Two new studies published in Psychological Assessment sought to gauge the medical community’s ability to identify people who feign symptoms of adult attention-deficit/hyperactivity disorder (ADHD) to obtain stimulant drugs and classroom accommodations. These persons, often called malingerers, are a growing concern.
In one study, Maryanne Edmundson, PhD, of the Minneapolis VA Healthcare System in Minnesota, and colleagues studied the ability of nonclinical college students to fake symptoms of ADHD both with and without coaching.1
The study involved two groups without ADHD—a nonclinical, coached group and a nonclinical, uncoached group—and an honest-responding group with diagnosed ADHD. A nonclinical, honest-responding group of participants without ADHD was added as an experimental manipulation check.
All participants received several performance validity tests (PVTs), self-report inventories of ADHD symptoms, and standard neuropsychological tests.
Participants underwent individual evaluation by two examiners. The first examiner completed pre- and post-test measures, as well as a debriefing to gauge whether the participants understood and followed instructions. The second examiner was blinded and administered the tests. Each session lasted approximately 3.5 to 4 hours, including regular breaks.
Results showed that coaching did not have a significant effect on how well a participant feigned ADHD symptoms, and that performance validity tests were only moderately effective at detecting nongenuine ADHD symptoms.
“Even noncoached, nonclinical college students produced results on the CAARS [Conners’ Adult ADHD Rating Scale, Self-Report, Long Form] that were not markedly different from those in the ADHD group,” the authors wrote. “Further, the coached malingering group was not significantly different from the noncoached group on this measure.”
In another study, Shannon T. Smith, PhD, of the Department of Psychology, Francis Marion University, Florence, SC, led a study to test the ability of the Personality Assessment Inventory (PAI) to distinguish between college students with genuine ADHD symptoms and those who were instructed to present with symptoms for secondary gain.2
Sixty-six participants who had successfully simulated ADHD symptomology on the CAARS scale were compared with a sample of students who met the diagnostic criteria for ADHD and a sample of adults who were diagnosed with ADHD following a comprehensive evaluation.
Participants who posed as malingerers were given explicit instructions to try to beat the test by faking symptoms of ADHD. If these participants succeeded, they would receive a cash prize. If they were not successful, they were told they would not receive the prize. However, each participant was given the prize regardless of the results.
Results showed that those who were successful at faking symptoms scored significantly higher on all relevant PAI validity indicators compared with both groups of patients with ADHD.
The scores in the ADHD simulation group were typically two standard deviations above the community normative mean. In contrast, the students who met ADHD criteria and the archival sample scored between average and one standard deviation above the mean.
“The PAI may be informative as an indicator of potentially exaggerated or malingered symptom presentation,” the authors wrote, “but alternative cut scores for symptom validity indicators may be necessary to maximize its utility in these particular types of psychological evaluations.”
The combined results of these studies may indicate that symptom exaggeration should be investigated to avoid malingerers obtaining ill-gotten gains. To read more about these studies, click here and here.
- Edmundson M, et al. Psychol Assess. 2017;29(12):1429-1436.
- Smith ST, et al. Psychol Assess. 2017;29(12):1447-1457.