Detection of Response Bias and Noncredible Performance in Adult Attention-Deficit/Hyperactivity Disorder

Abstract

Adults with attention-deficit/hyperactivity disorder (ADHD) are frequently prescribed stimulant medication and eligible for accommodations at work or school that serve as potent incentives to feign ADHD symptoms. The current investigation examined the predictive validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity scales in detecting and accurately classifying individuals attempting to feign ADHD. An archival ADHD clinical group (n = 34), normal control group (n = 37), and group instructed to feign ADHD symptoms (n = 32) completed the MMPI-2 and ADHD Current and Childhood Symptoms Scales. Behavior rating scales were unable to differentiate the clinical group from the simulated malingering group. Logistic regressions revealed that Infrequency-Psychopathology scale best detected response bias, followed by Infrequency scale, Back-Infrequency scale, Response Bias Scale (RBS), Henry-Heilbronner Index scale (HHI), and Fake Bad Scale (FBS). Results also indicate that recommended cutoffs for HHI, RBS, and FBS display inadequate sensitivity and specificity. Nevertheless, the MMPI-2 offers a number of validity indices that may assist in detecting individuals attempting to feign ADHD.

“Why Is This So Hard?” A Review of Detection of Malingered ADHD in College Students

“…Young and Gross (2011) compared a clinical ADHD group with ADHD simulators. The ADHD simulators were asked to read a set of instructions and criteria for ADHD.…”

Faking ADHD? Symptom Validity Testing and Its Relation to Self-Reported, Observer-Reported Symptoms, and Neuropsychological Measures of Attention in Adults With ADHD

“…The authors argue against the exclusive use of self-rating inventories for diagnosing adult ADHD. Young and Gross (2011) proposed to apply the Minnesota Multiphasic Personality Inventory Test (MMPI-2) in adult ADHD assessment as they were able to differentiate a malingering group and an ADHD group by a number of integrated validity scales in their study (Young & Gross, 2011). Using the ADHD Current and Childhood Symptoms Scales, there were no significant differences between individuals trying to feign symptoms of ADHD and an ADHD clinical group.…”

Development of the Subtle ADHD Malingering Screener

“…One approach to limiting the potential misuse of stimulant medications is identifying instances of legitimate prescription that were obtained for illicit purposes. For example, students may seek out an ADHD diagnosis to acquire prescription stimulants legally, which may be additionally incentivized by other academic accommodations such as extra time on tests (Garnier-Dykstra et al, 2012; Jasinski & Ranseen, 2011; Young & Gross, 2011; Zgierska, Miller, & Rabago, 2012). This presentation appears common in college settings, with previous research estimating that between 20% and 50% of students reporting symptoms of ADHD are either exaggerating or completely fabricating their symptoms (Harrison, 2006; Suhr, Hammers, Dobbins-Buckland, Zimak, & Hughes, 2008; Sullivan, May, & Galbally, 2007).…”

“…In particular, the widespread use of the MMPI-2 in clinical settings has contributed to substantial research on the utility of subtle scales, which have often been tested for identification of malingering of ADHD. These examinations have typically indicated poor sensitivity (Harp et al, 2011; Rios & Morey, 2013; Young & Gross, 2011), although this should not be extrapolated to indicate that subtle scales lack value in this domain. Rather, these results are reflective of the fact that existing subtle scales for ADHD have generally not been tailored to assess a focal construct (e.g., malingering).…”