Assessing Functional Impairment in ADHD: Concerns for Validity of Self-Report

Comprehensive diagnostic assessment of attention deficit hyperactivity disorder (ADHD) should include consideration of degree of impairment, and documentation of impairment is necessary to make service and accommodation determinations. While there has been increasing use of self-report as a way to document impairment, self-reported impairment could be just as vulnerable to invalid report as self-reported symptoms. We examined the influence of invalid self-report and invalid performance on report of functional impairment in a sample of 49 adults referred for evaluation for ADHD and/or learning disorder concerns. Overall, 26–59% of participants referred for evaluation endorsed at least moderate levels of impairment in the domains of understanding and communicating, household, and school/work. Individuals with evidence of invalid self-report of ADHD symptoms endorsed significantly higher levels of disability/impairment on the WHODAS, particularly in the domains of understanding and communicating, household, school/work, and participation in society. Further, individuals who failed a measure of performance validity reported significantly higher levels of impairment/disability, particularly in the domains of understanding and communicating, school/work, and participation in society. Results emphasize the need to assess for validity of self-report and performance in ADHD assessment. Since self-report of impairment may be suspect, clinicians should include data such as school records, past performance on high-stakes standardized testing, evidence of prior accommodations, and collateral reports before making diagnoses and/or recommendations regarding treatment or academic/workplace accommodations.     

Implicit attitudes toward violence among male perpetrators of intimate partner violence: a preliminary investigation

Whereas cognitive variables are hypothesized to play an important role in intimate partner violence (IPV) etiology and intervention, cognitive assessment methods have largely targeted offenders' explicit, controlled cognitive processing using paper-and-pencil questionnaires prone to social desirability biases. Using an implicit measure of attitudes (the Implicit Association Test [IAT]), we assessed attitudes toward gender, violence, and the association between gender and violence among 50 men enrolled in an IPV treatment program and a comparison sample of 40 nonviolent (NV) men. Although no group differences were noted on explicit attitudinal measures, men in the IPV group showed more positive implicit attitudes regarding violence, and a more rapid association between women and violence. Among men in treatment for IPV, the attitudes toward violence IAT was significantly correlated with self/partner-reported IPV frequency. In accordance with social information processing models of aggression, these results suggest that aggressogenic attitudes are likely to operate automatically and with little conscious deliberation. As a result, clinicians and researchers must adapt assessment and intervention strategies to capture both implicit and explicit aspects of cognitive processing.