John D. Ranseen

Detection of feigned ADHD in college students.

Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, todays students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Connerss Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Connerss Continuous Performance Test-II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.

Prevalence of ADHD Diagnosis and Nonmedical Prescription Stimulant Use in Medical Students

ObjectiveThe authors aimed to determine the prevalence of ADHD diagnosis and the prevalence of nonmedical prescription stimulant use among a sample of medical students.MethodsAn anonymous survey was administered to 388 medical students (84.0% return rate) across all 4 years of education at a public medical college.ResultsEighteen medical students (5.5%) reported being diagnosed with ADHD and 72.2% of those students were diagnosed after the age of 18. Thirty-three medical students (10.1%) reported using prescription stimulants for nonmedical purposes during their lifetime. The most commonly reported motivation for nonmedical prescription stimulant use was to improve academic performance. There was no significant correlation between an ADHD diagnosis and a history of nonmedical prescription stimulant use (p = 0.072).ConclusionThis survey suggests that medical students appear to be a relatively high-risk population for nonmedical prescription stimulant use.

Using Symptom Validity Tests to Detect Malingered ADHD in College Students

Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.

NEO PI-R profiles of adults with attention deficit disorder.

The personality functioning of adults diagnosed with attention deficit disorder (ADD) without comorbid psychiatric illness was examined. NEO PI-R profiles in a group of 25 adults referred for ADD evaluation meeting criteria for this diagnosis without any history of other psychiatric disturbance were compared to profiles from a control group of 23 nonpsychotic adult outpatients being treated with psychotherapy. All participants completed self-report measures of ADD symptoms as well as the NEO PI-R (Form S). The ADD adult group obtained significantly higher scores in the Neuroticism domain and significantly lower scores in the Conscientiousness domain than the outpatient comparison group. The NEO PI-R appears useful to the understanding of ADD in adulthood.

Test Accommodations for Postsecondary Students: The Quandary Resulting From the ADA's Disability Definition.

Legal wrangling precipitated by the Americans With Disabilities Act (ADA) has resulted in courts adopting a narrow view of disability. This narrow categorical disability definition is in conflict with current mental health and educational practice that presumes an inclusive view of disability. Test accommodations for licensing exams based on learning impairments provide an example of the conflict generated by legal versus mental health views of disability. Mental health practitioners often support test accommodation requests for students who do not meet the ADA’s strict threshold for disability determination. Mental health practitioners must understand the ADA definition of disability, and test organizations need to examine goals and alter standard practice in a manner that is fair and equitable independent of learning impairments. A recent Supreme Court decision ruled that professional golfer Casey Martin should be allowed to ride a cart in tournaments (PGA Tour, Inc. v. Martin, 2001). In his case, brought under the Americans With Disabilities Act of 1990 (ADA), it was successfully argued that Martin has a disability in walking that is covered by the ADA and that the professional golfers’ tour organizers have an obligation to provide this reasonable accommodation. The flurry of opinion articles expressing polarized views concerning the merits of this decision ranged from viewing it as atrocious to admirable (Feinstein, 2001; Leo, 2001; Rohrer, 2001). This decision did not lead to the downfall of professional sports, as suggested by some detractors, nor did it level the playing field for untold numbers of disabled individuals who merely needed some reasonable accommodation to succeed at this level. In fact, it may not be sufficient to help Casey Martin reach his goal of success at the professional tour level. The criticism of this decision highlights significant underlying conflict surrounding the various views of disability, how best to accommodate the disabled, and the role of the ADA in this process. Lost in the hyperbole of criticism surrounding the Martin (2001) decision was the fact that many legal scholars are expressing significant concern that the courts are taking an extremely narrow view of disability as defined by the ADA (Anderson, 2000; Burgdorf, 1997; Friedland, 1999; Lanctot, 1997; Locke, 1997; Mayerson, 1997). In less publicized decisions, the Supreme Court ruled that one is not disabled under this law if mitigating measures effectively remedy the problem (Albertsons, Inc. v. Kirkingburg, 1999; Murphy v. United Parcel Service,

The relationship between neuropsychological impairment in alcoholics and treatment outcome at one year

One hundred and thirty-two (132) patients with a diagnosis of alcohol dependence who participated in an inpatient treatment program were assessed on select neuropsychological measures and followed for a one year period. Neuropsychological, personality, and demographic variables did not predict outcome defined as abstinence at one year follow-up. Relapsed patients displayed slightly better initial neuropsychological functioning compared to abstainers, although this effect was not significant when these measures were controlled for age and education. These findings and the clinical implications of neuropsychological assessment in alcoholic populations is discussed.

Attention-Deficit/Hyperactivity Disorder in Childhood Is Associated with Cognitive Test Profiles in the Geriatric Population but Not with Mild Cognitive Impairment or Alzheimer's Disease

The frequency of ADHD in the aging population and its relationship to late-life cognitive decline has not been studied previously. To address this gap in our understanding, the Wender-Utah ADHD Rating scale (WURS) was administered to 310 geriatric subjects with cognitive status ranging from normal cognition to mild cognitive impairment to overt dementia. The frequency of WURS-positive ADHD in this sample was 4.4%. WURS scores were not related to cognitive diagnoses, but did show nonlinear associations with tasks requiring sustained attention. The frequency of ADHD appears stable across generations and does not appear to be associated with MCI or dementia diagnoses. The association of attentional processing deficits and WURS scores in geriatric subjects could suggest that such traits remain stable throughout life. Caution should be considered when interpreting cognitive test profiles in the aging population that exhibit signs and symptoms of ADHD, as attentional deficits may not necessarily imply the existence of an underlying neurodegenerative disease state.

The Intellectual Functioning of Eating Disorder Patients

This study investigated the intellectual functioning of a large group of eating disorder patients to examine two previously reported findings: (1) this population exhibits above-average general intellectual skills; and (2) a specific pattern of strength in verbal abilities. Standard intellectual testing of 100 consecutive inpatient females with eating disorder diagnoses was performed. Results indicate intellectual performance conforming to a normal distribution with no specific pattern of strengths or weaknesses.

WAIS‐R factors and performance on the Luria‐Nebraska's intelligence, Memory, and Motor Scales: A canonical model of relationships

The pattern and level of performance on the WAIS-R and the Luria-Nebraskas Intelligence, Memory, and Motor Scales were examined for 93 neurologically impaired adults. Maximum likelihood factor analyses of the WAIS-R indicated the presence of strongly correlated (.72) Verbal Comprehension and Perceptual Organization dimensions. Comparisons of these factors to those of the standardization group revealed an acceptable level of similarity (.94) for Verbal Comprehension, but not for Perceptual Organization (.53). Canonical correlations between WAIS-R factor scores and the three Luria-Nebraska scaled scores accounted for 82% of the total variance. Each set of procedures evidently is indexing the same theoretical constructs. Implications of these findings for our understanding of the measurement models that underlie clinical neuropsychology are discussed.

Trait analyses of the Luria-Nebraska Intellectual Processes, Motor Functions, and Memory Scales.

Trait analyses of the Luria-Nebraskas Intellectual Processes, Motor Functions, and Memory Scales were performed using multitrait-multimethod procedures and confirmatory factor analysis. Three measures each of intellectual, motor, and memory functions were administered to 161 neuropsychiatric patients. Intellectual scales (viz., Luria-Nebraska and WAIS-R) were found to have convincing discriminant properties, but motor and memory measures demonstrated visibly less such robustness. Confirmatory factor analyses supported a three-factor model of the 9 x 9 matrix, in which each of the three Luria-Nebraska scales serves as a marker for the factors. Issues related to the neuropsychological constructs, test construction, and construct validity of measurement procedures employed in clinical neuropsychology are discussed.