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Detecting Symptom Exaggeration in College Students Seeking ADHD Treatment: Performance Validity Assessment Using the NV-MSVT and IVA- Plus Detecting Symptom Exaggeration in College Students Seeking ADHD Treatment: Performance Validity Assessment Using the NV-MSVT and IVA-Plus

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Abstract

The symptoms of ADHD are highly subjective, and there is ample empirical evidence that demonstrates the ease with which impairments in attention can be feigned on many commonly used subjective and objective measures of attention. We examined the combination of two assessment measures, NV-MSVT and IVAþ, to screen for performance validity and ADHD symptoms in college students. Results indicated that the NV-MSVT was effective in differentiating between students with potential high impairment, such as ADHD, and possible malingerers. In addition, in vivo clinical data (N ¼ 350) resulted in lower validity cutoff scores on the IVAþ than had been previously suggested. Clinical implications and future research are also discussed.

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... Later studies focused mainly on the Conners' CPT (Lee, Pella, Singh, & Drew, 2010;J. A. Suhr, Sullivan, & Rodriguez, 2011), though some studies were performed on other CPTs (e.g., Test of Variables of Attention [TOVA], Quantified Behavior Test Plus [Qb+] and the IVA-CPT; Hirsch & Christiansen, 2018;Leppma, Long, Smith, & Lassiter, 2018;Robinson & Rogers, 2017). These studies provide initial support for the use of CPTs in differentiating between feigned and genuine ADHD. ...
... These studies provide initial support for the use of CPTs in differentiating between feigned and genuine ADHD. For example, Lee et al. (2010) found that college students simulating ADHD had lower mean scores and more scale elevations in the Conners' CPT than controls (see also Leark et al., 2002; Leppma et al., 2018). At least some studies, however, pointed toward unacceptably high false-positive rates (Robinson & Rogers, 2017) or insufficient discriminative capacity of CPTs in detecting feigned ADHD. ...
... Regarding the latter, the noncredible group examinees in J. A. Suhr et al. (2011) differed from genuine ADHD patients on only two subtests of the Conners' CPT-II (see also Sollman, Ranseen, & Berry, 2010). Importantly, several of these studies have limitations that include lack of a clinical ADHD patient group ( Leark et al., 2002), inclusion of participants who did not yet have definitive ADHD diagnoses ( Leppma et al., 2018), or reliance on previously provided diagnoses (i.e., possibly contaminating the ADHD group with malingerers, for example, Sollman et al., 2010). Finally, a substantial number of studies were conducted on neuropsychiatric disorders other than ADHD, thus making conclusions regarding the detection of feigned ADHD difficult (e.g., Erdodi, Pelletier, & Roth, 2018;Sharland et al., 2018). ...
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Objective: The objective of this study was to assess the MOXO-d-CPT utility in detecting feigned ADHD and establish cutoffs with adequate specificity and sensitivity. Method: The study had two phases. First, using a prospective design, healthy adults who simulated ADHD were compared with healthy controls and ADHD patients who performed the tasks to the best of their ability ( n = 47 per group). Participants performed the MOXO-d-CPT and an established performance validity test (PVT). Second, the MOXO-d-CPT classification accuracy, employed in Phase 1, was retrospectively compared with archival data of 47 ADHD patients and age-matched healthy controls. Results: Simulators performed significantly worse on all MOXO-d-CPT indices than healthy controls and ADHD patients. Three MOXO-d-CPT indices (attention, hyperactivity, impulsivity) and a scale combining these indices showed adequate discriminative capacity. Conclusion: The MOXO-d-CPT showed promise for the detection of feigned ADHD and, pending replication, can be employed for this aim in clinical practice and ADHD research.
... The relevance of this issue was emphasized by findings of noncredible reporting of both ADHD symptoms and cognitive performance in 15 to 48% of young adults, in particular college students, who presented for clinical evaluation of ADHD (Harrison & Edwards, 2010;Marshall et al., 2016;Sullivan, May, & Galbally, 2007). A large number of studies have used performance validity tests (Edmundson et al., 2017;Fuermaier, Tucha, Koerts, Grabski, et al., 2016;Harrison, Rosenblum, & Currie, 2010;Jasinski et al., 2011;Leppma, Long, Smith, & Lassiter, 2017;Morey, 2017;Sollman, Ranseen, & Berry, 2010;Suhr, Hammers, Dobbins-Buckland, Zimak, & Hughes, 2008) or validity indicators of personality assessment inventories (Aita, Sofko, Hill, Musso, & Boettcher, 2017;Musso, Hill, Barker, Pella, & Gouvier, 2016;Smith, Cox, Mowle, & Edens, 2017) in order to detect possible noncredible performance of adults being clinically evaluated for ADHD. The vast majority of these studies revealed mostly a moderate usefulness with high specificity but often low sensitivity. ...
... Promising candidates are variants of the Continuous Performance Test (CPT), a test that is frequently used in neuropsychological practice for the assessment of vigilance and sustained attention of adults with ADHD (Avisar & Shalev, 2011;Epstein, Conners, Sitarenios, & Erhardt, 1998;Huang-Pollock, Karalunas, Tam, & Moore, 2012;Marchetta, Hurks, De Sonneville, Krabbendam, & Jolles, 2008;. In the context of performance validity assessment, the CPT has been found helpful in distinguishing individuals with genuine ADHD from those simulating the disorder (Booksh et al., 2010;Leppma et al., 2017;Quinn, 2003), although it must be noted that the value of CPTs for the assessment of performance validity has not been supported by all studies (Sollman et al., 2010;Suhr, Sullivan, & Rodriguez, 2011). When considering these findings, it can be concluded that routine neuropsychological tests have the potential to support the assessment of credibility of individuals being evaluated for adult ADHD; however, when used as the only effort measure, such tests are likely not sensitive enough to identify genuine ADHD with sufficient accuracy (Marshall et al., 2016;Musso & Gouvier, 2014;Tucha et al., 2015). ...
... Instructed simulators showed overly poor performance on this test compared to genuine patients with ADHD, as indicated by significant differences in omission errors, commission errors, and reaction times, with effects reaching up to moderate and even large size (according to the classification devised by Rogers). ROC analyses revealed adequate predictive accuracy (AUC about 80%) on the basis of omission errors and reaction times, which is in line with previous research that highlighted the promising use of CPTs for the detection of noncredible cognitive performance in the clinical evaluation of adult ADHD (Booksh et al., 2010;Leppma et al., 2017;Quinn, 2003). However, contrary to our expectations, the measurement of motor activity failed to show clinical utility in distinguishing genuine from feigned ADHD, as only one of the group differences reached relevance according to the classification devised by Rogers. ...
Article
Objectives: Several approaches, ranging from self-ratings of symptoms and impairments to objective neuropsychological testing, have been utilized during clinical evaluation in order to assess symptom and performance validity of individuals with attention-deficit/hyperactivity disorder (ADHD) in adulthood. Motor activity has not been considered yet in this context, which is surprising given that hyperactivity is a prominent characteristic of ADHD. Hence, the goal of the present study was to explore the incremental value of motor activity when assessing the credibility of individuals with adult ADHD at clinical evaluation. Method: Forty-six patients diagnosed with ADHD took part in the study. A simulation design was performed, in which 152 healthy individuals were allocated to either a control condition (n = 36) or one of three simulation conditions (n = 116), the latter requesting participants to feign ADHD. All participants completed a self-rating scale of cognitive functioning and performed a computerized test for vigilance. Body movements were recorded during vigilance testing via a motion tracker attached to the back of the participant’s chair. Results: Patients with ADHD reported significantly more pronounced cognitive complaints and performed significantly poorer on the vigilance test than control participants. Simulators of ADHD, as compared to genuine patients, showed excessively low performance on the vigilance test. However, neither self-ratings of cognitive functioning nor measures of motor activity were suitable to distinguish genuine from feigned ADHD. A hierarchical logistic regression model showed that motor activity had no incremental value in detecting feigned ADHD when vigilance test performance has already been considered. Conclusions: Standard neuropsychological tests of vigilance may be useful to measure both performance and credibility of individuals with adult ADHD at clinical evaluation. In contrast, self-reports of symptoms and impairments, as well as measures of body movements, may not support the assessment of credibility in this context.
... Many ADHD-focused SVTs have been developed and show promise in clinical assessment (e.g., Courrege et al., 2019;Harrison et al., 2019;Musso & Gouvier, 2014;Suhr et al., 2011). Unfortunately, while some work has emphasized PVTs in this context (e.g., Frazier et al., 2008;Harrison & Armstrong, 2020;Leppma et al., 2018;Sollman et al., 2010), additional research is needed in this regard in line with recommendations for clinicians to "include performance validity measures in their assessment for ADHD" (Suhr et al., 2017, p. 158). ...
Article
Clinicians who evaluate patients with concerns related to attention-deficit/hyperactivity disorder (ADHD) are encouraged to include validity indicators throughout clinical assessment procedures. To date, no known previous literature has examined the Wisconsin Card Sorting Test (WCST) specifically to address noncredible ADHD, and none has attempted to identify an embedded PVT within the 64-card version. The present study sought to address these gaps in the literature with a simulation study. Sixty-seven undergraduate participants (M age = 19.30) were grouped as credible (combining healthy controls and individuals with ADHD) or noncredible (combining coached and uncoached participants simulating ADHD-related impairment) and administered a battery of neuropsychological tests. Results revealed the noncredible group performed significantly worse on several WCST-64 variables, including failure to maintain set, number of trials to first category, and total categories. Raw scores from these variables were entered as predictors as one set in a logistic regression (LR) with group membership as the outcome variable. An exponentiated equation (EE) derived from LR results yielded acceptable discriminability (area under receiver operating characteristic curve = .73) with modest sensitivity (.38) while maintaining ideal specificity (.91), generally commensurate with a standalone forced-choice memory PVT and better than an embedded attention-based PVT. These findings suggested the WCST-64 may be sensitive to noncredible performance in the context of ADHD and reiterates the importance of considering tests of various cognitive abilities in the evaluation of performance validity. Implications of these findings, limitations of the present study, and directions for future inquiry, including cross-validation in clinical samples, were discussed.
... Specifically, if ADHD is characterized by deficits in sustaining attention, one would expect that the performance of participants with ADHD declines more over time as compared to that of participants without ADHD. Second, many studies did not report mean RTs and/or accuracy, but reported measures derived from experimental data that were provided by test makers (e.g., Leppma, Long, Smith, & Lassiter, 2017;Moreno-García, Delgado-Pardo, & Roldán-Blasco, 2015;Tinius, 2003). This made it impossible for us to determine how the results from these studies relate to the findings from other studies. ...
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Computational models, in conjunction with (neuro)cognitive tests, are increasingly used to understand the cognitive characteristics of participants with attention-deficit hyperactivity disorder (ADHD). We reviewed 50 studies from a broad range of cognitive tests for ADHD to synthesize findings and to summarize the new insights provided by three commonly applied computational models (i.e., diffusion decision models, absolute accumulator models, ex-Gaussian distribution models). Four areas are discussed to improve the utility of (neuro)cognitive testing for ADHD: 1. the requirements for appropriate application of the computational models; 2. the consideration of sample characteristics and neurophysiological measures; 3. the integration of findings from cognitive psychology into the literature of cognitive testing to reconcile mixed evidence; and 4. future directions for the study of ADHD endophenotypes. We illustrate how computational models refine our understanding of cognitive concepts (slow processing speed, inhibition failures) presumed to characterize ADHD. We also show that considering sample characteristics and integrating findings from computational models and neurophysiological measures provide evidence for ADHD endophenotype-specific cognitive characteristics. However, studying the cognitive characteristics of ADHD endophenotypes often lies beyond the scope of existing research due to three reasons: some cognitive tests lack sensitivity to detect clinical characteristics; analysis methods do not allow the study of subtle cognitive differences; and the pre-categorization of participants restricts the study of symptom severity on a continuous spectrum. We provide recommendations for cognitive testing, computational modeling and integrating electrophysiological measures to produce more valuable tools in research and clinical practice (above and beyond the research domain of ADHD).
... Efforts made to detect feigned ADHD have gone beyond self-report measures and clinical interviews to examine the utility of personality inventories (Aita, Sofko, Hill, Musso, & Boettcher, 2017;Butcher, 2009;Morey, 1991;Musso, Hill, Barker, Pella, & Gouvier, 2016;Smith, Cox, Mowle, & Edens, 2017;Young & Gross, 2011), cognitive tests as they are employed in routine neuropsychological examinations ( Conners et al., 2000;Fuermaier et al., 2018;Morey, 2016Morey, , 2017Quinn, 2003;Suhr, Sullivan, & Rodriguez, 2011), as well as symptom validity tests developed specifically to uncover feigned cognitive impairment (Edmundson et al., 2017;Fuermaier, Tucha, Koerts, Aschenbrenner, & Tucha, 2017a ;Green, 2003Green, , 2008Leppma, Long, Smith, & Lassiter, 2017) in detecting simulated ADHD. While these efforts have yielded promising results, evidence warranting the use of any single instrument in the detection of aggravated or simulated symptoms is yet lacking. ...
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Introduction: The Structured Interview of Reported Symptoms (SIRS-2) utilizes various strategies in the detection of simulated psychiatric disorders. The present study aimed to examine which of these strategies proves most useful in uncovering feigned attention deficit hyperactivity disorder (ADHD) in adulthood. Method: One-hundred seventy-one individuals instructed to feign ADHD were compared to 46 genuine patients with ADHD as well as 99 neurotypical controls in their reports provided on the SIRS-2. Results: Responses provided by simulators resembled those of genuine patients with ADHD on all SIRS-2 subscales with the exception of a supplementary scale tapping Overly Specified symptom reports, where a moderate effect emerged (d = 0.88). Classification accuracy remained low, with particularly poor sensitivity (sensitivity = 19.30%). Sensitivity was higher when the decision rules postulated in the first edition SIRS were applied instead of its successor’s decision model, yet this increase in sensitivity came at the price of unacceptably low specificity. Conclusion: The present results call for a disorder-specific instrument for the detection of simulated ADHD and offer starting points for the development of such a tool.
... In addition, since the symptoms were subjective, it was possible to have people seeking for treatment without truly suffering from ADHD. They could be seeking for benefits believed to be related to psychotropic drugs (Leppma, Long, Smith, & Lassiter, 2017). ...
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Aim The aim of this study is to determine the possible links between attention-deficit hyperactivity disorder (ADHD) and the presence of concomitant addictions with or without substance use in a French student population. Measures A battery of questionnaire measuring socioeconomic characteristics, university curriculum, ADHD (Wender Utah Rating Scale and Adult ADHD Self-Report Scale), substance consumptions (alcohol, tobacco, and cannabis), and behavioral addictions [(eating disorders (SCOFF)], Internet addiction (Internet Addiction Test), food addiction (Yale Food Addiction Scale), compulsive buying (Echeburua's), and problem gambling (The Canadian Problem Gambling Index)] and measures of physical activity (Godin's Leisure Time Exercise Questionnaire) was filled up by university students in Rouen and Nanterre in France. Results A total of 1,517 students were included (472 from Paris Nanterre and 1,042 from Rouen). The mean age was 20.6 years (SD = 3.6) and the sex ratio male to female was 0.46. The prevalence of ADHD among the students (current ADHD with a history of ADHD in childhood) was 5.6%. A quarter (25.7%) of students had already repeated their university curriculum, compared to 42.2% among the students with ADHD. Students with possible ADHD had repeated classes more often and believed to have a lower academic level than the students without ADHD. Significant differences were found as students with ADHD were less likely to succeed in their studies (repeated classes more often) than non-ADHD students, and considered their academic level to be lower. They also had significantly higher scores on substance (alcohol, cannabis, and tobacco) as well as behavioral addictions (gambling, compulsive buying disorder, eating disorders, and Internet addiction). Conclusion It seems essential to determine students' problems and propose interventions adapted to students' needs, in order to reduce the negative impact on their future academic and global successes.
... In addition, since the symptoms were subjective, it was possible to have people seeking for treatment without truly suffering from ADHD. They could be seeking for benefits believed to be related to psychotropic drugs (Leppma, Long, Smith, & Lassiter, 2017). ...
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Aim: The aim of this study is to determine the possible links between attention-deficit hyperactivity disorder (ADHD) and the presence of concomitant addictions with or without substance use in a French student population. Measures: A battery of questionnaire measuring socioeconomic characteristics, university curriculum, ADHD (Wender Utah Rating Scale and Adult ADHD Self-Report Scale), substance consumptions (alcohol, tobacco, and cannabis), and behavioral addictions [(eating disorders (SCOFF)], Internet addiction (Internet Addiction Test), food addiction (Yale Food Addiction Scale), compulsive buying (Echeburua's), and problem gambling (The Canadian Problem Gambling Index)] and measures of physical activity (Godin's Leisure Time Exercise Questionnaire) was filled up by university students in Rouen and Nanterre in France. Results: A total of 1,517 students were included (472 from Paris Nanterre and 1,042 from Rouen). The mean age was 20.6 years (SD = 3.6) and the sex ratio male to female was 0.46. The prevalence of ADHD among the students (current ADHD with a history of ADHD in childhood) was 5.6%. A quarter (25.7%) of students had already repeated their university curriculum, compared to 42.2% among the students with ADHD. Students with possible ADHD had repeated classes more often and believed to have a lower academic level than the students without ADHD. Significant differences were found as students with ADHD were less likely to succeed in their studies (repeated classes more often) than non-ADHD students, and considered their academic level to be lower. They also had significantly higher scores on substance (alcohol, cannabis, and tobacco) as well as behavioral addictions (gambling, compulsive buying disorder, eating disorders, and Internet addiction). Conclusion: It seems essential to determine students' problems and propose interventions adapted to students' needs, in order to reduce the negative impact on their future academic and global successes.
... Patients can malinger very different symptoms, such as pain, disorientation, depression, lack of concentration, personality changes, or memory loss (Iverson, 2003;Leppma, Long, Smith, & Lassiter, 2017). Memory malingering is commonly used, for instance, to obtain monetary compensation (Oorsouw & Merckelbach, 2010;Porter & Woodworth, 2006;Simões, 2006). ...
Article
Evaluating performance validity is essential in neuropsychological and forensic assessments. Nonetheless, most psychological assessment tests are unable to detect performance validity and other methods must be used for this purpose. A new Performance Validity Test (DETECTS – Memory Performance Validity Test) was developed with several characteristics that enhance test utility. Moreover, precise response time measurement was added to DETECTS. Two groups of participants (normative and simulator group) completed DETECTS and three memory tests from the Wechsler Memory Scale III. Simulators achieved considerably lower scores (hits) and higher response times in DETECTS compared with the normative group. All participants in the normative group were classified correctly and no simulator was classified as having legitimate memory deficits. Thus, DETECTS seems to be a valuable computerized Performance Validity Test with reduced application time and effective cut-off scores as well as high sensitivity, specificity, and positive and negative predictive power values. Lastly, response time may be a very useful measure for detecting memory malingering.
Article
Objective: Base rates of invalidity in forensic neuropsychological contexts are well explored and believed to approximate 40%, whereas base rates of invalidity across clinical non-forensic contexts are relatively less known. Methods: Adult-focused neuropsychologists (n = 178) were surveyed regarding base rates of invalidity across various clinical non-forensic contexts and practice settings. Median values were calculated and compared across contexts and settings. Results: The median estimated base rate of invalidity across clinical non-forensic evaluations was 15%. When examining specific clinical contexts and settings, base rate estimates varied from 5% to 50%. Patients with medically unexplained symptoms (50%), external incentives (25%-40%), and oppositional attitudes toward testing (37.5%) were reported to have the highest base rates of invalidity. Patients with psychiatric illness, patients evaluated for attention deficit hyperactivity disorder, and patients with a history of mild traumatic brain injury were also reported to invalidate testing at relatively high base rates (approximately 20%). Conversely, patients presenting for dementia evaluation and patients with none of the previously mentioned histories and for whom invalid testing was unanticipated were estimated to produce invalid testing in only 5% of cases. Regarding practice setting, Veterans Affairs providers reported base rates of invalidity to be nearly twice that of any other clinical settings. Conclusions: Non-forensic clinical patients presenting with medically unexplained symptoms, external incentives, or oppositional attitudes are reported to invalidate testing at base rates similar to that of forensic examinees. The impact of context-specific base rates on the clinical evaluation of invalidity is discussed.
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Attention‐deficit/hyperactivity disorder (ADHD) among adults is characterized by inattentiveness and impulsivity. This article provides counselors with information about the etiology, assessment, and treatment of adult ADHD. The identification of the genetic and neurological features of ADHD has led to improvements in evaluation and treatment. Assessment of ADHD requires knowledge of the defining characteristics, subtypes, comorbid features, and functional aspects of ADHD. Effective treatments include both medical management and counseling to address psychosocial deficits.
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The current investigation sought to replicate and extend the findings of Green ( in press ), which demonstrated superior sensitivity of the Nonverbal Medical Symptom Validity Test (NV-MSVT) relative to the Test of Memory Malingering (TOMM) in the detection of suboptimal effort during neuropsychological assessment. Nearly twice as many examinees failed the NV-MSVT than the TOMM. Profile analyses of the NV-MSVT demonstrated patterns suggestive of inconsistent effort in those who failed the NV-MSVT but passed the TOMM. A classification analysis employing the Word Memory Test and Medical Symptom Validity Test as external criteria for poor effort showed that the NV-MSVT is substantially more sensitive to poor effort than the TOMM and maintains an acceptable false-positive rate. Overall, results closely matched those of the Green ( in press ) study and extend the evidence that the NV-MSVT possesses better sensitivity to poor effort than the TOMM.
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Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test-II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.
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Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behavioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunction, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed.
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This article summarizes evidence and issues associated with psychological assessment. Data from more than 125 meta-analyses on test validity and 800 samples examining multimethod assessment suggest 4 general conclusions: (a) Psychological test validity is strong and compelling, (b) psychological test validity is comparable to medical test validity, (c) distinct assessment methods provide unique sources of information, and (d) clinicians who rely exclusively on interviews are prone to incomplete understandings. Following principles for optimal nomothetic research, the authors suggest that a multimethod assessment battery provides a structured means for skilled clinicians to maximize the validity of individualized assessments. Future investigations should move beyond an examination of test scales to focus more on the role of psychologists who use tests as helpful tools to furnish patients and referral sources with professional consultation.
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The Conners' Continuous Performance Test (CPT) is a neuropsychological task that has repeatedly been shown to differentiate ADHD from normal groups. Several variables may be derived from the Conners' CPT including errors of omission and commission, mean hit reaction time(RT), mean hit RT standard error, d', and beta. What each CPT parameter actually assesses has largely been based upon clinical assumptions and the face validity of each measure (e.g., omission errors measure inattention, commission errors measure impulsivity). This study attempts to examine relations between various CPT variables and phenotypic behaviors so as to better understand the various CPT variables. An epidemiological sample of 817 children was administered the Conners' CPT. Diagnostic interviews were conducted with parents to determine ADHD symptom profiles for all children. Children diagnosed with ADHD had more variable RTs, made more errors of commission and omission, and demonstrated poorer perceptual sensitivity than nondiagnosed children. Regarding specific symptoms, generalized estimating equations (GEE) and ANCOVAs were conducted to determine specific relationships between the 18 DSM-IV ADHD symptoms and 6 CPT parameters. CPT performance measures demonstrated significant relationships to ADHD symptoms but did not demonstrate symptom domain specificity according to a priori assumptions. Overall performance on the two signal detection measures, d' and beta, was highly related to all ADHD symptoms across symptom domains. Further, increased variability in RTs over time was related to most ADHD symptoms. Finally, it appears that at least 1 CPT variable, mean hit RT, is minimally related to ADHD symptoms as a whole, but does demonstrate some specificity in its link with symptoms of hyperactivity.
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Perpetrators sometimes claim loss of memory for the crimes they have committed. For the neuropsychologist, the veracity of such crime-related amnesia is difficult to assess. The aim of the present study was to investigate whether Symptom Validity Testing (SVT) can be used to detect feigning of crime-related amnesia. Undergraduate students (N = 39) were instructed to commit a mock crime and asked to feign complete amnesia for the event. Subsequently, they were given 25 forced-choice items about the "crime" that were always followed by the correct answer and an equally plausible alternative. To counteract chance performance, test items were intermixed with 25 bogus questions that contained two equally plausible alternatives. Results show that a majority of participants (59%) scored below chance level on the critical items of the SVT. In addition, debriefing interviews showed that understanding the rationale behind the SVT was not related to chance performance. SVT procedures therefore might be helpful in identifying feigned crime-related amnesia.
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When conducting psychological evaluations, clinicians typically assume that the subject being evaluated is putting forth maximal effort and is not exaggerating or magnifying symptom complaints. While the field of neuropsychology has identified that factors, such as effort and motivation, can significantly interfere with correct interpretation of self-reported symptoms and test scores, evaluation methods for other psychological conditions, such as attention deficit hyperactivity disorder (ADHD) have not addressed effort and motivation as potential factors influencing accurate diagnosis. In analyzing the performance of students simulating ADHD, and comparing it to performance of both non-ADHD and genuine ADHD students, this study clearly demonstrated that the symptoms of ADHD are easily fabricated, and that simulators would be indistinguishable from those with true ADHD. In addition, students motivated to feign ADHD could easily perform poorly on tests of reading and processing speed, thus allowing them access to academic accommodations. Implications of these findings are discussed.
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To test the hypothesis that sub-optimal effort detected by one popular symptom validity measure, the Word Memory Test (WMT), should be interpreted as symptom exaggeration, the authors examined attention-deficit hyperactivity disorder (ADHD) and learning disorder (LD) assessment data collected from healthy adult patients over the past four years at one mid-size Southeastern college. They conducted six tests of this hypothesis, drawing upon extant research. Rates of apparent symptom exaggeration comparable to those found in medicolegal settings (e.g., personal injury cases), particularly in the context of ADHD evaluations, were found. WMT scores were positively correlated with intellectual and neurocognitive test scores, and negatively correlated with self-report symptom inventory scores. Measures of negative response bias embedded in one common self-report measure of psychopathology (the Personality Assessment Inventory) were not correlated with WMT performance. Unattended WMT administrations led to somewhat higher failure rates than were found when the examiners were present in the room during all phases of the test's administration. In light of considerable secondary gain motives in this population, the authors conclude that poor effort as evidenced by low WMT scores implies symptom exaggeration and not other factors in these assessments. The routine inclusion of empirically supported symptom validity measures in these evaluations is recommended, and future research directions are suggested.
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Objective The current investigation sought to define the relationship between established performance validity tests and measures of memory via a factor analytic strategy first published by Heyanka, Thaler, Linck, Pastorek, Miller, Romesser, & Sim (2015). A Factor analytic approach to the validation of the Word Memory Test and Test of Memory Malingering as measures of effort and not memory. Archives of Clinical Neuropsychology, 30, 369–376. Method The full range of Medical Symptom Validity Test (MSVT) and Non-Verbal Medical Symptom Validity Test (NV-MSVT) subtests were factor analyzed with the memory scales of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a sample of 346 service members with a history of concussion. Results A two-factor solution was extracted with the MSVT and NV-MSVT effort and paired associate subtests loading on one factor and the RBANS subtests loading on a second factor. Conclusions Results support the conclusion that the effort subtests of the MSVT and NV-MSVT tap a different construct from established memory measures.
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This is an overview of the some of the most recent and seminal research done on Attention Deficit Hyperactivity Disorders (ADHD). ADHD is currently one of the most common reasons for referral to child mental health services and still is under-recognised both in children (5.29%) and adults (2.5%). ADHD is a highly heritable disorder with a mulitifactorial pattern of inheritance. Parents, siblings and parents of a child with ADHD are 4-5 times more likely to have ADHD. Environmental factors also play a role in elucidating this disorder. Untreated ADHD leads to numerous co-morbidities, and longer term morbidity. Methylphenidate is suggested as the first line pharmacological treatment. ADHD is easy to treat, 80% of correctly diagnosed patients (children or adults) respond favourably to methylphenidate. All child and general adult psychiatrists should be aware of this disorder, comfortable with making the diagnosis and treating adults with ADHD. The purpose of the overview is to cover the epidemiology, aetiology, diagnostic criteria and different managements of ADHD.
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Abstract Perpetrators sometimes claim loss of memory for the crimes they have committed. For the neuropsychologist, the veracity of such crime-related amnesia is difficult to assess. The aim of the present study was to investigate whether Symptom Validity Testing (SVT) can be used to detect feigning of crime-related amnesia. Undergraduate students (N = 39) were instructed to commit a mock crime and asked to feign complete amnesia for the event. Subsequently, they were given 25 forced-choice items about the “crime” that were always followed by the correct answer and an equally plausible alternative. To counteract chance performance, test items were intermixed with 25 bogus questions that contained two equally plausible alternatives. Results show that a majority of participants (59%) scored below chance level on the critical items of the SVT. In addition, debriefing interviews showed that understanding the rationale behind the SVT was not related to chance performance. SVT procedures therefore might be helpful in identifying feigned crime-related amnesia.
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This study obtained construct (factorial) validity, internal consistency reliability, and 1-yr criterion coefficients for scores from the College Attention-Deficit/Hyperactivity Disorder (ADHD) Response Evaluation (CARE), an evaluation tool examining ADHD behaviors as reported by college students (average age 19.2 yrs) and their parents. Self- and parent-report scales from the CARE were gathered at the beginning of the school year. The following summer, the university provided data with respect to students' end-of-year, freshman grade point average. The university also supplied Verbal and Quantitative scores from the SAT at the time of the students' admission. Among the CARE variables, parent ratings were better predictors of college achievement than student ratings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Failure to evaluate the validity of an examinee's neuropsychological test performance can alter prediction of external criteria in research investigations, and in the individual case, result in inaccurate conclusions about the degree of impairment resulting from neurological disease or injury. The terms performance validity referring to validity of test performance (PVT), and symptom validity referring to validity of symptom report (SVT), are suggested to replace less descriptive terms such as effort or response bias. Research is reviewed demonstrating strong diagnostic discrimination for PVTs and SVTs, with a particular emphasis on minimizing false positive errors, facilitated by identifying performance patterns or levels of performance that are atypical for bona fide neurologic disorder. It is further shown that false positive errors decrease, with a corresponding increase in the positive probability of malingering, when multiple independent indicators are required for diagnosis. The rigor of PVT and SVT research design is related to a high degree of reproducibility of results, and large effect sizes of d = 1.0 or greater, exceeding effect sizes reported for several psychological and medical diagnostic procedures.
Article
In this study, the Nonverbal Medical Symptom Validity Test (NV-MSVT; Green, 20088. Green , P. ( 2008 ). Manual for the Nonverbal Medical Symptom Validity Test for Windows . Edmonton , Alberta , Canada : Green's Publishing . View all references) and the Test of Memory Malingering (TOMM; Tombaugh, 199617. Tombaugh , T. ( 1996 ). Test of Memory Malingering . Toronto , Ontario , Canada : Multi-Health Systems . View all references) were given to a consecutive series of outpatients undergoing disability assessment. No cases of moderate to severe traumatic brain injury (TBI) failed the easy NV-MSVT subtests or the TOMM. However, 26% of the mild TBI group failed the NV-MSVT and 10% failed the TOMM. More than 10% of the whole sample passed the TOMM but failed the NV-MSVT. Using profile analysis, the NV-MSVT has been shown to have a zero false-positive rate in three independent groups of patients with severe cognitive impairment arising from dementia. The more severe the actual cognitive impairment, the more likely it is that false positives for poor effort will occur. Therefore, using the same criteria, we would also expect zero false positives in people with much less severe impairment, such as mild TBI. Those in the current study who passed the TOMM and failed the NV-MSVT had profiles that were not characteristic of people with actual severe impairment. Instead, they were of the paradoxical type seen in simulators. The results suggest that the NV-MSVT is considerably more sensitive to poor effort than the TOMM, if the conventional cutoff is used to define TOMM failure.
Article
The study aimed to provide independent data on the specificity of the Nonverbal Medical Symptom Validity Test (NV-MSVT; Green, 200813. Green , P. 2008. Green's Non-Verbal Medical Symptom Validity Test (NV-MSVT) for Microsoft Windows. User's Manual 1.0, Edmonton, , Canada: Green's Publishing. View all references), a new test that combines conventional decision making based on cutoffs with profile analyses in order to identify invalid test performance and to reduce false positive classifications. The results of 65 bona fide neurological patients (with 21 of them meeting Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, DSM-IV, core criteria for dementia) were compared to 50 healthy volunteers. One patient was wrongly classified as malingering, resulting in a specificity of 98.5% for neurological patients and 100% for controls. A total of 13 patients with dementia (62%), 6 patients without dementia (14%), and 1 healthy participant exhibited a dementia profile in the NV-MSVT. While these results confirm the high specificity of the NV-MSVT for the classification insufficient effort, its sensitivity has to be verified by independent research data.
Article
Children with attention deficit disorder with hyperactivity (ADD+H; N = 48) were compared with those without hyperactivity (ADD-H; N = 42), as well as with learning disabled and control children, on an extensive battery of interviews, behavior ratings, tests, and direct observations. ADD+H children had more externalizing and internalizing symptoms by parent and teacher report, were more off task during vigilance testing, and had more substance abuse, ADD+H, and aggression among their relatives than did the other groups. ADD-H children were more day-dreamy and lethargic by teacher report, more impaired in perceptual-motor speed, and had more anxiety disorders among their relatives than did ADD+H children. Results indicate that these 2 types of ADD may be separate, distinct childhood disorders rather than subtypes of a common attention deficit.
Article
The use of continuous performance tasks has been examined as a potential measure for clinical/laboratory identification of Attention-deficit/hyperactivity disorder. The present study compared the performance of 30 children, 26 boys and 4 girls ranging in age from 9-0 to 12-11, with central auditory processing disorders (CAPD) who did not meet criteria for coexisting ADHD with the performance of children with CAPD coexisting with ADHD (CAPD/ADHD) on the Auditory Continuous Performance Test (ACPT). In interpreting the results, the variability as well as the actual counts for correct responses and total errors were considered. Results indicated limited potential for the use of the ACPT in the differential diagnosis of ADHD. Implications of the results as well as considerations for future research are discussed.
Article
Of 143 adults presenting for attention-deficit hyperactivity disorder (ADHD) evaluation, 46 (32%) clearly met diagnostic criteria, 46 (32%) clearly did not meet diagnostic criteria, and another 51 (36%) with current ADHD-like features did not meet criteria due to either a lack of childhood history and/or complicating severe psychiatric or substance abuse comorbidity. The three groups were similar in demographics, psychiatric diagnosis, psychiatric symptom severity, and functional impairment. Compared with the group not meeting ADHD criteria, patients with ADHD had more frequent histories of learning disability in childhood, poorer reading scores on the Wide-Range Achievement Test (WRAT), poorer scores on the Continuous Performance Test (CPT), and higher scores on the Wender-Utah Rating Scale (WURS) for ADHD. Patients in the ambiguous ADHD category had higher rates of current substance abuse than the other two groups. While this group resembled the non-ADHD group in having a low incidence of learning disability and normal reading scores, their poor performance on the CPT and high scores on the WURS more closely resembled those of ADHD patients. These findings suggest that there are a few rating scales, testing instruments, and lifetime history characteristics that help to clarify the difficult diagnostic distinction between adult patients who do and do not have ADHD.
Article
The performance of clinic-referred children aged 6-11 (N = 100) was examined using the Conners' Continuous Performance Test (CPT) and measures of auditory attention (Auditory Continuous Performance Test; ACPT), phonological awareness, visual processing speed, and visual-motor competence. The Conners' CPT overall index was unrelated to measures of visual processing speed or visual-motor competence. Although the Conners' CPT converged with the ACPT, the latter demonstrated age and order effects. Significant variance in Conners' CPT parameters was predicted by phonological awareness measures, suggesting that Reading Disordered (RD) children could be "false positives" on the Conners' CPT. The Conners' CPT overall index, phonological awareness, and visual-motor measures were submitted to a 2 x 2 MANCOVA (ADHD vs. RD, covarying for age and socioeconomic status): a main effect for RD status was found. Children with ADHD did not have higher Conners' CPT scores than did clinical controls; however, children with Reading Disorders did. Phonological measures distinguished RD children from ADHD children and other clinical controls. ADHD children who failed the Conners' CPT were rated by teachers as more hyperactive. Despite the strengths of the Conners' CPT, its utility for differential diagnosis of ADHD is questioned.
Article
Comparisons of two assessment measures for ADHD: the ADHD Behavior Checklist and the Integrated Visual and Auditory Continuous Performance Test (IVA CPT) were examined using undergraduates (n=44) randomly assigned to a control or a simulated malingerer condition and undergraduates with a valid diagnosis of ADHD (n=16). It was predicted that malingerers would successfully fake ADHD on the rating scale but not on the CPT for which they would overcompensate, scoring lower than all other groups. Analyses indicated that the ADHD Behavior Rating Scale was successfully faked for childhood and current symptoms. IVA CPT could not be faked on 81% of its scales. The CPT's impairment index results revealed: sensitivity 94%, specificity 91%, PPP 88%, NPP 95%. Results provide support for the inclusion of a CPT in assessment of adult ADHD.
Article
Although some areas of adult ADHD knowledge remain unclear, there isa strong sense of how to proceed with diagnosis using current DSM-IV criteria as a guide. Thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings, forms the backbone of the assessment. The poor psychosocial outcomes of patients with ADHD. often a consequence of unrecognized,untreated disorder manifestation, also can serve as a diagnostic indicator. Diagnostic and symptom assessment scales also can be a significant helpin diagnosing and establishing the symptoms of ADHD in adults. It is important to remember that according to DSM-IV, the cardinal criteria for making the diagnosis are the presence of sufficient current symptoms and impairment in two realms (home, school/work, and social interactions). Accordingly, adult ADHD remains a clinical diagnosis, and the clinician-administered interview remains the cornerstone of diagnostic evaluation.
Article
The detection of suboptimal effort has become crucial in clinical neuropsychological practice in order to make accurate diagnoses, prognoses, and referrals. Symptom Validity Testing (SVT) has been the most commonly utilized model for assessing effort, and frequently includes recognition memory tasks. Some conflicting views on this model purport, however, that measures of effort gathered from a recognition memory paradigm do not necessarily extend to effort in other cognitive domains and other areas of performance. The present study sought to investigate whether performance on an SVT measure, which utilizes recognition memory, the TOMM, could predict performance on other measures that do not evaluate recognition memory or just memory per se in a group of mildly traumatic brain-injured litigants. Results indicated that poor performance on the TOMM was significantly correlated with poorer performance on the WAIS-R and the HRNB-A. Further, experimental exploration of these results indicated that the overall neuropsychological performance of litigants with suboptimal effort was poorer than what is generally expected from mild TBI individuals, and was also lower than the other mild TBI examinees in the study, who were not classified by the TOMM as exhibiting suboptimal effort. These findings support the proposition that poor effort as measured by recognition memory effort measures is not restricted to recognition and memory measures. In fact, in the present study it appears that a poor performance on the TOMM is predictive of a generalized poorer performance on standardized measures such as the WAIS-R and the HNRB-A.
Article
The differential diagnosis of malingering in psychological evaluations for Posttraumatic Stress Disorder (PTSD) is complex and relies upon the integration of clinical knowledge and appropriate psychometric instruments. Over the years, there has been an increase in the use of validity measures, including Symptom Validity Tests (SVTs). In 2005, the National Academy of Neuropsychology published Symptom validity assessment: Practice issues and medical necessity, an official policy statement recognizing the importance of effort on test performance and recommending the utilization of specific SVTs to assess for response bias in neurocognitive and personality evaluations. As new SVTs become available, clinicians need a clear understanding of how to critique these tests and determine the strengths and limitations. This article demonstrates the fundamental principles of critiquing an SVT by applying a modified set of Hartman's [Hartman, D. E. (2002). The unexamined lie is a lie worth fibbing: Neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17, 709-714] criteria, originally developed for neuropsychological SVTs, to the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT).
Medical symptom validity test for windows: User's manual and program
  • P Green
Green, P. (2008). Medical symptom validity test for windows: User's manual and program. Edmonton, Canada: Green's Publishing.
Multiple assessment methods and sources in counseling: Ethical considerations. Ideas and research you can use: Vistas 2013. Retrieved from http://www.counseling.org/docs/vistas/multiple-assessment- methods-and-sources-in-counseling-ethical-considerations. pdf?sfvrsn=4
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Leppma, M., & Jones, K. D. (2013). Multiple assessment methods and sources in counseling: Ethical considerations. Ideas and research you can use: Vistas 2013. Retrieved from http://www.counseling.org/docs/vistas/multiple-assessment- methods-and-sources-in-counseling-ethical-considerations. pdf?sfvrsn=4
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Murphy, K., & Barkley, R. A. (1996). Updated adult norms for the ADHD behavior checklist for adults (pp. 12-16). The ADHD Report 4(4).
Diagnostic and statistical manual of mental disorders
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Intermediate visual and auditory continuous performance test interpretation manual
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Sandford, J. A., & Turner, A. (1995). Intermediate visual and auditory continuous performance test interpretation manual. Richmond, VA: Braintrain.