Validating Embedded Validity Indicators of Feigned ADHD-Associated Cognitive Impairment Using the MOXO-d-CPT

Evidence for Overlapping Visual Processing Difficulties in Adult ADHD and Visual Stress

We investigated the viability of spectral filters as an adjunctive treatment for adults with both ADHD and visual processing difficulties. Fifty-nine adults (age 18-50), diagnosed with both ADHD and visual stress received either spectral filters (n = 39) or no intervention (n = 20) to address visual processing difficulties. We administered the MOXO d-CPT, a computer based continuous performance test, before the intervention and one hour after the intervention to assess any short-term change in the participants' attention profile. We used the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) before and 3-6 months after the intervention to assess any long-term intervention impact after 3-6 months. The intervention group had significant short- and long-term improvements in overall attention compared to the control group (X2(1, N = 59) = 20.10, p < .001). On the DSM-5, 49% of participants with short term and 64% with long-term intervention no longer met criteria for an ADHD diagnosis. Findings suggest that spectral filters may be an adjunctive treatment for many adults suffering from perceptually-based attention issues common to visual stress and ADHD.

Settling the Score: Can CPT-3 Embedded Validity Indicators Distinguish Between Credible and Non-Credible Responders Referred for ADHD and/or SLD?

OBJECTIVE

The purpose of the present study was to further investigate the clinical utility of individual and composite indicators within the CPT-3 as embedded validity indicators (EVIs) given the discrepant findings of previous investigations.

METHODS

A total of 201 adults undergoing psychoeducational evaluation for ADHD and/or Specific Learning Disorder (SLD) were divided into credible (n = 159) and non-credible (n = 42) groups based on five criterion measures.

RESULTS

Receiver operating characteristic curves (ROC) revealed that 5/9 individual indicators and 2/4 composite indicators met minimally acceptable classification accuracy of ≥0.70 (AUC = 0.43-0.78). Individual (0.16-0.45) and composite indicators (0.23-0.35) demonstrated low sensitivity when using cutoffs that maintained specificity ≥90%.

CONCLUSION

Given the lack of stability across studies, further research is needed before recommending any specific cutoff be used in clinical practice with individuals seeking psychoeducational assessment.

Online search strategies utilized in feigning attention deficit/hyperactivity disorder (ADHD) while performing a continuous performance test (CPT)

BACKGROUND

The availability of information regarding neuropsychological tests threatens their confidentiality. This concern may be particularly relevant to Attention-Deficit/Hyperactivity Disorder (ADHD) considering its widespread online coverage. The present study explored simulators' online search strategies.

METHOD

Simulators (n = 39) searched for information before undergoing an evaluation which included performing a continuous performance test (CPT). Their search strategies were analyzed, and their performance was compared to that of ADHD patients (n = 36) and healthy controls (n = 38).

RESULTS

Most simulators reached high-risk websites that provided written and video-based information regarding the test. Sixty percent, comprised mostly of 3rd-year students, reached Google Scholar. These students were also easier to detect as simulators. Common strategies included performing the CPT in accordance with typical ADHD symptoms and avoiding the endorsement of both unusual and stereotypical symptoms.

CONCLUSION

Simulators can access online information that contains key test data. Higher education may increase the ability to reach academic research while decreasing the ability to convincingly feign impairment. While additional research is needed to examine coaching effects on neuropsychological testing, the risk to test security that many websites pose should be acknowledged and steps, including ones taken by test publishers, should be undertaken to minimize it.