Detecting Feigned ADHD in Later Adolescence: An Examination of Three PAI–A Negative Distortion Indicators

Detecting Attention Deficit Hyperactivity Disorder and its feigning using the Personality Assessment Inventory

Attention Deficit Hyperactivity Disorder is a relatively common and often disabling disorder in adults. However, feigning ADHD symptomatology is both easy and potentially common. We explored the most effective strategies for A) identifying individuals who had been diagnosed with ADHD based on existing PAI symptom indicators, and B), discriminating between feigned and genuine ADHD symptoms using PAI negative distortion indicators. Our sample consisted of 463 college aged participants who had been diagnosed with ADHD (n = 60), were asked to feign ADHD (n = 71), and a control group (n = 333). Self-reported diagnosis and successful feigning were corroborated by the CAARS-S: E scale. We first compared two PAI-derived ADHD indicators to determine which best differentiated between our ADHD and Control groups. Next, we compared seven negative distortion indicators to determine which could best distinguish between real and feigned ADHD symptoms. Our results revealed that the PAI-ADHD scale was the most effective symptom indicator. Further, the Negative Distortion Scale (NDS) and the Item-FAA scale were the most effective for identifying feigners. When assessing ADHD based on the PAI, the PAI-ADHD scale appears promising as an indicator of symptomatology, while the NDS and Item-FAA appear useful to rule-out feigning.

Using the Personality Assessment Inventory-Adolescent in Legal Settings

The Personality Assessment Inventory-Adolescent (PAI-A; Morey et al., 2007) is a self-report measure of personality and psychopathology appropriate for use with individuals aged 12-18. It is modeled after the Personality Assessment Inventory (PAI; Morey, 1991), a measure widely used with adults in clinical and legal settings. The PAI-A assesses a variety of features that have utility in legal settings, including validity scales that assess approach to testing, clinical scales measuring common types of psychopathology, and treatment consideration scales that provide indicators of treatment motivation and other factors that may be important for predicting outcomes. The PAI-A has been included in a limited number of research studies and few of those have focused on justice-involved youths. Additionally, because juvenile court records are not typically publicly available, there is limited information about the PAI-A available in case law. This manuscript reviews the properties, strengths, and weaknesses of the PAI-A and its existing literature. Factors for mental health and legal professionals to consider in relation to the admissibility of this measure, questioning and cross-examination, and how the PAI-A may be received in court are also discussed.

Detecting Feigning in Adolescents on the Personality Assessment Inventory-Adolescent Form

Much of the research on identifying feigning in psychological assessment has focused on adults with less attention to adolescents. The purpose of the present study is to expand the limited literature on detecting feigning in adolescents using the Personality Assessment Inventory - Adolescent. The study included 114 nonclinical adolescents (ages 15 to 18) recruited from high schools in the Midwest who were randomly assigned to experimental groups: honest nonclinical, uncoached feigning, and coached feigning. 50 randomly selected individuals with depression from the PAI-A clinical standardization sample were included as the honest clinical group. Sample demographics included a mean age of 16.64 years; 51.2% young men, 48.2% young women; 85.4% Caucasian, 6.7% African American, 5.5% Hispanic, and 2.4% Asian. 80% of feigning profiles reported clinical levels of depression. MANOVA results showed strong support for the Rogers Discriminant Function (RDF; d range = 1.85-2.05). The Negative Impression Management (NIM) scale also demonstrated promise (d range = 0.77-1.08), while the smallest effects for detecting feigning were found for the Malingering Index (d range = 0.58-0.70). The negative distortion indices showed good utility in differentiating between groups. Cut-scores and pragmatic implications are presented.

Discriminating malingered attention Deficit Hyperactivity Disorder from genuine symptom reporting using novel Personality Assessment Inventory validity measures

It is now widely understood that ADHD can be feigned easily and convincingly. Despite this, almost no methods exist to assist clinicians in identifying when such behavior occurs. Recently, new validity indicators specific to feigned ADHD were reported for the Personality Assessment Inventory (PAI). Derived from a logistic regression, these algorithms are said to have excellent specificity and good sensitivity in identifying feigned ADHD. However, these authors compared those with genuine ADHD only to nonclinical undergraduate students (asked to respond honestly or asked to simulate ADHD); no criterion group of definite malingerers was included. We therefore investigated these new validity indicators with 331 postsecondary students who underwent assessment for possible ADHD and compared scores of those who were eventually diagnosed with ADHD (n = 111) to those who were not [Clinical controls (66), Definite malingerers (36); No diagnosis (117)]. The two proposed PAI algorithms were found to have poor positive predictive value (.19 and .17). Self-report validity measures from the Connors' Adult Attention Rating Scale, and the Negative Impression Management scale on the PAI returned more positive results. Overall, more research is needed to better identify noncredible ADHD presentation, as the PAI-based methods proposed by Aita et al. appear inadequate as symptom validity measures.

Utility of the Personality Assessment Inventory in detecting feigned Attention-Deficit/Hyperactivity Disorder (ADHD): The Feigned Adult ADHD index

Objective

The high potential for secondary gain among college students presenting for Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations highlights the need for psychometrically sound embedded validity indicators. The purpose of this study was to develop new validity indicators specific to feigned ADHD for the Personality Assessment Inventory (PAI) and compare them to preexisting imbedded PAI validity measures.

Method

PAI scales that were theoretically related to feigned ADHD were evaluated. A binomial (ADHD simulators, n = 138, and genuine ADHD, n = 142) logistic regression was conducted with selected PAI scales and subscales. Classification rates were compared between the new and existing validity scales. A similar approach was used for item-level data in a second study in a subgroup of the original sample.

Results

The derived PAI scale-based logistic regression had a sensitivity of 54% and specificity of 92%. This algorithm accurately identified 97% of healthy controls as not feigning ADHD and correctly identified 98% of a no diagnosis group and 75% of a mood/anxiety disorders group. Classification accuracy of the new index was superior to the majority of existing PAI validity scales across groups. An item-level PAI algorithm had a sensitivity of 85% and specificity of 97% for identifying feigned ADHD.

Conclusions

New validity measures were compared to existing PAI validity indicators and performed better than many of them in this study. The algorithms developed in this study of ADHD simulators and genuine ADHD cases have adequate sensitivity and good specificity and appear to function differently than other PAI symptom validity scales.

Development of the Subtle ADHD Malingering Screener

The objective of this study was to develop a subtle self-report scale—the Subtle ADHD Malingering Screener (SAMS)—to screen for malingering among individuals reporting symptoms of attention deficit/hyperactivity disorder (ADHD). This study employed a cross-sectional experimental design with an ADHD group, a control group—comprising individuals without ADHD—and a malingering group—comprising individuals without ADHD who were instructed to feign ADHD in their responses. Factor analysis and psychometric testing were conducted to develop a final scale that could distinguish the malingering from the other groups. A 10-item, two-factor solution was obtained for the SAMS, with a sensitivity of 90.3% and specificity of 80.1%. The SAMS presents an innovative approach to help reduce overdiagnosis of ADHD and misuse of prescription stimulants. The efficient, straightforward form of the measure particularly enhances its potential application in both medical and psychosocial clinical settings.

Augmented Go/No-Go Task: Mouse Cursor Motion Measures Improve ADHD Symptom Assessment in Healthy College Students

Attention deficit/hyperactivity disorder (ADHD) is frequently characterized as a disorder of executive function (EF). However, behavioral tests of EF, such as go/No-go tasks, often fail to grasp the deficiency in EF revealed by questionnaire-based measures. This inability is usually attributed to questionnaires and behavioral tasks assessing different constructs of EFs. We propose an additional explanation for this discrepancy. We hypothesize that this problem stems from the lack of dynamic assessment of decision-making (e.g., continuous monitoring of motor behavior such as velocity and acceleration in choice reaching) in classical versions of behavioral tasks. We test this hypothesis by introducing dynamic assessment in the form of mouse motion in a go/No-go task. Our results indicate that, among healthy college students, self-report measures of ADHD symptoms become strongly associated with performance in behavioral tasks when continuous assessment (e.g., acceleration in the mouse-cursor motion) is introduced.

Utility of the Personality Assessment Inventory for Detecting Malingered ADHD in College Students

OBJECTIVE

The purpose of the current study is to examine the utility of the Personality Assessment Inventory (PAI) for detecting feigned ADHD in college students.

METHOD

A sample of 238 undergraduate students was recruited and asked to simulate ADHD (ADHD simulators) or respond honestly (controls) on the PAI. Archival data (n = 541) from individuals diagnosed with clinical ADHD, no diagnosis, learning disorder, mood/anxiety, comorbid ADHD-mood/anxiety, or suspect effort were used.

RESULTS

Few individuals scored above the cutoffs on PAI validity scales. When alternative cutoff scores were examined, cutoffs of ≥77 on the Negative Impression Management (NIM) scale, ≥3 on the Malingering Index (MAL), and ≥1 on the Rogers Discriminant Function (RDF) yielded excellent specificity in all groups and sensitivities of .33, .30, and .20, respectively.

CONCLUSION

Individuals who were asked to simulate ADHD easily manipulate the PAI; however, alternative cutoff scores proposed for PAI validity indices may improve the detection of feigned ADHD symptoms.

Evaluating the Validity Indices of the Personality Assessment Inventory-Adolescent Version

Past research has established strong psychometric properties of several indicators of response distortion on the Personality Assessment Inventory (PAI). However, to date, it has been unclear whether the response distortion indicators of the adolescent version of the PAI (PAI-A) operate in an equally valid manner. The current study sought to examine several response distortion indicators on the PAI-A to determine their relative efficacy at the detection of distorted responding, including both positive distortion and negative distortion. Protocols of 98 college students asked to either overreport or underreport were compared with 98 age-matched individuals sampled from the clinical standardization sample and the community standardization sample, respectively. Comparisons between groups were accomplished through the examination of effect sizes and receiver operating characteristic curves. All indicators demonstrated the ability to distinguish between actual and feigned responding, including several newly developed indicators. This study provides support for the ability of distortion indicators developed for the PAI to also function appropriately on the PAI-A.