Ladies and Gentlemen, Your Attention Please: The TOVA Company

A PSBA company gives medical professionals access to objective measures of attention

Female participant using the T.O.V.A instrument
The T.O.V.A in action: users must identify whether the screen shows a target or non-target image

In a rapidly developing world where we owe more and more of our lives’ ease and convenience to technology, focusing our attention may be harder than ever. Studies have shown that as available stimuli increase, there may be a connection between such things as internet use or digital screen time and attention problems such as attention deficit hyperactive disorder (ADHD). 

The TOVA company seeks to leverage technology to help schools and medical professionals diagnose such disorders and empower scientists in their research on attention-related topics. To date, the company’s patented T.O.V.A. instrument (Test of Variables of Attention) has been cited in over 260 peer-reviewed articles and used in clinics the world over.  

Perfected over 60 years, the T.O.V.A. is a gold-standard continuous performance test - an objective measure of attention able to capture a user’s response to stimuli on a millisecond level. Built to focus explicitly on attention, the test’s design is simple, low-stimulus, and, according to CTO - Andrew Greenberg, “purposefully boring.” Stripped of any use of language to ensure that it is culturally-neutral and accessible to users regardless of cognitive ability, the instrument can test users as young as four and as old as 90 and is currently in use in over 20 countries.

A portrait of Andrew Greenberg, the CTO of the TOVA company and an adjunct professor at PSU
Andrew Greenberg, CTO of the TOVA Company and adjunct professor at PSU

The T.O.V.A. is an extremely simple task. Every two seconds, one of two different squares will flash on the screen. If it is the correct "target" square, users will press down on a microswitch to register their response. If it is a "non-target" square, users are asked not to respond. Missing the target counts as an error of omission, which is a measure of inattention. Responding to a non-target is an error of commission and registers instead as a measure of impulsivity. Both inattention and impulsivity are associated with disorders like ADHD.

In addition to recording the presence or absence of a response, the T.O.V.A. also tracks a user’s response speed and compares it against the thousands of others drawn from its vast database of normative studies. As it so often turns out – timing is everything. 

“Yes, the test records how many you miss and how many you accidentally click on – but it’s the response time that makes the difference,” says Greenberg. Whereas individuals without attention issues will filter out distractions and produce consistent, quick responses, it turns out that those with attention deficits will not. 

“Because they are constantly snapping in and out of attention on a millisecond time scale, their results appear as a smeared out histogram, very broad and without a well defined peak in the bell curve,” says Greenberg. Due to its unique design, the T.O.V.A. can capture this crucial information with incredible precision, setting it apart from all other continuous performance tests used today which are unable to provide accurate timings.

Recently, the TOVA Company was tapped by the FDA to register their neuropsychological instrument as a certified medical device, opening the company to a new world of opportunities. The company also obtained a CE mark, which allows TOVA to sell their devices in the European Union. TOVA’s new designation also created a new customer base within the medical community. In addition to private psychiatrists and psychologists who use the T.O.V.A. for medical diagnoses, pharmaceutical companies now readily use their devices to run clinical trials and test new attention deficit medication.

The TOVA company’s research and development department has been a longstanding tenant of the Portland State University Business Accelerator (PSBA). Greenberg credits the PSBA for helping the company grow from its humble beginnings to a small but profitable business that is now segmenting its market and able to navigate the FDA’s extensive set of regulations and requirements. “It has greatly helped to sharpen our business practices, says Greenberg. “Our interactions with other companies at the Accelerator have been extraordinarily important.” Over the course of their ten years embedded within the PSU community, TOVA has also partnered with PSU’s math department and has sponsored capstone projects in the mechanical engineering department as well.

Looking forward, Greenberg anticipates that the TOVA company will continue to break new ground in the coming year. As studies have emerged out of China, more and more seem to suggest that significant neurological effects may accompany severe infections of COVID-19. If this is true, the T.O.V.A. may be able to help measure some portion of that impact. “Could attention be a secondary cost to the COVID Pandemic? I think the answer is yes,” says Greenberg. It is likely that as scientists continue to try to understand the full impact of COVID, that they will turn to the T.O.V.A. to assist in their research.