ADHD and TOVA

Factual Questions
1

Until a couple of years ago my now 17 year old daughter was consistently getting straight A’s for her schoolwork. More recently she has been getting the occasional B scattered in there as well. That would not be a big worry in itself, but now she has taken a couple of SATs (after a fair bit of privately paid for tutoring) and has really been bombing (at least in comparison to our expectations) on the test. She says it is not because of test anxiety, and I have not seen any signs to contradict that. If anything, she seems a bit too insouciant about the whole business. In fact, she has come back from the tests saying she feels she has done reasonably well, but the scores do not live up to that.

Yesterday my wife told me she had spoken to the director of the tutoring center about this, and he suggested that maybe our daughter is suffering from ADHD, and might benefit from getting this diagnosed, so she could retake the test under the special conditions provided for such people. I do not know how much direct contact this person has had with my daughter, I do not think he is the actual tutor, and I rather suspect he may just have been saying this to cover his ass. I have never seen anything to make me think she might have ADHD or any such problem, and I do not believe any of her regular teachers have ever suggested it. For her age, she is really very mature, well behaved, and responsible, although her younger sister (not an altogether unbiased source) has told me that at school she has a reputation for being a bit ditzy.

Anyway, my wife took this seriously, and spoke to our pediatrician, who mentioned the possibility of her taking a test called TOVA to diagnose ADHD. (It is not yet clear whether, or to what degree, this would be covered by our insurance.) I googled TOVA and found some rather conflicting opinions. This is the site that is selling the TOVA test. By contrast, this site (the second independent hit on Google) seems to think that it is absolutely useless quackery, very liable to give false positives. The Wikipedia page on TOVA has been marked by editors as lacking “neutral point of view.”

So, does anyone here have any knowledge or experience of TOVA, or of dealing with ADHD issues in general? If it is a reliable test (and does not cost us an arm and a leg) then I do not see much harm in her taking it. However, if it is not as reliable as advertized, I do not want my daughter to be falsely stigmatized as having ADHD, and perhaps start being pressured to get her medicated for it.

The site I noted above that is critical of TOVA - http://www.adhdtesting.org/ - actually seems to be critical of the whole concept of ADHD and from what I have seen of it so far the views expressed there are well written and coherently argued, and they appeal to my generally skeptical outlook. However, it is apparently a parent run site that deals with controversial children’s medical and psychological issues, which is the sort of thing that seems to provide the perfect environment for crankery to take root. I am a bit afraid that (despite superficial appearances) these people might be similar to the crazy anti-vaccine autism people, but I do not know enough about the issues to really judge. Does anyone here have a better grip on what is going on in this area?

Perhaps I should add that I can think of a couple of other possible reasons why my daughter may not be performing so well on her tests as she might ideally be capable of doing (though I am not sure what can practicably be done about them), so I am far convinced that ADHD is the problem. On the other hand, being fairly ignorant about it, I do not rule out the possibility altogether.

2

There is of course the general issue about whether or not ADD is a disorder or a variant of normal processing and the squishiness of the label at the edges under the best of circumstances. Some of that fuzziness is what you are reading. But let us, for this discussion, assume that ADD is a distinct “disorder” and that there is some level of it that warrants labeling it.

No single test, including the TOVA, is diagnostic of ADD. It is a clinical diagnosis based on meeting a variety of measures, most of which end up being quite subjective.

The circumstance which you describe is the toughest one in which to make that call. You are talking about someone who, from your description, if they have ADD, has ADD-I (Attention Deficit Disorder Inattention Predominant type) and who has been bright enough to compensate up to now.

This is an age in which the usual parent and inventory checklists become less useful and they are less clear for ADD-I even with younger children.

I would think that a TOVA, in such a circumstance, could be a useful bit of adjunctive information to a complete clinical picture in the hands of a skillful diagnostician. I would not use it alone as a diagnostic tool. I am in no way telling you what you should do, or givng you specific medical advice, but as a general pediatrician this is the sort of case that I would punt to a good neuropsychologist that I trusted rather than bandy about labels on my own, if it was felt that any label or intervention was needed at all. My job would be to make sure there was nothing else going on that mandated intervention. (From things like depression to a more traditional medical issue just turning up this way.)

3

I don’t know anything about TOVA, but I do know that ADHD is something you are born with, not something you acquire later in life. It’s possible she’s had it and it’s just becoming obvious now, but there are some pretty obvious symptoms.

Here’s what the DSM IV says about ADHD: http://www.turnertoys.com/ADHD/APA_diagCriteria.htm

I wouldn’t bother paying for a test if she doesn’t at least somewhat meet the criteria. Plus, if you have good insurance, you should be able to get an actual psychologist to do whatever test they want (though there may have to be an M.D. on staff.) Paying for a test that has to be graded by the company that makes it–it might be valid, but I’d trust the more conventional methods first.

Plus, $400 for a test just to maybe be able to take a different test (you didn’t mention any other problems)? That’s quite pricey. Not to mention that they sell laptops, too :confused:

4

Thanks. So far as I can judge she does not show any of the behaviors associated with ADHD on that DSM IV list, and there seems no reason to suspect depression or any other sort of chronic disease. Her only real “symptom” is unexpectedly poor performance on SAT tests, compared to her generally good performance at school (and fond parental hopes). I think my initial hypothesis, that the ADHD suggestion is just the test prep center director covering his ass, is looking stronger. I did think that if the TOVE was a fairly reliable quick test then it might be worth trying it, but from what DSeid is saying, that is not the case at all. Getting her involved in a big, lengthy and complex psychological assessment seems likely to do more harm than good unless we have much stronger reasons to suspect there is really a psychological problem.

That $400 is to buy the testing apparatus (program and some sort of hardware peripheral, even if you use your own computer), isn’t it? I presume what our pediatrician was suggesting to my wife was that the test be administered by some sort of medical professional. Like I said, I do not know how we would stand for that with our insurance.

5

Presumably she’s taken other standardized tests before this - has she had trouble with those?

6

Huh? Pediatricians “test” for ADHD/ADD at no extra charge. It’s basically a questionaire of ADHD behaviors. If you don’t see those behaviors yourself, then it’s probably not ADHD, particularly since her grades are so good in general. If you haven’t ever noticed ADHD/ADD behaviors up to now, it sounds like BS. Mostly A’s with occasional B’s doesn’t seem to point towards ADHD.

My kid goes to a little-known (but nationwide) tutoring center recommended by a poster here, and I’ve been extremely impressed with the results (*not *Kumon or Sylvan). There are a bunch of teens going for their ACT/SAT prep. If you’re interested, let me know.

7

I have two sons who are ADHD. The oldest was on medication for his situation. Otherwise, he’d probably have been kicked out of school. He really couldn’t focus and stay on task (he was also has Asperger syndrome which complicated the situation.)

My other son was also diagnosed as ADHD. However, he does quite well in school. He isn’t very organized, but tries hard, is very friendly and understanding, and bright. We talked about possibly giving him medication, but decided against it because he was doing well in life despite his issues, and the side effects from the medication might simply make things worse.

It is possible your daughter is like my second son: She’s very bright and is able to function well in school despite her ability to focus and organize remains somewhat affected by her possible diagnosis.

Then again, some kids don’t do well on multiple choice tests. My sister, who graduated Sigma Phi Kappa from the honors section of her college did very poorly on her SAT. She also officially has a borderline IQ. Yet, anyone who meets her would immediately realize she is an extremely capable and intelligent person. She simply is incapable of taking standardized tests. Give her an essay test, and she’s a wiz. Ask whether an Apple is to a shoe: A). As book is to a bird, B). As a hat is to a weasel, C). All of the above, or D). None of the above, and she simply freezes up.

My question would be this: Would giving your daughter more time help her on her SATs? If she is struggling to complete the test, the extra time might help. However, if she is walking out of the test filled with confidence about her grade, it doesn’t sound like she’s struggling with completing the test. Giving her more time to go over her answers might actually backfire. She could end up changing correct answers into incorrect answers.

My youngest son did get extra time on the SAT. Along with the ADHD, he is also learning disabled and has problems with writing. He needed the extra time because writing takes him much longer than most people. He gets time and a half for tests he takes in school. He knows the answers, he simply can’t write as fast. If he didn’t get extra time, he would have told me “I know all the answers, I just didn’t have enough time to write them down.”

It doesn’t sound like your daughter is having these types of issues.

However, it might be good to get your daughter evaluated not just for ADHD, but for other possible disabilities. If she has either LD or ADHD, she might be reaching the limit of her coping skills as she begins to enter college. Besides, college is a very different environment from high school. Many kids who did well in high school find themselves struggling with the new responsibilities. And, if your daughter does show she has LD or ADHD issues, she might find that she might need to look into a different sort of set of colleges and universities. For example, children with ADHD and LD might do better in smaller college settings rather than a large state college.

I can’t say much about the TOVA tests. However, as a student, your daughter has a right to be tested by the state for possible learning issues and to have an IEP drawn up which gives her certain legal rights. It is better if this is done in high school rather than college.

I have another son who was never diagnosed with ADHD. However, in retrospect it appears he has a slight learning disability. He is extremely intelligent, but was a mere B/B+/A- student in school. (Unlike his brothers who mainly got only As). He is extremely well organized and does pretty well in other aspects of his life. He wasn’t the academic his brothers are.

Now, he’s in college and has to take 1 1/2 years of a foreign language. He spent 12 years in elementary school in Hebrew, but unlike his two brothers, never really picked it up. (If he did, he could get out of the language requirement). He has tried several language courses in college, but almost immediately finds himself falling behind and getting lost. Unfortunately, since he was never classified with a learning disability in high school, he is having more problems getting classified in college which would allow him to get around the language requirement.

So, if you think your daughter might possibly have any sort of learning disability – be it dyslexia, dyscalcula, dysgraphia, ADHD, Asperger syndrome, or anything else – get her diagnosed in high school rather than waiting for college. This would be true even if it giving her extra time on the SAT would not help. It is her right and the school will pay for the evaluation.

8

From what you’re describing, it doesn’t seem like your daughter had ADHD, because it doesn’t appear that she meets criteria B, C, or D in BigT’s link to the DSM-IV diagnostic criteria. It’s unfortunate that the tutoring guy made this suggestion, as bullshit suggestions like this only serve to 1) delay figuring out what’s going on with your daughter and 2) cheapen the diagnosis for those people who really do have the disorder.

9

In all fairness to the tutoring guy, his job is not to educate the stuudent, his job is to get the student better SAT scores. If gaming the system to give the daughter extra time on the test works, his work is done.

10

My daughter took the TOVA twice and both times it came back as not-ADHD. So, we definitely didn’t see a false positive.

Thing is, her behavior is VERY ADHD-like. One practitioner suggested that it doesn’t adjust for the child’s intelligence-level (my daughter tests out as extremely bright).

11

This is actually touching a problem that has been covered by ABC’s 20/20 and CBS’s 60 Minutes

Parents are using ADHD and other such things to allow their kids to take SATs and other testing under more favourable conditions. Since there is no definitive test, all a parent does is have to look hard enough (or pay enough) to get a diagnosis.

Now I certainly am not saying this is the case with the OP but that a current controversy.