Detecting Feigned Attention-Deficit/Hyperactivity Disorder (ADHD): Current Methods and Future Directions

Feigned attention-deficit/hyperactivity disorder (ADHD) in adults is a significant issue in clinical settings, particularly regarding academic accommodations and access to controlled substances by university students. This article discusses the definitions, base rates, external incentives, psychometric detection strategies, and ethical implications of feigned ADHD. ADHD is characterized by a pattern of developmentally inappropriate inattentive, overactivity, and/or impulsivity, often persisting into adulthood. Estimates of the prevalence of non-credible ADHD in university settings range from 25 to 50%. Feigned ADHD may be detected with symptom and performance validity measures. The existing empirical research has failed to produce a clear psychometric solution to this important differential diagnosis. Identifying feigned ADHD is a difficult task, possibly because of the highly transparent, face-valid diagnostic criteria, and an atypical malingering strategy that evades established detection methods. Performance validity tests remain the best available method for identifying non-credible presentation during psychological evaluations of ADHD. Future practice recommendations should consider educational policy, diagnostic criteria, and psychometric research, including the development of self-report measures that reliably differentiate between genuine and feigned ADHD.     

The Effects of Attribution of Responsibility and Work History on Perceptions of Reasonable Accommodations

Under the Americans with Disabilities Act (ADA), employers must provide employees with disabilities reasonable accommodations that will enable them to perform job duties, as long as the accommodations do not financially burden the organization. Two studies were conducted to investigate whether disability origin and/or prior work history impermissibly influence the granting of reasonable accommodations under the ADA. In both studies, participants granted more accommodations for employees whose disability was caused by some external factor than for those whose disability was caused by the employee's own behavior. In Study Two, participants also granted more and costlier accommodations for an employee with an excellent work history than for an employee with an average work history. Implications of the use of extralegal factors in accommodation decisions are discussed.     

The Grooved Pegboard Test as a Validity Indicator—a Study on Psychogenic Interference as a Confound in Performance Validity Research

This study was designed to replicate an earlier report on the link between low scores on the Grooved Pegboard test (GPB), invalid responding, and elevated self-reported psychiatric symptoms. A fixed battery of neuropsychological tests was administered to 100 consecutively referred outpatients (M_Age?=?38.3, M_Education?=?13.6 years) following traumatic brain injury at a Midwestern academic medical center. Classification accuracy of GPB validity cutoffs was computed against a free-standing PVT and three composite measures of embedded validity indicators. Previously suggested GPB validity cutoffs (T?≤?29 in either hand) produced good combinations of sensitivity (0.25–0.55) and specificity (0.89–0.98) to psychometrically defined invalid performance. Raising the cutoff to T?≤?31 resulted in a reasonable trade-off between increased sensitivity (0.36–0.55) and decreased specificity (0.84–0.94). T?≤?31 in both hands was highly specific (0.93–0.98) to noncredible responding. GPB validity cutoffs were unrelated to psychiatric symptoms or injury severity. Failing PVTs based on forced choice recognition was associated with elevated self-reported depression, somatic concerns, and overall symptomatology. Low scores on the GPB are reliable indicators of noncredible responding. Self-reported emotional distress has a complex relationship with performance validity. Psychogenic interference is a potential mechanism behind PVT failures, and its expression is likely mediated by instrumentation and sampling artifacts. Further research on the topic is clearly needed to advance current understanding of psychogenic interference as a confound in cognitive testing.     

Work Impairment and Disability in Posttraumatic Stress Disorder: A Review and Recommendations for Psychological Injury Research and Practice

Work impairment and disability are common consequences of posttraumatic stress disorder (PTSD), as reflected by significant rates of sickness absence, failure to return to work, and reduced work performance. Within the psychological injury field, the issue of work impairment and disability in PTSD often arises in workers’ compensation and disability insurance claims and in personal injury litigation. In this context, clinical and forensic practitioners are faced with challenges in rendering expert opinions on diagnosis, causality, prognosis, and recommendations for treatment and rehabilitation. To promote understanding of this important, yet understudied area, there are three aims of this paper: first, to review the current literature on work impairment and disability associated with PTSD; second, to draw on this literature to present a biopsychosocial framework of work impairment and disability in PTSD; and third, to offer suggestions for improving the assessment and management of PTSD-related work impairment and disability.     

Further Validation of the Test of Memory Malingering (TOMM) Trial 1 Performance Validity Index: Examination of False Positives and Convergent Validity

Assessment of performance validity is an essential part of a neuropsychological evaluation, with the inclusion of two or more performance validity tests (PVTs) becoming routine practice. Considering the time to administer multiple tests, there has been some support for use of the Test of Memory Malingering (TOMM) Trial 1 (T1) as an independent, “one and done” PVT. Notably, cutoffs for TOMM T1 need further validation, with an emphasis on minimizing false-positive classifications among those with bona fide cognitive impairment. In a clinically referred sample of 127 veterans, this study examined the role of cognitive impairment in TOMM performance and the utility of a TOMM T1 as an independent PVT. Examinees were administered the TOMM and three additional PVTs as part of a comprehensive neuropsychological battery. Sixty-eight percent of examinees were classified valid (35% of valid examinees were cognitively impaired). TOMM T1?≤?40 had excellent observed sensitivity (83%) and specificity (93%) overall, with minimal false-positive classification. TOMM T1 was also significantly correlated and concordant with other memory-based PVTs. Given score ranges and failure rates for TOMM T1?≤?40 among those with neurological/neurocognitive conditions, scores in the 37–40 range may merit administration of additional TOMM trials to maximize accuracy in identifying valid-cognitively impaired versus noncredible performance. Otherwise, an abbreviated TOMM administration (i.e., only T1) using a cutoff of ≤?40—in conjunction with one or more additional PVTs—may be sufficient for detecting noncredible/invalid test performance in the absence of known or suspected neurological/neurocognitive disorders.     

The Challenges and Limitations of Diagnosing and Pharmacologically Treating ADHD in University Students

The diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in university students present particular challenges. The lack of quality childhood historical data and limitations of existing neuropsychological instruments can create difficulties, especially when this easily feigned condition presents with numerous incentives for it to be feigned (i.e. access to psychostimulants, academic accommodations). The need for a thorough history in combination with symptom validity test (SVT) use is emphasized. A brief overview of psychostimulant mechanism of action, risks, side effects and long-term effects is provided, followed by suggestions for future research directions.     

Predictive Validity of the Neuropsychological Assessment Battery-Screening Module for Assessing Real-World Disability in Patients with Mild Traumatic Brain Injury

The present study set out to examine the ecological validity of the Neuropsychological Assessment Battery-Screening Module (NAB-S) and to examine more specifically, whether performance on this test battery is related to real-world disability status in patients who have sustained a mild traumatic brain injury (mTBI) as a consequence of a motor vehicle collision (MVC). Seventy-nine patients were recruited from a random sample of litigating patients who incurred an mTBI and were referred for a neuropsychological examination due to subjective complaints of cognitive function. Of the total sample, 54 patients were categorized into the non-disabled group and 25 patients were categorized into the disabled group using the 4th edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (AMA; 1993). A multivariate analysis of variance revealed that performance on the NAB-S significantly differed between the two groups, and that memory and attention domains provided a more discriminative index of disability than general neuropsychological functions. In addition, discriminant function analyses revealed that the NAB-S correctly classified 73% of patients according to their group membership. The current findings provide evidence for the ecological validity of the NAB-S as a reliable index of real-world disability status as defined by the AMA Guides.     

Assessing treatment readiness in violent offenders

Although violent offenders are widely considered to be difficult to engage in therapeutic change, few methods of assessing treatment readiness currently exist. In this article the validation of a brief self-report measure designed to assess treatment readiness in offenders who have been referred to violent offender treatment programs is described. The measure, which is an adaptation of a general measure of treatment readiness developed in a previous work, displayed acceptable levels of convergent and discriminant validity and was able to successfully predict treatment engagement in violent offender treatment. These results suggest that the measure has utility in the assessment of treatment readiness in violent offenders.     

Detection of Malingered ADHD Using the MMPI-2-RF

This study examined the utility of the Minnesota Multiphasic Personality Inventory—2 Restructured Form (MMPI-2-RF) validity scales for detecting feigning and exaggeration of attention-deficit/hyperactive disorder (ADHD) among college students. Under a simulation study design, participants with and without ADHD were assigned to perform honestly or to feign or exaggerate deficits related to ADHD while completing self-report symptom inventories. Participants instructed to feign produced symptom profiles similar to honest clinical profiles and more severe than honest nonclinical profiles. Participants with ADHD instructed to exaggerate produced less severe profiles than those instructed to feign and more severe profiles than clinical controls. MMPI-2-RF scale Fp-r showed potential for use in malingered ADHD detection at a revised cut score, which was significantly lower than the cut score suggested in the test manual; use of the revised cut score will require further validation. Scales F-r, Fs, and FBS-r did not classify well, but should be assessed in future studies of malingered ADHD. Detection of exaggeration was consistently poorer than detection of feigning.     

Family, welfare, and delinquency

Data from a five-wave panel probability sample of families in the State of Washington were analyzed to test the hypothesis that female headship and welfare experience increased participation in and frequency of juvenile delinquency. Appropriate statistical models of random effect probit and negative binomial were employed. Results indicated that there were no direct effects of female headship and welfare experience on either prevalence or frequency of juvenile delinquency. Instead, it was found that the number of adult presence in a household and the child's school attachment significantly reduced the probability of delinquency and the tendency of being referred again in court.     

Fear of the Disability Con: Perceptions of Fraud and Special Rights Discourse

This article presents a new framework for analyzing the development and implementation of disability law: the prism of the fear of “the disability con”—popular perceptions of fraud and fakery. We all encounter disability rights and accommodations in everyday life. However, people with disabilities pay a price for the legal recognition of their rights. People who park in disabled parking spots, use service dogs, move to the front of lines, receive Social Security benefits, or request academic accommodations are often viewed as faking disabilities and abusing the law. This disability con stereotype thus serves as an important invisible barrier preventing Americans with disabilities from fully taking part in society, as it not only undermines the public legitimacy of rights but also restricts the design and implementation of the legal regime illustrating those. Nevertheless, this moral panic around disability con in American society and its manifestations has yet to be studied in a systematic‐empirical way, nor has it been addressed in sociolegal scholarship. Using a mixed‐methods approach composed of an original nationally representative survey along with in‐depth interviews, this article fills this gap. The data suggest that the stereotype of disability con applies to multiple disability rights across venues and contexts; that nearly 60% of Americans with disabilities feel that others question their disability; that the stereotype of disability con extends to visible disabilities and to less apparent ones; and that, counterintuitively, the people most suspicious are nondisabled individuals with a personal connection to a disabled person and disabled people who experience suspicion themselves. Based on the richer understanding of the sociolegal phenomenon, this article suggests strategies to increase trust and reduce suspicion of the disability con.     

A study of male veterans' beliefs toward domestic violence in a batterers intervention program

Domestic violence in intimate relationships is a ubiquitous social problem. This study addresses a gap in the research literature on batterers intervention programs with heterosexual male batterers by evaluating whether or not self-reported attitudes about partner abuse and sexist beliefs could be modified over time as a result of participation in a Batterers Intervention Program (BIP). Using the Inventory of Beliefs about Partner Abuse (IBAPA) to measure attitudes toward domestic violence and the Ambivalent Sexism Inventory (ASI) to measure sexist beliefs, results of the study provide empirical support for the notion that participation in BIPs affects the self-reported beliefs about their rights to physically and emotionally abuse their partner. These self-reported scores were adjusted for response bias by the long version of the Marlowe-Crowne Social Desirability Scale (MCD). Response bias and how it is treated in self-report measures with batterers is also discussed.     

Validation of the Sexual Assault Symptom Scale II (SASS II) using a panel research design

To examine the utility of a self-report scale of sexual assault trauma, 223 female victims were interviewed with the 43-item Sexual Assault Symptom Scale II (SASS II) at 1, 3, 7, 11, and 15 months postassault. Factor analyses using principal-components extraction with an oblimin rotation yielded 7 common factors with 31 items. The internal consistency was high for 4 factors and moderate for 2 factors. The multitrait-multimethod matrix, correlating the factor subscale scores of self-reported trauma and clinical assessment ratings, demonstrated both convergent and discriminant validity, indicating that the SASS II has construct validity. Correlations between the SASS II subscales and the intrusion subscale of the Impact of Events Scale also indicated the convergent and discriminant validity of the SASS II. Significant positive correlations between current and prior trauma levels further evidence the validity of the SASS.     

The Role of Legal Education in Producing Psychological Distress Among Law Students and Lawyers

The anecdotal literature suggests that the process of legal education impairs the maintenance of emotional well-being in law students. The purpose of this article is to present the results of a cross-sequential research design that empirically assessed the validity of this hypothesis. Data were collected, using four standardized self-report instruments (Brief Symptom Inventory, Beck Depression Inventory, Multiple Affect Adjective Checklist, and Hassle Scale) on subjects before and during law school and after graduation. Before law school, subjects expressed psychopathological symptom responses that were similar to the normal population. Yet during law school and after graduation symptom levels were significantly elevated. The implications of these results are presented.     

Assessing police work experiences: Development of the police daily hassles and uplifts scales

The development of two self-report scales that measure police daily hassles and uplifts is reported These scales reflect the positive and negative work experiences common to police officers. Self-report questionnaire data were provided by 330 police officers drawn from a systematic sample of all ranks and work sections within an Australian police department. Results showed that 19 dimensions of police hassles and 12 dimensions of police uplifts could be grouped into two broad domains of organizational and operational experiences. Correlations with job satisfaction and perceived quality of life (PQOL) indicators supported the construct validity of the scales and suggested that organizational hassles and uplifts were more important than operational experiences in determining a police officer's PQOL. When compared to population norms, police officers reported more favorable levels of PQOL. These results raise questions about the assertion that policing is highly stresful, and they demonstrate the need for a more systemic view of police work that takes into account experiences that are beneficial as well as experiences that are harmful to an officer's well-being.     

Biopsychosocial Considerations in Unnecessary Work Disability

The current definition and management of medical conditions causing impairment and unnecessary disability in workers’ compensation (WC) systems are suboptimal. Fundamental problems include the failure to recognize and address the unique biopsychosocial diathesis of each individual; the powerful influence of human psychology in the genesis, perpetuation, and refractoriness to treatment of many conditions, including medically unexplained symptoms and chronic pain; the work relevance of even non-work-related conditions; the considerable effects of administrative and clinical iatrogenicity; and the plethora of complex factors potentially affecting the course of conditions treated in WC systems. Once claims are established in WC, administrative and medical management of both identifiable pathologic conditions and unexplained symptoms are fragmented, not based on available scientific evidence, and adherent to a biomedical care approach which is not appropriate for a significant number of cases. These obstacles prevent effective understanding and management of many WC cases and may contribute to eventual recovery failure and unnecessary work disability (UWD). This article explores biopsychosocial factors in WC claimants and elements that may contribute to or ameliorate progression to UWD. The author offers a heuristic diathesis stress model of work-related disability as a framework for general and specific interventions to improve system performance and outcomes for all stakeholders.     

A cognitive-based indicator of deviant sexual interest: Concurrent validation of the Stroop task

ABSTRACT

One of the strongest predictors of sexual recidivism is sexual deviance [Hanson, R. K., & Bussière, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348–362. doi:10.1037/0022-006X.66.2.348]. Phallometric testing, the most commonly used method of assessing sexual deviance, has elicited methodological and ethical criticisms, while self-report is vulnerable to social desirability and poor insight. To overcome these limitations, researchers have utilised cognitive measures, including a modified Stroop task, to measure deviant sexual interests among sex offenders using victim selection as a comparison measure. However, the results have been inconclusive. The current study explored the validity of the modified Stroop task as a measure of deviant sexual interest among a non-offending sample of 570 females and 223 male participants, using self-report as the comparison measure. The results indicated a significant gender difference in concurrent validity; there was a significant relationship between self-reported deviance and deviant word Stroop performance for male but not for female respondents, suggesting the Stroop is a viable option for assessing sexual deviance among males. Implications of these findings are discussed relative to sexual recidivism risk assessment.     

Atypical Accommodations for Employees with Psychiatric Disabilities

People with psychiatric disabilities often need atypical accommodations to participate in today's workforce. Some of these accommodations, including structural and social changes in the workplace, can address biases against people with psychiatric disabilities, while others ameliorate deficits that may affect performance or interaction with others. Many courts have denied requests for such accommodations based on employers' assumptions about performance or the direct threats purportedly posed by people with psychiatric disabilities. By challenging these assumptions, which can be influenced by stigma and stereotypes, and by enforcing an employer's duty to interact regarding potential accommodations, employees with psychiatric disabilities could benefit from structural and social accommodations. Courts should consider social science research in determining which nontraditional accommodations may be reasonable and whether the employer can establish that they impose any undue hardship. Such consideration will expand opportunities for people with psychiatric disabilities in the workplace without unduly interfering with employers' interests.