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Tower of London-Drexel University (TOLDX): 2nd Edition
Availability
Please visit this website for more information about the instrument: Tower of London-Drexel University 2nd Edition
Classification
Supplemental: Mitochondrial Disease (Mito)
Short Description of Instrument
TOLDX is designed to assess higher-order problem solving (i.e., executive planning abilities) in children and adults. Aspects of executive planning and problem solving that are assessed include move test performance, rule adherence, and temporal efficiency.
Comments/Special Instructions
TOLDX is sensitive to the following neuropsychological functions:
  • Executive problem solving and planning

  • Behavioral inhibition and impulse control

  • Attentional allocation

  • Cognitive flexibility

  • Abstract/conceptual reasoning

  • Rule-governed behavior  

  • Monitoring

 
Scoring and Psychometric Properties
Scoring: Normative data available for nonclinical children and adults aged 7 to 80 years. Clinical group data is available for children with Attention-Deficit/Hyperactivity Disorder (ADHD) and individuals with Parkinson's disease.
 
Specific scores include total moves, total correct, total rule violations, total time violations, total initiation time, total execution time, total problem-solving time, and total stimulus bound score.
 
Psychometric Properties:
  • Scores exhibit age progression with older children and adults demonstrating greater executive planning proficiency than younger examinees. These findings are consistent with other studies of executive functions.

  • Test-retest reliability for a sample of ADHD children 7 to 10 years of age over an average 20-day interval was acceptable for move and time violation scores with moderate to high correlation scores.

  • Criterion-related validity: Highly significant intercorrelations were found between the TOLDX and other executive measures for young adults and ADHD samples. Compared to children with ADHD, neurotypical children demonstrated more proficient planning performance with fewer problem-solving moves, time violations, and rule violations.

Factor analysis of TOLDX performance of ADHD children supported a 4-factor model with highest loading of executive measures.
Rationale/Justification
Strengths: Provides insight on executive planning skills that may translate to functioning in daily life tasks that involve complex problem solving, planning, organization, meeting demands, and following rules.
References
Key References:
Culbertson WC, Zillmer EA. Tower of London-Drexel University, second edition (TOLDX). Toronto, Canada: Multi-Health Systems; 2005.
 
Culbertson WC, Zillmer EA. The Tower of London(DX): a standardized approach to assessing executive functioning in children. Arch Clin Neuropsychol. 1998 Apr;13(3):285-301.
 
Culbertson WC, Zillmer EA. The construct validity of the Tower of LondonDX as a measure of the executive functioning of ADHD children. Assessment. 1998 Sep;5(3):215-26.
 
Additional References:
 
Donders J, Larsen T. Clinical utility of the Tower of London--Drexel University, Second Edition (TOLDX) after adolescent traumatic brain injury. Dev Neuropsychol. 2012;37(4):333-42.
 
Krishnan M, Smith N, Donders J. Use of the Tower of London - Drexel University, Second Edition (TOLDX) in adults with traumatic brain injury. Clin Neuropsychol. 2012;26(6):951-64.
 
Riccio CA, Wolfe ME, Romine C, Davis B, Sullivan JR. The Tower of London and neuropsychological assessment of ADHD in adults. Arch Clin Neuropsychol. 2004 Aug;19(5):661-71.
 
Document last updated March 2024