1. Understanding the Rationale for the IVA-2 Flowchart

    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.

  2. IVA-2 Normative 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.

  3. What are some possible, unusual reasons for low IVA-2 Quotient scores or large changes in quotient scores between tests?

    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:

    • Were any behavioral observations made during testing?
    • Was the testing time of day the same between the first and second administration, both morning, both afternoon, etc.?
    • Was any feedback obtained about their experience from the person after testing?
    • There are IVA-2 behavioral rating and self-report scales designed to address testing motivation and attitudes that, if completed, would help clarify the changes observed.
    • Were Ss paid to complete the test or compensated in any way or be motivated to perform and make their best effort?
    • Were adults or children the tested?
  4. How does a clinician learn to Integrate the IVA-2 test results in their comprehensive ADHD evaluation?

    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.

  5. What is the IVA-2 Impairment index used to determine possible malingering based on?

    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.

























  6. How to protect your BrainTrain test data from any breach of Personal Health Information (PHI).

    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.

  7. How do I use the included Rating Scales?

    We have assembled a comprehensive, visual walkthrough for setting up and incorporating the IVA-2 rating scales. That page can be viewed HERE.

  8. Can I print and use a Rating Scale offline?

    Absolutely! Instructions for doing so can be found HERE.

  9. How do I purchase additional test administrations and/or reports?

    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.

  10. What kind of reports are in the IVA-2 and what do they include?

    There are many reports to choose from. Please refer to THIS page for samples.

  11. Can you explain how to run a Clinical Report?

    Sure, please refer to THIS PAGE for detailed instructions.

  12. What is the difference between the Data Analyses and the Reports?

    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.

  13. What do the Comprehension Scales measure and indicate?

    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.

  14. What is the clinical usefulness of the IVA-2, and how do I use the test to help me in my diagnostic decision-making process?

    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.

    It is recognized in the American Psychological Association Recommended Diagnostic Guidelines that no test definitively confirms or refutes the diagnosis of any psychological disorder. Any clinical diagnosis of ADHD always requires a health care professional’s clinical determination based on his extensive overall evaluation. However, while the diagnosis of ADHD does not require the use of a specific psychological assessment, clinicians often prefer to utilize various tests, of which the IVA-2 is one, to provide data to help support their comprehensive clinical evaluation.

    The IVA-2 Standard, Detailed, and Comprehensive reports are provided primarily to help the examiner summarize and interpret the numerous IVA-2 test scores. These reports are intended to be used secondarily to help guide the clinician in making his diagnosis. Given the challenge and numerous steps now required in DSM-5 for diagnosing ADHD, we recommend to clinicians that they use the IVA-2 Report Writer. The Report Writer systematically guides the clinician through the diagnostic process, requiring him to answer the important diagnostic questions needed to help him determine his clinical diagnosis and to create a draft diagnostic report. By itself, the IVA-2 CPT can only provide data along with suggestions to help guide the examiner in the interpretation of its scale scores.

    To create a draft diagnostic 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

    If ADHD rating scale data are collected, these data are incorporated into the Report Writer system and used as part of the clinician’s diagnostic decision process. The clinician’s answers to the questions above will affect the diagnostic decision tree used by the program, which will then suggest one or more working diagnoses for the clinician to consider in ruling in or ruling out the diagnosis of ADHD.

    The main challenge of this type of psychological test (i.e., CPTs) in general is that they are not always sensitive to the symptoms of ADHD and, hence, tend to under-identify individuals with the disorder. In addition to the Report Writer, clinicians have the option of using the IVA-2 written Flowchart to help guide them through the procedure of making their diagnostic decision. For a mixed clinical population, it was found that the use of this Flowchart with the IVA-2 test scores that were combined with ADHD rating scale data correctly identified 90% of individuals with ADHD and only incorrectly classified 10% of individuals who do not have ADHD based on a comprehensive clinical diagnosis (see the IVA-2 manual for more details). All diagnoses obtained using either this Flowchart method or the IVA-2 Report Writer are provided only for the examiner’s consideration; any clinical diagnosis must be made by the clinician based on his or her comprehensive evaluation.

  15. How can the IVA-2 Reports be utilized to help clinicians in making their diagnostic decision when presented with complex cases?

    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.

    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.

  16. Is it possible to export and de-identify a record?

    Yes, please visit THIS PAGE for details.

  17. How can I arrange for Dr. Joseph A. Sandford to consult with me regarding an IVA-2 test?

    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.

  18. How does the IVA-2 handle malingering?

    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 adults aged individuals 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.

    Summary of additional factors to consider below:
    1. Was the client closely observed during the test? A clinician’s observations can possibly identified “faking bad” performance.
    2. This individual’s response to every test stimuli is recorded. An examiner can look for response patterns that may be unusual. It is an optional analysis provided in the IVA-2 called the “Trial Response Data.”
    3. Additional tests that specifically evaluate malingering are useful and appropriate based on the referral question or a clinician’s judgment.
    4. Any comprehensive evaluation will require clinical judgment based on the interview, self, parent and/or teacher rating scales and additional relevant tests.
    5. Medication may or may not be a possible first line intervention. In some cases therapy or cognitive training can be explored first.
    6. No diagnosis or determination of malingering should ever be made on the basis of any one test in isolation. All diagnoses are based on the clinical determination of the examiner based on a comprehensive evaluation.

    Please visit THIS PAGE for details.

  19. Where do I find the IVA-2 manual?

    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.

  20. How do I contact technical support if I have an issue?

    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.

  21. How were each of the IVA-2 sub-scales constructed i.e. prudence, stamina, focus, etc.?

    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.”

  22. What if the person tested does not identify as either male or female?

    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.

  23. How would someone compare scales on the IVA-2 with other psychological test measures?

    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.

  24. If an individual has suffered physical trauma and the brain tissue damage is primarily localized in the Frontal lobe, in general, how would this type of brain injury be reflected his IVA-2 test scores?

    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.

  25. How can the IVA-2 validity scale indicate valid when the person obtains a Standard Score of ZERO on the Sustained Attention scale?

    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.

  26. An IVA-2 test scale score was zero. Is this correct or a scoring error?

    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
    best effort?

    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.

  27. Balance nor Readiness scales are in the IVA-2 manual or Scale List. Is Balance still scored? Has it been changed to a different term?

    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.

  28. Can the IVA+Plus database be transferred to IVA-2?

    Yes. Please refer to THIS article on the Knowledge Base for instructions on how to transfer.

  29. How is the IVA-2 different from the IVA+Plus?

    Please refer to the Seven Key Features in the IVA-2 page.

  30. Is the IVA-2 test itself any different than the IVA+Plus test?

    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.

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