Computerized Measures of Attention have a Legitimate Role in ADHD Evaluations? ADHD Report, 1(6), 5-6.

Hagelthorn, K.M., Hiemenz, J.R., Pillion, J.P. & Mahone, E.M. (2003). Age and Task Parameters in Continuous Performance Tests for Preschoolers. Perceptual and Motor Skills, 96, 975-989.

Harding, K.L. (1999). An Alternative Treatment for Children with Attention Deficit/Hyperactivity Disorder: An Exploratory Analysis.

Harding, K.L., Judah, R.D., & Gant, C.E. (2003). Outcome-based Comparison of Ritalin versus Food-supplement Treated Children with AD/HD. Alternative Medicine Review, 8 (3), 319- 330.

Kane, H. & Whiston, S.C. (2001). Review of the IVA Continuous Performance Test. Buros Fourteenth Mental Measurements Yearbook, 592-595.

“By providing measures of visual and auditory attention in a single administration, the IVA has a clear advantage over several CPTs. In addition, administration and scoring are computerized, removing the element of human error. By providing a number of scales and quotients, the IVA attempts to measure the multi-dimensionality of attention. Results are easily interpretable... As part of a comprehensive assessment of ADHD, the IVA is most appropriately used when it complements information gained from interviews, rating scales, and observations.”

Lowther, J. L. & Mayfield, J. (2004). Memory Functioning in Children with Traumatic Brain Injuries: a TOMAL Validity Study. Archives of Clinical Neuropsychology (19), 105-118.

Mahone, E.M., Pillion, J. & Hiemenz, J.R. (2001). Initial Development of an Auditory Continuous Performance Test for Preschoolers. Journal of Attention Disorders, 5, 25-38.

Miller, L., West, S. & Smolensky, M. Assessment of Body Activity of Attention Deficit Hyperactivity Disordered (ADHD) Children by Actigraphy: A Case Series. Hermann Center for Chronobiology & Chronotherapeutics, Houston, TX. VIII-6.

Monastra et al. (2001). The Development of a Quantitative Electroencephalographic Scanning Process for ADHD: Reliability and Validity Studies. Neuropsychology, 15, 136-144. As reviewed by Rabinier, D. (2001) in New Support for the Use of QEEG Scanning in Diagnosing ADHD. Attention Research Update, 42.

Moore, B.A., Donders, J., & Thompson, E.H. (2004). Validity of the Children’s Category Test-Level 1 after Pediatric Traumatic Brain Injury, Archives of Clinical Neuropsychology, 19, 1-9.

Nussbaum, D. & Jacobs, H. (1996). Computerized Neuropsychological Screening of Patients Referred for Pain Using MicroCogTM and IVA. Presented at the Canadian Psychological Convention. Abstract published in Canadian Psychology.

Neuropsychological evaluations of patients reporting significant pain are rendered difficult by subtle issues including malingering, pain-based attentional distraction and general stress. To address these concerns, a novel approach to these assessments was initiated during which the patient is initially screened by two computerized neuropsychological instruments, MicroCog and IVA, treated for pain for six weeks and re-screened. Data on the first 100 post-trauma, chronic head and neck pain patients completing this procedure demonstrate two primary patterns, with a majority of patients demonstrating improvement in neuropsychological function with amelioration of pain, others with a replicable specific deficit pattern despite improvement of pain. In general, pain patients performed approximately one standard deviation below expectation for age and education levels. The practicalities of using this dual-screening approach and the importance of aggressively and immediately treating pain were discussed. Selected scales correlated at 0.40, which speaks to the concurrent validity of these two different measures of cognitive impairment. This correlation is all the more remarkable as the pain patients averaged well below scale scores of 85, rendering this a severely truncated distribution.

Nussbaum, D. (2000). The METFORS Fitness Questionnaire: A Self-Report Measure for Screening Competency to Stand Trial. Presented at the XXVII International Congress of Psychology, Stockholm, Sweden. Canadian Psychological Association, Ottawa, Ontario.

Fitness (Competency) to Stand Trial is the most common referral for forensic experts. Over 65% of such referrals are found competent, rendering the process very inefficient. The METFORS Fitness Questionnaire (MFQ) is a permutation based test which provides indices of Fitness/Unfitness, Blatant Malingering and Subtle Malingering. In the current study of 120 patients at Toronto’s Mental Health Court, MFQ correlated highly (r=0.77) with the Georgia Court Competency Screening Test (Canadian modification). Based on the cases of disagreement with psychiatric decisions, it is recommended that the MFQ appears to be a sensitive and specific screen for competency to stand trial. Computerized neuropsychological testing using IVA was able to discriminate between the competent and incompetent groups of patients and a number of the scales correlated significantly with both MFQ and Georgia scores. MicroCog appeared too difficult for even the competent mentally disordered offenders, resulting in no differentiation between the competent and incompetent groups and non-significant correlation with both competency measures. Sustained attention and attentional drift are reasonable components of an evaluation of competency to stand trial. As a measure of such, the IVA appears both theoretically and empirically relevant to these assessments.

O’Laughlin, E.M., & Murphy, M.J. (2000). Use of Computerized Continuous Performance Tasks for Assessment of ADHD: A Guide for Practitioners. Independent Practitioner.

This article provides an overview of the usefulness of CPTs in ADHD diagnosis. Unfortunately, the information contained in the article about the IVA is erroneous and very outdated. The authors do state that the integration of CPT results with other assessment data can be useful in helping clinicians arrive at an accurate diagnosis of ADHD, and, in addition, that CPTs can be an effective tool in evaluating medication effectiveness.

Pastyrnak, S.L., Montgomery, M.S., Last, C. & Burns, W. (1997). Symptom Differences Between Children Diagnosed with an Attention Deficit Disorder and those Diagnosed with an Anxiety Disorder. Presented at the C.H.A.D.D. Conference, San Antonio, TX.

A pilot study was performed that compared the results of the IVA administered to a group of children diagnosed with an anxiety disorder (n=3), attention deficit hyperactivity disorder (n=5) and a comorbid group (n=3) consisting of children diagnosed with both ADHD and an anxiety disorder. Diagnoses were based either on a semi-structured diagnostic interview (K-SADS; Last, 1992) or a questionnaire based entirely on DSM-IV criteria (Burns-Montgomery, 1994). Following the diagnostic interviews, children were assessed using the Integrated Visual and Auditory CPT (IVA).

Data were analyzed to compare the CPT performance of the three diagnostic groups on measures of 1) Full Scale Response Control, 2) Full Scale Attention, 3) Auditory Response control, 4) Visual Response Control, 5) Auditory Attention, and 6)Visual Attention. Results indicate that children in the anxiety group performed better than both the comorbid and ADHD groups on all measures of impulsivity and attention analyzed, and that all diagnostic groups performed worse than normal children on these measures. Performance was notably the poorest for the comorbid group whose scores were consistently lower than the ‘pure’ diagnostic groups.

Quinn, C.A. (2002). Detection of Malingering in Assessment of Adult ADHD. Archives of Clinical Neuropsychology, 580, 1-17.

Three assessment measures of ADHD – Barkley’s ADHD Scale, Basis-II Scale, and the IVA Continuous Performance Test were examined using undergraduates (N=44) randomly assigned to a control or a simulated malingerer condition and undergraduates with a valid diagnosis of ADHD (N=16). It was predicted that malingerers would successfully fake ADHD on the two rating scales but not on the IVA CPT for which they would overcompensate, scoring lower than all other groups. Analyses indicated that Barkley’s Scale was successfully faked for childhood and current symptoms. The Basis-II was not successfully faked on 7 out of 8 sub-scales, but its impairment index did not produce high criterion validity for the different groups. The IVA CPT could not be faked on 81% of its scales. IVA’s impairment index results revealed: sensitivity 94%, specificity 91%, PPP 88%, NPP 95%. Results provide support for the inclusion of a CPT in assessment of adult ADHD.

Rasey, H. W., Lubar, J. F., McIntyre, A. & Zoffuto, A.C. (1996). EEG Biofeedback for the Enhancement of Attentional Processing in Normal College Students. Journal of Neurotherapy, 1(3), 15-21.

Seven college students diagnosed as free of any neurological or attention deficit disorder received EEG biofeedback to enhance beta activity while simultaneously inhibiting high theta and low alpha activity in order to evaluate improvements in attentional measures. Following short-term treatment, subjects were evaluated and categorized as either learners or non-learners based upon standard pre- vs. post-treatment neurofeedback measures. Attention quotients taken from pre- and post-treatment measurements using the Integrated Visual and Auditory (IVA) Continuous Performance Test identified significant improvements in attentional measures in learners, while non-learners showed no significant improvements. Results suggest that some “normal” young adults can learn to increase EEG activity associated with improved attention. Twenty sessions, however, even for this population may represent the lower limit for achieving significant improvement.

Riccio, C.A., Cecil, R.R., Lowe, P.A. (2001). Clinical Applications of Continuous Performance Tests: Measuring Attention and Impulsive Responding in Children and Adults. New York: John Wiley & Sons, Inc.

This comprehensive handbook examines the clinical use and limitations of Continuous Performance Tests (CPTs) and their diagnostic efficacy for children, adolescents and adults with ADHD. The authors thoroughly examine and compare the four major, commercially available CPTs and the research literature related to the various CPT paradigms. Brain-behavior correlates of CPT scores and the use of CPTs for monitoring effectiveness of treatment approaches are discussed.

Rivas-Vasquez, R.A., Mendez, C. Rey, G.J., & Carrazana, E.J. (2004). Mild cognitive impairment: new neuropsychological and pharmacological target. Archives of Clinical Neuropsychology, 19, 11-27.

Rosen, L.D. (1995). Three ADHD Tests Prove Computerized Technology Vital Tool for Clinicians. The National Psychologist.

Royan, J. Tombaugh, T. N., Rees, L., & Francis, M. (2004). The Adjusting-Paced Serial Addition Test (Adjusting-PSAT): thresholds for speed of information processing as a function of stimulus modality and problem complexity. Archives of Clinical Neuropsychology (19), 131-143.

Ryan, C., Srokowski, S., Nolte, C. & Lehman, E.B. (2000). Visual Attention: Comparision of the NEPSY and Gordon CPT. Presented at the 108th Annual APA Convention, Washington, DC.

Sandford, J.A. Utilizing the IVA CPT in Measuring the Effectiveness of Medication Treatment of ADHD.

Twenty-nine children, adolescents and adults were tested using the IVA CPT. In addition to the IVA, comprehensive test batteries, clinical observation, parental rating scales, and teacher rating scales were used to make a diagnosis of ADHD. These individuals were then given a trial of medication. IVA test results showed that 76% of these subjects improved both in attention and response control. This result is congruent with other clinical results using rating scales to evaluate the effectiveness of medication and supports the use of the IVA CPT in helping to evaluate and quantify functional improvements resulting from medication management in the treatment of ADHD.

Sandford, J.A., Fine, A.H. & Goldman, L. (1995). A Comparision of Auditory and Visual Processing in Children with ADHD using the IVA Continuous Performance Test. Presented at the Annual Convention of CH.A.D.D., Washington, DC.

In 1994, R.A. Barkley’s analysis of visual CPTs found that they failed to identify ADHD in previously diagnosed children 37% of the time. This study was conducted to investigate the importance in integrating both auditory and visual stimuli in a CPT. Responses to the auditory and visual modalities were compared and their relationships to ADHD diagnosis were studied. The subjects consisted of 26 children(22 boys and 4 girls) between the ages of 7 and 12, who were all previously diagnosed with ADHD. The Integrated Visual and Auditory Continuous Performance Test (IVA) was used to produce data on 22 different scales, which are grouped into seven primary scales of Prudence, Consistency, Stamina, Vigilance, Focus, Speed, and Fine Motor Hyperactivity. The analysis of the IVA showed that ADHD children are likely to be more impulsive aurally and to make more errors of commission in response to auditory stimuli than visual stimuli. This study also supports the premise that ADHD involves a higher level processing disorder, since in this ADHD population, the choice reaction time speed for visual stimuli was impaired, but not the speed of simple visual reaction time. This research supports the argument that both the visual and auditory stimuli are necessary to properly identify ADHD, as a subject might by impaired in only one of the modalities.

Sandford, J.A., Fine, A.H. & Goldman, L. (1995). Validity Study of IVA: A Visual and Auditory CPT. Presented at the Annual Convention of the American Psychological Association, New York, NY.

The diagnostic and concurrent validity of IVA was studied. IVA’s sensitivity (92%), specificity (90%), PPP (89%) and NPP (93%) between ADHD and “normals” were sufficient for clinical use with children. IVA had the lowest rate of false negatives (7.7%) among two CPTs and two ADHD rating scales. Thus, IVA did not fail to identify ADHD, which has been a major limitation of visual-only CPTs, and it also did not over-identify normals as ADHD (False Positives = 10%). IVA had excellent concurrent validity (>90%) with other instruments. This research supports the conclusion that IVA provides important objective data which aides in the clinical diagnosis of ADHD.

Sandford, S.E. (2001). The Effect of Music on Attention. Journal of Neurotherapy, 4 (4), 96-97.

The IVA Continuous Performance Test was used to determine whether a particular type of music (i.e., classical or pop) or quiet test conditions (no music) enhanced attention functioning. Many young people like to listen to music while they study and a number of studies were found in the research literature that reported that music composed by Mozart enhanced visuo-spatial cognitive functioning. Other studies failed to replicate this benefit.

The first hypothesis was that a person will be better able to pay attention while listening to classical music than to no music. The second hypothesis was that a person would be better able to pay attention in a condition of no music than while listening to pop music. The third hypothesis was that a person would be better able to pay attention while listening to classical music than to pop music. Twenty subjects between the ages of ten and eighteen were tested in a counterbalanced, random order with half of the participants tested under both no music and pop music conditions, and the remaining half tested under both no music and classical music conditions.

The first hypothesis was not supported. Individuals, while listening to classical music, did not show improvement in their visual or auditory attention or in their visual or auditory response control. There was no significant difference between the pop music group and the no music group in visual attention, auditory response control or auditory attention. There was a significance difference (p<,02) for popular versus no music but not in the predicted direction. Pop music led to better visual response control than no music. There was a significant difference (p<.04) in visual response control between pop and classical, but it was not in the predicted direction. A very strong trend was also found for auditory attention, (p<.06), which again was not in the predicted direction, with people performing better while listening to popular versus classical music.

Seckler, P., Burns, W., Montgomery, D. & Sandford, J.A. (1995). A Reliability Study of IVA: Integrated Visual and Auditory Continuous Performance Test. Presented at the Annual Convention of CH.A.D.D., Washington, DC.

The IVA CPT was designed to specifically control for the effects of learning and fatigue over the course of the test and to assess both visual and auditory attention processing and response control. A test-retest reliability study of IVA was completed in order to provide an index about stability of IVA test scores over time. The subjects were 70 individuals without identified problems of neurological, current psychological, learning, attention or self-control problems. Testing was 1 to 4 weeks apart. The volunteers were 5 to 70 years old. Detailed analysis is provided by IVA with 22 different raw scales and six composite quotient scales. All IVA composite quotient scores showed significant and moderately to very strong correlations for test-retest positive relationships. The correlations range from .37 to.75. The analysis of the 22 IVA scale raw scores found that 20 scales had significant positive relationships, and 18 out of these 20 correlations showed a moderately strong to very strong relationship (.46 to.88). Thus, the IVA CPT was found to be a significantly stable measure of performance in many ways both globally and in terms of specific scales. The overall changes in quotient scores were very small ranging from 1.05% to 3.03%. Nonetheless, a statistically significant (p<.01) improvement of 3.03% in the visual Attention Quotient (VAQ) was found. Overall, this study found that “normal” individuals when retested did not show any substantial practice or learning effects. Given that the few changes in scores observed were very small, it is concluded that comparisons of pre- and post- IVA scores can reliably be interpreted to reflect possible medication, treatment or environmental effects.

Sherrill, R. Can a “Mind Enhancing” Herb Really Improve Attention?
(Pre-publication)

The purpose of this experiment was to test the efficacy of Ginkgo biloba in enhancing concentration and memory in normal adults. Eight adult volunteers took Ginkgo biloba and a placebo for four weeks each, in a counterbalanced design, to control for practice effects. The hypothesis was that the subjects taking Ginkgo biloba would improve their IVA scores on three scales, and that these scores would not improve when they had taken a placebo for four weeks. The experiment measured speed of response, variability in response times; and resisting fatigue over time, when attention had to be maintained for 13 minutes. The hypothesis was partly confirmed. Ginkgo biloba did not improve average speed of responding. It improved variability in response times slightly. It had its greatest effect upon attentional stamina. Both auditory and visual stamina improved from the normal range to high-average (78^th and 85^th percentiles).

Sherrill, R. Malingering and Sustained Attention. (2000). Presented at SNR conference, St. Paul, MN. Abstract published in the Journal of Neurotherapy, 4(4), 96.

Malingering is, “The deliberate exaggeration of psychological and/or physical complaints for purpose of tangible gain (monetary rewards, etc.).” It is a difficult problem in health care. Head injuries frequently cause problems in attention and memory. Tests of attention capacity require the subject to make reasonable effort. This makes them easier to “fake” than most medical evaluations. The purpose of the experiment was to determine if the behavioral observations or a mathematical decision rule could identify malingering on a test of sustained auditory and visual vigilance. The hypothesis was that subjects attempting to malinger would respond in a way which was clearly different than when they were instructed to try their best. Thirteen adult volunteers took a computer-administered test of attention on two separate occasions. On the first testing half the subjects, chosen at random, were told to do their best. The other subjects were instructed to fake an attention problem as cleverly as they could. On the second round, each subject was given the instruction he/she had not received in the first trial. Behavioral observation identified persons attempting to malinger 31% of the time. Analysis of test scores showed five variables of attention to change greatly under the malingering condition. When these were added together for each subject, the summary scores separated the malingering subjects from those told to try hard with 100% accuracy, on both testing trials. On cross-validation, a modified decision rule classified all brain injured and Attention Deficit Disorder subjects as making satisfactory effort.

Stanford, S., Sandford, J., Helvie, C.O., Royal-Standford, C. & McLaughlin, S. (1999). Attention Deficit Hyperactivity Disorder Among the Homeless. Presented at A.P.H.A. Conference, Chicago, IL.

An incidence study among homeless adults was carried out using the IVA Continuous Performance Test. The homeless population was associated with the ODU Nursing Center and the Judeo-Christian Outreach Center in Virginia Beach, Virginia. Fifty-three participants were tested and eight of these were edited for invalid response patterns. The overall incidence of ADHD in this homeless population was forty-two percent. The individuals were sub-divided into five categories by DSM-IV criteria: 1.)Hyperactive/Impulsive; 2.) Inattentive; 3.)combined; 4.)Attention problem not otherwise specified; 5.) No ADHD. It was concluded that the homeless population has a significant incidence of undiagnosed ADHD which should be considered when designing and planning professional services to this population.

Storandt, M. & Beaudreau, S. (2004). Do Reaction Time Measures Enhance Diagnosis of Early-stage Dementia of the Alzheimer type? Archives of Clinical Neuropsychology (19), 119-124.

Teicher, M.H., Yutaka, I., Glod, C.A. & Barber, N.I. (1996). Objective Measurement of Hyperactivity and Attentional Problems in ADHD. Journal of American Child Adolescent Psychiatry, 35 (3), 334-342.

Tinius, T.P, & Tinius, K.A. Changes After EEG Biofeedback and Cognitive Retraining in Adults with Mild Traumatic Brain Injury and Attention Deficit Hyperactivity Disorder. Journal of Neurotherapy, 4, 2, 27.

Adults diagnosed with mild traumatic brain injury (mTBI) or Attention Deficit Hyperactivity Disorder (ADHD) were treated with EEG Biofeedback and cognitive training. Psychological and neuropsychological tests were completed at pre-treatment and post-treatment and compared to a normal control group that did not receive training, but was tested on two occasions. The results showed significant improvement on full scale attention and full scale response control score on the IVA Continuous Performance Test. in the mTBI and ADHD groups compared to the control group. Errors on a problem solving task decreased only in the mTBI group.

Tinius, T.P. (2003). The Intermediate Visual and Auditory Continuous Performance Test as a neuropsychological measure. Archives of Clinical Neuropsychology, 18, 199-214.

The Intermediate Visual and Auditory Continuous Performance Test (IVA) and Neuropsychological Impairment Scale were completed with adults diagnosed with Mild Traumatic Brain Injury (mTBI), adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), and controls. On the IVA, the mTBI and ADHD groups performed significantly lower on the full and secondary scales for attention and response accuracy. For individual scales, the mTBI and ADHD groups showed lower performance on measures of reaction time, inattention, impulsivity, and variability of RT. The mTBI and ADHD groups showed similar patterns of performance on the IVA. On the Neuropsychological Impairment Scale, the mTBI and ADHD groups reported more neuropsychological symptoms than the control group and the mTBI group reported more neuropsychological symptoms than the ADHD group. The results are discussed in regard to changes in cognitive processing and sustained attention in individuals diagnosed with mTBI and ADHD.

Turner, A. & Sandford, J.A. (1995). A Normative Study of IVA: Integrated Visual and Auditory Continuous Performance Test. Presented at the Annual Convention of the American Psychological Association, New York, NY.

The Integrated Visual and Auditory (IVA) CPT was designed to measure both auditory and visual impulsivity and inattention. This study evaluated auditory and visual, and sex and age differences for IVA based on a normative database of 487 individuals ranging in age from five to 90 years. [Please note: As of January, 2001, IVA’s normative database consists of 1700 individuals.] These volunteers were without identified neurological, current psychological, learning, attention or self-control problems. Overall, males were found to have faster reaction times for correct responses than females, but females were less impulsive, making fewer commission errors. Reaction time speed by age followed a U - shaped curve suggesting that IVA may identify developmental milestones. Auditory commission errors were more frequent than visual commission errors, suggesting that auditory stimuli may evoke more of a reflex reaction. More mental fatigue occurred aurally than visually. Visual errors of omission occurred at a higher rate than auditory errors of omission. Also, visual reaction times were found to be significantly more variable than auditory reaction times. The results of this study support the view that CPTs need to include both modalities and that the clinical interpretation of CPT test scores will be most accurate when compared to the appropriate sex and age group.

Turner, A. & Sandford, J.A. (1995). Developmental Age and Sex Differences in Auditory and Visual Processing using the IVA Continuous Performance Test. Presented at the Annual Convention of CH.A.D.D., Washington, DC.

Comparisons of normative data from the IVA CPT (Integrated Visual and Auditory Continuous Performance Test) for age groups 5-7, 8-10, and 11-13 showed different maturation patterns for various components of attention. Speed improved in a gradual and linear fashion with age, while vigilance, prudence, consistency and off-task behaviors showed a more marked improvement between the ages of six and nine which leveled off for the next age group. In contrast, stamina was stable over all age groups. Gender differences were also found, with males being faster and females more prudent. Maturational patterns were also varied with sensory modality, auditory prudence and visual vigilance showing steeper rates of improvement between the ages of six and nine. These findings emphasize the importance of age and gender based cutoff scores in the diagnosis of ADHD and point out the potential value of CPT results in studies of the developmental neurophysiology of attention and response control.

Vickery, C.D., Berry, D.T.R., Dearth, C.S., Vagnini, V.L., Baser, R.E., Cragar, D.E., & Orey, S.A. (2002). Head Injury and the Ability to Feign Neuropsychological Deficits. Archives of Clinical Neuropsychology, 19, 1, 37-48.

White, J.N., Lubar, J.F. & Hutchens, T.A. (2001). Neuropsychological and QEEG Assessment of Adult ADHD, Presented at AAPB Conference, Raleigh-Durham, NC.

This study examines the use of the theta/beta and a low-alpha/beta ratio in adults with ADHD (N=10) and without ADHD (N=10) both at rest and during neuropsychological test performance using the IVA CPT, the Paced Auditory Serial Addition Task (PASAT), and the Wisconsin Card Sorting Test. Overall, adults with ADHD demonstrated lower performance on the PASAT and a lower attention quotient on the IVA. Differential QEEG findings were also observed. For adults, examination of activity in the low=alpha range as related to activity in the beta range may be indicated as opposed to the theta/beta relationship, a ratio often associated with ADHD in children and adolescents.

Xiong Z, Shi S, Xu H. (2005). A controlled study of the effectiveness of EEG biofeedback training on-children with attention deficit hyperactivity disorder.
Journal of Huazhong University of Science and Technology. 2005;25(3):368-70.

In order to study the treatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuous performance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6% after 40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). It was suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.

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IVA+PlusTM Annotated Research Bibliography

Contents: The Role of Peak Alpha Frequency in Reading.

IVA+Plus^TM
Annotated Research Bibliography

Contents:

The Role of Peak Alpha Frequency in Reading.