Clinicians are responsible for the the validity of the test results. Testing guidelines and test interpretation are not considered by BrainTrain to be valid unless the test administration is supervised by the clinician. There is a comprehensive set of test administration procedures specified in the manual that need to be followed in order for the test results to be valid. For example, test takers must keep their finger positioned over the leftmost mouse button throughout the test and if it is removed then they need to be redirected to place their finger back on the mouse button. Consequently, BrainTrain recommends that clinicians actively supervise and visually observe test takers’ behavior during the entire test both in the office and during remote testing. Parents can assist in remote testing, but will need to be instructed and supervised by the clinician in order to validly administer the test.
More information and guidelines for administering the test remotely can be found at https://www.braintrainhelp.com/remote-testing-device-for-iva-testing/
When running the test remotely, are there any concerns about connection speed or connectivity drops?
With both the Web/Chrome and the iPad remote test versions, all timings are run locally on the device and then uploaded at the end of the test. Thus, internet speed or interruptions in connection do not affect the timing or variability of responses. Additionally, both the remote tests and Windows IVA-2 programs have Timing Checks built in so that clinicians can make sure that the devices are recording responses within the appropriate range.
Is the RTL-I is an effective and reliable testing measure?
Before releasing the remote versions of the IVA test programs, BrainTrain performed extensive internal timing tests to insure that the response times between Web, iPad and Windows versions did not differ in order to assure that test scores did not differ. The reliability and accuracy of test scores requires that web versions be administered using the Chrome browser and completed on either Window 10 or Mac PCs. All of the different types of iPads were confirmed to be reliable and consistent in respect to test response times.
In the test timing evaluation procedures, an automated, electronically controlled mouse was used which responds to light (the visual stimulus) or sound (the auditory stimulus). This automated mouse was used to control for the natural variability that inherently occurs in human subject responses. For example, the automated mouse does become fatigued or attempt to anticipate a response like a human tester may do. Thus, it was possible to accurately measure and correct for any observed differences in timing between different test configurations that controlled for the potential timing irregularities.
Timing comparisons were completed for remote testing using the following device and operating system configurations:
As for timing comparisons between the Remote tests and the desktop/Windows application, BrainTrain performed internal testing on the following platforms:
BrainTrain completed statistical tests across the different OS versions and devices that confirmed for all of the above listed configurations no significant differences existed in respect to any timing issues. Periodically, BrainTrain retests new OS and hardware configurations in order to identify any issues that may need to be addressed.
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.
The first time the system is run, it will ask you to create a system password protect the IVA 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 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.
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.
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.
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.
Yes, please visit THIS PAGE for details.
Dr. Sandford is willing upon request to provide professional consultations to health care professionals regarding the interpretation of the IVA test results within a comprehensive evaluation. However, he recommends that the interested party first consider completing an IVA 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 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 the IVA, 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.
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.
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.