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This study aimed to validate a novel parent-report measure of ADHD symptom inflation, the Parent-Reported ADHD Symptom Infrequency Scale (PRASIS), in a clinical sample. The PRASIS is composed of an Infrequency subscale and an ADHD subscale. Online participants were assigned to one of three groups: mothers of children with diagnosed ADHD (n = 110), mothers of children with diagnosed ODD and/or anxiety (n = 116), and mothers of children without ADHD, ODD, or anxiety. The third group was then randomized to either receive instructions to complete the questionnaire honestly (controls, n = 164) or to complete the questionnaire as if they were trying to convince a provider that their child has ADHD (simulators, n = 141). Results indicated good to excellent internal consistency (INF α = .83, ADHD Total α = .93); strong convergent validity of the PRASIS ADHD scale with the ADHD Rating Scale-5 (r(529) = .85, p < .001); excellent group discrimination of the PRASIS Infrequency scale and the PRASIS ADHD scale (η2 = 0.38–0.42); and specificity of 86.7, sensitivity of 67.4%, and an AUC of .86 for the Infrequency scale. Overall, these outcomes supported the utility of the PRASIS in samples including mothers of children with psychiatric diagnoses of ODD and/or anxiety. [ABSTRACT FROM AUTHOR]

Objective: Differential diagnosis of attention deficit/hyperactivity disorder (ADHD) is one of the most common referral questions for neuropsychological evaluation but is complicated by the presence of external incentives. Validity assessment is therefore critical in such evaluations, employing symptom validity tests (SVTs) and performance validity tests (PVTs) to assess the validity of reported symptoms and cognitive test performance, respectively. This study aimed to establish the base rate of symptom and performance invalidity in adults referred for ADHD, compare concordance between performance and symptom validity, and assess the impact of each type of validity on cognitive test performance. Method: This consecutive case series included data from 392 demographically-diverse adults who underwent outpatient neuropsychological evaluation for ADHD. All patients were administered the Clinical Assessment of Attention Deficit-Adult (CAT-A) and a uniform cognitive test battery, including seven PVTs. Results: Invalid symptom reporting and PVT performance were found in 22% and 16% of the sample, respectively. Sixty-eight percent had concordantly valid SVTs/PVTs and 6% had invalid SVTs/PVTs, whereas the remaining 26% had either invalid SVTs or PVTs (but not both). Invalid PVT performance resulted in a significant decrease across all cognitive test scores, with generally large effects (ηp2=.01-.18). Invalid symptom reporting had minimal effects on cognitive test performance (ηp2= ≤.04). Conclusions: PVTs and SVTs are dissociable and therefore should not be used interchangeably in the context of adult ADHD evaluations. Rather, symptom and performance validity should continue to be assessed independently as they provide largely non-redundant information. [ABSTRACT FROM AUTHOR]

The present article outlines the development of the parent-reported ADHD symptom infrequency scale (PRASIS), a novel stand-alone questionnaire designed to discriminate between parents exaggerating ratings of ADHD symptoms of their child from parents more accurately reporting symptoms. The PRASIS includes an Infrequency scale (INF) to measure infrequently reported symptoms of ADHD and a clinical scale to measure Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5) defined ADHD symptoms (ADHD Total). An initial list of infrequency and clinical items was revised over the course of three studies, each conducted on a different sample of participants (n1 = 154, n2 = 203, n3 = 167) recruited via CloudResearch and consisting of mothers of children 4–12 years old. Analyses on the final version of the measure demonstrated good to excellent internal consistency (INF α = .87, ADHD Total α = .94) and high convergent validity of the PRASIS ADHD Total scores with ADHD Rating Scale-5 Total scores (r = .87, p < .001). Omnibus ANOVA comparisons demonstrated excellent group discrimination of both the PRASIS Infrequency scale and the PRASIS ADHD scale (Cohen’s f = 0.81-0-90). Specificity was above the minimum requirement set a priori (≥.80) and resulting sensitivity was similar or higher than other non-ADHD measures in the symptom validity literature. Specificity and sensitivity are reported for multiple cutoff scores, and positive predictive values (PPV) and negative predictive values (NPV) are presented for several base rates. [ABSTRACT FROM AUTHOR]

Objective: There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD. Method: The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures. Results: The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity <42% at specificity >90%). Conclusion: The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments. [ABSTRACT FROM AUTHOR]

Objective: Clinical evaluation for attention-deficit/hyperactivity disorder (ADHD) not only requires assessment of symptoms, but also consideration of the degree to which symptoms lead to impairment within various functional domains. However, ADHD evaluations in adulthood often rely on self-reported functional impairment, which might be vulnerable to malingering/noncredible responding. The present study utilized a clinical sample/known groups design to examine the relationship of noncredible presentation to functional impairment ratings by analyzing differential associations with both symptom and performance validity tests (SVTs and PVTs). Method: Participants were 168 postsecondary students who completed psychoeducational assessments for ADHD to determine their eligibility for academic accommodations and/or medications. Impairment ratings on the Weiss Functional Impairment Rating Scale (WFIRS) of 71 students who presented in a noncredible fashion were compared to 72 students who appeared to present credibly (controls) and 25 students diagnosed with ADHD who appeared to present credibly (clinical controls). Results: Relative to both control groups, individuals who presented noncredibly reported higher levels of disability on most functional domains and a higher percentage provided responses that fell in the impaired range on all functional domains of the WFIRS. Conclusions: Findings provide additional evidence that ADHD-related functional impairment ratings are susceptible to noncredible presentation and highlight the need for assessors to include both SVTs and PVTs in ADHD evaluations. [ABSTRACT FROM AUTHOR]

Objective: This study examined concordance between symptom and performance validity among clinically-referred patients undergoing neuropsychological evaluation for Attention-Deficit/Hyperactivity Disorder (ADHD). Method: Data from 203 patients who completed the WAIS-IV Working Memory Index, the Clinical Assessment of Attention Deficit-Adult (CAT-A), and ≥4 criterion performance validity tests (PVTs) were analyzed. Results: Symptom and performance validity were concordant in 76% of cases, with the majority being valid performance. Of the remaining 24% of cases with divergent validity findings, patients were more likely to exhibit symptom invalidity (15%) than performance invalidity (9%). Patients demonstrating symptom invalidity endorsed significantly more ADHD symptoms than those with credible symptom reporting (ηp2 =.06–.15), but comparable working memory test performance, whereas patients with performance invalidity had significantly worse working memory performance than those with valid PVT performance (ηp2 =.18). Conclusion: Symptom and performance invalidity represent dissociable constructs in patients undergoing neuropsychological evaluation of ADHD and should be evaluated independently. [ABSTRACT FROM AUTHOR]

The current project outlines the development of the Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Infrequency Scale (ASIS), a stand-alone measure designed to identify individuals feigning or exaggerating symptoms to receive a diagnosis of ADHD. Over the course of 3 studies, valid data was collected from 402 participants assigned to control, simulator, ADHD diagnosed, or possible undiagnosed ADHD groups. Group assignment was based on self-reported history of ADHD diagnosis including information about the credentials of diagnosing professional and methods used. The ASIS includes an Infrequency Scale (INF) designed to detect rarely reported symptoms of ADHD and several clinical scales designed to measure genuine symptoms. The final version of the ASIS demonstrated high internal consistency for the INF (α = .96) and the ADHD Total scales (α= .96). Convergent validity for the ADHD Total was established through a strong correlation with Barkley Adult ADHD Rating Scale-IV (r = .92). Initial validation of the INF yielded high discriminability between groups (d = 2.76; 95% confidence interval [2.17, 3.36]). The final INF scale demonstrated strong sensitivity (.79-.86) and excellent specificity (.89). Using our study's malingering base rate of 29%, positive and negative predictive values were strong (.71-.79 and .92-.93, respectively). Additional information is provided for a range of base rates. Current results suggest that the ASIS has potential as a reliable and valid measure of ADHD that is sensitive to malingering when compared to a sample of individuals self-reporting a history of ADHD diagnosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]