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The article presents the discussion on evaluation ensuring accurate diagnosis and optimal treatment. Topics include attention-deficit/hyperactivity disorder (ADHD) increasingly being recognized as a chronic, lifelong disorden persists into adulthood in approximately two-thirds of patients; and ADHD to other neurodevelopmental disorders such as autism spectrum disorder or social communication disorder.

Objective: Research consistently shows how easily students can feign symptoms of ADHD on self-report checklists to determine eligibility for curricular and standardized testing accommodations. However, it is unclear how easily students can feign psychological symptoms to accesses academic accommodations, making the assessment of symptom validity important in both populations.Method: Using a between-subjects design, 75 college students were randomly assigned to one of three groups: (1) coached feigning of ADHD, (2) coached feigning of depression and anxiety (DA), and (3) honest responding (HR). Participants completed the Depression, Anxiety, and Stress Scale (DASS-21) and the Structured Inventory of Malingered Symptomatology (SIMS).Results: The SIMS showed 100% specificity, but low sensitivity (36-52%) for detecting feigned symptoms with different cutoffs. Differences on SIMS subtests were apparent by group with elevated scores for the DA group on the Affective Disorders subscale and elevation for the ADHD group on the Low Intelligence and Amnestic subscales. Participants identified as feigning by the SIMS typically reported more severe symptoms than participants not identified on the DASS-21.Conclusions: The SIMS equally classified the feigned ADHD and DA participants for both cutoff scores utilized. Potential reasons for low sensitivity rates are discussed and future research recommendations are made. [ABSTRACT FROM AUTHOR]

Objective: Risk factors that contribute to brain pathology and cognitive decline among older adults include demographic factors (e.g., age, educational attainment), genetic factors, health factors, and depression (Plassman et al., 2010). Variability within an individual's performance across cognitive tasks is referred to as dispersion (Hultsch et al., 2002), which appears sensitive to subtle cognitive impairments associated with neurodegenerative pathology in older adults (Bangen et al., 2019; Kälin et al., 2014). Thaler and colleagues (2015) found that dispersion across domains of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was a useful indicator of cognitive changes associated with cardiovascular disease and mortality. Also, research by Manning and colleagues (2021) found that elevated ratings of depression and anxiety in older adults was associated with greater dispersion across neuropsychological testing. The present study aimed to replicate findings that greater dispersion in neuropsychological performance is associated with impaired neurocognitive performance and greater self-reported depression among older adults who present for neuropsychological evaluation with cognitive concerns. Participants and Methods: Neuropsychological testing data was obtained from a university hospital. Chart reviews were conducted on 369 participants who met initial criteria (60 years or older with testing data from the RBANS Form A, Wechsler Test of Adult Reading, and Geriatric Depression Scale [GDS]). Retrospective analyses were conducted on a final sample of 293 participants from 60 to 94 years old (Mage = 74.41, SDage = 7.43; 179 females, 114 males). Diagnoses were used for group comparisons between cognitively intact individuals with subjective cognitive complaints (SCC, n = 49), persons with Mild Neurocognitive Disorder (mND, n =137), and persons with Major Neurocognitive Disorder (MND, n = 107). Results: As expected, results indicated that higher dispersion was related to lower Total RBANS Scores (r = -0.54, p <.001) and significant differences across diagnostic groupings (F(2, 289) = 29.19, p < 0.001; SCC, mND, MND) indicated that variability in performance was an indicator of greater neurocognitive impairment. Contrary to expectations, greater dispersion was very weakly associated with lower reported depressive symptomatology (r = -0.13, p = 0.03). A three-stage hierarchical linear regression was conducted with the RBANS Coefficient of Variation (CoV) as the dependent variable and three predictor variables (Age, Total RBANS, Total GDS). The regression analysis results indicated that age was not a significant predictor, but both Total RBANS and GDS Scores were. The most important predictor was Total RBANS Scores which uniquely explained 21% of the variation in dispersion. Conclusions: This study adds to the current literature regarding the clinical utility of dispersion in neuropsychological performance as an indicator of early and subtle neurocognitive impairment. Depressive symptom reporting was expected to help predict the degree of variability, but this factor was only weakly associated with the RBANS CoV. Limitations of this study include its retrospective use of archival data and the restricted range on some variables of interest. Further research is needed to examine the relative utility of different measures of dispersion and why increased cognitive performance variability is related to neurocognitive impairment and decline. [ABSTRACT FROM AUTHOR]

While the Neuropsychological Assessment Battery, Screening Module (S-NAB) is a commonly used cognitive screening measure, no composite embedded performance validity test (PVT) formula has yet been described within it. This study sought to empirically derive PVT formulas within the S-NAB using an analog simulation paradigm. Seventy-two university students (M age = 18.92) were randomly assigned to either an Asymptomatic (AS) or simulated mild traumatic brain injury (S-mTBI) group and were administered a neuropsychological test battery that included the S-NAB and standalone and embedded PVTs. The AS group was instructed to perform optimally, and the S-mTBI group received symptom and test coaching to help simulate mTBI-related impairment. Both groups received warnings regarding the presence of PVTs throughout the test battery. Groups showed significant differences (all ps <.001) on all S-NAB domain scores and PVTs. In the S-NAB, the Attention (S-ATT) and Executive Function (S-EXE) domains showed the largest effect sizes (Cohen's ds = 2.02 and 1.79, respectively). Seven raw scores from S-ATT and S-EXE subtests were entered as predictor variables in a direct logistic regression (LR). The model accurately classified 90.3% of cases. Two PVT formulas were described: (1) an exponentiated equation from LR results and (2) an arithmetic formula using four individually meaningful variables. Both formulas demonstrated outstanding discriminability between groups (AUCs =.96–.97) and yielded good classification statistics compared to other PVTs. This study is the first to describe composite, embedded PVT formulas within the S-NAB. Implications, limitations, and appropriate future directions of inquiry are discussed. [ABSTRACT FROM AUTHOR]