title: Effectiveness of symptom validity measures in identifying cognitive and behavioral symptom exaggeration in adult attention deficit hyperactivity disorder.
abstract: This study examines the effectiveness of symptom validity measures to detect suspect effort in cognitive testing and invalid completion of ADHD behavior rating scales in 268 adults referred for ADHD assessment. Patients were diagnosed with ADHD based on cognitive testing, behavior rating scales, and clinical interview. Suspect effort was diagnosed by at least two of the following: failure on embedded and free-standing SVT measures, a score > 2 SD below the ADD population average on tests, failure on an ADHD behavior rating scale validity scale, or a major discrepancy between reported and observed ADHD behaviors. A total of 22% of patients engaged in symptom exaggeration. The Word Memory test immediate recall and consistency score (both 64%), TOVA omission errors (63%) and reaction time variability (54%), CAT-A infrequency scale (58%), and b Test (47%) had good sensitivity as well as at least 90% specificity. Clearly, such measures should be used to help avoid making false positive diagnoses of ADHD.
authors.affiliation: Department of Psychiatry, Hennepin County Medical Center, 914 South 8th Street, Minneapolis, MN 55404, USA. paul.marshall@hfanet.org
authors.forename: Paul
authors.initials: P
authors.lastname: Marshall
authors.forename: Ryan
authors.initials: R
authors.lastname: Schroeder
authors.forename: Jeffrey
authors.initials: J
authors.lastname: O'Brien
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fischer
authors.forename: Adam
authors.initials: A
authors.lastname: Ries
authors.forename: Brita
authors.initials: B
authors.lastname: Blesi
authors.forename: Jessica
authors.initials: J
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D001526:Behavioral Symptoms / Q000175:diagnosis* / Q000209:etiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011930:Reaction Time / Q000502:physiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014894:Weights and Measures; D055815:Young Adult