Allyson G. Harrison

Symptom Exaggeration in Post-Secondary Students: Preliminary Base Rates in a Canadian Sample

Recent studies conducted at American post-secondary institutions report that a high proportion of college students seeking evaluations for either attention-deficit/hyperactivity disorder or learning disorders fail symptom validity tests (SVTs), calling into question the validity of their performance on standardized assessment measures. The current study undertook to investigate the rate of SVT failure in a Canadian post-secondary sample, drawing on assessment data from a large regional assessment facility. Evaluating the data from 144 consecutively tested students, the present study found that 14.6% of students failed an SVT, and those who failed returned lower scores on many other assessment measures compared with those who passed. These findings indicate that the rate of symptom exaggeration or low test-taking effort may be lower in Canadian samples than in U.S. samples but still represents a substantial number of students. Recommendations and suggestions for future directions are discussed.

Identifying Students Feigning Dyslexia: Preliminary Findings and Strategies for Detection.

When conducting psychological evaluations, clinicians typically assume that individuals being evaluated are putting forth maximal effort and are not exaggerating or magnifying symptom complaints. Recent research, however, suggests that students undergoing post-secondary-level assessments to document learning difficulties may not always put forth their best effort, and may even be motivated to exaggerate or magnify symptoms. This paper presents evidence indicating that symptom exaggeration in this context is not only possible, but is indistinguishable from valid symptomatology when it occurs. We argue that symptom validity assessment should be included in all higher-education assessments for dyslexia and other specific learning disorders, and suggest some preliminary strategies for detection.

Easier Said Than Done Operationalizing the Diagnosis of Learning Disability for Use at the Postsecondary Level in Canada

A Canadian context for the diagnosis of students with specific learning disabilities (LD) was investigated in the present literature review. A systematic review of the literature was undertaken to determine the current and best practices in this field. Overall, no agreed upon definition of LD was identified, although core similarities in definitions were noted. Furthermore, recent research shows that many psychological assessments fail to adhere to any one definition when making this diagnosis, and as a result the diagnosis may or may not reflect the presence of a permanent disability that impairs academic functioning at the postsecondary level. There is, therefore, a need to adopt a consistent, evidence-based approach to diagnosis of LD in Canada. Recommendations regarding best practices and appropriate criteria for diagnosis of LD are discussed.

Examining Unusual Digit Span Performance in a Population of Postsecondary Students Assessed for Academic Difficulties

Methods of identifying poor test-related motivation using the Wechsler Adult Intelligence Scale Digit Span subtest are based on identification of performance patterns that are implausible if the test taker is investing full effort. No studies to date, however, have examined the specificity of such measures, particularly when evaluating persons with either known or suspected learning or attention disorders. This study investigated performance of academically challenged students on three measures embedded in the Wechsler Adult Intelligence Scale—III, namely, low Digit Span, high Vocabulary-Digit span (Voc-DS), and low Reliable Digit Span scores. Evaluating subjects believed to be investing full effort in testing, it was found that both Digit Span and Reliable Digit Span had high specificity, although both showed relatively lower sensitivity. In contrast, VOC-DS was especially weak in both sensitivity and specificity, with an apparent false positive rate of 28%. Use of VOC-DS is therefore not appropriate for those with a history of learning or attention problems.

Cognitive Responses to Stress, Depression, and Anxiety and Their Relationship to ADHD Symptoms in First Year Psychology Students

Objective: To explore the relationship between levels of reported depression, anxiety, and stress with scores on the Conners’s Adult ADHD Rating Scale (CAARS). Method: Information was obtained from 84 1st-year psychology students using the CAARS, the Depression Anxiety and Stress Scale (DASS), and the Life Experiences Survey (LES). Results: Approximately 23%, 18%, and 12% of students scored above critical values on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) Inattention Symptoms, the DSM-IV ADHD Symptoms Total, and the Inattention/Restlessness subscales, respectively. CAARS scores were positively related to reported levels of depression, anxiety, and stress, which accounted for significant variance among the three subscales. Only 5% of participants scored above recommended critical values on the ADHD index; however, a significant amount of the variance on this measure was also attributable to the DASS. Conclusion: Mood symptoms such as depression, anxiety, and stress may obscure correct attribution of cause in those being evaluated for ADHD.

Word Memory Test Performance in Canadian Adolescents With Learning Disabilities: A Preliminary Study

The purpose of this study was to evaluate Word Memory Test (WMT) performances in students with identified learning disabilities (LDs) providing good effort to examine the influence of severe reading or learning problems on WMT performance. Participants were 63 students with LDs aged 11 to 14 years old (M = 12.19 years), who completed psychoeducational assessments as part of a transition program to secondary school. Participants were administered a battery of psychodiagnostic tests including the WMT. Results indicated that 9.5% of students with LD met Criterion A on the WMT (i.e., perform below cut-offs on any of the first three subtests of the WMT), but less than 1% met both criteria necessary for identification of low effort. Failure on the first three subtests of the WMT was associated with word reading at or below the 1st percentile and severely impaired phonetic decoding and phonological awareness skills. These results indicate that the majority of students with a history of LD are capable of passing the WMT, and use of profile analysis reduces the false-positive rate to below 1%.

Recommended Best Practices for the Early Identification and Diagnosis of Children with Specific Learning Disabilities in Ontario

Despite the importance of early intervention for most disorders to minimize potential deleterious lifetime effects for the individuals concerned, there is currently no universally accepted protocol for the early screening, identification, and assessment of specific learning disabilities, and no consistent age at which initial diagnosis occurs. In Ontario, as well as in other jurisdictions, the distinction between key terms, such as identification and diagnosis, for the sake of service provision and funding in the school system is often not clearly understood. This article presents a rationale and recommended best practice procedures for the screening, identification, and diagnosis of specific learning disabilities in Ontario for children aged 4 to 8 years. A clarification of key terms, challenges to diagnostic accuracy, and implications of recommended improvements to current practice are articulated.

Documenting Disabilities in Postsecondary Settings Diagnosticians’ Understanding of Legal Regulations and Diagnostic Standards

Increasing numbers of students with learning disability and attention deficit/hyperactivity disorder (ADHD) diagnoses are applying for accommodations in postsecondary education and employment settings. However, students’ documentation of these conditions is often substandard. One possible reason for this is that clinicians have failed to apply proper criteria when determining disability status. We surveyed 119 clinicians who diagnosed these conditions in students applying for accommodations to determine clinician levels of knowledge about appropriate diagnostic and legal standards. We found weak clinician knowledge on certain key issues, including the meaning of functional impairment and understanding of the different laws governing academic accommodation of children versus adults. The average respondent’s score on a 30-item true/false questionnaire was only 69% correct. Implications of these results for practice and future research are discussed.

The Importance of Symptom Validity Testing in Adolescents and Young Adults Undergoing Assessments for Learning or Attention Difficulties.

It is almost self-evident that test results will be unreliable and misleading if those undergoing assessments do not make a full effort on testing. Nevertheless, objective tests of effort have not typically been used with young adults to determine whether test results are valid or not. Because of the potential economic and/or recreational benefits of obtaining the diagnosis of attention deficit hyperactivity disorder (ADHD) or a learning disability (LD), concerns have been raised regarding the ease with which unimpaired young adults can feign either of these disorders to gain access to test accommodations, stimulant medication, or disability benefits. Much evidence has been presented recently regarding the need for symptom validity tests (SVTs) in assessment of college-aged students seeking diagnoses of LD and/or ADHD. Four cases are presented here in which intelligence and other test scores of young adults greatly underestimated their actual abilities, owing to poor effort that sometimes went undetected. Selected effort tests for use with young adults are discussed. Objective testing of effort is recommended to avoid misinterpreting invalid test data, which is why the use of effort tests is now standard practice in forensic neuropsychology.

Comparing Canadian and American Normative Scores on the Wechsler Adult Intelligence Scale-Fourth Edition

Psychologists practicing in Canada must decide which set of normative data to use for the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). The purpose of this study was to compare the interpretive effects of applying American versus Canadian normative systems in a sample of 432 Canadian postsecondary-level students who were administered the WAIS-IV as part of an evaluation for a learning disability, attention-deficit hyperactivity disorder, or other mental health problems. Employing the Canadian normative system yielded IQ, Index, and subtest scores that were systematically lower than those obtained using the American norms. Furthermore, the percentage agreement in normative classifications, defined as American and Canadian index scores within five points or within the same classification range, was between 49% and 76%. Substantial differences are present between the American and Canadian WAIS-IV norms. Clinicians should consider carefully the implications regarding which normative system is most appropriate for specific types of evaluations.