Symptom and performance validity with veterans assessed for attention-deficit/hyperactivity disorder (ADHD).

Abstract

Little is known about attention-deficit/hyperactivity disorder (ADHD) in veterans. Practice standards recommend the use of both symptom and performance validity measures in any assessment, and there are salient external incentives associated with ADHD evaluation (stimulant medication access and academic accommodations). The purpose of this study was to evaluate symptom and performance validity measures in a clinical sample of veterans presenting for specialty ADHD evaluation. Patients without a history of a neurocognitive disorder and for whom data were available on all measures (n = 114) completed a clinical interview structured on DSM-5 ADHD symptoms, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), and the Test of Memory Malingering Trial 1 (TOMM1) as part of a standardized ADHD diagnostic evaluation. Veterans meeting criteria for ADHD were not more likely to overreport symptoms on the MMPI-2-RF nor to fail TOMM1 (score ≤ 41) compared with those who did not meet criteria. Those who overreported symptoms did not endorse significantly more ADHD symptoms; however, those who failed TOMM1 did report significantly more ADHD symptoms (g = 0.90). In the total sample, 19.3% failed TOMM1, 44.7% overreported on the MMPI-2-RF, and 8.8% produced both an overreported MMPI-2-RF and invalid TOMM1. F-r had the highest correlation to TOMM1 scores (r = -.30). These results underscore the importance of assessing both symptom and performance validity in a clinical ADHD evaluation with veterans. In contrast to certain other conditions (e.g., mild traumatic brain injury), ADHD as a diagnosis is not related to higher rates of invalid report/performance in veterans. (PsycINFO Database Record

The Divergent Roles of Symptom and Performance Validity in the Assessment of ADHD

“…Among those with discordant PVT and SVT performance, more exhibited valid PVT performance and invalid SVT performance (15% of the total sample), with the remaining 9% of the overall sample exhibiting invalid PVT performance and valid SVT performance. These findings reflect a significantly lower rate of performance invalidity than previous studies using only one PVT failure to classify performance invalidity (e.g., 19%-48%; Shura et al, 2017;Suhr et al, 2008;Sullivan et al, 2007). However, they are fairly consistent with a study by Van Dyke et al (2013), which used more conservative validity classification criteria of ≥2 failures on PVTs or SVTs as indicative of invalidity in their respective categories.…”

“…Despite promising findings regarding the utility of PVTs (e.g., Jasinski et al, 2011;Marshall et al, 2010;Sollman et al, 2010;Williamson et al, 2014) and SVTs (e.g., Cook et al, 2016;Fuermaier et al, 2016;Harrison & Armstrong, 2016) in ADHD evaluations, a majority of the extant literature has examined these constructs independently. However, in a recent study examining both symptom and performance validity, Shura et al (2017) found that veterans who met criteria for ADHD were not more likely to overreport symptoms on the MMPI-2-RF than those who did not meet diagnostic criteria nor were they more likely to fail a well-validated PVT. However, the veterans who failed a well-validated PVT reported more ADHD symptomatology than those who passed it.…”

Rates of Performance Validity Test Failure for ADHD Evaluations in a Military Population: An Exploratory Study

“…This indeed continues to substantiate that poor cognitive effort is a concern for adults referred for ADHD evaluation. In addition, in agreement with Shura and colleagues (2017), this study indicates that poor effort is a concern for those seeking ADHD evaluations in military populations. This study extended the findings from Shura and colleagues and indicates poor cognitive effort occurs not only in those with a history of military service but also in those that are currently serving.…”

“…Although several studies have demonstrated base rates of PVT failure in college populations presenting for ADHD evaluation, to date there has only been one study examining this issue in U.S. military populations (Shura, Denning, Miskey, & Rowland, 2017). Although their approach primarily examined subjective report of symptoms (symptom validity testing), they did include one PVT measure and found a near 20% failure rate (19.3).…”

Descriptive Profiles of the MMPI-2-Restructured Form (MMPI-2-RF) across a National Sample of Four Veteran Affairs Treatment Settings

“…The Minnesota Multiphasic Personality Inventory-Restructured Form (MMPI-2-RF; Tellegen and Ben-Porath 2008/2011) is a widely-used broadband instrument within the VA and research has consistently supported the reliability and validity of scores on MMPI-2-RF scales in veterans and military service members (e.g., Russo 2018). The validity scales consistently discriminate between valid and invalid patterns of responding (Goodwin et al 2013;Nelson et al 2011;Sellbom et al 2012b;Shura et al 2017), offering a means to evaluate the potential for response bias within the VA (Ray 2017). Similarly, the substantive scales are useful in predicting diagnostic presentations and identifying important clinical concerns (Koffel et al 2012;Gottfried et al 2014;Sellbom et al 2012a;Wolf et al 2008).…”