Feigning Adult ADHD on a Comprehensive Neuropsychological Test Battery: An Analogue Study

Abstract

The evaluation of performance validity is an essential part of any neuropsychological evaluation. Validity indicators embedded in routine neuropsychological tests offer a time-efficient option for sampling performance validity throughout the assessment while reducing vulnerability to coaching. By administering a comprehensive neuropsychological test battery to 57 adults with ADHD, 60 neurotypical controls, and 151 instructed simulators, we examined each test’s utility in detecting noncredible performance. Cut-off scores were derived for all available outcome variables. Although all ensured at least 90% specificity in the ADHD Group, sensitivity differed significantly between tests, ranging from 0% to 64.9%. Tests of selective attention, vigilance, and inhibition were most useful in detecting the instructed simulation of adult ADHD, whereas figural fluency and task switching lacked sensitivity. Five or more test variables demonstrating results in the second to fourth percentile were rare among cases of genuine adult ADHD but identified approximately 58% of instructed simulators.

Cognitive Underperformance in a Mixed Neuropsychiatric Sample at Diagnostic Evaluation of Adult ADHD

“…Neuropsychological test performances on eight tests, 17 test variables, and their corresponding 17 EVIs were presented and analyzed in descriptive statistics, including measures of central tendency and variation, summary scores, and (cumulative) frequencies. EVI cut scores were applied as presented in Table 2 and as derived and presented in earlier research [19,50,63,68]. Further, EVI failure was analyzed on the test level if at least one EVI showed a positive result, and on the level of the battery if at least one EVI of the entire battery indicated a positive result.…”

“…It would be a time-and resource-efficient manner to combine clinical assessment of functioning with validity assessment using the CFADHD. In recent research [50], an analogue study evaluated its use for validity testing and derived cut scores for embedded performance validity (see Table 2). The present study employed eight of the tests as described below, with a total of 17 EVIs.…”

“…Based on the current state of evidence, only a few studies are available that help research and practice determine which EVIs are most helpful in the diagnostic evaluation of ADHD. Recently, Becke et al [50] reported findings from an analogue study on 247 individuals, of which 57 were genuine patients with ADHD and 151 typically developing individuals who were instructed to perform the assessment as if they had ADHD. All participants were requested to complete a comprehensive neuropsychological battery of eight neuropsychological tests that offer a broad range of 21 test variables (i.e., Cognitive Functions Adult ADHD; CFADHD; [50,51]).…”

“…Recently, Becke et al [50] reported findings from an analogue study on 247 individuals, of which 57 were genuine patients with ADHD and 151 typically developing individuals who were instructed to perform the assessment as if they had ADHD. All participants were requested to complete a comprehensive neuropsychological battery of eight neuropsychological tests that offer a broad range of 21 test variables (i.e., Cognitive Functions Adult ADHD; CFADHD; [50,51]). With the claim of reaching specificity levels of at least 90% for all measures, sensitivity rates ranged from 0 to 65% per test variable.…”

“…The present study employs 17 of the recently developed EVIs on eight different neuropsychological tests derived from the CFADHD [50,52] on a mixed sample of 464 individuals consecutively presenting for the clinical evaluation of adult ADHD. The first aim of this study was to establish base rates of noncredible performance per function and test (variable).…”