Abstract

Measuring performance validity in Attention Deficit Hyperactivity Disorder (ADHD) assessments is essential, with multiple studies identifying how easily young adults can feign symptoms on self-report measures. Few methods, however, exist to identify such feigning when it occurs. While some clinicians include computerized tests of attention (e.g., Test of Variables of Attention [TOVA]) when assessing for possible ADHD, it is unclear how symptom exaggerators perform, and whether the TOVA Symptom Exaggeration Index (SEI) adequately identifies performance-based exaggeration when it occurs. Using archival data from a university-based ADHD screening clinic we investigated the performance of 245 late adolescents/emerging adults. Three groups were created: (1) Good effort but not ADHD (n = 183); (2) Good effort and diagnosed ADHD (n = 13); and (3) suspect effort (n = 49), based on final diagnosis and performance on an existing validity measure. Results showed clearly that those with suspect effort performed more poorly than the other two groups on all but second-half commission errors on the TOVA. Similar to Nicholls et al., the suspect effort group showed significantly subaverage (i.e., greater than two standard deviations below the mean) scores in Omission errors; in this replication, however, this was true for both the first and second half of the test. Response time variability was similarly exaggerated, with the suspect effort group again returning extreme scores in both halves of the test. Suspect effort students were indistinguishable from those with genuine ADHD when looking solely at self-reported symptoms; however, embedded symptom validity measures on an ADHD rating scale discriminated well between groups. Overall, results support the use of the TOVA as an embedded performance validity measure in the assessment of late adolescents/emerging adults and support previous findings that symptom report alone cannot distinguish credible from noncredible ADHD presentation.

摘要

衡量注意力缺陷多动障碍 (ADHD) 评估中的表现有效性至关重要，多项研究确定了年轻人在自我报告测量中假装症状的难易程度。然而，很少有方法可以在这种伪装发生时进行识别。虽然一些临床医生在评估可能的 ADHD 时包括计算机化的注意力测试（例如，注意力变量测试 [TOVA]），但不清楚症状夸大者的表现如何，以及 TOVA 症状夸大指数 (SEI) 是否充分识别基于表现的夸大当它发生时。使用来自基于大学的 ADHD 筛查诊所的档案数据，我们调查了 245 名晚期青少年/新兴成年人的表现。创建了三个小组：（1）努力但没有多动症（n = 183); (2) 努力并诊断出 ADHD ( n  = 13)；(3) 可疑的努力 ( n = 49)，基于对现有有效性测量的最终诊断和性能。结果清楚地表明，在 TOVA 上，除了下半年的佣金错误之外，那些有可疑努力的人的表现都比其他两组差。与 Nicholls 等人类似，可疑努力组在遗漏错误方面表现出明显低于平均值（即，低于平均值的两个标准偏差）；然而，在这次复制中，测试的前半部分和后半部分都是如此。响应时间的可变性同样被夸大了，可疑的努力组在测试的两半中再次返回极端分数。仅查看自我报告的症状时，怀疑努力的学生与真正的多动症学生无法区分；然而，ADHD 评分量表上的嵌入式症状效度测量在组之间有很好的区分。总体而言，结果支持在评估晚期青少年/新兴成人时使用 TOVA 作为嵌入式绩效有效性衡量标准，并支持先前的发现，即仅凭症状报告无法区分可信和不可信的 ADHD 表现。