All clinicians in making the diagnosis of ADHD will generally conduct a Diagnostic Clinical Interview including history, collect ADHD rating scales from one or more parents and one of more teachers, collect one or more parent and one or more teacher emotional/psychological problem checklists (e.g., BASC-2), complete a psychological test battery appropriate to the issues identified in the Diagnostic clinical interview (typically about 4 hours of testing) and as part of the psychological test battery include the IVA-2 CPT (and IVA-AE2 with adults), during which they will closely observe and rate the client’s behavior using the IVA-2 behavioral checklist.
The Clinician will then make the diagnosis based on their clinical interpretation of all of the data collected using their clinical judgement. All clinical diagnostic decisions are based on the clinician’s expertise, experience and judgement and in this process the clinician will generally look for a congruence of the data in order to help identify the causal factors for the client’s dysfunction.
Deficits in attention and impulsive thinking and behavior can have numerous causes: motivation, attitude, depression, anxiety, mental deficiencies, PTSD, poor sleep, family conflicts, sibling issues, teacher conflicts, etc. The IVA-2 test is the only CPT that is QEEG verified in that abnormal brain patterns associated with poor attentional functioning are highly correlated with it. No other research studies of rating scales or other tests have been published research identifying a significant correlation of this magnitude (.8) with QEEG measures of attentional dysfunction. It has also been found to agree with differential clinical diagnoses of ADHD in research studies 70% to 90% of the time, depending on the comparison group. In comparison, the PAP test for cancer has been found in clinical research to be only about 70% accurate.
ADHD is a clinician’s diagnosis and no “gold standard” test exists for it. The IVA-2 and other CPTs are used by thousands of clinicians worldwide as one component of a multi-modal diagnostic assessment of individuals who have psychological disorders in order to help them better understand the causal factors underlying their client’s problems. No test makes the diagnosis, the clinician does. However, the correlation of CPTs and behavioral rating scales has been found to be significant in numerous published studies and, thus, many clinicians believe that it is clinically relevant and necessary to include a CPT in their diagnostic test battery to either confirm or rule out that the underlying ADHD behaviors are not caused by other factors such as a student’s boredom, lack of motivation, teacher and/or parent conflicts or other emotional/psychological factors such as depression or anxiety.
The difficulty many clinicians also now face in diagnosing ADHD is that the ADHD symptoms and history of problems can be easily faked. Clients can want to obtain stimulant medications for a variety of non-medically justified reasons. This possibility is now recognized as a common problem for clinicians who are attempting to accurately diagnosis teenagers and young adults looking for what are referred to as a “good grade pill.”
To aid clinicians in misdiagnosing ADHD when the possibility of Malingering exists the IVA-2 includes a test of Malingering based on a published study. It is now relevant for clinicians to consider the exaggeration of ADHD symptoms as part of their thorough evaluation and diagnosis of ADHD. The research had found that the ADHD Behavior Rating Scale was easily faked for childhood and current symptoms. in contrast the IVA-2 CPT’s impairment index results revealed it to be highly accurate with a sensitivity 94%, specificity 91%, PPP 88%, NPP 95% for diagnosing individuals in college. These results provide strong support and value for the inclusion of a CPT in assessment of adult ADHD.
An additional research study provided strong evidence of the value of the IVA-2 in helping to accurately identify attention deficits in adults with ADHD and mTBI. The IVA-2 was found to be highly correlated with the Neuropsychological Impairment Index; supporting its clinical efficacy.
The IVA-2 and other CPTs have been reviewed by experts in the field and their evaluation has supported the clinical efficacy and inclusion of CPTs in making the clinical diagnosis of ADHD. In a review of the clinical value of CPTs in helping clinicians make an accurate diagnosis of ADHD Drs. Root and Resnick concluded that using the CPT provides important descriptive information regarding a child’s ability to sustain their attention and inhibit their impulsivity, their flexibility in thinking and reasoning, their ability to shift their attention, and their ability to continuously perform tasks. The CPT data as stated above always needs to be interpreted clinically by the health professional making the diagnosis in conjunction with all of the other data collected during the evaluation process. At this point in time based on numerous research studies its clinical efficacy in helping clinicians to make an accurate diagnosis of ADHD is well established.
Additional recent studies of the IVA-2 supporting its sensitivity in identifying ADHD symptomatology.
This 2015 study of Spanish children shows that children determined to not have ADHD had standard scale scores
for almost all IVA-2 scale scores at about 100 whereas children diagnosed with ADHD have significantly impaired scores.
This research supports that the IVA-2 Normative database continues to be clinically valid in ADHD evaluations.
These three new studies provide further support of the strong relationship between physiological measures of attentional impairment and the IVA-2.
The rules and steps outlined in the IVA-2 Flowchart that help guide clinicians in their determination of the diagnosis of ADHD is based on an empirical analysis of the normative database. For any diagnostic decision process to be evaluated it needs to be recognized that it can only be made in comparison to a criterion reference. Thus, the IVA-2 validity studies compared the flowchart classification of ADHD (i.e., indicated or not) to the formal comprehensive diagnoses made by experienced clinicians. Using the flowchart criterion the vast majority of individuals with ADHD in these validity studies were corrected identified and there were very few false positives. The flowchart indications of ADHD are also supported by psycho-physiological EEG data from a number of published research studies which found that individuals with ADHD were identified to have significantly more slow brainwave activity in comparison to others who were not indicated to meet the flowchart’s ADHD criterion.
The construction of the flowchart reveals a systematic empirical analysis of the numerous ADHD symptoms performed in a step-by-step procedure. The cutoff levels of 85 are based on the fact that this is a standard deviation. It needs to be kept in mind that the IVA-2 normative database is a supra-normal reference group in that individuals with factors that were likely to have possibly impaired attention or who could not validly complete the test were specifically excluded. This aspect of its design was an important factor in helping to make the reference group criterion more sensitive in its indication of ADHD. The specific steps involved were based on the author’s extensive clinical experience and judgement and then verified by validity studies.
There is also an underlying assumption of the IVA-2 flowchart which underlies its construction that is based on an empirical criterion. The assumption used was that it would be possible to set a percent level that was acceptable in labeling individuals who were not identified to have ADHD-type symptoms as suggesting that they may meet ADHD diagnostic criterion. This level was set to 10% and was used to guide the flowchart analysis. Using this criterion meant that when the flowchart rules are applied to the IVA-2 normative reference group that 10% of the individuals who comprise it will be indicated as possibly meeting ADHD diagnostic criteria.
It is by necessity that any formula for determining ADHD will result in both false positive and false negative indications. However, it is only possible to set the false positive level for any normative reference group in applying this formula. The 10% criterion level has been verified when the IVA-2 flowchart is applied to the its normative reference group. There will always be a trade-off and lower false positive criterion will inherently lead to higher false negative ADHD indications, whereas higher values will result in lowering the test’s sensitivity to correctly indicating individuals with ADHD.
In summary, it is the clinician who makes the ADHD diagnosis. When the IVA-2 test results are not supported by a comprehensive evaluation and the other clinical data, then it is clearly specified in the manual that the clinician will need to discount the IVA-2 test results given that the clinician’s evaluation will in accordance with general clinical practice need to be based on the preponderance of the clinical data.
Normative data were collected from individuals not known to have past neurological disorders, not be taking any medication aside from birth control and nasal sprays, not currently active in psychotherapy or counseling, not known to have learning or attentional problems, and not known to demonstrate hyperactivity. The purpose of using a reference group without any known influences that would impair test performance was to help make the IVA CPT more sensitive to impairments in mental processing problems. This normative database was collected from a number of different sites throughout the country. The original IVA normative database was published in 1995 and is discussed in “Turner, A. & Sandford, J.A. (1995). A Normative Study of IVA: Integrated Visual and Auditory Continuous Performance Test.” 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.
The normative database was updated to 1700 individuals in December of 1999 and included individuals aged 6 to 96. The IVA-2 norms were first released in July of 2014 and consist of 1700 individuals ranging in age from 6 to 96. Normative groups are separated by age and gender. The normative database is divided into appropriate age and sex groups. There are currently 1700 records divided into Forty two separate male and female age groups. An effort was made to obtain at least 30 males and 30 females in each age/sex group. It was empirically established that about thirty test scores were needed to help obtain a stable measure for each test variable. All data are rounded to the nearest tenth. A minimum standard deviation for all scale scores was set to 0.1.
By definition, all Global test scores have a mean of 100 and a standard deviation of 15. All IVA-2 test scores because they are presented in the standard score format can easily be compared to standard IQ test scores and converted to percentile ranks when needed. The IVA-2 primary test score means are reported along with their standard deviations in the Help file called Test Norms. 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.
The first time the system is run, it will ask you to create a system password protect the IVA-2 system from unauthorized access. Every time the system starts up, you will be required to enter the password. Also, when a test is completed, you will be required to enter the password to re-enter the test menu or view reports. While it is not recommended, you can in System Options disable the password by clicking on the Security Settings button. It is recommended that you save your password and provide a hint to help you remember it.
The password you enter must be a minimum of 8 characters in length. You must use a combination of uppercase and lowercase letters, numbers, and special characters. Please note that IVA-2 passwords are case-sensitive. There is an option to have one master System Password (default) or to create an Administrator and User security system. This more advanced security system permits the creation of different User Names/Password combinations for up to 4 users one of whom will have administrator rights.
You can have up to four accounts: one admin and three standard users. The first user created will be the admin. Standard users can only be created by the admin. The passwords for the user accounts have the same requirements as the system password. You can set up an “Idle Timeout” where the program will become locked after it is idle for a certain amount of time. You will need to enter the password of the current user to unlock it. Also, you can set up the passwords to be reset after so many days. Only the admin can set up the “Idle Timeout” and password reset. If the user fails to enter their password five times, the user account will be locked for fifteen minutes. The admin can unlock standard user accounts and also change standard user passwords.
The Administrator will also be the only individual to have the right to view, print and save off-site the log files which record all important actions by User name. These log files are stored in encrypted format and, thus, cannot be edited by anyone.
Generally, the IVA-2 has very little practice effect and large changes in pre to post test scores would not normally occur without intervention between the testing dates. If individuals were confused, unmotivated, slept poorly, were jet-lagged, felt sick or tired, held the right mouse button down inadvertently, got distracted, stressed for some reasons, etc. then any of those, or a combination of factors, could lead to the initial poor scores. You can look at the Raw data under the “Trial Response Data” to see why the scores were so low initially as it records the response to every trial and may help clarify the causal factors.
Some questions to ask that may help determine reasons for very low scores of large changes in scores between test administrations:
The clinical diagnosis of ADHD is determined by a clinician’s judgment after completing a comprehensive diagnostic intake and history, making clinical observations and collecting any appropriate clinical rating scale or other relevant test data. As part of this evaluation, other clinical disorders need to be ruled out as causal factors, including anxiety, sleep disorders, bi-polar disorders, major depression, head injuries and other possible issues that may account for ADHD-like symptoms considered.
Rating scale scores are often translated to standard scores which have a mean of 100 and a standard deviation of 15 and the IVA-2 data is also reported in the same standard score format as many ADHD rating scales. Thus, it is relatively easy to compare the iVA-2 test results with ADHD rating scale data. The IVA-2 test reports have the option to include any ADHD rating scale scores as part of its various reports. When ADHD rating scale scores from parents and teachers are included in the IVA-2 system this information is then compared and contrasted to help guide the clinician’s understanding of how the IVA-2 and ADHD rating scales are congruent or differ in specific ways.
In addition, the IVA-2 provides a multi-faceted step-by-step diagnostic clinical questionnaire called the Clinical Report that any clinician can easily complete. The questions in the IVA-2 Clinical Report have to be answered by the clinician and address all of the key diagnostic factors that need to be considered. The data collected by this report follows the detailed diagnostic guidelines specified in DSM-5 that need to be considered in formulating a clinical diagnosis in accordance with its established standards. Thus, any clinician who collects the necessary clinical data and enters it into the IVA-2 Clinical Report will be following the diagnostic criterion specified in the DSM-5. The IVA-2 Clinical Report is a clinical decision support system that integrates the IVA-2 test results with all of the other clinical data important in evaluating that individual’s attention, hyperactivity and impulsivity.
Any clinician licensed to make clinical diagnoses will in all likelihood find the IVA-2’s Clinical Report system and its other reports to be valuable in helping him or her to integrate all of the relevant clinical data collected with the IVA-2 test results. As part of the IVA-2 system, detailed twenty page reports (e.g. Comprehensive Reports) are provided that review in great detail each of the IVA-2 scales and offer insight into their interpretation in clear language. Thus, the IVA-2 Comprehensive Report serves to provide clinicians with insight and understanding of the IVA-2 test scale scores in such a way that they can be easily understood by any clinician familiar with ADHD and its symptoms.
The impairment index is based on using specific IVA-2 scale score cutoff values determined by the researcher to best differentiate individuals known to be diagnosed as having ADHD based on an independent clinical evaluation and students instructed to “fake bad.” Using this cutoff criterion, the measures of Sensitivity and Specificity were computed.
Here is the link to “Detection of malingering in assessment of adult ADHD”: https://www.sciencedirect.com/science/article/pii/S0887617702001506
Here is the table from the study. Note the global Auditory Response Control and Global Auditory Attention scale scores were determined to discriminate the best. The Malingering test report is based on using this research based cutoff criterion.
In respect to the IVA-2, malingering is defined as deliberately making test responses that feign impairments of attention or response control for personal gain. Published research has found that individuals who malinger on this test produce extreme quotient scale scores. Such intentionally impaired scores result from an excessive number of omission, commission, or idiopathic response errors.
Intentionally, faking impaired performance on the IVA-2 is difficult. The individual needs to make a number of sporadic mistakes, but not too many. For adult-aged individuals attempting to malinger, 90% or more will make an excessive number of errors that will result in the malingering analysis of the IVA-2 being positive. This is based on one research study. Thus, it is possible to fake bad and have the IVA-2 performance be considered valid. The validity of the IVA-2 is based on a determination of the probability whether or not an individual randomly responded and should not be used to evaluate the possibility of malingering. There is a separate malingering analysis that needs to be examined and in addition all test takers need to be clinically observed during their test in order to make a clinical determination of valid or possibly malingering performance. Nevertheless, the determination of malingering requires that a clinical decision be made by the examiner. In most cases, additional tests of malingering will need to be administered in order to accurately identify its occurrence.
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All test data is stored locally and BrainTrain has no access to the database records. The testing database is encrypted and password protected by default, so that only local application access to the data is possible. The customer can elect to change the default database password to a unique password of their own choosing and then even local application level access will require the password each time. Additionally, the test software enables users to set up separate user accounts (1 administrator and up to 3 limited users) that monitors all use, logs user actions, and has built-in tampering controls. The test system can also be enabled to lock out access after a specified number of failed password attempts for a specified time limit. Only the Administrator who has logged in with their own unique password can change the test database password and this password can never be removed once set. The Administrator can change this password, but to do so they must enter the current password. By utilizing any combination of these features you can institute a multi-tiered password policy to access the data (local PC login, individual IVA User logins, and/or unique database password) and prevent access to PHI data.
In the event that you may need to share a record or database with an outside party, there are procedures built-in to the system whereby you can export a completely de-identified and randomized record ID to a separate database. This can be used to share a record with another clinician, BrainTrain or as part of a research group without the chance that the Name, Test ID or Date of Birth can be traced back to a specific individual. This procedure can be done for single records, groups of test records or the entire database at once.
Further security is also possible by entering unique code names for all individual persons tested that are mapped outside of the test system. For example, Test100319 (date) as first name and last name can be Time1310 (1:10PM). The DOB can be set to any value that generates their correct age based on the testing date using any month/day/year that is not their true birthday. In this way the test database will not contain ANY PHI information. Reports can be exported in Word format and then edited as necessary to enter the person’s real name and DOB. Thus, anyone viewing the test data will not know who it is or be able to figure that out in any way as the test database will not have any PHI data in it. A separate record needs to be entered in the person’s chart documenting their code name. In this case, if anyone able to get access to the test database it would not provide any PHI information as all data stored in can not be used to identify any person.
These combined methods together will meet all their security needs and prevent any PHI data breach from occurring via test database access by anyone. In addition, only connecting the PC to the internet for updates periodically as necessary will minimize risk of unauthorized access to PHI data.
The IVA-2 test interpretation has the capability to include the clinical behavioral data obtained as part of a comprehensive diagnostic intake pertaining to the number of significant ADHD symptoms identified by any of the ADHD rating scales currently available. In addition, the IVA-2 system provides its own online ADHD rating scale that can be administered both in the office setting and remotely online. The results of an ADHD rating scale can be easily entered into the IVA-2 clinical data as a percentile rank, a T-score, or the specific number of the inattentive and the hyperactive/impulsive that are rated as occurring often or very often. The ADHD rating scale data can be important means that helps clinicians to evaluate the psycho-social functioning of their client in being able to meet the demands of their life. ADHD rating scale data can provide the basis for a clinical determination of whether or not the person’s ADHD symptomatology is significantly impairing their ability to function in their social, work and/or school environments. It always needs to be kept in mind that an individual’s performance in respect to testing conditions in an office setting with a health care professional and their behavior in their work, home or social environment can be very different. For this reason DSM-5 diagnostic criteria requires that the clinical diagnosis of ADHD necessitates that this disorder must be determined to significantly impair the person’s functioning in two or more domains of their life. The value of the IVA-2 test is that it can often help illuminate the causal factors that contribute to
the impairment is identified in ADHD rating scales that effect an individual’s ability to perform well and meet the demands of their life.
In a study documented in the IVA-2 manual that compared clients presenting with ADHD symptoms for an evaluation it was determined that the inclusion of ADHD rating scale data helped to improve the accuracy of a clinical diagnosis when the rating scale data was combined with the IVA-2 test results. By using both the IVA-2 clinical indication of significant ADHD symptoms combined with ADHD rating scale cutoff score criterion, the sensitivity of the ADHD diagnostic accuracy improved by 10%. In this study the reference was the clinical diagnosis based on a comprehensive evaluation including history, clinical observations and additional test data. The inclusion of ADHD rating scales in the diagnostic process makes it possible to compare psycho-social behavioral data with test data collected under quiet control test conditions that do not include distractions. Test conditions are also highly structured with the inherent demand to perform well when challenged with a boring and repetitive test task. From one perspective the IVA-2 test is a unique “challenge” that was specifically constructed for individuals who are impaired by ADHD. Consequently, when both IVA-2 test results and ADHD rating scale findings are supportive of a diagnosis of ADHD then the clinician can be more confident in the validity of their diagnostic determination. Likewise, clinicians will need to clarify and compare the IVA-2 test results with ADHD rating scales when they do not agree; keeping in mind that both methods for evaluating ADHD have their strengths and weaknesses. In most cases clinicians are likely to find that an in-depth examination of both the IVA-2 test and ADHD rating scale data will aid them not only in formulating the most accurate clinical determination possible, but also guide them in developing effective targeted treatment plans and interventions.
We have assembled a comprehensive, visual walkthrough for setting up and incorporating the IVA-2 rating scales. That page can be viewed HERE.
Absolutely! Instructions for doing so can be found HERE.
We have made this as simple as possible. You can purchase additional test administrations and/or reports from within the IVA-2 software. The instructions can be found HERE.
There are many reports to choose from. Please refer to THIS page for samples.
Sure, please refer to THIS PAGE for detailed instructions.
The Data Analyses provide a review of the test findings in graph/chart format. The Reports are a written interpretation of the test findings, which can be edited in the software’s built-in word processor.
The Comprehension auditory and visual scale scores are measures of both idiopathic errors of omission (not clicking to a ‘ 1’ which is the target) and errors of commission (clicking to a non-target ‘2’). There are sections of the test where the stimuli pattern would “pull” for an error. Comprehension pulls from sections where there is no good reason not to respond to a ‘1’ (i.e., a target) or to respond incorrectly to a ‘2’ (i.e., a foil). For instance,
during the high demand block of the IVA-2 test there are long repeated sequences of targets such as “1, 1, 1, 1, 1, 1.” If the person taking the test fails to click to the last ‘1’ in this sequence, that would be classified as an idiopathic error of omission and loads onto the Comprehension scale. The reasoning is that there was no change in the stimuli pattern that would have evoked a failure to respond to this specific target at the end of a sequence. In contrast, the failure to respond to the last one in the sequence “1, 1, 2, 1” is more likely as the preceding ‘2’ requires inhibition and then individuals are predisposed to wait and not immediately respond to the last target in this sequence. The failure to respond to the last one is not classified as an idiopathic error, but as a propensity error of omission “pulled” for by the test pattern and this error loads on the Prudence scale.
The Comprehension scales also include auditory and visual idiopathic errors of commission. When a test taker responds to any ‘2’ following a sequence of any two ‘2’s under low demand conditions such as “2, 2, 2” this is an idiopathic error of commission and loads on the Comprehension scale. In comparison a response to a ‘2’ following two or more ‘1’s during high demand test conditions is “pulled” for by test test pattern in that the individual is clicking, clicking and then has to inhibit clicking when a ‘2’ appears. In this case the error is an error of commission that loads on the Prudence scale. It is important to keep in mind that when low standard scale scores (i.e. < 80) on either the auditory or visual Comprehension scale are observed that it is likely that a number of other scales will show impairments. Also, if a person randomly responds and the test is found to be invalid, then it is still possible to calculate the Comprehension scale scores which will in this case be very low.
There are three ways to determine possible shifting set issues for an individual:
First, review the Sensory Modality analyses and reports.
Next, examine the High and Low Demand reports and analyses.
Finally, explore the Quintile Response analysis.
Clinical judgment will be needed to interpret these reports based on the client’s presenting symptoms and concerns.
Health care providers are often faced with challenges in accurately diagnosing ADHD. The diagnostic process requires clinicians to proceed step-by-step in evaluating a number of factors in their diagnostic decision making process. The IVA-2 is a psychological test that provides supporting and clarifying information about ADHD-type symptoms. While the IVA-2 test by itself cannot be used to rule in or out any specific diagnosis, clinicians report that they find that the secondary supportive data provided by the test data can be helpful as part of their comprehensive evaluation. There are many times when clinicians are faced with challenging diagnostic questions pertaining to clients with one or more presenting types of problems. It is for these types of complex cases that BrainTrain provides the various types of IVA-2 in-depth analysis and interpretation reports. For complex cases we recommend that the clinician review the interpretation guidance provided by these four reports: Comprehensive Report, Sensory Modality Report, Sustained Attention Report and High/Low Demand Report.
After reviewing these reports, then clinicians can answer the important diagnostic questions required by the Clinical Report and be provided with guidance in making their final diagnostic decision. The Clinical Report draft can then be modified and expanded using the relevant information identified in the above four reports based on what is deemed relevant by the examiner for each individual case. Almost all comprehensive evaluations will include ADHD rating scale data and this information is automatically utilized in the IVA-2 reports when available. To create a Clinical report, the IVA-2 Report Writer will require the examiner to answering various questions pertaining to the following diagnostic issues:
– Primary presenting symptoms
– Whether ADHD symptoms can be accounted for by other factors
– Settings in which symptoms occur
– Whether functioning is impacted
– How long symptoms have been present
– Confirmation of the validity of the test taker’s motivation and performance
– Behaviors observed during the clinical intake and testing
– Clinical history of ADHD symptoms
– Family history of ADHD
– Clinical assessment of test validity
– Medications at the time of testing
– Recommended accommodations and treatment approaches
– Additional factors that may contribute to the individual’s impairment
In addition, other test data, clinical impressions, presenting symptoms and the client’s history, etc. will need to be integrated by the examiner in making an accurate diagnosis and in ruling out alternative diagnoses. This additional clinical data is entered by the health care professional as part of the decision process required by the Clinical Report system.
The depth and detail of the interpretation of the IVA-2 test data can often be of great benefit for all clinicians. It provides them with the consultation advice of the test authors. This information will often prove useful in helping guide them in better understanding how to interpret the test data particularly when faced with clients who present with complex histories and symptoms.
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Dr. Sandford is willing upon request to provide professional consultations to health care professionals regarding the interpretation of the IVA-2 test results within a comprehensive evaluation. However, he recommends that the interested party first consider completing an IVA-2 Comprehensive Report, because this report is designed to provide in-depth interpretative guidance that systematically addresses each test analysis scale. If a consultation is still desired, then Dr. Sandford will need the full IVA-2 test file (not just the test analysis scores) which needs to be de-identified by name and DOB but the age must remain the same. He will also need all other test data, a summary of the intake along with history, presenting symptoms, initial and subsequent diagnoses. He will need to know whether or not this is a legal case, and he will consult on legal cases at his sole discretion. This information can be faxed to him (804-320-0242), except that the IVA-2 record must be exported in de-identified format and mailed on a USB drive with tracking. He will destroy this USB drive record after the consultation is finished and will shred all records faxed. His role is to consult with the clinician only and communication will be in an interactive verbal format. These services do not include a written report and he does not permit recording of the consultation. The fee is based on the time required at his consultation rate (available upon request) with a minimum of one hour necessary. It is possible to include multiple cases in one consultation session. Consults must be pre-paid to BrainTrain and will be based on the number of case reviews requested.
Once you are on the main menu in either the IVA-2 or IVA-QS, there is a green “Help” button at the bottom of the screen. Clicking that will lead you to the full, built-in software manual, which can be printed to PDF or as a hard copy.
You can contact Tech Support directly from your IVA-2 software with the built-in support ticket system. Instructions on using the system can be found HERE.
Click on the Help button from within the IVA-2 software Main Screen and the Test Manual can be reviewed. This manual has a chapter titled, “Test Content and Construction.” This chapter provides a highly detailed description of the IVA-2 test scales’ construction. The normative means and standard deviations for all the scales are provided in the Help file titled, “Test Norms.” The test validity issues are reviewed in the IVA-2 Test Manual chapter titled “IVA-2 Research Studies.”
The Full Scale Attention Quotient (FSAQ) takes into account both High and Low Demand conditions whereas the Sustained Attention Quotient is primarily Low Demand. Someone with a normal FSAQ and Impaired SAAQ would be someone who tends to drift off when the demand isn’t high. Vice versa, someone with an Impaired FSAQ but normal SAAQ is likely someone who was unable to keep up with High demand but made relatively few mistakes when the demand was low.
The FSAQ, Auditory Attention Quotient (AAQ) and Visual Attention Quotient (VAQ) are global scales constructed from Vigilance (omission errors), Focus (variability in response time) and Speed (mental processing speed).
The SAAQ and the SVAQ are based on different the primary scales of Acuity, Dependability, Elasticity, Reliability, Steadiness and Swiftness which are described below. The Combined Sustained Attention Quotient (CSAQ) is its own global scale based on the SAAQ and the SVAQ global scales.
The original IVA did not include the SAAQ or the SVAQ, but I decided to add them in order to identify the specific symptomatology of individuals with ADHD, Predominately Inattentive type. These are individuals who do not perform well under boring, low demand conditions, because they “tune out.” In addition, they often have difficulty switching sets under high demand conditions and getting “back on track.” The reason I added these two new global scales was that it helped improve the test’s sensitivity to ADHD symptomatology. In adding these new sustained attention global scale scores, I had to then modify and update the IVA-2 Interpretative Flowchart (attached). By studying the Flowchart it is possible to see how the SAAQ and the SVAQ are used in the Steps to make a diagnostic determination and that the AAQ and VAQ are used in the overall higher level Rules which determine which “case” the score pattern indicates as the best match. Once the Rule is determined, then the examiner has to drill down “step-by-step” to refine the specific type of ADHD or other disorder classification is indicated for consideration.
Each one of the 500 test items in the IVA-2 loads specifically on one or more primary scales. I went through the test and classified each type of
error of omission and commission that can be made.
Here is a more detailed description of Sustained Attention –
Sustained Attention Analysis
The Combined Sustained Attention Quotient provides a global measure of a person’s ability to respond to stimuli under low demand conditions accurately, quickly, and reliably. In addition, it includes an assessment of the ability to sustain attention and be flexible under high demand conditions when stimuli change. This is also reported separately for the auditory and visual modalities on the first page of the IVA-2 Standard Scales as the Auditory and Visual Sustained Attention Quotient. These global measures of sustained attention are comprised of the following scales: Acuity, Dependability, Elasticity, Reliability, Steadiness and Swiftness. These are reported as separate scale scores for both the auditory and visual modalities.
Acuity is defined as the percent of correct responses to the “1″s (targets) under low demand conditions (when the “2″s, or foils, are prevalent). Acuity is a subset of the IVA-2 Vigilance scale, but does not include “propensity” errors of omission.
Dependability reflects the variability of reaction times to “1″s under low demand conditions. A person who responds in a similar fashion to every trial demonstrates a high level of dependability. He or she is able to stay focused on the task at hand. A person whose response times are variable may be showing that she is distracted by internal or external conditions.
Elasticity measures the number of errors of omission occurring when a 1 is presented immediately after a 2 during periods when the 1s are frequent. A low score on this scale may reflect the individual’s difficulty being flexible when faced with changing conditions.
Reliability is a measure of the number of idiopathic errors of commission. It reflects errors of clicking on a “2″ when the “2″s are frequent, but excludes all three types of errors of commission that load on the Prudence scale. A person with a high reliability score would not make many of these types of error.
Steadiness is defined as the percentage of correct responses to the “1″s under high demand conditions (“1″s are prevalent) when the requirement to respond is sustained. Propensity errors of omission (missing the first “1” following a “2”) are not included in the Steadiness scale.
Swiftness is a measure of reaction time to “1″s under low demand conditions. A high score on this scale shows that the person responds quickly when a target appears. A low score may indicate that the test taker has slow processing speed.
Full Scale Attention Quotient is based on the VAQ and AAQ which are based on three primary scales listed below.
The two Attention Quotient scales combine the Vigilance, Focus and Speed scales. These two global Attention Quotient scales are based on separate groups of scales divided according to auditory and visual domains. The Auditory Attention Quotient (AAQ) is based on equal weights (⅓ each but not averaged) of the quotient scores for the following three primary scales:
Vigilance Auditory (VIA)
Focus Auditory (FOCA)
Speed Auditory (MNA)
The Visual Attention Quotient (VAQ) is derived in the same way using the following three scales:
Vigilance Visual (VIV)
Focus Visual (FOCV)
Speed Visual (MNV)
A new standard deviation is derived in computing the AAQ and the VAQ, separately.
Both the AAQ and VAQ scales are used in equal weights (not an average) to create a third composite scale, referred to as the Full Scale Attention Quotient (FSAQ). The FSAQ has its own standard deviation used in converting these weighted scores into a new quotient score. In other words, using an equal weight method with a standard deviation being derived can result, if the weighted component scores are low, in an even lower global quotient score, and vice-versa. This attribute of equal weighting balances strengths and weaknesses and is also applied in the same way for the other Global scales.
The IVA-2 norms for males and females do differ. We only have norms for these two sexes. In the case where a person does not identify as either male or female, examiners can complete Analyses and Reports using both the male and female normative database. Please note that there is no additional charge for running multiple analyses or reports. A clinical decision can then be made as to which normative set is in accordance with their comprehensive clinical assessment. In general, male and female test responses differ the most for younger individuals in comparison to older people.
If a substantial degree of impairment is identified, then it is likely that both male and female analyses will prove helpful in identifying specific attention and response control deficits.
We recommend that you use the IVA Researcher’s Kit to export the test data. The Researcher’s Kit provides an Excel compatible or statistical compatible data export of all the test data and includes both standard scores and raw data variables. The PDF export is not designed for this type of export and would most likely involve manual data entry and detailed verification for accuracy. The Researcher’s Kit is a one time investment and is automatically renewed at no additional cost as long as the IVA license is maintained.
The primary function of the frontal lobe system is to help the person to sustain attention by inhibiting distracting or off-task thoughts and feelings. Since the frontal one has the primary function of inhibition, then it helps individuals to regulate their emotions. In order to control your emotions you have to inhibit reactions to stressors or negative stimuli and then “stop and think” before responding in order to determine the best course of action given the situation and circumstances. Thus, low scores on the IVA-2 global Attention scale scores indicate that a person is likely to have problems sustaining attention sufficiently in order to think through the consequences of a course of action oriented towards the achievement of relevant goals. While low scores on the global Response Control scale scores is likely to reflect an individual’s tendency to respond more impulsively; exhibiting less emotional self-control in stressful life situations.
A full review of the IVA-2 validity checks start on page 121 of the IVA-2 Manual.
The primary quantitative factor for determining IVA-2 test validity is whether or not the test performance indicated random responding.
In addition, the examiner’s clinical observation of the test taker’s behavior and attitude towards the test is also important in
evaluating whether or not the individual understood the test and made a valid effort to perform the test task to the
best of his or her ability.
From the IVA-2 manual:
The first step in reviewing and interpreting the IVA-2 CPT results is to examine the Auditory and Visual Validity Checks on the first page of the IVA-2 Standard Scale Analysis. These validity checks are based on a measure of idiopathic errors (i.e., random responses) on the IVA-2. Statistically, the test results for a specific sensory modality are considered invalid when the probability of the individual’s response pattern being self-directed in accordance with the test rules is less than 1 in 1000. In other words, it is highly likely that the test taker responded randomly to the test stimuli, thus invalidating the test results. If the test is interrupted due to an excessive number of zero reaction times, then the examiner may want to retest this person. In some cases individuals will inadvertently hold down the right mouse button with their middle finger, while they click away using their index finger on the left mouse button. If this problem has occurred, then examiner will need to pay extra attention to be sure that the right mouse button is not held down excessively during a re-test.
Here is how Malingering is indicated from the Help section in the manual titled, “Malingering Analysis.” Note: A decision of malingering can only be made by a clinician and a quotient score of 0 for any scale by itself is not necessarily malingering, but can reflect severe cognitive impairment due to many different causal factors.
Malingering Analysis and Evaluation
In respect to the IVA-2, malingering is defined as deliberately making test responses that feign impairments of attention or response control for personal gain. Published research has found that individuals who malinger on this test produce extreme quotient scale scores. Such intentionally impaired scores result from an excessive number of omission, commission, or idiopathic response errors. This pattern of response errors is rarely observed for individuals who have been diagnosed as having ADHD, unless they have severe to extreme ADHD symptoms or other significant cognitive deficits. Nevertheless, the determination of malingering requires that a clinical decision be made by the examiner. In most cases, additional tests of malingering will need to be administered in order to accurately identify its occurrence.
The Malingering Analysis provided in the IVA-2 is useful in cases where the examiner suspects the possibility of malingering. While this analysis helps the examiner identify possible malingering, it needs to be kept in mind that a person with extreme attention and/or response control problems may have such impaired scores that he or she looks like a malingerer. Also, random responding may lead to malingering being suggested as a possibility in this analysis. Since, it would be very rare for an individual under the age of 13 to malinger, no Malingering Analysis is available for children who are twelve years and younger. The strength of the IVA-2 Malingering Analysis lies in the fact that most “normal” adults make very few errors in their responses to the IVA-2 test stimuli. Thus, if an individual is consciously trying to “look bad” for some ulterior purpose or personal benefit, his or her standard scores are likely to fall in the very extreme range, well beyond the impairment level usually found in the IVA-2 test scores for adults who truly have ADHD or mild traumatic brain injury.
The cut-off scores used in the IVA-2 test are based on the research study published in the Archives of Clinical Neuropsychology titled the Detection of Malingering in Assessment of Adult ADHD, by C. Quinn (Volume 18, Issue 4 (May, 2003), pages 379-395). When the IVA-2 global Auditory Response Control Quotient (ARCQ) is added to the global Auditory Attention Quotient (AAQ) scale score and the total is less than or equal to 118, then possible malingering is indicated. Also, when the IVA-2 global Visual Response Control Quotient (VRCQ) is added to the global Visual Attention Quotient (VAQ) scale score and the total is less than or equal to 116, then this result indicates possible malingering, as well. If the box marked Malingering Evaluation is checked, then a section will be added to the Standard, Detailed and Comprehensive reports that helps guide the examiner in interpreting the individual’s test scores for possible malingering. This interpretation is based on the published research cited above and will need to reviewed by the examiner.
In addition to the two global scale score combinations indicative of possible malingering, additional cut-off scores suggestive of malingering have been identified for Comprehension and Vigilance primary scales when either their visual or auditory quotient scores were six or more standard deviations below the mean (less than or equal to 40). The Prudence auditory and visual scales were also identified to suggest possible malingering when either quotient test score was three or more standard deviations below the mean (less than or equal to 55). These additional primary scales are included in the malingering interpretation for reports only when at least one of the two IVA-2 global scale indicators of malingering is positive. In that case, these scales provide additional markers that the examiner may want to include in their assessment of possible malingering. As always, the evaluation and determination of malingering is a clinical judgment and will generally be based on a comprehensive evaluation, additional tests of malingering, and the examiner’s clinical observations regarding unusual test taking behaviors and patterns throughout the evaluation.
Yes it is possible for the test to be valid and for an adult to have a zero scale score. The reason is that a zero scale score is calculated when an individual’s responses are greater than 6.67 standard deviations below the mean adult raw score for that scale (100 – 15 x 6.67 = 0).
This degree of impairment is labeled Extreme and may also be interpreted by the examiner as indicative of possible malingering which can be evaluated in a test report or by consulting the manual and relevant test global scale scores.
Step 1: Review clinical observations during the test based on examiner’s judgment. Was the test taker observed and judged to make their
Step 2: In the Standard Analysis determine whether or not individual validly responded based on the manual guidelines below.
Clinical observations during the entire test procedure can be very useful in confirming or refuting test findings depending on concordance. Some people may engage in many types of off-task, hyperactive, or inattentive behaviors during the test which are clinically important in understanding their problems. Double-clicking is the most common hyperactive test behavior which can be observed. To some degree, test comprehension and motivation can be inferred from the person’s behavior and verbal statements. After the IVA-2 is completed, it is important for the test interpreter to form his or her own clinical opinion regarding the test taker’s comprehension and understanding of the test task, motivation to perform to the best of his or her ability, and degree of compliance with the test rules. Guidelines and scoring forms are provided in the Help file called Questionnaires that can be printed out and used to help structure the examiner’s test observations. This data can be entered after the test is completed by the examiner and it will be added to the end of the Standard Analysis printout for later reviewThe first step in reviewing and interpreting the IVA-2 CPT results is to examine the Auditory and Visual Validity Checks on the first page of the IVA-2 Standard Scale Analysis. These validity checks are based on a measure of idiopathic errors (i.e., random responses) on the IVA-2. Statistically, the test results for a specific sensory modality are considered invalid when the probability of the individual’s response pattern being self-directed in accordance with the test rules is less than 1 in 1000. In other words, it is highly likely that the test taker responded randomly to the test stimuli, thus invalidating the test results. If the test is interrupted due to an excessive number of zero reaction times, then the examiner may want to retest this person. In some cases individuals will inadvertently hold down the right mouse button with their middle finger, while they click away using their index finger on the left mouse button. If this problem has occurred, then examiner will need to pay extra attention to be sure that the right mouse button is not held down excessively during a re-test.
If only one of the Response Validity Checks (e.g., Auditory) is valid and the other is invalid (e.g., if the Auditory Response Validity Check is valid but the Visual Response Validity Check is invalid), only auditory global primary scales can be meaningfully interpreted. The Full Scale Response Control and the Full Scale Attention Quotients cannot be validly interpreted, because they are based on both visual and auditory responses. However, all other global composite quotient scales of the sensory domain for which valid test responses have been found can be analyzed, as well as, the Fine Motor Hyperactivity Quotient scale. Sometimes one or the other Response Validity Checks will instruct the examiner to “Interpret with caution.” This indicates that there is a probability that there was some random responding during the course of the test or that the mouse button was held down an unusual number of times. If the examiner judges that the test taker validly tried to the best of her ability then this prevalence of idiopathic errors can be interpreted as indicative of significant attentional and/or response control problems.
A situation where one of the Response Validity Checks is valid and the other is invalid suggests that the test taker may have difficulty shifting sets between the two sensory modalities. To determine if a person’s problems involve impairment in shifting sets, the IVA-2 CPT can be run again separately in auditory only mode (i.e., turn off the monitor for about thirteen minutes after the test begins) and then after at least an hour break or on a separate day the test can be given again in visual only mode (i.e., disconnect speakers during the test). The Warm-Up Practice Period can be given focusing only on the sensory modality being tested and ignoring the training for the other modality. In either of these modes, IVA-2 would be expected to be easier to do, and test scale scores likely would be somewhat higher than in regular mode. No norms are available when IVA-2 is administered in this separate sensory mode. Naturally, when IVA-2 is given this way, the test interpretation can only be made for the sensory mode presented with the understanding that the quotient scores will in all likelihood somewhat overstate a person’s functioning. If an individual can perform better for each sensory modality separately and the test scores are judged to be valid, they can be compared to the regular test results. In some cases, difficulty shifting sets may be attributable to limited intellectual abilities. Additional intellectual and neuropsychological tests (e.g., WAIS-IV coding sub-test or Trail Making B) will be required to confirm this “shift-set” problem and aid the test interpreter in making a meaningful interpretation of these findings.
Step 3: Clinically interpret based on a comprehensive evaluation, history, other test scores, etc.
Balance used to be displayed in IVA+Plus, but it proved difficult to interpret. Balance was replaced by the Sensory Modality Report and Analysis in the IVA-2 Analysis. The Sensory Modality Report and Analysis in IVA-2 comprehensively addresses an individuals strengths and weaknesses in
respect to differences in their visual and auditory processing abilities.
Balance is determined in IVA-2 by comparing the Visual Speed Quotient score in relationship to the Auditory Speed Quotient scale score.
If they differ by 8 points or more, then one sensory modality is a relative strength in comparison to the other.
For example, an individual has a quotient score for Visual Speed of 100 and their quotient score for Auditory Speed is 80.
Then these results show that they are better at processing information in terms of mental speed if it is presented to them first
visually and secondarily in the auditory modality. You can also compare Visual and Auditory Vigilance in the same way in respect to accuracy of
processing information and Visual and Auditory Prudence in respect to the differences in impulsive errors.
All of these analyses and reports are also discussed in the Comprehensive IVA-2 Manual, but it is best to review each report in conjunction
with its corresponding analysis in order to understand how to utilize and interpret these IVA-2 test scores.
Yes. Please refer to THIS article on the Knowledge Base for instructions on how to transfer.
Please refer to the Seven Key Features in the IVA-2 page.
The test administration process in the IVA-2 functions the same as the IVA+Plus. As of 2013, the IVA+Plus testing structure received both QEEG and fMRI validation. It is the only CPT with that dual validation. To read more about the QEEG validation, please refer to THIS link. To read more about the fMRI validation, please refer to THIS link.