The prevalence of ADHD diagnoses more than doubled in VA settings between 2009 and 2016 (Hale et al., 2020). However, attentional difficulties are not exclusive to ADHD and can also be seen in non-neurodevelopmental disorders, including depression, anxiety, substance use, and PTSD (Marshall et al., 2018, Suhr et al., 2008). Further, patients can easily feign symptoms of ADHD with few available instruments for accurate detection (Robinson & Rogers, 2018). Given the significant symptom overlap and rising rates of reported ADHD among Veterans, accurate detection of feigned ADHD is essential.

This study examined the utility of the experimental Dissimulation ADHD scale (Ds-ADHD; Robinson & Rogers, 2018) on the MMPI-2, in detecting feigned ADHD presentation within a mixed sample of Veterans.

In this retrospective study, 173 Veterans (Mage = 36.18, SDage = 11.10, Medu = 14.01, SDedu = 2.11, 88% male, 81% White, and 17% Black) were referred for neuropsychological evaluation of ADHD that included the MMPI-2 and up to 10 PVTs. Participants were assigned to a credible group (n=146) if they passed all PVTs or a non-credible group (n=27) if they failed two or more PVTs. Group assignment was also clinically confirmed. The Ds-ADHD was used to differentiate groups who either had credible or non-credible performance on cognitive measures. Consistent with Robinson and Rogers’ study, “true” answers (i.e., erroneous stereotypes) were coded as 1 and “false” answers were coded as 2, creating a 10- to 20-point scale. Lower scores were associated with a higher likelihood of a feigned ADHD presentation.

Preliminary analyses revealed no significant group differences in age, education, race, or gender (ps > .05). An ANOVA indicated a significant difference between groups (F[1, 171] = 10.44, p = .001; Cohen’s d = .68) for Ds-ADHD raw scores; Veterans in the non-credible group reported more “erroneous stereotypes” of ADHD (M raw score = 13.33, SD = 2.20) than those in the credible group (M = 14.82, SD = 2.20). A ROC analysis indicated AUC of .691 (95% CI = .58 to .80). In addition, a cut score of <12 resulted in specificity of 91.8% and sensitivity of 18.5%, whereas a cut score of <13 resulted in specificity of 83.6% and sensitivity of 44.4%.

The Ds-ADHD scale demonstrated significant differences between credible and non-credible respondents in a real-world setting. Previously, this scale has primarily been studied within laboratory settings. Further, results indicate a cut score of <12 could be used in order to achieve adequate specificity (i.e., >90%), which were similar findings to a study examining SVT-based groups (Winiarski et al., 2023). These results differ slightly from prior research by Robinson and Rogers (2018), who indicated a cut score of <13 based on the initial simulation-based study. In similar clinical settings, where there are high rates of psychiatric comorbidity, a cut score of <12 may prove clinically useful. However, this cut-score was associated with low sensitivity within this mixed Veteran sample. Further research should focus on replicating findings within other clinical settings, including ones with larger non-credible samples.

Performance validity (PVT) and symptom validity tests (SVT) have become standard practice in assessing credibility of neuropsychological profiles and symptom report. While PVTs assess cognitive task engagement, SVTs assess credibility of patient symptom report. Although prior research aimed to conceptualize the relationship between the two validity measure types, it generally focused on SVTs from the Minnesota Multiphasic Personality Inventory (MMPI-2 &RF) and the Structured Inventory of Malingered Symptoms (SIMS; Ord et al., 2021, MMPI-2; Van Dyke et al., 2013). Further studies have demonstrated mixed results, with many studies concluding that symptom and performance validity are separate but related constructs. The current study aimed to assess the relationship between PVTs and SVTs utilizing symptom validity measures from the Personality Assessment Inventory (PAI) across three samples, including neurodevelopmental, psychiatric, and traumatic brain injury groups.

Participants included 634 individuals consecutively referred for neuropsychological assessment who completed the Test of Memory Malingering (TOMM) and the PAI (mean Age = 41.7, SD = 15.7; mean Education = 13.7, SD = 2.7; 53% female; 89% Caucasian). Participants were divided into three groups based on referral, including neurodevelopmental (mean Age = SD = 10.7; mean Education = 13.4, SD = 2.5; 39% female; 79% Caucasian), psychiatric (mean Age = 44.7, SD = 15.0; mean Education = 13.8, SD = 2.8; 58% female; 90% Caucasian), and traumatic brain injury samples (mean Age = SD = 15.5; mean Education = 13.3, SD = 2.3; 50% female; 91% Caucasian). Four structural equation models (latent variable models) were constructed. The first model was fit across the entire sample while the remaining three were fit for the aforementioned subsamples. TOMM trials modeled the performance validity latent variable while SVTs from the PAI modeled the symptom validity latent variable (Positive Impression Management and Defensiveness Index modeled underreporting; Negative Impression Management, Malingering Index, and Cognitive Bias Scale modeled overreporting).

In the full sample model overreporting significantly predicted performance validity (p < 0.001, r = -0.31), indicating higher symptom overreporting related to poorer performance validity while symptom underreporting did not significantly predict performance validity (p = 0.09, r = 0.08). In the neurodevelopmental model overreporting did not significantly predict performance validity (p = 0.44, r = 0.10). Further, symptom underreporting did not significantly predict performance validity (p = 0.40, r = 0.10). Similarly, for the TBI model, overreporting did not significantly predict performance validity (p = 0.82, r = -0.02) and symptom underreporting did not significantly predict performance validity (p = 0.50, r = -0.08). For the psychiatric sample symptom underreporting did not significantly predict performance validity (p = 0.06, r = 0.11); however, symptom overreporting significantly predicted performance validity (p < 0.001, r = - 0.39).

The current study expands on prior research comparing the relationship between SVTs and PVTs in neuropsychological evaluation utilizing SVTs from the PAI. Results of the present study suggest the relationship between the SVTs and PVTs varies by referral type and further supports using both PVTs and SVTs in neuropsychological assessment.

Assessment of response validity is essential to neuropsychological assessment. Although informant report of examinee functioning has previously been associated with examinee-generated performance and cognitive symptom invalidity (PVT; SVT-C), empirically-derived guidelines for interpreting informantreport validity are lacking. This study sought to assess the classification accuracy of a widely used informant-report measure, the Dementia Severity Rating Scale (DSRS), for discriminating examinee-generated PVT and SVT-C.

Data were collected from 145 examinee-informant dyads who completed neuropsychological batteries as part of a routine workup in an epilepsy monitoring unit. PVT status was determined by below-threshold performances on >2 indicators (Test of Memory Malingering, Wechsler Digit Span Age Corrected Scaled Score, Word Memory Test). SVT-C status was determined by above-threshold responses on both the Minnesota Multiphasic Personality Inventory-2-Restructured Form Response Bias Scale (MMPI-2-RF RBS) and Structured Inventory of Malingered Symptomatology Amnestic Disorders subscale (SIMS-AM). After assessing demographic and relational covariance via t-test and chi square analyses, receiver operator characteristic curves were derived to assess the classification accuracy of the DSRS for discriminating examinee PVT and SVT-C status.

DSRS total score demonstrated acceptable accuracy in classifying PVT status (AUC = .77), with cut scores of >21 and >15 yielding .93-.82 specificity and .44-.63 sensitivity. The DSRS also classified SVT-C status with acceptable accuracy (AUC = .71), with the aforementioned cut scores exhibiting .90-.78 specificity and .50-.64 sensitivity. The DSRS also classified SVT-C status using only one indicator (i.e., MMPI-2-RF RBS or SIMS-AM) with acceptable accuracy (AUC = .71-.72), with the aforementioned cut scores exhibiting .92 specificity and .37-.42 sensitivity.

The DSRS can be used to classify examinee-generated PVT and SVT-C on an epilepsy monitoring unit. Results provide empirically-derived psychometric guidelines for interpreting informant-report response validity that are clinically useful and lay the groundwork for future investigations of informant-report response validity.

No significant relationships.

No significant relationships.

Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with validity test performance and may thus lead to an incorrect (i.e., false-positive) classification of the patient’s scores as non-credible. The study aimed at examining the false-positive rate of three validity tests in patients with cognitive impairment and apathy.

A cross-sectional, comparative study was performed in 56 patients with dementia, 41 patients with mild cognitive impairment, and 41 patients with Parkinson’s disease. Two PVTs – the Test of Memory Malingering (TOMM) and the Dot Counting Test (DCT) – and one SVT – the Structured Inventory of Malingered Symptomatology (SIMS) – were administered. Apathy was measured with the Apathy Evaluation Scale, and severity of cognitive impairment with the Mini Mental State Examination.

The failure rate was 13.7% for the TOMM, 23.8% for the DCT, and 12.5% for the SIMS. Of the patients with data on all three tests (n = 105), 13.5% failed one test, 2.9% failed two tests, and none failed all three. Failing the PVTs was associated with cognitive impairment, but not with apathy. Failing the SVT was related to apathy, but not to cognitive impairment.

In patients with cognitive impairment or apathy, failing one validity test is not uncommon. Validity tests are differentially sensitive to cognitive impairment and apathy. However, the rule that at least two validity tests should be failed to identify non-credibility seemed to ensure a high percentage of correct classification of credibility.

This study aimed at analyzing the validity and reliability of the continuous reaction time (CRT) test, the finger-tapping test (FTT), the Digit Span Test (DST), the Trail Making Test – part B (TMTB), and the Mini-Mental State Examination (MMSE) in patients with metastatic cancer.

Eighty adult patients and 81 healthy controls were assessed between July of 2010 and November of 2015. The neuropsychological tests were analyzed regarding construct/discriminant/criterion validity and reliability.

In terms of construct validity, it was not possible to estimate a model for the MMSE because of a skewed response distribution. For discriminant validity, patients were slower on two measures of the CRT (p = 0.00483, p = 0.00030) and FTT dominant hand (p = 0.00306). Regarding sensitivity and specificity, only the DST and TMTB seemed to predict cognitive deficit; however, the ROC curve areas were ≤ 0.73. In terms of criterion validity, there were few significant correlations between the tests and the sociodemographic and clinical variables, and for the most part were very weak. Reliability was deemed to be adequate for the TMTB, DST, and FTT.

The findings of the full validation analyses were not clear-cut. However, CRT test, DST, FTT, and TMTB demonstrated partial positive results, indicating that these tests have good potential for use in clinical settings and require further study.